How Ebola affects Midwives in Liberia and Sierra Leone

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As the Ebola epidemic rages on, it greatly affects midwives in their work to care for pregnant women, mothers and their babies. Since the Ebola crisis the health system has been crutched and in many ways and the efforts to improve maternal and newborn health have been undermined. “In Liberia too many health workers contracted the virus and died just like that”, says Anita Varney, Assistant Secretary of the Liberian Midwives Association (LMA). The President of LMA Lucy Barh identified the key issues in relation to Ebola: “death of health workers and the closure of health facilities”. The outbreak of the virus brought great fear upon the nation and even to the Ministry of Health that ordered the immediate closure of some major health facilities in the city as they were over stretched and could no longer contain the situation. Closing the facilities meant that the women had nowhere to go and gave birth in the streets or at home. Some of them died from major complications that could not be handled because no one was there. But Varney says: “on the other hand, some health workers that took the risk to save lives at all cost, sacrificed their lives and succumbed to the virus and died.” A big problem is that health workers have not received personal protection equipment (PPE) and have not been sufficiently trained on how to protect themselves in order not to contract the virus. “If we must consider safety first, all midwives should be given a comprehensive training by WHO and certified as they are handling all bodily fluids when dealing with labor patients. Amongst the health workers, more midwives die because we are at higher risk”, explains LMA President Barh. Fortunately, the new Ebola cases have dropped significantly as Barh reports in February. According to the Ebola case management Team leader there are 25 suspected cases in Liberia of which 5 are confirmed as postitve case. "The most important thing is almost all of our midwives are being trained in infection prevention control in Ebola response case management, and are working along with other service providers to carry on IPC training and assessment at health facilities. Our schools and midwifery training institutions will reopen the 2nd of March 2015", reports a happy Barh. 


In Sierra Leone the situation is slightly different but midwives also face many challenges. “We are trying to cope with the burden but it is not easy as people continue to die in numbers including midwives”, says Joanne Shepherd, President of the Midwives Association in Sierra Leone. The midwives at the main referral hospital in Freetown and the Districts have been trained in Personal Protective Equipment, Infection prevention and control measures in the midst of Ebola.
But fear is prevalent: many pregnant women are afraid to go to the hospitals to give birth in the health facility, fearing they might contract the virus from the health workers; midwives while trained and protected, also fear to contract the virus from their clients and are wary when a pregnant woman shows up with high temperature (fever) and other signs of Ebola. “It’s quite pathetic to see the gains made over the years in maternal and newborn mortality staring right back into our faces with the Ebola Viral Disease”, says Shepherd. Mortality rates have soared since the outbreak of Ebola, particularly in geographically isolated areas. “Midwifery practice is scary now as there is lots of exposure with blood and bodily fluids but we are insisting of treating all patients with all midwives abiding by the Standing Operating Procedures in Ebola Viral Disease, explains Shepherd. Sierra Leone is one of the countries in the State of the World’s Midwifery Report facing a high shortage of midwives. There were plans underway to train more midwives to ease the shortage and according to Shepherd “we were getting there. Then Ebola struck.” In December the two midwifery training schools and all nurse training institutions in the country were temporarily closed by the Nurses and Midwives Board and students were sent home to avoid body contact and cross-contamination.

However, with the help of the International community and adherence to precautionary mentions, the situation is improving now as the number of new cases is greatly declining. Nevertheless, there is still a lot that needs to be done. It's too early to rejoice yet.