Like most other countries, Bangladesh is facing the onslaught of Covid-19. The frontline healthcare workers (FLW) are on their toes providing services to the ailing people, both corona-related and otherwise.
One of these FLWs are the midwives. They are attending to duties in unprotected or partially-protected environments. The Midwife Led Care Centre (MLC) at the Charikata Union Health and Family Welfare Centre (UH&FWC) in Jaintiapur, Sylhet, is such a centre where midwives are continuing their care and services despite unfavourable circumstances.
The primary job of a midwife is to prevent maternal and newborn mortality and morbidity. In the current discourse on maternal health, provision of respectful maternity care in centres which are led and managed exclusively by midwives is being promoted in many countries.
BRAC University decided to try this in the Bangladesh context and has been running two such centres, one in Urban Dhaka and another in rural Sylhet for over a year. In doing this, the university works with two NGOs -- BRAC in Dhaka and FIVDB in Sylhet.
In the latter, the university works with the Ministry of Health and Family Welfare in a union health and family welfare centre in Charikata under Jaintiapur Upazila, about 50km from Sylhet City. Here, four midwives, educated at BRAC University, are providing round the clock services to the local population.
They all stay in the UH&FWC and take turns in giving antenatal care (ANC), post-natal care (PNC), family planning, and safe delivery services to mothers. They also visit the mothers in their homes to build rapport and follow up. Even now when the whole country is in some kind of corona-hysteria, these midwives are offering respectful maternity care 24/7.
At the start of the current situation, the midwives were a little scared as the mothers were not maintaining social distance and were crowding up as before. They had minimum awareness about Covid-19 and had little ideas on the importance of cleanliness and cough etiquette.
To bring discipline and enforce containment measures, BRAC University used posters and leaflets to make visitors aware of the gravity of the situation. A quick training session was organized for the midwives and other staff of the UH&FWC.
A pail of water and soap was placed at the entrance and mothers were obligated to wash their hands. Attendants and visitors stayed outside.
Midwives measured the body temperature before offering services to the mothers and if the temperature was above normal the mother was referred immediately to Sylhet Osmani Medical College Hospital after doing necessary counselling.
These steps contributed to the midwives’ confidence building, reducing their worries and anxieties. They were also given personal protective equipment (PPE) by BRAC University which helped to relinquish any fear or stigma.
Lakshmi Rani, one of the four midwives, narrated how she managed a post-partum haemorrhage (PPH) in this critical time. An 18-year-old woman with first pregnancy came to Charikata UH&FWC with prolonged labour.
She was tried for delivery at home unsuccessfully and finally came to the midwife-led UH&FWC. Here she gave birth to a baby boy with normal weight. After 15 minutes of delivery, the mother started bleeding.
Lakshmi got worried and wanted to refer the case to a higher facility, but in the lockdown situation, there was no way but to manage the PPH herself.
With all her knowledge and skills she successfully managed the case till a transport was available to take the mother to Sylhet where she was transfused with a bag of blood.
Both the mother and the newborn were released after two days. Lakshmi described how tensed she was but, on the other, was proud that she could save the mother with initial stabilization in this difficult circumstance.
Sabia Akter Ria, another midwife, managed a case of birth asphyxia (extreme respiratory problem) of a newborn when the baby was brought to the centre in a critical condition during the early corona days.
Sabia applied the Helping Babies Breathe (HBB) technique and the baby cried within one minute, with a normal heart rate.
Every day such cases are being brought to the MLC and the midwives are managing the situations with their acquired knowledge, experiences, confidence, dedication, and, most importantly, commitment.
The Covid-19 crisis did not alter the functioning or reputation of the Charikata UH&FWC cum MLC. Despite discouragement in view of the Covid-19 situation, 170 antenatal visits took place in April alone. These show how the midwives have earned the trust of the local people. In addition, they also continued their family planning work.
The midwives are always ready to offer care. Their respect for women’s individual circumstances and privacy has encouraged mothers to have increased trust in this unprecedented situation.
The Charikata MLC sets an example of how the frontline health workers are standing beside the worried mothers in the corona crisis.
Mushtaque Chowdhury, Selina Amin, Bilkis Ara, and ATM Nayeem are associated with the Developing Midwives Project of the BRAC James P. Grant School of Public Health, supported generously by UKAid.