Esther Madudu – AMREF’s Nominee for the Nobel Prize 2015
Esther Madudu, 32, is an enrolled midwife employed by the Government of Uganda. She works at the Atiriri Health Centre IV in the Katine sub-county in Eastern Uganda.
Atiriri health centre IV, located just outside Tiriri trading centre in Katine, is the main facility for the seven sub-counties that make up the county of Soroti in Eastern Uganda. A health centre IV is a mini hospital, the level below a district hospital. Atiriri has 34 beds and sees up to 100 out-patients each day, including referrals. For a long time, it has been run by two clinical officers, but a doctor was recently employed there for the first time.
The health centre has three midwives, although one of them is currently on study leave, and has not been replaced. As a result Esther and her colleague have to share the workload of three people between them. Their duties include antenatal services – including examination of the mothers, counselling HIV-positive mothers, nutritional education, Prevention of Mother-to-Child Transmission of HIV; maternity services, including delivering babies, and post-natal care.
Alongside their other duties, the midwives deliver 45 to 50 babies every month at this health centre. Following training from AMREF, Esther is now able to handle more difficult deliveries, but those that are beyond the capacity at this health centre are referred to the district hospital at Soroti, 26 kilometres away. Atiriri health centre has an ambulance to transport referral cases to Soroti, but there is often no fuel for it, so the health workers have asked the community for help in raising money for fuel.
How long have you worked as a midwife?
I turned 32 in March 2012, and I have been a midwife for 11 years. I began working at a maternity home in Kumi District, Eastern Uganda for a year and then later joined the district hospital there for three years. I have been in Soroti District for the last 7 years. For the last three and a half years I have been working at Atiriri Health Centre IV, which has been refurbished as part of AMREF’s work in the local sub-county of Katine. Katine is in Soroti District in Eastern Uganda.
Atiriri is deep in a rural area. There is no fence around the health centre, it has had no power for some time and the solar panels do not work. This makes our work very difficult, particularly in the maternity ward. AMREF had given us head torches that we could at night, but these no longer work, so we use the light from our mobile phones to deliver the babies. Sometimes the mothers bring candles, but it is not easy to carry out a delivery by candlelight.
What’s the main focus of your work as a midwife?
The integrated antenatal care I carry out includes counselling, delivering babies, immunization, post natal clinics, post-abortion care, follow up of mothers and their babies, and outreaches, as well as activities such as deworming, HIV testing, malaria treatment and prevention.
Why do you work as a midwife?
Saving the lives of mothers and children is my biggest motivation. My own birth was premature and I am sure that I am only alive because someone made a sacrifice.
How many lives have been saved through your work?
I have supported safe deliveries for more than a thousand mothers and babies already through my work.
What does your typical day look like?
My workload varies. For instance, last night I delivered five babies, in the morning I delivered one. In our antenatal clinic, we see about 35-40 mothers each day, Monday to Friday.
The heavy workload makes it difficult to do all of our work effectively. We should make follow-up home visits to HIV-positive mothers, but we are so tied down at the health centre, we cannot go out to make the visits. There is a risk that because of stigma, women might not follow our advice, because they do not want other people to know that they are infected. Because of this, they do not take Nevirapine at onset of labour, and they go ahead and breastfeed their babies, putting their babies at greatly increased risk of infection with HIV.
At the moment only two of the 38 staff at this health centre are midwives. Can you believe that? Only two? There is so much work to do and yet there are only a few of us. We are forced to work day and night.
Today, I have been on my feet all day and have not had time to eat. Most days we just have a bottle of fizzy drink while we work. I do not even have time for my son because of my workload. He is only 10 months old, and because he was spending too much time on his own, I had to decide to take him to stay with my mother. She lives in Pallisa, which is 100km away. The housegirl I had employed did not look after my baby properly because I was not able to supervise her closely. She left when she became pregnant herself. I was rarely at home and so she also didn’t feel that I paid her enough for all the work she did.
I have two other children – a girl who is six and a boy who is two – they are now in Pallisa with my mother too; I see them when I can. Lately, it has been more difficult. I was busy over the entire holiday period last Christmas, so I could not go and see my kids. I am sure they were upset – they do not understand why they have to live with their grandmother permanently. I have to do this though, because without me, some children will not even get a chance to live.
What are the best and worst experiences you have had in working with mothers and children?
Sometimes it is difficult for me to pinpoint one – they are so many. I remember a baby girl born with her buttocks out first. It was one of the most difficult deliveries I have been involved in. It took such a long time, and the mother was in agony. When the baby was born she had to be resuscitated. When she pulled through, they named her after me. So you see, it could be a very tough day that ends very well. I remember another pregnant lady who had craved tamarind. She had asked her husband to climb a tree to get some, but he had refused. She had climbed it herself, and had fallen from it. When she fell down, she had pierced her belly and almost lost her baby. I was very angry, especially at the husband. This is why I call for male involvement. It takes two to make a baby and both parties need to be part of the entire process.
How long have you been working with AMREF?
I worked with AMREF in Serere district since 2007 when AMREF was implementing a water and sanitation programme there.
When were you trained by AMREF?
I received refresher training from AMREF as part of my job in 2010. Currently, I am also having ICT training via AMREF, which I’ve been doing for the last two and a half months.
Even though I work in very difficult circumstances, I know I do an important job. On top of the training I had at nursing school, AMREF has given me knowledge and skills in additional areas, such as how to handle severe malaria during pregnancy, post-abortion care, immunisations, and complications in delivery. The training that AMREF gave to the Village Health Teams has helped us greatly too, because most mothers are referred to us in good time for deliveries.
What is your role within the Stand Up for African Mothers work? How long have you been working against maternal and child mortality?
For as long as I have been in midwifery, I have been championing for this cause. My job goes beyond delivering babies. It is about getting proper information and services to people who need them most, and advocating for maternal health to be prioritized. We are all alive today because someone gave birth to us…how can we not make that a priority in healthcare?
What do you think about the campaign?
I am excited by it. I want the entire world to understand the need of mothers and the need for more trained mid-wives to address their needs. I also see this as an avenue to advocate for better infrastructure… we basically need more and better equipped health facilities. Maternal mortality in Africa is alarming and to me, this campaign is a step in the right direction, to get the world to pay attention. I am just a midwife but there is a lot for me to do out there where no one else goes. The world needs to see this.
Do you have a particular wish relating to caring for pregnant women and children?
My dream is just to save more lives. I want to have saved lives in the thousands by the time I am thirty five. (Giggles) Three years to go but I can make it!