Harriet Nayiga is a practising midwife born in Masaka, Uganda. She is the seventh born in a family of ten children. Due to her great performance in her Advanced Levels in 2009, she was offered a Government Scholarship to undertake a diploma in midwifery at Mulago School of Nursing and Midwifery.
During that period she also volunteered as a casualty nurse in the same hospital. Right after nursing school where she was recognized and awarded as the midwife of the year 2013, she was recommended to work with Wakisa Ministries, an organization that offers pregnancy care, temporary shelter and counselling for teenagers with crisis pregnancies.
Here she spent 3 years working as a full-time house mother and took care of the pregnant adolescents. She organized antenatal clinics, conducting training on birth preparedness and gave health education talks. She also empowered those girls by teaching them how to make handicraft items for sale such as candles, bags and key holders.
Having worked with those girls for so long, Harriet realized that there were major challenges in the provision of maternal healthcare services. She decided to further her studies to become a more competent midwife. So she resigned from Wakisa Ministries and joined The Aga Khan University in Kampala to undertake a Bachelor of Science in Midwifery. She also took up a part-time job as a midwife at Wentz Medical Centre. She is set to complete the course in December 2018 then graduate in February 2019. As of now she also engages the community in health education matters such as testing for STI’s, HIV and Hepatitis B. Having practised midwifery for about 10 years, Harriet shares her thoughts about her career.
1. Tell us a little about yourself.
I am a professional midwife of passion, with four years experience and now pursuing a Bachelor of Science in Midwifery at Aga Khan University Kampala Campus, training from Mulago National Referral Hospital. My career desire is focused on adolescents and youth’s sexual and reproductive health, to see that they pass through those developmental stages with better health choices and behavioural practices, in order to age gracefully.
2. You were given a scholarship to join Mulago School Nursing and Midwifery, what made you decide to pursue it as a career?
The decision to pursue this career was pushed by the love of assisting a new life coming into existence, which was geared by my secondary school career guidance teachers, who explained the difference between midwifery from other health professionals. Later on, I started reflecting on mothers and young girls in my rural community who had died due to preventable causes especially HIV/AIDS, unsafe abortions, postpartum haemorrhage and sepsis due to lack of knowledge to seek early medical attention and went to traditional birth attendants and local herbalists who mismanaged the conditions.
Other mothers tended to run away from health centres to seek native treatment and care from TBAs and Herbalist hence die from homes. This therefore tuned my brain to consider midwifery profession and it was not a mistake for me to be a midwife, I am so proud to be a God chosen person in playing the role of saving the lives of mothers and babies.
3. Did you want to be a midwife?
My childhood dream was becoming a Nurse, a profession l grew up hearing about in the community I was raised in, from my mother, playmates and over the radio, little did I know that there was midwifery as an independent profession. I was born and raised in a rural setting characterized by Traditional Birth Attendants (TBA) who were elderly women and herbalists, with no or minimal scientific knowledge in midwifery and this deprived me of health professional role models including midwives.
Midwife, Harriet Nayiga
4. You worked with Wakisa Ministries that deals with teenage crisis pregnancies, what can you say are the struggles faced by teen mothers?
Teen mothers usually come from dysfunctional families where parents and guardians are not in an adequate position to give them enough guidance towards making wise health choices and decisions. This coupled with poverty where they struggle to meet personal needs, information and knowledge on sexual and reproductive health to the extent of lacking a simple radio to get the right information on SRH, most information received is from fellow boys and girls and which information is full of myths and misconceptions. So some of these factors force them to engage in early sexual relationships that end up in unplanned pregnancies, unsafe abortions and various maternal complications.
If such issues are not addressed well, the teen mothers may end up with immediate second pregnancy which results from lack of support from the family and the men responsible, so in looking for baby’s milk the consequences are early second pregnancy, abandonment by family, early marriage, child-headed families, HIV/STIs, child labour, sexual assault and social stigma where the public still sees Teen pregnancy as a shame so they fail to seek medical care hence severe maternal complications. Those who get a chance to be enrolled back in school, they may find it hard to concentrate in class due to trauma, stigma and lack of social and psychological support they, therefore, become academic failures, engage with unproductive/unfocused peers, start taking drugs or become homeless.
5. Is there a difference in the care given to teen mothers as opposed to older pregnant women?
Despite the fact that every pregnancy stands a risk of complications, teen mothers are candidates to many complications of pregnancy, labour and puerperium (the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition) including haemorrhage, obstructed labour and high blood pressure which are direct causes of maternal mortality so extreme attention should be provided while assessing and managing teen mothers, without forgetting psychological support. When I look at health education, in particular, older pregnant women have held firm to the myths and misconceptions which take time to correct and attain positive change while teen mothers are ready to receive and apply viable health information. This calls for our initiative as midwives to provide the needful to save the young generation.
6. Why was it so important to teach the girls at Wakisa Ministries handcrafting skills?
Since pregnant girls tend to be abandoned by families and men responsible for their pregnancies, it is important to teach them to be creative by providing survival skills for economic sustainability to take care of their children which enables them not to approach men looking for money in exchange for sex hence delaying the second pregnancy.
7. What difference is seen in the communities you have worked in as a midwife?
There is a follow-up program in communities I have worked in and this has revealed significant physical and psychological change in the lives of teen mothers enabling them to accept and believe in themselves. With good pregnancy care, young girls have delivered without sustaining complications and they have put the health knowledge acquired into practice while caring for themselves and their babies and others have attained formal education. Sustainable simple business such as candle making, beaded bags production and jewellery have enabled them to start earning a living without depending too much on the man responsible for the children.
Health education knowledge has enabled couples including teen mothers to opt for appropriate family planning methods and early treatment and prevention of STIs and HIV / AIDS. Through community health sensitization, community members are able to seek immediate medical care, there is increased turn up for services like cervical cancer screening, HIV counselling and testing, Screening for Hepatitis B and immunization.
Midwife Harriet Nayiga
8. What challenges have you faced in your practice of midwifery?
It has been tough practising in limited resource hospitals where there are little or no supplies including medicine and sundries yet mothers are unable to buy these for themselves. As a midwife there is a time when the condition of a mother gets out of my hand for example with obstructed labour and this is when immediate intervention at a higher level of care is necessary but due to inadequate resources including few theatres compared to the number of mothers, this leads to delay in the management of complications.
Another limitation is that of the language barrier as I engage mothers and families coming from different regions of the country and this has led to inappropriate communication hence a hindrance to proper assessment and management of these mothers.
9. You joined The Aga Khan University School of Nursing and Midwifery Kampala Campus in 2016. How has been your experience so far?
I always say that Aga Khan University is the right place for me to pursue my course from, my experience so far has been exciting, studying in a conducive environment that facilitates my learning. It is at Aga Khan University where I have seen lecturers who individualize the needs of each student and totally devote themselves to help and support a student towards attaining her objectives.
Personally, I have been transformed and the change is conspicuous at my places of work through improved quality of midwifery care and in communities where I provide health sensitization so Aga Khan University is training world changers. On top of all that, I would not have managed to meet all the financial requirements of the Programme but the partial scholarship given to me by the university has been a great opportunity for me.
10. What does the curriculum entail?
It is a competency-based program building clinical practice with theory including the normal and complicated births.
11. Why are such programmes important?
Such programmes are very important in a way that they act as eye openers to a midwife/nurse to not only wait to inject a patient or deliver a mother but to use critical thinking skills in providing holistic care to women and families. The programmes provide evidence-based knowledge that enables a midwife/nurse to deliver culturally sensitive and friendly health services that meet the satisfaction of people which is not the case with enrolment or registration level.
12. What more can be done to improve maternal healthcare services?
The general challenges faced by maternal health sector need to properly be addressed and improved. These include low pay in limited resource working environment where midwives improvise to an extent of tearing a glove to tie the babies cord or using a glove paper for documentation, mothers delivering on the floor, one midwife attending to many mothers, poor referral system and the three delays (delay in decision making to seek care, delay in reaching a healthcare facility and delay in initiation of treatment from arrival at health facility).
There is need to put up youth-friendly health centres where teenage mothers can receive their specialized maternal care not coupled with stigma and fear from older women who put a blame on them and this will increase the number of teenage mothers seeking maternal health services. Family planning clinics need to be extended to all communities and standardized to a level that will favour male involvement where couples will receive adequate information and feel free to opt for appropriate contraceptive methods. There is need to develop information giving programs for the community to know the role of midwives in improving maternal health care services.
On the other hand, I cannot leave out the challenge which has bothered me for quite long, wherever I introduce myself to friends especially in communities that am a midwife, I have to receive some responses which may include: let me hope you are not one of the midwives who are rude to our wives when they come to deliver and many other responses of which some come from health professionals. This has indicated to me that there is a dark spot which the public has put on midwives, therefore, we need to bleach it bearing in mind that the quality of midwifery care begins with us the midwives and since attitude cannot be taught, there is need to mentor young ones who are planning to pursue midwifery as their career so that it stems from their passion but not as an accident.
13. You have practised midwifery for a while now, what can you say are the differences between the practice of midwifery when you started and now?
When I started midwifery, my practice was relying on classroom knowledge that generalizes midwifery practice but after hands-on am able to combine theory and practice which is evidence supported. I engage fellow midwives through CMEs at my place of work and in other health centres on the evidence-based practice which may be lacking hence strengthening a midwifery team. Through observation and interacting with mothers I have done personal research on various issues that have enabled me to build my career through discovering health issues across cultures.
14. What are the positive and negative impacts of those changes?
Mothers and families receive midwifery care with respect, however, it is hard for them to change their beliefs towards positive change.
15. What are some of the lessons you have learnt in your career as a midwife?
I have learnt that as a midwife am the centre of care for a mother in a way that even amidst all challenges, mothers will expect the best out of me.
16. What are your plans for the future?
I have started a program identified as Midwife-led Community Transformation International (MILCOTI), which envisions a Nation free from teenage mothers with midwives on the frontline of change. My objectives in this program include engaging out of school adolescents and youths at the grassroots in Sexual Reproductive Health education and empowering them with life management skills to be able to make informed health choices and decisions as well as addressing issues related with child sexual abuse and gender-based violence.
17. How best can we sensitize the community about the importance of midwifery?
We cannot just talk about the importance of midwifery, the importance should manifest starting from the clinical areas through the provision of friendly individualized care then down to communities. Knowing that in the developing world, a number of factors like poverty, long distances, poor transport systems and others disable mothers from reaching health facilities, therefore, Midwifery services should not wait for them to reach the centres but also go down to reach the people who are in most need. I think this is why the traditional birth attendants and herbalists have been found to be satisfying in communities. For example, in my community, I can encounter almost five herbalists every day using the door to door approach explaining the importance of their services, unlike the midwifery services.
As midwives, we are also trained to be educators, counsellors, researchers, leaders and advocates for communities. We should, therefore, engage the community together with political leaders, cultural leaders and religious leaders through different platforms like community radios, home visits, village meetings, churches, schools, through village theatres (music, dance and drama), sports competitions, walk and marathon programs. among others. There is also need for midwives to engage in leadership right from community level so that our voices can be heard. This is when a friendly healthy relationship will be created between midwives and local people that will enable us discover their health needs and address them appropriately and they will always look for our services.
18.For those who are considering this as a career what things do they need to know?
The future midwives need to know that they are a God chosen generation to love and serve with their passion knowing that they are the centre of care for mothers and families, therefore, every single decision and action was taken at all levels of care plays a big role in ensuring quality midwifery care. I encourage them not to fear the challenges which currently exist in the maternal health sector but instead, they should be encouraged that they are going to be part of the struggle which is going to lift our nation to another level in midwifery. It is possible to work as a team and use the acquired knowledge and available resources to create positive change and enable all communities to feel satisfied with midwifery services.