“There was no one around in the village to help when my pregnant sister told me, ‘I want to deliver.’ I assisted the delivery and after that I became a birth attendant,” recalls Hawa, a traditional birth attendant now called ‘grandmother’.
In the rural areas and camps of Darfur most babies are born at home, with mothers sometimes being assisted by a midwife, and more often by a traditional birth attendant, who may or may not have any prior training.
Hawa was forced to flee her original village in West Darfur three years ago due to the conflict in the region. She now lives in a camp for displaced persons in Kubum, South Darfur where she continues to work, assisting three or four mothers each week to deliver their babies.
“I am very old, I have helped women to give birth and I am now helping their children to give birth,” explains Hawa. “The work is in the heart. God is the only guidance I have had.”
The stark reality of the basic conditions in which many women give birth becomes clear as Hawa explains that the only equipment she has used in the past is a razor blade (and not necessarily a new one), wash cloths and hot water. Due to her age, Hawa had not received any training in midwifery, or any prior education. She only speaks her mother tongue, Fur.
Many traditional birth attendants, especially older ones, are also illiterate and have never received any formal training. Even younger traditional birth attendants typically only receive three months of training and have a similarly limited range of equipment, extending to include a pair of scissors and maybe a pair of clamping forceps.
Over the past three years, ACT-Caritas has set up mother and child health care services in all its health care facilities across South and West Darfur. The centres offer ante, intra and post-natal services, health education, safe delivery facilities and assistance carried out by trained midwives.
Record keeping was introduced in the clinics two years ago even though birth registration is not widely practised outside of towns in Darfur. Reporting was limited, but nevertheless, the results revealed an alarming rate of infant and maternal mortality.
Reports also indicate that despite the large number of consultations, there are very few deliveries in the clinics with 85% of women still preferring to give birth at home. In Darfur culture, women typically will only go to a hospital to deliver if there is a complication with the birth.
At the town clinic in Kubum, run by ACT-Caritas, Hadilla is pregnant with her fourth child and is visiting the midwife for a check up. “When it is time to deliver, I will call for the midwife to come to see me in my home and if there are no complications, I will stay at home to deliver. Thanks be to God, my three other children were easy deliveries and there was no need to go to hospital.”
Prompted by data from the reports, ACT-Caritas last year trained and equipped 82 midwives and traditional birth attendants. They are now working in camps and rural areas in South and West Darfur to improve services and support the clean, safe delivery of babies.
“The training taught me the importance of cleanliness during delivery so as to prevent disease. Since the training I have changed the way I work. Now, I wash my hands, use gloves, only use a new razor and new cloths and to sterilize the equipment,” says Hawa.
In Kubum camp, Mariom talked about her latest delivery of a healthy baby boy, her sixth. “Hawa helped me during the delivery, and washed the baby and me and brought me pain relief tablets afterwards,” she said.
For traditional birth attendants like Hawa, the training was the first they had ever received. For midwives and those with some training already the course served as a refresher covering topics including the theory and practice of ante-natal care, recognizing and dealing with complications early, sterilization and clean delivery, hygiene and post-natal care.
After the successful training of 82 midwives and traditional birth attendants at the end of last year, and because of the great need for them, ACT-Caritas will train another 100 women during February and March. Last week, a group of 50 midwives of all ages travelled from far and wide across South Darfur to attend a five day refresher-training course held in Nyala.
Butheina, one of the younger midwives from Kass locality, talked proudly of all the things they had learned on the course. Amongst other things she said, “We have learned how to combat harmful traditional practices, how to care for women before and after delivery, as well as the need for urgent referral in complicated cases.”
Fatima Omer, who has been working as a midwife for 18 years and has delivered over 300 babies said, “The skills we have learned here are something new, so we are going to share them with our sisters in the village who did not have the chance to be here.” This was her first chance to receive any training in eight years.
With the investment by women who are learning new skills and the safe and clean equipment provided by ACT-Caritas, birth attendants such as Fatima and Hawa are now more able to support and reduce the risks faced by mothers and babies in South and West Darfur