Risk and Recognition: The Traditional Midwives Who Filled the Gap in the Time of Ebola
- 327 Downloads
The chapter focuses on vignettes of three traditional midwives who carried out deliveries in their community when the Ebola outbreak forced their local hospital to close its in-patient services. They operated with little equipment and scant information on infection control, often using plastic bags or rewashing black-market personal protective equipment (PPEs). They worked in an environment of great fear, rumor, and uncertainty, especially regarding the health status of delivering pregnant women. As facilities reopened for delivery, and traditional midwives were being told “no more home deliveries”, these women felt unrecognized by the formal health system and the Ministry of Health for the risks they took and the efforts they made. As influential figures in the community, this resentment can remain a barrier for pregnant women from going to the hospital. The chapter will explore how the system of facility deliveries quickly crumbled during the Ebola epidemic, and people reverted to traditional ways to deliver. It explores what makes these traditional supports able to operate during both the crisis points and the good times for the Liberian formal health system. It recommends greater two-way learning between different approaches to maternal health care, especially as the residual effects of Ebola make the need to work with community-based supporters greater than ever.
KeywordsTraditional Midwives Traditional birth attendants Ebola Pregnancy Delivery Obstetrical risk Health systems Liberia Midwives Maternal health Ebola virus disease
- Keiny, M., Evans, D., Schmets, G., & Kadandale, S. (2014). Health-system resilience: Reflections of the Ebola crisis in western Africa. Bulletin of the World Health Organization, 92, 850. Retrieved November 12, 2017, from http://www.who.int/bulletin/volumes/92/12/14-149278/en/.CrossRefGoogle Scholar
- Kleinman, A. (1980). Patients and healers in the context of culture. Los Angeles: University of California Press.Google Scholar
- LISGIS [Liberia Institute of Statistics and Geo-Information Services], Ministry of Health and Social, Welfare [Liberia], National AIDS Control Program [Liberia], ICF International. (2014). Liberia Demographic and Health Survey 2013. Monrovia, Liberia.Google Scholar
- Loewenson, R., Kaim, B., Chikomo, F., Mbuyita, S., & Makemba, A. (2006) Organizing people’s power for health: Participatory methods for a People Centred Health System. PRA toolkit. Ideas Studio, South Africa.Google Scholar
- Loewenson, R., Laurell, A. C., Hogstedt, C., D’Ambruoso, L., & Shroff, Z. (2014). Participatory action research in health systems: A methods reader. Harare: IDRC/CRDI Canada and World Health Organization, EQUINET.Google Scholar
- Lori, J. R. (2009). Cultural childbirth practices, beliefs and traditions in Liberia (Doctoral dissertation, College of Nursing, University of Arizona).Google Scholar
- Ly, J., Sathananthan, V., Griffiths, T., Kanjee, Z., Kenny, A., Gordon, N., et al. (2016). Facility-based delivery during the Ebola virus disease epidemic in rural Liberia: Analysis from a cross-sectional, population-based household survey. PLoS Medicine, 13(8), e1002096. https://doi.org/10.1371/journal.pmed.1002096. Retrieved November 12, 2017, from http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002096.CrossRefPubMedPubMedCentralGoogle Scholar
- Mbwili-Muleya, C., Lungu, M., Kabuba, I., Zulu Lishandu, I., & Loewenson, R. (2008). EQUINET Participatory Research Report. An EQUINET PRA project report. Harare: EQUINET. Retrieved November 12, 2017, from www.equinetafrica.org/sites/default/files/uploads/documents/PRAequitygauge2008.pdf.Google Scholar
- Miller, L. (2016). Whenever light enters darkness, the places becomes bright. Evaluation of IRC support of the Restoration of Health Services at Redemption Hospital. Liberia: International Rescue Committee.Google Scholar
- Ministry of Health & Social Welfare. (2010). National reproductive & sexual health policy. Liberia: Ministry of Health & Social Welfare. Retrieved November 12, 2017, from www.liberiamohsw.org/Policies%20&%20Plans/National%20Sexual%20&%20Reproductive%20Health%20Policy.pdf.Google Scholar
- Minor Peters, M. (2014). Community perceptions of Ebola response efforts in Liberia: Montserrado and Nimba counties. Ebola Response Anthropology Platform, 2015. Retrieved November 12, 2017, from http://www.ebola-anthropology.net/case_studies/community-perceptions-of-ebola-response-efforts-in-liberia-montserrado-and-nimba-counties/.
- World Health Organization. (2005). The world health report (2005) —make every mother and child count. Geneva: World Health Organization. Retrieved November 10, 2017, from http://www.who.int/entity/whr/2005/whr2005_en.pdf?ua=1.
- World Health Organization. (2010). Working with individuals, families and communities to improve maternal and newborn health. Retrieved October 4, 2017, from http://whqlibdoc.who.int/hq/2010/WHO_MPS_09.04_eng.pdf.
- World Health Organization. (2015). Health worker Ebola infections in Guinea, Liberia and Sierra Leone. A preliminary report 21 May 2015. Retrieved November 18, 2018, from http://www.who.int/hrh/documents/21may2015_web_final.pdf