My names are Leah Kavere Amadi a registered Nurse Midwife from Kenya.I work as IUNV Midwife for UNFPA stationed in Wau,Western Bahr El Ghazal State, South Sudan.
I was first posted to work at Wau teaching hospital as IUNV midwife in February 2011, a contract of one year.After my orientation and rapid assessment of maternal health care activities in the hospital,most of the reproductive health components activities were missing in the hospital,no universal precautions for infections control,no use of important formats for managing mothers in labour .e.g partograph and admission registers not maintained.Cases of puerperal sepsis and the newborns was too high because they had few equipments and used without proper sterilization and no disinfectants.
I started to train the staff in Maternity ward on the importance of maintaining universal precautions.I worked closely with the nurse midwife in charge of maternity ward,l asked her to show me if they had any store where they kept items for maternity ward.I was surprised, the store she showed me was having cartons containing midwifery kits from UNICEF and UNFPA.
I assembled all medical materials, items and planned for a training for maternity staff on packing and sterilization of equipment using autoclave l found in the same store.The staff sterilize equipments without close supervision/ they are competent and no more cases of sepsis in maternity ward. Established inventory checking monthly in order to ascertain what is in stock at a given time and avoid running up and down when and emergency has arrived( emergency preparedness).
Also started EPI program in maternity ward.l prepared formats for use in monitoring labour e.g. partograph and observation charts.I set maternity ward and maintained its cleanliness until the nursing and midwifery schools in Wau managed by two Catholics institutions started to bring their students for clinical experiences in Wau teaching Hospital Maternity Ward.
Established prevention of mother to child transmission of HIV testing in Wau teaching hospital Maternity ward and availability for provision of ARV'S.By the end of my contract, deliveries by skilled personnel had increased from 100 - more than 200 per months in maternity ward.
UNFPA Juba office, entered in partnership with ARC (American Refugee Committee) Juba and funded their Sub office in Wau to train with me health workers in Western Bahr El Ghazal State on emergency Obstetric care( EMOC),family planning and clinical management of rape survivors, so as they start the services in their health facilities and the commodities provided by UNFPA.These services are now available.
All these interventions are for better health care in improving maternal health care.
On 20/7/2011- Supported in establishing Nurses/ Midwives association in Western Bahr El Ghazal State.86 nurses and midwives met on that day. They formed a task force and they selected me as their overseer for the association and 117 members have registered as members of the association. They held their general meeting on 16/9/2011.The representatives from Juba UNFPA/ ROSS came for the launching of the association on 22/9/2011.
Participated in assessment of the Midwifery School Wau, for the State Ministry of Health which is about to start training of Midwives soon. The Assessment was done by team from MoH Juba- Director of Trainings/State Ministry of Health/ UNDP- rehabilitated the old buildings and build the new dometry block/the previous principal and deputy principle/Midwifery advisor UNFPA/IUNV Midwife- UNFPA.
Attend RH coordination meeting -- discuss issues affecting maternal and child health and how we can improve on it.There are challenges but challenges help to think and get solutions.Some of the challenges faced are:Lack or inadequate number of qualified staff, inadequate supply of emergency drugs, inadequate power and water supply, poor laundry services – makes it hard to maintain universal precautions, lack of transport for outreach activities, lack of stationery- printer/papers( affect continuous training on Job- no admission papers and partograph) at times out of stock, no blood bank( some patients with emergency obstetrics complications may die because blood for transfusion is not easily available and at times accompanying relatives, their blood is incompatible,delays both in the community and also in the referral hospital is major challenge- discussion making to seek medical care/lack of transportation/delay at the referral hospital( no emergency drugs/ready blood for transfusion/in adequate number of qualified staff.
As UN Volunteers, especially midwives, we contributed a lot towards recognition and improvement of maternal & Child health services geared towards reducing maternal and infant mortality & morbidity of the said population.There a lot of achievements as l have mentioned in the above paragraphs.
After the end of my contract at Wau teaching hospital by the end of February 2012, l was re deployed at the State Ministry of Health Wau in Western Bahr El Ghazal State to also support and mentor midwives in the Primary health Care Centers in the State.I did assessment of 16 health facilities and gave the recommendation to the director of Primary health care and the director general of State Ministry of Health for Western Bahr El Ghazal State.So far, we ( l, reproductive health Coordinator for the state and County health team)have trained ten senior nurse midwives on active management of third stage labour and focused on establishing deliveries 24 hours/ 7 days in the primary health care centers and provide the required materials and equipments in order to improve maternal and child health care services in these facility.Already, we have established deliveries 24 hours/7 days in two health facilities.
We have also improved ON SPOT SUPERVISION- at the health facilities whereby we support the staff and train them on Job, HANDS ON and how to use the medical materials and equipments supplied to them.South Sudan has the highest maternal mortality ratio of 2,054 deaths per 100,000 live births - one of the highest in the world. Still about 81% of women prefer to deliver at home with about 05% births are attended by skilled attendants. The unavailability and lack of access to basic and emergency obstetric care is a major factor behind the high levels of maternal mortality and morbidity.
By establishing deliveries 24 hours/7 days in health facilities in the community, we anticipate improvement in deliveries by skilled personnel. Working as a team with the State RH coordinator/County health team will improve community participation and self health seeking behavior. I feel as UN Volunteers,our actions Count in development of programmes, through our action and conduct. This promotes volunteerism and positively enriches the understanding of local and social realities and create abridge between the volunteers and the people in the host community. This makes the time of volunteering more rewarding and productive.