Catherine Aanyu, midwife

My journey to becoming a midwife

“My mother was a Traditional Birth Attendant (TBA) and when I was young I would see women coming to my home to deliver. I remember my elder sister shouting because there was a mother almost dying; ‘Can’t you let this mother go and deliver in a hospital? Because the midwives there, they are trained!’ So 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 - where the midwives are - she comes back with a baby that is alive.”

Today, Catherine is studying for her diploma in midwifery through the eLearning programme Amref runs with support from GSK. Newly-qualified midwives are known as enrolled midwives, while the next qualification up is a diploma. “I wanted to get my diploma before the age of 28, that is my goal,” she says. “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.”

Addressing an urgent skills gap

Catherine is one of just 20,000 midwives and nurses serving a population of 33 million: that’s one nurse or midwife to 1,650 people. 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there is a lack of access to continuous development training, meaning most of the health workforce are relying on outdated training received several years ago.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 runs 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 working night duty and a mother came to us almost pushing,” Catherine explains. “But because she was not monitored, the baby was asphyxiated [lacked oxygen]. We desperately needed oxygen. In theatre it was not there; the children’s ward, the maternity ward - all empty. I cared for that baby for three long hours, stimulating and transferring my own oxygen with a mask. I thank God, the baby survived. After that I kept reporting, reporting, reporting to say we have no oxygen. Even now, we have no oxygen.”

In an emergency like this, Catherine could refer patients to Soroti Regional Referral Hospital: but it is 34 miles away. Travelling there on the untarmacked road can take one to two hours, which means referral carries significant risks. “We have one ambulance but the fuel is not provided for us. We have to tell our patients to find the money for fuel,” explains Catherine. “It is a poor referral system and it can lead to us losing babies, even mothers.”

Amref began delivering 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.

And for every newly-trained nurse or midwife, the ripple effect is huge. Their financial independence increases, they acquire new skills and knowledge to share with their peers, and they have newfound confidence to bring to each shift.

Catherine’s story illustrates the real, everyday impact of better training for women working on the frontline of healthcare - and how we can help them prepare for the next emergency.

Images (c) Sam Vox for Amref Health Africa UK