Hope for Midwifery in Liberia

Karen Shulman, Senior Manager of Strategic PartnershipsBlog, Liberia, Midwifery, Uncategorized

Midwives are the heart of maternal and child health around the world. The support, care and advice they give during pregnancy, labor and the postpartum period is essential for the wellbeing of mothers, families, and communities. Seed Global Health is proud to teach and train midwives, and we’ve been doing so in Liberia since 2016.

Dr. Nicole Geller, a nurse midwife, is in her second years of service as a visiting faculty member, helping to build the future of midwifery practice in Liberia.  She shared her thoughts with me on her work and her great hopes for midwifery in the country as she continues to help build the next generation of midwives and local leadership. -KS

Midwifery in Liberia is making great progress.  There is more to do and it is exciting to see that, right now, there is a strong focus on the education level of practicing midwives.  For instance, there is a push across the board to make midwifery a 3-year degree program, as opposed to the current one lasting 2-years.  This will allow the schools to prepare more well-educated and highly skilled midwives into practice areas.

Additionally, the leadership of midwifery in Liberia is trying to provide more educational opportunities to midwives in practice.  From continuing education to refreshers on specific skills, practicing midwives are being given opportunities to reach new heights.  Most have two or three years of training, so their practice is being strengthened with more current skills.  There is also a movement to have each nurse and midwife have the opportunity to matriculate on a baccalaureate level.

In my year and a half here, I have understood that the need is not for new equipment or technology.  The need rests in new ways of teaching and receptiveness to different ways of managing education, teaching methods, and variety of resources already in place.  And that’s just one the many ways a visiting faculty member, like me, can help.

For instance, I have been working with faculty to understand how we can best use the skills lab.  I try to model a few news ways of incorporating the lab’s equipment into lectures.  This way, we can better prepare the student for clinical practice by integrating a little bit of a ‘hands on’ component to a lecture.   I have supervised many a delivery using what we have, in class or lab, using students as proxies for patients.  Our current faculty are starting to expand and do similar for their specific specialties.

Initially, some of my colleagues were apprehensive about using a new form of teaching – when you have been successful in the past, why change?  But, they see other faculty members engaging with the skills lab in an alternative way and they are quiet intrigued.

It is always a challenge to ask people do something that they haven’t done before, however everyday more and more faculty are considering adapting their lectures to include lab materials.   I remind myself, daily, that I need to continue to demonstrate the value of the lab as a place of skill enhancement and the lectures as a place to start integrating the didactic materials and simulate what we have learned.  Putting theory into practice in this one specific way increases challenge for the student.  The more the student is challenged, the more (s)he will benefit when the time comes to apply their learning in the real life of a midwife.

As for gaps in training and resources, there are just not enough faculty to go around.  One example of how Seed is helping is by sending me.  A local faculty member could continue her education and enhance her skills in the classroom.  Because I could come here, she can attend classes and will have earned Masters in Education by the time I leave.  Not enough faculty, and a great need for new skills in our local experts translates into a gap.  Seed met the gap before it occurred and will have sustained both a program and its enhancement and development in one action – sending one visiting faculty to teach.

And, with this Liberian colleague, I have developed a close friendship over time.  I have watched her grow, learned from her experience, she has learned from mine and contributed to my understanding of our students.  We have been challenged together and have stuck together as we both held onto the same teaching position.

Her ability to go back to school and gain skills, support, mentoring, and exposure to different resources will make her a stronger midwife and teacher.  When I leave, she will take back her students and be better prepared to train the next generation of midwives.  And, I will have left her a cabinet full of new resources to continue in her development as a teacher.  Both of us have benefitted from this relationship in immeasurable ways.

In the hospital, as well as most birthing places around Liberia, the midwives may be the only providers patients see from admissions to discharge.  That means they take on the lions’ share of preparation, education, and care – it can all be done by the midwives.  If all goes well, the patient will never need to see a physician.

In the community the midwives attend to prenatal care, delivery, and postnatal care. They are the ones that immunize babies, as well as assess the babies’ growth, development, and nutritional status.  Liberian midwives are comprehensive clinicians – they can take care of absolutely everything.

But they face resources shortages.  From batteries for equipment, hand sanitizers, and much more ‘stuff’ we take for granted, they need all that will keep them and their patients safe in their care.   If you run out of something at night, because no one has extra and there may not be a place to purchase what you need to make it through the shift.  Impressively, everyone makes due with what they have.  There are times they run out of basic necessities like suture or cord ties.  What happens?  They ration.  The keen skills of a midwife requires her or him to assess who will most need what there is the least of and to proceed with that decision.  There are lots of decisions around allocating resources when they are so scarce.  So far, I have seen some pretty remarkable ways that my colleagues improvise and make their shift work.  I have a tremendous amount of respect for their adaptability to the lack of resources.  They put safety first, and they do their best with what they have.  As a result, I have become a better teacher now because I understand the difference between ‘need’ and ‘want’ in a delivery.  Here, there is no fine line between the two.  In Liberia, I have been taught about the delineation in that line by my midwifery colleagues.

Most of all, it has become clear to me that all our students need in their professional life is a mentor, teacher, or someone to just help encourage you along the way.  In the toughest times, it makes having limited resources easier to manage.  So much about the thinking within the midwifery practice requires support.

There is work to be done, but my colleagues are experts, strong, and looking toward the future to actualize their potential – and I have a lot of hope and faith in the future of midwifery in Liberia.  I have that because I have gotten to intimately see my colleagues in action.