Delivering child and maternal health in Malawi

CUSO-VSO volunteer, Jan Teevan, always wanted to help mothers and children in the developing world. She got the chance in 2007 through a joint project with the Malawi Ministry of Health. 

As a child, Jan Teevan says she dreamed of travelling the world on “The Good Ship Hope,” working as a doctor and providing care to mothers and children in the developing world.

Unfortunately, her dream of becoming a doctor ended after she took her first volunteer hospital job.

“I became a candy stripper [hospital volunteer] for a summer in high school, working in a hospital, and I thought, no, doctors deal with sick people,” she says. “I don’t want to be a doctor.”

It was only after she had her three children that Jan says she found another way to fulfill her dream of working with mothers and children. A self-proclaimed hippie, Jan decided to opt out of hospital care and have her children at home with the assistance of a midwife.  That’s when she found her true calling.

“When I heard about midwifery, I realised that I could do the medical stuff for healthy people having babies. It was the perfect job for me.”

In the 1980s, Jan apprenticed with her own midwife in Calgary, as part of a home birth movement that was still illegal in that province. She later went on to become one of the first fully certified and government-recognised midwives in Ontario – and established along with her colleagues a thriving practice in Ottawa helping mothers who wanted the experience of home birthing their babies.

But one piece of the dream was still missing.

“What I’m always looking for is a new experience, a feeling like I’m making a difference. If there’s need, it makes me feel like I’m doing more. I was working with women who pretty much had it all. So I thought, wouldn’t it be cool to go overseas?”

A midwife abroad

Jan was recruited by CUSO-VSO in 2007 to be part of a joint VSO project with the Malawi Ministry of Health. At the time, Malawi was facing a health care crisis; the ratio of health workers to patients was very low and as a result, the average life expectancy of a Malawian was 39-years-old. The country desperately needed volunteers and foreign workers to plug the gaps while new health workers could be trained. The country also needed to build the capacity of the existing Malawian health care workers to become tutors and lecturers.

With her long history in midwifery, Jan Teeves became part of the solution.

She was placed at the St. John’s Nursing School in Mzuzu where she worked for six months as a clinical tutor in midwifery for nursing students and nursing birthing technicians. 

“The mandate is that any nurse must be trained in midwifery because so much of the health care revolves around maternal-child health issues,” she says.

For Jan, it was a bit of a shock finding herself in a system that valued institutional childbirth over home-birth.

 “As far as the staff went, a lot of staff were brought up in the British-Malawian system of ‘I’m a nurse, I have skills – lie there. I found that they looked down at the patient rather than providing a collaborative, compassionate approach.

“There was a value difference – that’s for sure. When I said to the staff that a woman didn’t need to be flat on their back to give birth, they just laughed at me.  Said: ‘Oh, Jan, you’re so funny.’ You definitely got the feeling that if people couldn’t hear you about birth positions, how would they hear you about other things?”

The challenge of maternal health

There was also the challenge of helping the more than 11 per cent of Malawian women who presented in the hospital with the HIV/AID virus.  Each woman was required to take an HIV/AIDS test when they signed up for pre-natal care and delivery.

“We were following a protocol. When the women came into labour, they got medication while the baby was still inside and when the baby was outside, we gave the medication to the baby.”

Mothers were strongly encouraged to breast feed for six months, with no solid foods. This regime was followed to ensure the lining of the baby’s stomach wasn’t irritated by food and then infected by HIV through mother’s milk.
The use of formula was restricted because of the cost and the chance the formula would be contaminated by dirty water.

“We impressed upon the students the importance of using universal precautions at all times,” she said. “And we saw that students were more reluctant to hold the babies after birth, which is different than in North America where everybody touches the babies. But those were just precautions. There was strict confidentiality – the same rules for everybody – so nobody was labelled as being HIV.”

Jan believes her biggest contribution in Malawi was working with the nursing staff and students to help improve professional development.

 “One thing we realised was the important role the staff nurses played in the educational process for students. We needed to make sure that the already trained nurses were getting professional development.  After I left Malawi, that was the big piece that needed to be developed by the partners.”

Jan found herself in a key role, training the staff in emergency delivery procedures, after hearing about a baby who had died over one weekend from shoulder dystocia, a serious obstetrical emergency in which an infant’s shoulders becomes lodged in the mother’s birth canal.

In talking to senior nursing staff, Jan learned that the nurses were not required to become re-certified after graduation and, as a result, many were not adequately trained to perform modern emergency procedures.

“Every nurse in Ontario is required to do an emergency skills workshop every two years as part of their certification,” she says. “Every doctor at that hospital was required to attend continuing professional activity. But the nurses were not.

“I talked to my fellow tutors, and they picked out the skills that were important so I ran workshops with senior students on emergency skills – that was my contribution.”

Advice for volunteers

Jan has this advice for North Americans wanting to volunteer abroad.

“I’d advise any volunteer not to have high expectations. As my mother once said: ‘Catch them doing something right and build on that.’ It’s important to build the confidence of people who are doing great stuff, but who aren’t getting recognition. That’s certainly a place where an ex-pat can play a key role – really appreciate the good stuff that’s going on.”

Jan Teeven (Malawi - Health)

Challenge

Malawi had a shortage of health workers and midwives preferred a more institutional approach to childbirth.

Catalyst

CUSO-VSO volunteer Jan Teevan works as a clinical trainer in midwifery in Mzuzu. 

Result

Nurses receive training on emergency procedures and improve their professional development.

Malawi Health

How to apply

Interested in volunteering with VSO? Find out what you need to apply and begin your application process now.

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