Linvell Chirwa: Midwife in Malawi

My name is Linvell Iddes Chirwa. I am 27 years old and come from the remote area of Mzimba District in the northern part of Malawi. I am the seventh born child in a family of eight children. Four of us siblings are civil servants in the Malawi government, the other four earn a living by mere subsistence farming.

Linvell Chirwa: Midwife in Malawi

I am married to a civil servant and we have a year and a half year old son. My husband and I are from poor families and our parents are all aged.

I am very proud today because I am a State Registered Nurse Midwife, and a graduate from the University of Malawi, Kamuzu College of Nursing. Currently, I am working with the Ministry of Health at Mitundu Community Hospital, in Lilongwe District in Central Malawi. For me to reach this far, the road was just too tough. My parents could not afford secondary school fees. Due to good class performance the school secured a Bursary for me (Mamie Martin Fund- at Robert Laws Secondary school). The first two years in college I was on a government funded scholarship. I struggled the last two years since the government had stopped giving these scholarships. My parents sold the only cows they had for me to finish my tertiary education.

Newborn in Malawi

I do not regret being a midwife. There is job satisfaction in midwifery, and I feel the creator has given me a chance to witness the beginning and ending of life.

As much as l like bedside midwifery, there are challenges that I face as a mere midwife and as a midwife manager. There is a shortage of qualified midwives, a lack of incentives, poor infrastructure, not enough medical supplies and equipment, inadequate salary and the inability to pursue my career path.

Mothers wait in a crowded maternity ward at Bwaila District Hospital in Lilongwe, Malawi.

Imagine one midwife taking care of 60 antenatal women per day, or two taking care of 10 women in the labour ward while also responsible for others in postnatal ward. These midwives are expected to check on the labouring mothers every 30 minutes or more frequently, check their blood pressure using a manual blood pressure machine. Will they provide quality care? Will they have tea or lunch break? Usually not.

There are no simple incentives for midwives such as the provision of meals. Imagine a midwife attending to 80 family planning clients a day, some coming very far away from the facility. Often times we choose not to go home and wait to have lunch till 3:00 or 4:00 p.m. after attending to all so that they reach their homes in good time.

Imagine one oxygen concentrator for both labour ward and postnatal ward. Who are you going to give oxygen to? The neonate with birth asphyxia? Or the postnatal mother on whom you are doing cardiopulmonary resuscitation? And, you are also unable to check her hemoglobin level due to lack of laboratory supplies. This is what we face.

Sometimes I work 24 hours a day for seven consecutive days, especially when I am covering the operating theatre since there is no stationed theatre nurse or midwife. For instance, I have my department as Family Planning/Antenatal, but when there is a Caesarean Section, I will leave the family planning clients and assist with the operation from theatre then must go back to family planning. During the night I will be called four times to assist with operations and yet at 7:30 a.m. I am expected to be at the family planning clinic again. This can go on for a full week, without a break, since there is no one to cover your department. Yes, with this work we are supposed to get an allowance but the allowance is very little and the amount fluctuates and is inconsistent — sometimes we get it after several months and sometimes not.

Due to a shortage of doctors who can perform operations, it often happens that none are available and no ambulance is around when a woman with obstructed labour needs you to help her. Midwives work under stress, they carry all the challenges of the women and their newborns. And they are dedicated. Sometimes we use our own mobile phone airtime for communicating to other facilities, colleagues and ambulance drivers.

Premature twins at Bwaila District Hospital in Lilongwe, Malawi.

Imagine one oxygen concentrator for both labour ward and postnatal ward. Who are you going to give oxygen to? The neonate with birth asphyxia? Or the postnatal mother on whom you are doing cardiopulmonary resuscitation? And, you are also unable to check her hemoglobin level due to lack of laboratory supplies. This is what we face.

Many midwives need to find alternative sources for income to pay their bills. Linvell farms groundnuts and sells them at the market on her days off.

Since I come from a poor family, culturally and morally I must help my parents and in-laws. I also pay school fees for other dependents. But the salary I get is just enough for my family’s daily consumption and utility bills. No savings, no investments. Little time to do other income generating activities other than midwifery work. I depend on my salary for everything, and recently started farming ground nuts for extra income. If I pay school fees for dependents and send some money to my parents, then that month I will not be able to eat good food. Life becomes hard when salaries are delayed because we end up borrowing money from friends for us to survive.

Unless we address these challenges, we should stop dreaming of achieving Sustainable Development Goal 3 because a healthy start is central to the human life, with birth holding the highest risk of death, disability and loss of development potential, leading to major societal effects.

As much as I want to further my education in midwifery and get a Masters degree in midwifery, I see this ambition as impossible due to lack of funds. My salary cannot take me that far. Government scholarships are limited and if I manage to find my own sponsors I will be removed from the pay roll because I will be considered as someone just receiving salary without work. So I better choose no Masters degree in order to sustain my family. Or I can apply for a scholarship when there is no fear of being deleted from a pay roll because I will be assured that my family will survive whilst I am in school.

With the salary I get I cannot afford to buy a land/plot for myself. I know that if I were to die today, my son will be homeless because his mother and father are less paid and cannot make investments. With the working conditions we are facing, well-qualified midwives are flocking to Non-Governmental Organizations for a greener pasture.

Linvell Chirwa is a proud midwife and advocate.

Unless we address these challenges, we should stop dreaming of achieving Sustainable Development Goal 3 because a healthy start is central to the human life, with birth holding the highest risk of death, disability and loss of development potential, leading to major societal effects.

Therefore, we must invest in midwifery; we must invest in women and girls because they carry families and communities as I do.

The first-ever, groundbreaking global survey of midwives conducted by World Health Organization, International Confederation of Midwives and White Ribbon Alliance, was released on 13 October 2016 in Geneva. Follow #MidwivesVoices to learn more.

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