Barbara Zalwango — Citizen Champion

Celebrate International Day of the Midwife #IDM2017 by meeting a midwife who has dedicated her career to saving the lives of mothers and babies in Uganda.

“I love midwifery. Helping mothers and newborns is a part of me, ”Midwife Barbara Zalwango (front row, 2nd from left). Photo Credit: WRA Uganda.

“There is no trauma like that of losing a mother or newborn over something that can be prevented,” says midwife and White Ribbon Alliance Champion Barbara Zalwango. Which is why Barbara has advocated so passionately for change at the Bulera Health Centre in rural Uganda where she has worked for the past decade.

The challenges she faced were daunting, from the sheer poverty of the community to the terrible neglect of the health services. “The government is supposed to send medicines and supplies to all health centers around the country,” she says. “But sometimes, drugs are missing or too few. Other shortages range from lack of gloves and cotton wool to antibiotics and life-saving emergency medicines like magnesium sulphate. We often have to ask mothers to go and buy these necessities, yet the women here are so poor that some cannot even afford stitching thread in the event of a tear during childbirth.”

Meanwhile, the health centre was run down and understaffed, with only one nursing assistant, a nurse and Barbara — the sole midwife for the whole community. “It had no maternity department, only a tiny and uncomfortable room for births,” says Barbara. “Expectant mothers were supposed to go to Mityana District General Hospital. Yet that was 17 kilometers away and so a dozen women a month gave birth at Bulera, despite the lack of facilities and equipment to deal with life-threatening complications, while a further 60 attended the ante-natal clinic here.”

Barbara began to advocate for a proper maternity wing at Bulera. She talked to the District Health Officer and to the Health Unit Management Committee about the challenges. Minutes of these meetings were documented and forwarded to District health authorities. It took time, but after two years came success! Bulera Health Centre II was upgraded to a Health Centre III, and Barbara became Head of a new Maternity Department with an additional two clinical officers, five nurses, two lab technicians, and a second midwife.

“We often have to ask mothers to go and buy these necessities, yet the women here are so poor that some cannot even afford stitching thread in the event of a tear during childbirth.”

However, Bulera’s troubles were far from over. The health facility still had no electricity and the midwives were forced to use torches or paraffin lamps during the night. Barbara, now a seasoned advocate, went again to the Health Management Committee. As a result, Bulera was connected to the national power grid and recently got solar power as a backup.

Yet Bulera still had no running water. As sepsis and infections cause 22% of maternal deaths in Uganda, the shortage of water was a huge risk to mothers and newborns. Again Barbara went to the Committee, and the health facility got its first water tank so that there is now running water in the maternity ward.

Meanwhile the improvements were attracting more and more women to seek care at Bulera. The number of births increased four-fold while double the numbers of women were attending the ante-natal clinic. Yet staffing levels stayed the same and Barbara and her fellow midwife were nearly overwhelmed by the sheer amount of work. “We had to do ante-natal, immunizations, family planning, community outreaches and births,” Barbara says. “We were understaffed, overworked and always tired.”

The two midwives worked out a routine where each would work for at least three full days, 24 hours a day, so that the other could rest and return to take up the mantle for the next three day.

Meanwhile, Barbara joined members of White Ribbon Alliance Uganda (WRA) who were campaigning for safe motherhood in Mityana District. “We did a survey and found a shortage of midwives in all Health Centre IIIs,” she says. “The situation was appalling. Most health facilities fell below the Ministry of Health staffing norms. There were frequent shortages of medicines and supplies. Operating theatres were dilapidated and there was a general lack of equipment, especially resuscitation devices for the newborn.”

The District authorities said they had no money to recruit more staff, but they did write a report — and then shelved it. Barbara and her fellow midwife trudged on like all other battle-hardened midwives in countries trying to provide maternal and newborn care without enough back up or resources. The two midwives worked out a routine where each would work for at least three full days, 24 hours a day, so that the other could rest and return to take up the mantle for the next three days.

Fast forward six years — when an NGO arrived in Mityana to prevent the transmission of HIV from mother to child. Midwives have a central role in this effort, and so the District Health Team pulled out the old report on the poor staffing of midwives.

At the same time, the NGO recruited two “peer mothers” for each Health Centre III to support the midwives. “This is their second year working with us,” Barbara explains, “advising and counselling mothers mostly in the ante-natal clinic. This has freed us up to attend deliveries and emergencies.”

While staffing and conditions were improving at Health Centre III, newborns were still dying due to lack of resuscitation devices. “Many could not breathe at birth and yet we had no suction machines to save them. So we had dialogues with the community, the Health Unit Management Committee and District government.”

In 2014, Barbara was invited by the Ministry of Health in Kampala to give evidence of the problems. As a result, the Ministry delivered emergency newborn resuscitation devices to Bulera and five other health centers in Mityana. At last, newborn deaths in Bulera began to decline.

Barbara on the cover of WRA Uganda’s “Act Now to Save Mothers” Policy Brief. Photo Credit: WRA Uganda.

Barbara continued to work with White Ribbon Alliance Uganda, bringing together other midwives in Mityana with elected representatives and other community leaders to raise their voices about the state of maternal and newborn care in the District. “In 2014 we petitioned our MPs to demand that the government recruit more midwives and doctors, and also increase salaries and build living quarters for health workers in order to retain them.”

The petition had a massive impact and the government responded by increasing health workers’ salaries nationally by up to 18%. It also renovated or built new staff quarters at many health centres. Midwives can now live at those health facilities and attend to mothers any time of the day or night. It was an exhilarating moment for Barbara that the campaign had achieved national results.

Since then, Barbara has also become the Mityana District mentor for other health workers in Maternal and Child Health, and Prevention of Mother to Child Transmission of HIV. “Midwives study these things in school but I teach them how to anticipate and manage emergencies when they are working alone, and what to do to prevent HIV transmission to the newborn,” she says.

These are truly inspiring achievements by a champion for her fellow women, yet Barbara’s motivation is clear and simple: “I love midwifery. Helping mothers and newborns is a part of me.”


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