An Update from Thomas Kraemer at the Edna Adan University Hospital
Fifty prospective Post-Basic Midwives sat for the written portion of the qualifying examination on Sunday. Monday, the students underwent the clinical portion of the exam (the evaluation process consists of a written examination and a clinical examination, each worth 40% of the total grade, and an interview making up the final 20%). The curriculum is approved by the Somaliland Ministry of Health, which also sends a representative to assist with the administration of the examination. Those who pass will become registered midwives and will be eligible to continue on and earn their Bachelor of Science in Midwifery degrees from Edna Adan University.
Edna looks on during the clinical examination.
The Post-Basic Midwifery course is funded through a grant from the Edna Adan Hospital Foundation. As a prerequisite to acceptance into the program, each of the women must have already completed a three-year general nursing course and passed the examination to become a registered nurse. The participants then have nine months of training focused specifically on midwifery skills.
The Post-Basic Midwifery curriculum is a combination of theoretical (classroom) study and practical training. To complete the course, each student must assist in a minimum of 50 deliveries. At least the first 25 births must take place at Edna Hospital under the supervision of the program instructors. Once the instructors are satisfied with their students’ progress, the students will rotate through the country’s Hargeisa Group Hospital, the country’s main public hospital, and four Maternal and Child Health centers in Hargeisa.
After completing their practical training, students who pass the qualifying examination will be certified as registered midwives and will be eligible for government employment. However, the majority of the students will likely remain for another nine months of study to earn their Bachelor of Science in Midwifery degrees before entering the workforce.
A student uses a mannequin during her clinical examination.
The clinical examination took place in a large classroom that had been converted into a hospital room, complete with patient beds, scales, IV stands, hazardous waste disposal bins and patient charts. A large table was laid out like a hospital storeroom, stocked with everything from rubber gloves, blood pressure cuffs and bandages, to medications, syringes and suture kits.
Students entered the room individually and were assigned to two examiners. There were 52 possible situations that each student might be asked to handle; these situations were assigned randomly and the students were required to orally explain the proper treatment while demonstrating the requisite skills on a mannequin or role-playing with one of the examiners.
The potential situations varied greatly and students had only one chance; they had to be ready for anything. Some of the scenarios posited were general:
A 28-week pregnant woman has presented at the antenatal clinic. Identify what steps you would follow in her case. What health education would you give her?
Other scenarios were much more specific:
A neonate was brought back for admission 9 days after delivery with umbilical sepsis. What are the signs/symptoms and management of umbilical sepsis?
The doctor ordered “Give gentamycin injection 60 mg, IM Stat.” On hand, you have an ampoule labeled “Gentamycin 80mg/2ml.” How many ml will you give?
The students were graded not only on correct procedure, but also on how they went about their business—interacting with the patient, explaining what she was doing and why, calmly gathering everything she needed before beginning, and properly cleaning up afterward. It appeared that most of the students were able to carry out their assignments efficiently and confidently, and the women are well on their way to becoming qualified midwives.
This is the fourth group of Post-Basic Midwives that have been trained under Edna’s watchful eye. The course coordinator, Ayan Abdi Hussein, was among the first group of Post-Basic Midwives to graduate and has remained at the hospital to help the midwifery training programs flourish.
Learn more about Edna’s effort to train 1000 Midwives: Community Midwives: Improving Maternal and Child Health
Today is Universal Health Coverage Day, a day to advocate for universal health coverage to be a cornerstone of the sustainable development agenda and a priority for all nations. Healthcare is a necessity everywhere, but it’s especially important to advocate for healthcare in developing countries. Maternal healthcare can present a lot of difficulties, especially when only one in three women in rural communities in developing countries receives necessary care. According to the World Health Organization (WHO)’s Global Strategy for Women and Children’s Health from 2010, 350,000 women die every year during childbirth. The WHO also said that the planet needs another 3.5 million health workers to improve women and children’s health in the 49 lowest income countries.
The Edna Adan University Hospital specializes in training midwives in Somaliland*, using modern medical knowledge and techniques. Currently, most births in the country are aided by a traditional birthing attendant, a person who hasn’t gone through any sort of formal medical training. Births are often in unsanitary conditions, with no recourse if a complication arises. This takes a harsh toll on the mothers of Somaliland, with 1,044 mothers dying per 100,000 live births, which is one of the highest rates in the world.
Additionally, almost all of the following deaths are preventable:
- 289,000 women and 2.6 million newborns who died during childbirth in 2014.
- 3 million infants died within the first few months of their lives.
- A woman who is 100 times more likely to die during childbirth in sub-Saharan Africa than in an industrialized country.
This same case study by the WHO found that 500 midwives educated and deployed in Bangladesh could save 36,000 lives over the course of 30 years. 87 percent of the essential care for women and newborns can be performed by an educated midwife.
The midwives that the hospital trains are disbursed throughout the country after their education is complete. They serve a vital role in Somaliland society, helping to form a protective web across the country so that women in any part of Somaliland can have a trained medical professional on hand for a pregnancy. Midwives can assist in births in rural areas and help to funnel difficult pregnancies back to the hospital. The hospital hopes to train 1,000 midwives to cover the country. We have currently trained 400.
The other part of providing adequate maternal health care is access to proper supplies. The Edna Hospital has expanded its facilities, including a radiology department which was built this year. It also uses improvised technological devices, such as an oxygen mask that runs through a water bottle, so that it bubbles when oxygen is flowing. Continued support can help the hospital and the midwives it trains to reach more women and children in need, because everyone, and especially mothers, should have access to affordable healthcare.
* Somaliland is the former British Protectorate which borders between Djibouti and Ethiopia.
This post was featured in Girls’ Globe website