Nakaseke district has a population of more than 197,000 people, many of whom seek all sorts of medical health from Nakaseke General Hospital. In the maternity ward is Gertrude Kawala a midwife. from Monday to Friday Kawala checks in at 8 am. Her daily duties include prepping mothers ready for delivery, those waiting for Antenatal care and babies in critical conditions. “Some mothers can be on oxygen.” The World Health Organization recommended that a midwife should handle 175 deliveries a year but the scarcity of health workers is a challenge Uganda is grappling with especially in rural areas.
Kawala attends to an average of 10 births a day. on average Kawala attends to 2,690 mothers in a year a tough that is supposed to be handled by 15 midwives as per the World Health Organization recommendation. “And at the end of the day, you find yourself very exhausted because you have to be in every place to see that a mother has received her service, the baby has received the service it really needs, so it is a very big challenge.”
Due to poverty and cultural practices, many of the mothers turn to traditional birth attendants. The situation is worsened by some mothers who turn up at the hospital without materials they’re use. “She has come in the second stage and then she is pushing, you tell her not to push, the poor waters are bouncing, as you come yourself to deliver the mother, suddenly the water showers you.” said kawala Power outages are a major challenge in Nakaseke and many times, power has gone out during deliveries. It is upon the midwives to improvise light to save both the mother and the baby. “What we usually do, you either use a lamp or a torch or even these phones that have torches on.” Midwives are always accused of being hostile to mothers but Kawala said.... “But then in this HIV/Hepatitis B era, someone gets a needle to take an injury. It is very sad, it is very disappointing. You see yourself you’re trying to help a mother have a safe delivery, have her live baby and do you know what challenges most; some mothers who’re in denial, in this state in HIV.” These accusations of hostility came by because mothers do not want to abide by their rules. “But you see the scenario of delivery, it is not a friendly field until you see that the mother is safe and the baby is safe.” The five days she works a week, Kawala does not get time off for lunch due to congestion. Despite all this, she is still proud of her profession. “I feel am proud to be a midwife and am proud to see babies being born. Yes, several times I had the opportunities for other jobs like to go into teaching because I can teach, but I find myself coming back to midwifery.”
The 2016 demographic and health survey report indicated that 43 mothers die of every 1,000 births. In most cases when a mother dies in labor, negligence of the midwives are the main cause. Kawala said the country could get on top of this problem if the communication between the midwife and the mother was reached. “You tell them that we are trying to trace for the blood, if the blood is not there then you have to inform them still; that you know we have tried but the blood is not here but we are trying to make that we get blood for you so that they get to know but if you keep quiet and you keep running around and you don’t tell them, they will say you have neglected the mother.” She has been a midwife for 20 years now but many of her colleagues quit to do other things. She said that the government should think of increasing their pay to keep experienced midwives in the profession. “When the midwives are not appreciated most of them are diverting, they are aborting the profession and joining other businesses whereby they are not being blamed. Because here they just look at blames only and finger pointing and fault finding, so people are diverting not many of them even during this era of HIV AIDS and Hepatitis. Many of them when they look at the field they are working in, others are resorting to other things and do general nursing.”
