“Empowering my students as advocates for women” – Teaching midwifery in Uganda

Andrew MarxBlog, Featured, Nursing, Sharing Strengthening Saving, Uganda, Uncategorized

Rebecca Munger teaching at Mirembe School of Nursing in Tanzania

Rebecca Munger teaching at Mirembe School of Nursing in Tanzania

As a nurse, a midwife, an educator, and a public health leader, Rebecca Munger has dedicated her career to providing, teaching, and advocating for quality health care for women.

Growing up “kind of at the bottom end” in a family with eight girls, Munger recalls, “I was around my older sisters having children and struggling with the healthcare system and having healthy normal births. It inspired me to want to get involved in women’s health care.”

She was particularly attracted by “the philosophical approach to supporting normal birth” she had observed among midwives. “That’s what led me to midwifery” – first in California and now, more than 30 years later, in Tanzania and Uganda, where she is currently passing the knowledge, skills, and philosophical approach of midwifery along to students in Uganda’s first Bachelor’s of Midwifery program.

Munger came close to joining the Peace Corps shortly after she graduated from nursing school more than 30 years ago. “I started to put an application in, but then I met my husband and he kind of talked me out of it.”

But over the decades, she never let go of her dream of serving with the Peace Corps or her interest in global health. And along the way she accumulated a great deal of experience that has served her and her Tanzanian and Ugandan students well.

From the time she graduated from nursing and midwifery school in the early 1980s, Munger’s experience included: practicing midwifery at a rural birthing center; “a lot of teaching”; working with a family practice residency program for almost 20 years, during which she was responsible for starting antenatal clinics and ultrasound programs with them; holding leadership positions in perinatal services and maternal, child, and adolescent health for the Department of Health Services in Sonoma County, California; and in 2013, completing a Masters of Public Health in Global Health.

Rebecca Munger with one of her students in Tanzania

Rebecca Munger with one of her students in Tanzania

“Teaching was something that I really enjoyed and wanted to get back to,” Munger said. So when she heard about the Peace Corps’ partnership with Seed Global Health in the Global Health Service Partnership (GHSP), she saw an opportunity both to get back to teaching and to fulfill her long-delayed desire to serve in the Peace Corps .

With her husband’s full support this time (“I kind of called in the promise he made that he would support me in doing it some time”), she taught at Mirembe School of Nursing in Dodoma, Tanzania, as part of GHSP’s second group of volunteers in 2014-15. And when Seed’s Deputy Chief Nursing Officer Julie Anathan invited her to go back to Africa in 2016 and teach at Lira University in Uganda for a semester, “I got very excited.”

What particularly excited Munger about going to Lira was the opportunity to do a lot of clinical teaching in the hospital, something she had not been able to do when she was in Dodoma.

Some of Rebecca Munger's students at Lira University in Uganda

Some of Rebecca Munger’s students at Lira University in Uganda

Since she arrived in Lira, Munger reports, she taught in the classroom for eight weeks and then switched to five days a week in the hospital. “A couple of those days, at the end of the day, I have the students for an hour and a half to do clinical presentations and review what they’ve been doing on the wards. It’s been pretty remarkable. It really confirmed my expectation that to be able to teach you really have to be able to spend time in the clinical setting. Because students need support in taking what they learned in the classroom and applying it with their clients.”

Munger has identified two areas where she feels her teaching has been particularly helpful to students.

Baby Donald Ray with his mother (right) and grandmother. The mother wanted to show her gratitude and respect for Rebecca Munger by naming the baby after her. But since the baby was a boy, she named him after Rebecca's husband instead.

Baby Donald Ray with his mother (right) and grandmother. The mother wanted to show her gratitude and respect for Rebecca Munger by naming the baby after her. But since the baby was a boy, she named him after Rebecca’s husband instead.

The first is in organizing their approach to patients by starting with an assessment to see what their needs are. “That sounds really straightforward,” Munger said, “but it’s something that they hadn’t necessarily been doing.”

The second area she has focused on, which comes back to the philosophy that originally attracted her to midwifery, is “empowering my students as advocates for women and supporting the dyad of the mother and the baby.”

One good example has been stressing the importance of skin-to-skin contact immediately after birth for the health of mothers, babies, and the bond between them. Often, Munger said, “as soon as the baby is born it kind of gets whisked away to be weighed and given vitamin K. So we’ve really been spending time talking about the benefits of skin-to-skin contact and early initiation of breastfeeding.

“I have been trying to empower the students around how as midwives they are probably going to be the only ones supporting that and carrying it forward. If they aren’t doing it, nobody’s going to keep that pair together. So that’s one thing that I’ve been doing – just in general trying to get them to see themselves as advocates for women.”

As she works with them on the wards, she has been moved to see her students taking on that role. As an example, she cited the heart-wrenching case of a woman who had already lost four or five pregnancies before she came in from the antenatal clinical with a fetal death. After they had induced labor and delivered the woman’s dead fetus, “the staff just put her on the postpartum ward. So here was this poor women, lying there without a baby and going through a lot of grief, surrounded by 25 beds with mothers, and babies crying, and families all talking about babies. So my student spent a day trying to figure out a way to support her and get her out of that environment. And finally we worked out a way where my student went to the doctor and got them to rewrite the order so this woman could get discharged home on oral antibiotics instead of an IV.”

“It was sad,” Munger concluded. “But I felt really proud of my student. It just felt like one of those moments where you can see how he ‘got it’ – that he was there for the mother and he really made a difference in her life.”