While some people are drawn to midwifery by the natural-curiosity of childbirth, the story is different for Daniel Kawaye who joined the profession for his deep seated desire to care for patients.
The idea of ushering new life into the world might seem idyllic and heart-warming, but after years of practice, Kawaye, a nurse and midwife at Zomba Central Hospital, finds himself in a position dreaded by most midwives.
The profession is known for its under-staffing and consequently heavy workload which may lead to reduced quality of care to would-be mothers.
In Kawaye’s eyes, having few midwives in the country deprives women and newborns of high-quality midwifery care.
“In some situations, we need to monitor the maternal and fetal condition every 30 minutes but that is difficult when you have more women in labour.
“Due to heavy workloads, midwives may choose to focus on delivering the babies without proper monitoring during labour. As a bedside midwife I have also been in that situation several times when I could not monitor the women because of workload,” he explains.
He adds that staff shortages also prevent some women from being attended to on time.
“Some mothers go for ante-natal visits in the morning only to be attended four or five hours later because the midwife was busy assisting other women. This is happening in most public health facilities,” he says, adding that some midwives have even considered leaving the profession due to rising work demands.
With such conditions, Esther Phiri, a mother of three believes that women in the country are not safe.
Having witnessed the shortage of midwives first hand as she delivered her three children, Phiri cites that it is a huge problem in public health facilities, with the result that some women deliver on their own in the wards.
“We are complying with government’s orders to deliver from health facilities but when we get there we find there are few midwives, and they get exhausted. They are so overwhelmed with the workload that sometimes in our labour pains they order us to take a walk to progress labour.
“This has led to some people giving birth outside the labour ward, which unfortunately also attracts the nurses’ wrath and insults,” she explains.
She also bemoans the insufficient beds in the labour wards, and lack of resources which are also affecting delivery.
White Ribbon Alliance for Safe Motherhood (WRASM) national coordinator, Nancy Kamwendo agrees that they are short-staffed and that they lack resources.
“The situation is pathetic. We have told all our women to come to health facilities for delivery and for antenatal care. They have obliged and are coming in large numbers, but we have done nothing on the side of suppliers. The number of midwives is pathetic in the public facilities, and there are no resources. Even the infrastructure is pathetic,” she says.
She highlights that most health centres in the country have only one midwife juggling family planning clinic, antenatal care clinic, delivery and postnatal care all on their own, which can be strenuous.
“These midwives are working 24 hours a day, and seven days a week. Yet we expect them to provide quality care; are we being realistic? I think not. We are demanding too much from our midwives but we are not ready to support them.
“They need support and recognition for the great work they are doing. Our midwives love their jobs, and that is why they go to work in those conditions, improvising wherever they can. But if anything goes wrong in the improvising, they are blamed,” she laments.
Spokesperson for Nurses and Midwives Organisation of Malawi (NONM), Prince Henderson echoes Kamwendo’s sentiments.
He deems it unfortunate that the vacancy rate for nurses and midwives in Malawi today stands at 60 percent with very few resources to work with.
“Practically, this means one nurse-midwife is working on behalf of three or four others. It is a burden and heavy workload. It is like one driver expected to drive three of four other vehicles without an accident,” he notes.
World Health Organisation (WHO) recommends one midwife to attend to 75 women but in Malawi one midwife attends over to 1 000.
With all these wretched working conditions combined, Malawi may have trouble achieving Sustainable Development Goal (SDG) three which envisions a reduction in the global maternal mortality ratio to less than 70 per 100 000 live births and ending preventable deaths of newborns and children under five years of age by 2030.
Nonetheless, White Ribbon Alliance observes that the midwives and clinicians are doing their best with the available resources.
“Maternal and neonatal deaths are slowly reducing but we still have a long way to go. We need to provide resources for the midwives to work professionally, and increase the number of midwives for things to improve,” Kamwendo advises.
She argues that having more midwives at a health centre would give them time to rest and not be stressed.
Similarly NONM also calls on government and other stakeholders to consider employing more nurses and midwives to fill the vacancy rate, and to provide all the required resources.
But in defence, Ministry of Health principal secretary Dan Namarika argued that the ministry recently recruited 908 nurses to work in central hospitals, Christian Health Association of Malawi (Cham) facilities and Local Authority Service Commission of Malawi (Lascom).
As for lack of resources, the PS says they are already working to provide all the resources required in the public hospitals.
“If passed by Parliament, our drug budget for the 2019-2020 financial year will increase across the board by 33 percent. And that is a huge increase. So I believe that government is doing everything to assist our personnel. And through the Health Sector Joint Fund we will spend about K8 billion on health sector soon. So give us time, we will support the midwives,” he said.