Meet Catherine, one of the powerful women working on the frontline of healthcare in Uganda. Catherine is a 26-year-old midwife from Katakwi, a small town in Eastern Uganda.
Catherine works at Katakwi General Hospital “in the many areas that they need me; antenatal, family planning, the labour suite – it depends on the day!”
The story of Catherine paints a picture of the real, everyday impact of better training for women working on the frontline of healthcare – and how they can be supported to prepare for their next emergency.
“My mother was a Traditional Birth Attendant (TBA) and when I was young I would see women coming to our home to deliver. I remember my elder sister shouting because there was a mother who was almost dying. Can’t you let this mother go and deliver in a hospital because the midwives there are trained? From this, I understood it’s the midwives who should be helping these mothers to deliver. My mother is so proud of me. She stopped being a TBA around 2002. She could see that when a mother goes to the hospital instead of delivering at home, she comes back with a baby that is alive.”
Catherine acquired her Diploma in Midwifery through Amref’s eLearning project in Uganda. “I wanted to get my diploma before the age of 28. That was my goal. I needed this, I am the head of our family. I am educating my little sister, caring for my mother and my two nieces. I need to increase my salary, my skills and further my career.”
She is one of just 20,000 midwives and nurses serving a population of 33 million, which means one nurse or midwife serves 1,600 people in Uganda. The difficult conditions in which many health workers operate – a shortage of medicines and lack of basic amenities like clean water and lighting, coupled with limited opportunities for professional development, mean that health worker retention is a struggle.
In Uganda, there is a lack of access to continuous development training, meaning most of the health workforce are relying on outdated training received several years ago. There are very few training courses available and those that do exist are mostly expensive face-to-face courses, which require long periods away from work and family. The eLearning training courses that Amref run, are a powerful way of addressing these challenges. Their flexible nature means health workers don’t have to give up their jobs and can fit their studies around work and family lives. One-to-one support is provided by a dedicated eLearning tutor, visiting them at work. Plus, they can put their much-needed new skills into practice immediately.
“I was once on night duty and a mother came to us almost pushing,” Catherine explained. “But, because she was not monitored, the baby was asphyxiated [lacked oxygen]. We desperately needed
oxygen. It was not available in theatre, children’s ward and the maternity ward. I cared for that baby for three long hours, stimulating and transferring my own oxygen with a mask. I thank God, the baby survived.”
In an emergency like this, Catherine could refer patients to Soroti Regional Referral Hospital but it is 34 miles away. This can mean that referring patients carry greater risks because of the time it takes to get there: 1-2 hours on the untarmacked road, when a vehicle is available. “We have one ambulance but the fuel is not provided for us. We have to tell our patients to fuel. It is a poor referral system and it can lead to us losing babies, even mothers,” Catherine explains.
Women like Catherine put their passion into practice every day. They resolutely care for hundreds of patients every month, often without basic amenities – or an ambulance to call if something goes wrong. But with the odds so stacked against them, they can only do so much. The training courses Amref provide mean health workers feel equipped and able. They can confidently respond to the emergencies they already face each day and in turn, thousands of people live happier, healthier lives.
As an African-led organisation, Amref is uniquely placed to support this transformation. Amref began eLearning training in Uganda in 2012 and since then, nearly 400 nurses and midwives have graduated. eLearners have consistently performed better than those attending the face-to-face course: 61% passed with merit, against just 40% of paper-based learners.
“I have learned so much,” says Catherine. “One thing is antenatal paternal involvement. There are really few men attending the appointments. We want the men to stand up and say, ‘I too I’m involved.’ I really feel so happy and blessed, because, with this new training, I find myself succeeding and handling our mothers and babies so well.”