Afghanistan: How to manage a maternity unit

11 July 2018

Two years ago, Mimansa, a midwife with Médecins Sans Frontières / Doctors Without Borders (MSF) was working in a maternity unit in Afghanistan. Now, as she returns to the project – in a region with one of the highest rates of maternal mortality in the world – she shares the third part of her story.

I often get asked the question: ”What does a normal day in Afghanistan look like for you?”

It is a question that is very difficult to answer because ”ordinary” days are so unusual here. Unusual, because every day there is a new situation to deal with.

But, of course, there are some basic routines that must be carried out to support our life-saving work each day. So I'll try to describe some of it...

The teams

The international fieldwork team currently consists of:-

  • Christine, our team manager from France
  • Guy, our HR manager from Côte d'Ivoire
  • Davit, a logistics specialist from Armenia
  • David, a medical director from Kenya
  • Myself, responsible for all midwifery at the hospital

We also usually have an international staff anaesthetist. However, they stay for short periods, usually four to six weeks. At the moment we have Helmut who comes from Australia. 

After arriving at the project each morning, usually around 7:30 am, we spread out depending on what tasks we have. I switch to my purple uniform (the midwife's colour here) with a white coat on top. I then go immediately to assess the situation in each department:

  • Reception
  • Obstetrics department
  • Aftercare department
  • Caesarean section unit
  • Extra surveillance ward (where we care for mothers and newborns suffering from complications)
  • In-patient antenatal

Morning meetings

At 7:45 am we have a morning meeting.

I meet as many staff as possible from the different departments, both the night shift and day shift. All departments report quickly about their patients’ statuses, we hear how many patients have been registered in the last 24 hours, and how many health information sessions have been given (provided by health counsellors to patients or their relatives).

By 8:00 am the morning meeting is over.

Mimansa organising a display on the maternity ward. Photo: Ahmadullah Safi/MSF

Mimansa organising a display on the maternity ward. Photo: Ahmadullah Safi/MSF

Together with the three midwife supervisors, I then go through the plan for what their day looks like.

They often share situations that have occurred in the last 24 hours, which I then get to work on. These can be staff issues, patients with complications, conflicts that have come up, shortages of supplies, or there may serious personal issues for a team member. The list of potential crises is long. Often, I can help staff to structure and plan their work. The previous lack of structure here sometimes seems to me to be the biggest challenge to daily tasks.

At 08:15 am it’s onto the next meeting with the hospital management team.

We review the situation from the last 24 hours, thanks to the input from our own teams. We discuss what’s going on outside the hospital, the medical situation, logistics, HR issues and staff education.

The basic rule

Every day has its own "basic rule". 

With 50-60 children born in the hospital every day, and 27% of those being complicated births, it’s a huge activity to ensure that everything is in the right place at the right time. This includes managing medicines and equipment as well as staff and patients. This plan forms the ”basic rule”, coordinated by the midwives, controlled by the supervisors and supported by me.

We come together to find laughter and warmth in the midst of stress, vulnerability and limited resources."

The issue of supplies involves other groups from across the hospital – the pharmacy, a materials buyer and technicians of various kinds – all in a coherent system that depends on everyone playing their part in the processes.

Teamwork of the highest level is needed!

The midwife group itself is the largest of the different categories of staff, consisting of about 65 midwives who rotate according to a schedule between the different units. They are supported by about 30 assistant nurses.

Reassuring relatives

My office is in the same building as our clinic, with a short walk between them. There are many trips during the day and I am often stopped by patients' relatives who are worried or want more information.

We do receive language lessons every Friday, however, I often need a colleague or translator to help me understand the relatives’ concerns. These are conversations that may need sensitivity and tolerance, but still need to be clear. Sometimes it is not so easy to have these conversations through a translator, but it usually goes well.

It is not at all difficult to understand why relatives are concerned in a place where childbirth is associated with an actual danger to life.

A bridge with many roads

I try to be in each department as much as I can – to see and understand, to supervise and teach. The theoretical knowledge of the staff here is good, but there is sometimes a difference between knowing and doing.

My role is important and often challenging, but it is very inspiring when there’s a balance between being a clear leader and also having fun together. We come together to find laughter and warmth in the midst of stress, vulnerability and limited resources.

I would probably best describe my work as being a bridge with roads in many different directions. A bridge that many people can use, where meetings are taking place, but where there can also be collisions. I have to choose the direction, make it clear when is the time to go ahead and when is the time to stay.

At 5:00 pm my time at the hospital is over. However, I often bring work home that I’m thinking or writing about.

It's good that the days are so intense because life outside the workplace can sometimes be restricted. I usually bake cookies on days off, it's nice to do something "normal". I'm also grateful for the movies I have on my hard drive. But, after such tough days, I’m usually asleep before the movie is over.

 

 

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