Tanzania
A Midwife Bears Witness to Temeke Hospital Labour Ward in Dar es Salaam
By Tessa Dunning, Midwife from London, UK
As the end of my midwifery training at King's College Hospital in London drew closer, I knew I wanted to experience midwifery care somewhere different than a busy London hospital — somewhere that would open my eyes to issues facing women across the world. I had become involved with WRA — including by organizing a cake sale on International Women's Day, raising £500 — and was put in contact with their National Alliance in Tanzania.
With the assistance of Rose Mlay, National Coordinator for WRA in Tanzania, I arranged a two-week placement at Temeke hospital in Dar es Salaam, Tanzania. The hospital was featured in the inspirational WRA film Play Your Part and also in a moving account of a recent visit by Naomi Campbell.
Midwife Tessa Dunning volunteers with a doctor and pregnant and newly-delivered women at Temeke Hospital
Temeke hospital facilitates between 60 and 80 deliveries per day. There are 12 basic delivery beds split between two rooms and a limited number of staff, sometimes two nurse/midwives running the labour ward. All delivery beds were full, and women were labouring on the floor, waiting for a bed to become available. A woman who had just given birth was halfway off the bed when an expectant mother clambered in the other side.
Temeke hospital's labour ward was under-resourced and over-stretched. Latex gloves were used as cord clamps as midwives improvised to facilitate deliveries. As a midwife, it was possible to see how these improvisations may well leave women at risk of long-term problems. I am used to women enjoying basic rights such as privacy, support and informed consent, yet I experienced rows of labouring women, alone, in pain and terrified. Women observe each other giving birth on an hourly basis; sometimes the baby is alive, sometimes the baby is not.
Once a baby is born, it may be a while until mother and baby are united. It struck me that the only way of recognising which baby belongs to which mother is by the colour and design of the kanga (a piece of wrapping material). There are no name bands and no real way of ensuring the mother takes home the baby she has birthed.
One key challenge facing the doctors, nurses and women in Tanzania is the use of herbs. I learned that the leading causes of maternal death at Temeke were uterine rupture and postpartum haemorrhage. The local medicines can have disastrous consequences for the mother, but babies can be born premature, in poor condition, with a slim chance of survival.
In two weeks, I witnessed three stillbirths, a neonatal death and two maternal deaths. This is one hospital, in one city, in one country. The deaths I witnessed could have been prevented with adequate and continuous care, as we expect in the western world. It is a terrible injustice that where a woman lives determines her chances of survival through childbirth.
TheRole of WRATZ
By Rose Mlay, National Coordinator of WRA in Tanzania
“The White Ribbon Alliance for Safe Motherhood Tanzania (WRATZ) will continue advocating with policy/decision-makers and mobilizing communities to demand and seek life-saving safe motherhood services until all women's and newborns' lives are safe and dignity restored. Specifically, WRATZ is seeking adequate numbers of qualified health workers (doctors, midwives and nurses). Right now, Tanzania has only 32 percent of the qualified health workers it needs. WRATZ is also seeking a clearly-identified and adequate budget for maternal and newborn health. Right now, it is very difficult to point out budget lines in district budgets that will help a pregnant woman and a newborn to be safe during childbirth. The health budget per head is US $14 in Tanzania, while the World Health Organization says the minimum should be US $40. We use our National White Ribbon Days to advocate with politicians and policy-makers on these issues. WRATZ conducts community mobilizations so communities can know their right to life-saving safe motherhood services and demand such services. We also disseminate our yearly advocacy messages to district leaders who are the implementers on the ground. The WRATZ focal persons we have at almost every region help with follow-ups at the district-level.”
WRATZ PSA
