Liberia after Ebola - turning midwives into surgeons

Liberian midwives are being trained as surgeons to assume the role of maternal health doctors killed by Ebola, according to a recent episode of The Cure, Al Jazeera’s award-winning medical series.

South African Dr Tlaleng Mofokeng travelled to Liberia to investigate. “Liberia has one of the highest maternal mortality rates in the world,” she says. “It is estimated that three women die every day from complications during childbirth. Many of these deaths are preventable with simple surgery and adequate equipment. However, a chronic lack of doctors here means that many maternity wards are overstretched and understaffed.”

The Ebola epidemic killed 184 doctors in Liberia, creating a chronic skills shortage. “In the last government report, Liberia had only 117 practicing doctors [in a country of 4.5m people],” says Dr Mofokeng. “This depleted healthcare system is being supported by midwives, who through no other choice, are taking on the risks of surgery to help hundreds of mothers facing difficult and possibly life-threatening births…”

The process is called task shifting and is run by international charity Maternal Childcare Advocacy International.

Dr Mofokeng’s first stop in Liberia was the CB Dunbar maternity hospital in rural Bong County, where just three fulltime doctors serve the 65 000 population. She met one of them, Dr Obed Dolo, who is also the master trainer at the hospital responsible for upskilling nurses. “Dr. Dolo’s aim is to train midwives in months, rather than the years normally required to become a qualified doctor,“ says Dr Mofokeng.

The success at CB Dunbar has resulted in the project being rolled out to two more hospitals.

Dr Mofokeng also visited Redemption hospital in Monrovia, which provides free health care to a large slum area.  With the Ebola epidemic, the hospital became overwhelmed with patients and had to be shut down. It recently re-opened but conditions are tough, with basic equipment, few staff and a shortage of drugs.

Dr Mofokeng witnessed a woman giving birth during an electricity outage, in sweltering heat without airconditioning, and heard of nurses operating by torchlight, sometimes improvising with a needle holder with a blade on it when a scalpel was not available.

She also witnessed the birth of two breech twins, which were the wrong way up and had to be taken out via Caesarean section. With neither baby breathing and minutes passing, Dr Mofokeng put on gloves and stepped in to help keep them alive, without incubators or even a stand for the team to use to resuscitate them.

Visibly emotional afterwards, Dr Mofokeng said, “I just couldn’t bare to watch and do nothing. The babies seem like they will make it but there’s no IV lines, there’s no incubators, there’s no ICU. In any other setting, these kids could have been incubated right then and cared for properly in ICU. To think that there’s so many other kids who don’t make it, every day… My heart’s very sore at the moment.”
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