I am elated to be discussing my involvement in the building of a very special place. The locals are calling it Atsede and Indie’s Clinic, but it is so much more than that. A Women and Children’s Clinic situated in Gubriye, just 5 hours south west of Addis Ababa, Ethiopia’s capital city. There is just one road running through the village, and the clinic is right off that road.
The tragedy, the beauty, the heartbreaking, life affirming, soul lifting ways of life and death all marry and meet in the maternal & birth culture of this village. The strength and vulnerability, hope and faith that Indie & Atsede see in the women they support is indescribable. Many mothers here have between 6 to 8 children, the generations before them often having more than 10. To say the birth culture and stories run deep and vast would be an understatement.
We’ve decided to share a few stories with you to help give you perspective…
The advise from the Ministry of Health is for each woman to have four antenatal appointments, but for Aklila, she could only afford to go to two. Antenatal care is free, including the iron medication that all women receive as part of that care, given the high rates of anaemia either due to malnutrition or diseases such as malaria; and the higher risk of antenatal and postnatal bleeding our women face. Payment wasn’t the problem for Aklila – distance was the issue. She lives two hours walk from the nearest health facility, and she already has five children at home.
Who would look after them? Who would look after the household; milking the cow, making the injera, harvesting the fruits she takes to sell at the market? If she were to spend all day getting to and from the hospital, how could she sell that fruit at the market to earn her income?
Aklila had no complications with her previous deliveries. One day, whilst Aklila was moving a sack of ground tef (which forms the dough for injera, the staple food of Ethiopia!) she felt a twinge and noticed she was bleeding. Not a lot but enough to think something was wrong. So she started walking…
Indie and Atsede were covering the weekend at the health centre in Amorameda, the closest one to her. They checked her vital signs, listened for her baby’s heartbeat and looked for her bleeding. She hadn’t had an ultrasound scan, and she wasn’t really certain of how many weeks pregnant she was – she assumed somewhere between 7 and 8 months.
Having considered her symptoms, Indie and Atsede suspected placenta praevia, meaning her placenta was growing close or over her cervix. The only way to be sure was by ultrasound scan, which the health centre didn’t have.
They called the only ambulance covering 50 square kilometres ( which thankfully wasn’t otherwise needed!) and referred her to the nearest hospital, where Indie worked.
The next day, Indie saw her on morning rounds. Placenta praevia had been confirmed, and the advice was for her to stay at the hospital until she delivered. Aklila was in tears, already she’d been there one night, without any means of telling her family where she was or even that she was alive – all they knew was that she’d been bleeding.
What could they do? What could she do? The hospital only had the Delivery room mobile phone, for calling ambulances and for calling the only obstetrician working in a hospital delivering almost 4000 babies a year – but even then that was useless as her family had no phone.
After some time, it was worked out that they knew someone from her village with a phone. Indie found his number, and Aklila could pass on the message that she wanted to stay in hospital
In the end, she didn’t stay so long, instead going into premature labour at 34 weeks and delivering a tiny but determined 2.2kg boy!
The day following birth, she left. The hospital advised her to stay a few more days, to make sure everything was definitely okay with her son, but as she said, he was breastfeeding well and certainly gave a lusty cry when they vaccinated him, so he was okay. She’d been gone long enough. It was time to walk home.
Semira, Asnakech, Belay, Tishi, Askale, Bizunesh, Woinshet, Yeshi, Tsion, and Selfinesh
Over the one year Indie’s worked at the hospital, she has had ten maternal deaths out of almost 4000. (One in four hundred women died having their baby.) But phrasing it like that doesn’t really mean anything. It doesn’t capture the shock, the grief, the disbelief. It doesn’t pay tribute to Semira’s mother who kept vigil at her bedside all day and all night, who collapsed into Indie’s arms after pronouncing death. It doesn’t do justice to Askale’s relatives who came from all over to donate blood as we transfused unit after unit and tried to save her. It doesn’t reflect the lost husband of Tsion, suddenly faced with raising his newborn twins alongside four older siblings. He couldn’t afford shoes, how could he afford formula powder? Women here die in childbirth. It’s not an abstract concept, maternal death, it’s not a statistic to have heads shaken over at WHO or UNICEF round table meetings on perinatal mortality. It’s the tears of the staff and the ululating of the relatives. It is wrapping bodies in blankets and putting them on litters to be taken home, it’s spending hours at the OR table only to step away afterwards covered in blood and wondering what more could have been done. No words could do the women that are lost, true justice.
Sadly, stillbirths are also not uncommon. In one month, 20 babies were delivered ‘sleeping’. There are so many reasons here why stillbirth rates are high; the diseases, the lack of adequate antenatal care, the malnutrition, insufficient pregnancy spacing.
In amongst all of the difficulties, the challenges, and the tears – are the moments of joy and love and laughter. And that is why we want to open this clinic. Indie, Atsede and I love midwifery and passionately believe in what Midwives do.
At the moment the hospital is where women go to deliver. It is an incredible place, opened by the catholic Medical Mission Sisters 50 years ago, and it is because of the hospital that only 10 women have died rather than 100 (as it was at the beginning).
Because there are almost 4000 deliveries a year, and each day only three midwives working and each night only two, there isn’t the chance to have one-on-one, individualised care.
And whilst keeping women alive and safe is of inexpressible importance, Atsede and Indie now have the chance to do more than that. We can give women a place to come where they are safe, but also where they can feel empowered and important and loved and supported. We want the women to take back their birthing experience. We think they have the right to ask for more than just good clinical care, and we can give them that.
“My journey to Ethiopia started many, many years ago, though I didn’t realise it at the time, sitting in a lecture hall at Cambridge University during my first degree, anthropology, with a wonderful, chaotic lecturer who was teaching us about childbirth rituals. I was captivated and knew that somehow this was the element of humanity that I would make a career of. After graduating, I took up a position with UNICEF in Kyrgyzstan, Central Asia, working with the maternal and neonatal health team. I thought maybe policy writing was how I could make a difference but before long, I realised I wanted to do something more. So I moved back to the UK and started my midwifery training. After that I found myself in southern Ethiopia, in a hospital, about to embark on a year-long adventure that would change my life. The year became a year and a half, and then more! In the beginning my role was establishing a Neonatal Unit, now handed over to a local team of nurses, as well as working as a midwife on the busy Delivery Room. Through all of the challenges and triumphs of this time, there was Atsede. She is my closest confidant and my favourite friend, as well as an inspiring colleague and endlessly patient teacher.”
“I am Atsede, the daughter of Askale and Kidane. I grew up in a village called Sisay, through the forest and across the river from the hospital where I would, one day, spend seven years working as a midwife. I didn’t go to school as a young child, instead helping look after the children at home but I knew from when my father, who was a nurse’s aide at the hospital, used to come home and tell us of the patients he’d seen, that one day I also would work there. I spent three years in Hosana, getting my diploma and, as I had said to myself all those years ago, started work as the first qualified midwife the hospital had ever had. The years passed, and with it my knowledge and experience grew, until I found myself the Senior, taking the lead with all high-risk women and teaching the junior staff members the ways of midwifery. And then one day Indie came and she is the same as me, just in a different body. And now together we will have a Clinic, caring for my people, for the women and their children, and taking them safely through their pregnancies and deliveries.”
Firstly, we would like to be raising $4000 per month. This would allow us to build the clinic AND allow us the opportunity to offer the majority of our services for free without compromising the quality of care. Ideally we would like to raise enough for ambulance care, too! This amount of funding would also mean Indie and Atsede could be paid for their time, as well as possibly hiring other help and/or training people in the community.
Secondly, for those expressing interest in donating supplies, the post going in and out of Ethiopia is completely unreliable. The only way to donate supplies would be to visit yourself or post to the United Kingdom where supplies could be picked up every 6 months.
Exciting news is that we are also going to be offering Doula training ON SITE, as well as a variety of volunteer and placement opportunities.
Once the clinic is finished being built, we will have a registered charity number. For now, you can make straight donation by clicking the DONATE NOW button below.
“Our heartfelt thanks go to all those who have helped us to build, who have chopped and carried wood, quarried and transported stone, collected the water, and laid the foundations. To Dawit, who has project managed, answering innumerable phone calls, sourced the nails and bolts and screws, and kept enthusiasm high in the searing heat and pouring rains. To Siby, from Kings College, London, for fundraising for the instruments. To Dr Sr Toni, MMS, who held our hands and buoyed our spirits during the more difficult days when the challenges felt insurmountable, and to Dr Sr Rita, MMS, who bought us together and gave us a chance. And, of course, Angela, to you, for believing in us, for your enthusiasm and excitement, your patience and understanding, and for taking us where we could not go alone.”