Harsh times in Liberia

Angela Gorman visits West Africa to give life to African mothers

Liberia, with a lifetime risk of death in pregnancy and childbirth of 1:8 is amongst the most dangerous places on earth to be pregnant. The country is still recovering from the civil war, which ended in 2005. Many of the midwives and support staff have not received any training since 1991, before the war started. As well as a lack of trained midwives, there is a shortage of all medications and basic equipment including blood pressure monitors and urine testing kits.

In July Life For African Mothers, the Cardiff-based charity that works in sub-Saharan Africa, visited Liberia to provide workshops for midwives and other health professionals. The team comprised myself, Georgina Short, a midwife at Princess Royal University Hospital in Kent, and Grace Nambozim, a senior midwife at Hull University.

As well as training local medical staff we distributed baby clothes been donated by Welsh Government staff as part of their Charity of the Year initiative and by the Women’s Institute and other women’s groups based in and around Cardiff.

In May we had arranged a three-day training workshop for 25 midwives in Bopolu County, one of the most inaccessible regions of the country. This was funded by GoodGifts and delivered by two Liberian national midwifery trainers. At the request of the Ministry of Health and local midwives, a further 3-day workshop was planned to take place in the capital, Monrovia, to be completed before the beginning of August when the wet season is at its worst. The demand for this help was demonstrated by the immediate over-subscription for the workshop – more than 50 requests.

Prior to the visit, Georgina was able to obtain a brand new piece of training equipment, called “MamaNatalie” which has never been used in the UK or Africa. This provides realistic and affordable training in maternity care. It is an artificial female abdomen which enables simulation of a haemorrhage during labour. Post-partum haemorrhage is responsible for the greatest number of deaths in childbirth, 180,000 a year world-wide. Rapid haemorrhage control is crucial in saving a mother’s life. The manufacturing company, Laerdal, has said that for every model purchased by an NHS maternity unit, they will donate one free of charge to a developing country. The cost per model is just £450.

Following our arrival in Liberia we visited Redemption Hospital in the city of Monrovia, featured in a BBC documentary The worst place in the world to be a midwife earlier this year. There we met Dr Dada, the hospital’s Medical Director and several of his staff, including the Nurse Director who told us they were experiencing four maternal deaths per month.

The following Monday we travelled to a Health Clinic on the outskirts of Monrovia. Nine midwives and traditional birth attendants gathered to see the demonstration of the MamaNatalie. Its first demonstration in Liberia took place in a small room, with nine staff who were astounded at the simulated haemorrhage and the need for immediate and appropriate action to prevent the death of the mother.

The next day we embarked on a 45 mile journey to the rural Kakatan Hospital’s maternity unit, to deliver a large bag of donated baby clothes. This hospital has already received a supply of Misoprostol from Life For African Mothers. The Head Midwife told us they had a woman in the labour ward who was suffering from Eclampsia.

In the labour ward we were met by the sight of a 15-year-old girl in advanced labour having eclamptic fits. The staff were giving her magnesium sulphate intra-muscularly, which had the desired effect of stopping the fitting. Further fitting followed and she knocked out her IV line. A decision was made by the medical staff to deliver her by caesarean section. When she arrived in theatre, she delivered normally, but then began haemorrhaging and required the Misoprostol which Life For African Mothers had provided.

Much to everyone’s delight and amazement, the baby cried vigorously soon after delivery and was taken to her grandmother. When the work in the theatre was completed, baby clothes were distributed were given to the grandmother of the baby, now named Georgina Grace, combining the names of two of our team.

The team returned to Monrovia shaken by what they had witnessed: equipment not working or unavailable and staff unable to properly manage this girl’s worsening condition.

The need for training was also brought into stark relief as our workshops began. Participants included a consultant general surgeon who is occasionally asked to perform a caesarean section, three medical staff who work on the maternity unit, midwives and assistants. The guest house which had been the Team’s home for the past week, was almost constantly visited by local women. curious to know whether we would be visiting again. Each knew at least one woman who had died in childbirth from within their community.

The journey to the airport was filled with reflections on the visit. We had saved the life of the 15-year-old girl in Kakatan Hospital and that nobody was bitten by mosquitoes. A negative was the heavy rain, which made getting around difficult on side roads which were repaired but then washed away. It certainly brought home the dangers for women in labour having to be taken to hospitals in those conditions.

Angela Gorman is the founder of Life For African Mothers (formerly Hope for Grace Kodindo). A former winner of the Inspire Wales Awards, she first brought our attention to the issues surrounding childbirth in the developing world in an article for the IWA's journal, Agenda.

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