"Women know that we are here and that we can assist them if they develop any complications during pregnancy or childbirth"
November 27, 2010
Liza Ramlow, a 62-year-old midwife from the US, arrived in Nigeria in May. Her aim was to help implement an MSF project providing primary healthcare and antenatal care in some of the most deprived slums in Lagos. Now nearing the end of her time in Nigeria, Liza takes stock of what has been achieved in the project so far and what remains to be done.
Can you describe the project in Lagos and what your work involves?
When I arrived in Lagos about six months ago, I joined a team – including a doctor, a nurse, a logistician and a field coordinator – who were negotiating with the authorities to start working at a health centre that was no longer operating in Makoko, one of the main slums in the city. Fortunately negotiations went well, and after rehabilitating the building, medical activities started in early July.
In the health centre, MSF is offering primary healthcare and antenatal care. My role in the team is to supervise and coordinate all the reproductive health services. Basically, we provide antenatal care to pregnant women, and we assist deliveries 24 hours a day, seven days a week. If complications arise – for instance if there’s a need for a caesarean section – we refer women to hospitals where they can receive the right care. We also do family planning on request.
What does antenatal care involve, and what are the main medical problems you deal with?
At the antenatal care clinics we follow the MSF basic protocol, which means we run a number of tests to make sure that the women and their babies are healthy. We measure blood pressure and vaccinate against tetanus. We do blood counts, urinalysis and a rapid test for malaria. The test for malaria is important because malaria – which is endemic here – can be particularly dangerous during pregnancy. This is why we also distribute mosquito nets impregnated with insecticide to the women who come to the clinic.
We also treat any problems detected during the examination. The main pathologies we treat at the antenatal care clinic include malaria, severe anaemia, high blood pressure, sexually transmitted infections and urinary tract infections. The services we provide during pregnancy are basic, but essential. Even when a woman attends antenatal care just once, it is still worthwhile, because the care she receives is very relevant.
What has the response been to the antenatal care on offer?
The response has been very good. Currently we see about 40 women every day, and demand keeps on growing. Many women decide to have their babies at home, or with a traditional birth attendant, and only come to the centre if they have problems. But I think that a very important part of our work is that these women know we are here and that we can offer them good care if complications arise.
Women tell us that they come to the centre because the staff are well trained and any medication they receive is of a good quality. Often they come to us with problems which they have tried, unsuccessfully, to treat in some other way.
What is the relationship between MSF and the traditional birth attendants?
In Lagos, women have to pay a lot of money for antenatal care or to deliver in a hospital – even in public health facilities. It is common for women to seek help from traditional birth attendants, or from the churches, which often hire people with some medical knowledge to provide healthcare.
When we opened the project we met with the traditional birth attendants and healers who – in that part of Lagos – are mostly men. The purpose of the meeting was to let them know we were beginning work in the area, to tell them what services we could provide, and to encourage them to refer women to us who needed more specialised care. A number of the traditional birth attendants have brought their patients to see us and have used our services during pregnancy and childbirth.
What are the main challenges the project is now facing?
In the first three months of the project we conducted about 2,000 antenatal care consultations and assisted with more than 100 deliveries. As the number of women seeking our services is growing quickly, we need to hire more national staff to keep up with the demand.
The midwives need to be able to spend more time with the pregnant women they see to provide them with proper care. The more we listen to these women, the more clearly we will get to know the main problems that women in this area face. This will help MSF determine the best ways of providing assistance to the people living in the neighbourhoods around the health centre.
We are also beginning work in three other sites in the city, through outreach clinics. Antenatal care will be provided in these sites, and we will employ community health workers to help us get to know these communities and convey basic health messages.
After 30 years working in a hospital in the US, how would you rate your first experience with MSF?
In Lagos, the challenge is to work as best we can using the resources we have. So far, we are having very good results, taking into account our limitations. Most of the babies born at the centre come to the world without complications and go home with their mothers shortly afterwards. Working with MSF and with the national staff of the health centre has been an amazing and very enriching experience for me.