She’s one of 54 midwives who’ve graduated from the Hamlin College of Midwives since 2010, helping fill the shortage of qualified midwives in Ethiopia and improve the chances that pregnant women in rural Ethiopia deliver their babies safely. These midwives also are helping build confidence among rural residents — especially women — in the country’s formal healthcare system.
Receiving care from a capable midwife during pregnancy can mean the difference between life and death. But midwives are scarce in Ethiopia, which contributes to the country’s high rates of maternal injury and child mortality.
One of the aims of Hamlin Fistula Ethiopia is to put a skilled birth attendant in every rural village. Well-trained midwives can detect and prevent a host of medical complications that may arise during pregnancy. Fistula is one of them.
Addisalem, who is 26 years old, works out of the Wotetabay Health Center outside of Bahir Dar, the capital of northwest Ethiopia’s Amhara Region. Most residents trek barefoot across rolling hills and broad plains, few men without a dula (wooden staff) in hand. It is home to the famous rock-hewn churches of Lalibela and to prodigious fields of teff, the staple crop used to make the country’s spongy injera, which are deluged by rain from mid-June to early September.
Meeting Dire Needs
As a midwife in training, Addisalem is on her way to joining a very select group. As of 2012, Ethiopia had an estimated 4,725 midwives for a population of 85 million — four times less than the minimum ratio recommended by the World Health Organization. The numbers are even more dire in the Amhara Region: Only 802 midwives operate in an area home to more than 17 million people, according to the Ethiopian Midwives Association.
As of 2012, Ethiopia had an estimated 4,725 midwives for 85 million people — four times less than the minimum ratio recommended by health experts.
The importance of these health professionals cannot be overemphasized: Each year, more than 350,000 women around the world die as a result of complications from pregnancy and childbirth. If midwives were in place and able to refer the most severe complications to specialized care, up to 90 percent of these deaths could be prevented, according to the International Confederation of Midwives.
Training more midwives is key to achieving the UN Millennium Development Goal of reducing the maternal mortality rate by three-quarters between 1990 and 2015.
A Vast Office
Distances are enormous in rural Ethiopia, and where Addisalem works is no exception. Amhara is dotted by plains, gorges, hills and mountains, intersected by several major rivers including the Blue Nile, and home to Ethiopia’s highest peak: 14,928-foot-tall Ras Dashen.
Motorized transport is expensive and hard to come by, so Addisalem usually walks to the rural health posts in her district. Today’s trip to Mekeni takes three and a half hours. As she approaches the village, dozens of women await her arrival.
Some of the women have been waiting for days. They’ve come to vaccinate their infants, to nourish their children with therapeutic food, to care for the babies still inside them, and to receive treatment for a variety of ailments.
All too often, a woman will walk for hours — sometimes days — over rugged terrain, only to find the nearest health post deserted.
A Fragile Health System
Most of the country’s few doctors work in cities; many healthcare workers trained in Ethiopia leave for better-paying jobs abroad.
Only 7 percent of midwives in Ethiopia earn $200 or more a month.
Low salaries, poor working conditions and under resourced facilities are major challenges facing Ethiopian midwives. Hamlin is addressing these issues in its own clinics, stocking them with essential drugs, modern equipment and ambulance services, and by offering midwives a package of financial incentives beyond their salaries.
Hamlin is one of 46 midwifery training institutions in the country — and one of its best-equipped to teach tomorrow’s healthcare workers.
The good news is the number of midwives is increasing. Hamlin is one of 46 midwifery training institutions in the country — and one of its best-equipped. The College features lecture rooms complete with simulators and demonstration materials. Its curriculum meets the stringent standards of the International Confederation of Midwives, which includes a stipulation that students conduct at least 40 deliveries before graduation.
About two-thirds of a student’s credit load is earned outside the classroom, in clinical practice in places such as government health centers, Hamlin hospital and rural clinics.
Caring For Women
In addition to caring for women during pregnancy and birth, midwives also provide primary care to women. Addisalem may take a routine blood sample to test for HIV, blood type and Rh factor, which could cause complications during pregnancy. Tests for venereal diseases and iron deficiency might also be administered.
Medical histories are recorded and kept at each health post to ensure high-quality care and continuity among different health providers.
Educating communities about maternal health is a key part of Addisalem’s job. By addressing gatherings like this church service, she spreads important health messages, such as the perils of early marriage, danger signs during pregnancy, the facts about fistulas and obstructed labor, and the need for frequent checkups during pregnancies.
Most of the people in Amhara are Orthodox Christians, and speaking at church helps Addisalem reach two key constituencies whose support is vital: the village elders and the men.