Devpro Resource Centre
A Chadian midwife in the refugee camp of Dajabal
In the health center of Djabal refugee camp, Rachel takes care of a baby that has just been born – three months too early. © UNICEF Chad
Why did you decide to be a midwife?
The very first time when I helped a woman to give birth I was very proud and couldn’t stop to admire the color of the baby’s skin, its features, its smell. With every birth my love for this profession has further grown.
A birth-giving situation that has marked me profoundly happened in June 2008:
After several days of travel in a donkey-chariot, a Sudanese woman had come from her country to our maternity in eastern Chad. Her husband, an ex-military from the Sudanese army, had settled down several years before in the refugee camp of Djabal, with another wife. Our patient was his second wife.
Mariam was highly pregnant and had never followed any antenatal care. When she arrived at the health center we realized that she was ready to give birth – but she had profound anemia and far too little blood. She was completely dilated and by the time we had managed to transfer her to the hospital of Goz Beida, it was too late. She died – the child survived.
I was with the nurse of the camp’s health center on duty the night when Mariam died. The traditional birth-helper of the Djabal camp, who works with us to translate when we do not understand the Sudanese people’s language, was also present.
On the day following Mariam’s death, we sent the technical evaluation of the case to our medical coordinator, in order to elucidate all the circumstances. That is how we learned that she had come from Darfur. We always proceed with this verbal autopsy to assess the reasons why a woman does not come to the antenatal care consultation. Only if we follow up on these causes – which can be tradition, fear for related costs (the service for refugees is free), lack of follow-up by community agents, resistance of the husband, negative practices in terms of traditional medicine – can we can address them and reach more women.Men and women are both affected by the disease, but the body of a pregnant woman is feebler and the virus can kill her easily.
This event marked me deeply. It would have been Mariam’s first child and she had no chance to see her baby even once. Without a mother and without the attention of her father, the girl will never feel the protective environment of a family. If only Mariam had benefited from the antenatal consultation in the maternity service we could have saved her! The service includes anti-anaemia medication, prevention of malaria, parasites, tetanus and supplementary feeding. All this was available – for her. It’s such a pity! Today her little girl is nine months old. When Mariam arrived at the health center she was already too feeble to say anything. She didn’t utter a word from the moment when she entered the maternity, until her death, passing away silently like a ghost.
Another situation that has affected me a lot was the Hepatitis E epidemic in 2004/2005. During that period 27 women passed away under my hands. Men and women are both affected by the disease, but the body of a pregnant woman is feebler and the virus can kill her easily. At the time I was the only midwife in the Dar Sila area, covering a community of 18,000 refugees in the camp of Goz Amir – with about four births per day or 80 births per month. With the beginning of internal displacement in 2006 (due to inter-ethnic conflict) the NGO with which I am working increased the capacity of maternity services, recruiting eight additional midwifes. The following year I became the focal point for reproductive health care for the entire Dar Sila area. Today all these midwives are working under my supervision and I use this position to teach them as much as possible of my experience and knowledge. To make sure that every woman gets a chance to save her own life and that of her baby.
4 May 2009
How long did you train/study to be a midwife?
3 years in Bangui, Central African Republic, 1997–2000
How long have you been working as a midwife?
I have been working without interruption since 2000. For two years I was deployed in Central African Republic, before my return to Chad – first in the south and since 2004 with the NGO COOPI in eastern Chad.
What is the most challenging aspect of your job?
To help a woman to give birth when complications are involved (cesarean, placenta before) is very challenging. Especially if the woman is living far from the health center; for example refugees in the camp of Goz Amir have to travel 45 kilometres to come to the hospital of Goz Beida to be operated. During the rainy season when all the roads transform into rivers it becomes close to impossible to reach the women in time, even less to bring them to the hospital. This kind of situation discourages me – the other circumstances I can take care of.
What is the most rewarding aspect of your job?
Once in 2005 I helped to give birth to triplets. All of them were born under weight (under 2 kilograms). We cared for them during two months in the local nutrition center until their mother had recovered. The three babies survived and are today in very good health!
Most recently I helped save a prematurely born baby. The little boy had only six months (1.1 kilograms) and we were 99 percent sure that he wouldn’t make it. Today – five days later, he is still alive. It was very difficult at the beginning, because he was too small to breathe or eat. His body was not ready yet to confront the world – and the circumstances in eastern Chad are not the ideal ones to help a child like this survive – but we did. As his mother has no milk he is cared for in the nutrition center and over the past two days he has gained nearly one pound (1.5 kilograms).
Any other comments?
I am a mother of three children – two girls and one boy. When I was pregnant for the very first time in my life I thought about all the women that I had seen suffering before and I didn’t feel any pain. They had managed, I thought – you will do so as well – and I did.