By Ruby Pratka
Cuso International Volunteer Communications Adviser for Midwives Save Lives
Dina Kamata is the midwife others call when a crisis hits.
She recalls a case where a mother from a remote village travelled 130 kilometres to give birth at a rural dispensary. Shortly after delivery, the woman began to go into shock from loss of blood. The midwife on duty, unsure of what to do, called Dina’s cell phone.
Dina remembers telling her colleague, “First of all, don’t panic.”
Dina is the chief maternal and child health officer for Ushetu district council in Tanzania, and teaches the Midwife Emergency Skills Training (MEST) program. She’s calm and collected when medical emergencies arise.
With her colleague on the phone, Dina ran through a checklist of what could be causing the bleeding. “Check hemoglobin, check for contractions, check the bladder—and if it’s full, empty it. Also check if there is a tear in the cervix,” Dina remembers saying.
Within 20 minutes they had identified the problem and stopped the bleeding. The mother was safely transferred to a health centre where she received a blood transfusion and recovered.
EMERGENCY SKILLS KEY TO SURVIVAL
The World Health Organization cites postpartum hemorrhage—excessive bleeding after delivery—as one of the most common causes of maternal death in the world. Globally, about 70,000 new mothers die from the condition every year.
“Before midwives started receiving the MEST training, there was no knowledge, or very little knowledge, on how to manage postpartum hemorrhage and eclampsia,” says Dina. “For a long time, in the labour wards, we have seen lots of women die due to eclampsia and postpartum hemorrhage.”
Developed by the Tanzanian Midwives Association (TAMA) and the Canadian Association of Midwives (CAM), MEST training is implemented through Cuso International’s Midwives Save Lives project.
The training covers clinical decision making and management of delivery room emergencies such as postpartum hemorrhage and breech deliveries, as well as conditions like eclampsia, a rare but potentially fatal condition where high blood pressure during pregnancy leads to seizures. It also emphasizes the importance of respectful, mother-centred maternity care.
“In the past, if someone was having a postpartum hemorrhage, we would refer her to the regional hospital,” she says. “Now, we tell the woman, ‘Don’t panic. Take a deep breath. We are going to give you IV fluids and find out what’s causing this.’
“Sending a woman to another hospital when she’s hemorrhaging is not hemorrhage management. Finding the cause and treating it—that’s hemorrhage management.”
Today, 460 nurse-midwives working in regional hospitals and village dispensaries in Shinyanga and Simiyu provinces have received the training—and the number of deaths is decreasing.
In Dina’s district, there were 16 neonatal deaths as of mid-December 2018, down from 50 deaths the previous year. During that same time frame, maternal deaths dropped by 75 per cent with a total of five.
Dina continues to share her experience with midwives around East Africa, travelling to Kenya, Uganda and Ethiopia with TAMA as an international MEST facilitator.
“I like to be a MEST trainer because I know I have the skills and the knowledge to manage obstetric emergencies theoretically and practically,” she says. “I have the skills to help reduce maternal and perinatal death, which is the ultimate aim of everything we do.”
Midwives Save Lives (MSL) is a four-year initiative in Benin, DRC, Ethiopia and Tanzania. Led by Cuso International in partnership with the Canadian Association of Midwives (CAM) and local midwifery associations, MSL is contributing to the reduction of maternal and newborn mortality by improving the supply and demand of health services and strengthening the work of midwives’ associations. MSL is funded by the Government of Canada through Global Affairs Canada.