March 9, 2025 • 50 mins
Welcome to a transformative episode that dives deep into saving lives through improved maternal health in Sierra Leone. We share inspiring stories from a recent training conference in Kenema, focusing on the critical role midwives play in reducing maternal and infant mortality rates. You'll hear from Matron Mary Augusta Fuller, Chief Nursing and Midwifery Officer, who shares insights on the vital need for comprehensive training programs for midwives, addressing both essential newborn care and postpartum hemorrhage management.
In our conversation, we explore the significance of mental health awareness among healthcare providers, highlighting how integrated training can create better support systems for mothers and their newborns. Additionally, we tackle cultural barriers women face in rural settings, often inhibiting their access to crucial medical care. The episode emphasizes the importance of empowering midwives with both knowledge and practical training to advance community health outcomes.
Through dialogue about new initiatives and the ambitious strategic plans laid out by the Ministry of Health and Sanitation, we present a hopeful vision for the future of maternal health in Sierra Leone. Join us in understanding how these efforts can pave the way for a healthier tomorrow for mothers and their children. Stay tuned as we inspire meaningful change in local healthcare communities.
Help spread the mission of maternal health advocacy by subscribing, sharing our episode, and leaving a review!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:34):
This is Optimistic Voices.
I'm your host, yasmin Vaughn.
Normally I host all of ourepisodes on global health, but
this week we have a reallyunique episode of Optimistic
Voices for you.
In January, helping ChildrenWorldwide collaborated with
members of the Together forGlobal Health Network to hold
another maternal and childhealth training conference.
You may recall our two-partepisode last year on the
(00:57):
training we did in Bow, where wetrained almost 100 midwives and
nurses.
This year we were asked by theMinistry of Health and
Sanitation to do the trainingagain in Kenema and we had 43
participants from Kenema,kailaun and the surrounding
hospitals and clinics.
The training is focused on twomain curricula essential newborn
care and helping motherssurvive bleeding after birth.
(01:20):
These two curricula are focusedon tackling the top causes of
maternal and infant mortality inSierra Leone, namely postpartum
hemorrhage, which is bleedingafter birth, and infant
resuscitation, which is ahelping babies breathe
curriculum.
But it also included morninglectures on burnout, maternal
mental health and respectfulmaternal care, helping to build
(01:40):
up some of those soft skillsthat are so important within the
nursing practice.
All of this was held at the newKenema School of Midwifery,
which just opened in December oflast year and is now training
the first class of midwives inthe region.
Today's episode of OV wasrecorded with the Chief Nursing
and Midwifery Officer, matronMary Augusta Fuller live from
(02:03):
the training we were doing inKenema.
Interviewing her is one of theTogether for Global Health
partners and a very dear friend,josephine Garnham, who is the
Executive Director of the HealyInternational Relief Foundation,
who is an instrumental part ofour Together for Global Health
network and the training thatwe're doing.
In this interview she talkswith Matron Augusta about the
(02:25):
Ministry of Health's prioritiesfor maternal and child health
over the next few years, thechallenges that they've had and
the successes that they'recelebrating within maternal and
child health in Sierra Leone.
Before we get into theinterview, I want to share a
little bit about the importanceof training for midwives and
nurses.
The WHO states that skilledmidwives could avert more than
(02:47):
80% of all maternal stillbirthand neonatal deaths In Sierra
Leone.
Things like limited equipment,inadequate mentorship and
education constraints mean thatmidwives sometimes don't have
the chance to receive hands-ontraining.
In fact, the Kedema School ofMidwifery was the first school
of midwifery built in thecountry with a skills lab, and
(03:10):
it's a really fantastic laballowing the students to get
hands-on training usingsimulators to practice their
experience.
Midwives need practicalexperience and support to
improve their skills and toboost their confidence, because,
in addition to knowledge,midwives have to be confident.
They have to be prepared to actdecisively and effectively in
(03:33):
life-saving situations, which iswhy often, high pressure and
resource-limited situations meanthat they lack their confidence
.
So it's essential not only toequip midwives with the
necessary knowledge, but tofoster their confidence in
performing those skills inchallenging circumstances.
(03:54):
So our Together for GlobalHealth Network members in Sierra
Leone have been workingtogether to address the
challenge of maternal andneonatal mortality by increasing
the competence and theconfidence of midwives to
perform life-saving procedures.
As a part of the conference andthe training, we also offer
ongoing mentorship and refreshercourses, and we provide
(04:17):
supplies and equipment for whatthey call low-dose,
high-frequency training, whichis where you have nurses take
the supplies and equipment backto their facility and do little
mini training sessions withother people at their facility
the other nurses and midwivesthat are working there so that
they can continue to refinetheir skills and build them,
(04:39):
with the ultimate goal, ofcourse, of contributing to a
reduction in maternal and infantmortality rates.
This collaborative effort isconducted completely in
partnership with the Ministry ofHealth and Sanitation, both at
their invitation and at theirdiscretion, to ensure that
everything that we're doing isin alignment with national
priorities and avoids theduplication of efforts, because
(05:00):
there are a lot of organizationsthat are engaged in working in
maternal and child health inSierra Leone, so we want to make
sure that everything isfiltered through the Ministry of
Health.
Now, with that introduction,you can hear from Chief Nursing
and Midwifery Officer, matronFuller, as she shares more about
the ministry's plans for SierraLeone's future in maternal and
child health.
Speaker 3 (05:23):
My name is Josephine Garnham and I'm sitting in for
Yasmin Vaughn for today'sepisode.
We're interviewing Matron MaryA M Fuller, who serves as the
Chief Nursing and MidwiferyOfficer at the Ministry of
Health in Sierra Leone, leadingand providing oversight to over
12,000 nurses and midwivesnationwide site to over 12,000
(05:48):
nurses and midwives nationwide.
She played a pivotal roleduring the Ebola epidemic,
working in the reproductivehealth and family planning
program at Princess ChristianMaternity Hospital.
In her current capacity, matronFuller has been instrumental in
initiatives such as theintroduction of the Maternal and
Child Health Handbook aimed atstrengthening the continuum of
care for pregnancy through earlychildhood.
(06:11):
A dedicated public healthspecialist, she has over 37
years of experience in the civilservice sector.
She has been a strong advocatefor the development of midwifery
schools across Sierra Leone anda key convener bringing
together subject matter expertsto develop context-specific and
(06:31):
up-to-date curricula.
Her passion for capacitybuilding among nurses and
midwives is driven by hercommitment to reducing maternal
and child health mortality ratesin the country.
To reducing maternal and childhealth mortality rates in the
country.
Mitra Nkfula, tell me a littlebit about yourself where?
Speaker 4 (06:58):
you're from and how you got to where you are now.
Hello everyone, I hail from thesouth of Sierra Leone, to be
specific Puget District, and Iwent to the Holy Rosary School
in Puget.
I also proceeded after myO-level exams at that time, so
(07:22):
the National School of Nursingin Freetown.
After my three-year studies Iwent for two years course well
midwifery within the samewestern area of Freetown.
At the end of my training asmidwife I was posted to various
areas, one to PugetongGovernment Hospital.
(07:44):
After some years I was postedto various areas, one to
Pugetong Government Hospital.
After some years I wastransferred.
That was during the war, andduring the war we were then sent
to the camp at Gundama.
We spent some time there andthere I developed the passion
for midwifery and public healthtogether.
(08:05):
To me those two are the twocareers that should match
together.
So we developed a lot of.
We developed a lot of booths atthat time, not hospitals but
small, small booths withinchiefdoms.
We divided the camp intochiefdoms and we developed
(08:26):
booths for them where we do ORT,where we do some deliveries and
so forth.
So I developed passion also forpublic health and I went to do
my public health in FurabeCollege.
I did the diploma in publichealth and was then transferred
back to a longer governmenthospital to practice and I
(08:47):
practiced at the clinical sitefor a few years, about five
years there.
I know the relationship betweenclinical and public health.
From there I was transferred toPujo as the district health
sister.
I spent some time in Pujo andproceeded to Kambia in the north
(09:08):
and then to Bombali district.
From Bombali district I wasthen transferred to Western area
.
At that time Western area wasone not OBA and rural.
So I was there as the districthealth sister, one there at the
district health system one.
At the end of five years I wastransferred to the reproductive
(09:29):
health and family planningprogram.
At that time we were atPresence Christian Mentality
Hospital.
There I worked with themidwives within that facility to
develop SOP standards fordelivery standards for the use
(09:49):
of MSOB store standards for theuse of Maxsoft.
That was at that time.
That was what we used.
So trainings and so forth.
We do trainings for ourfacility workers, for the DHMT
workers, for the peripheralhealth unit workers.
(10:12):
So I was finally transferredthere.
We had Ebola Then.
I was then transferred to theDirectorate of Nursing as deputy
and I was in charge of thetraining that we are going on
with Ebola.
So we trained before theforeigners came in to assist us.
At the end of Ebola I went anddid my master's in public health
(10:39):
and then I came back.
I was now appointed as thechief nursing and midwifery
officer in the Ministry ofHealth.
I have worked with so manypartners and we decided to
develop the maternal and childhealth handbook.
I went to Japan where I learnedabout the handbook and we, as
(11:02):
serial unions, decided todevelop our own in our own
context.
So now we are trying to rollout this handbook to all the
facilities if we can get helpfrom other people, because what
we have learned is a routinebook is not a one-off printing
book, so we need everybody allhands on deck.
I've enjoyed working in theMinistry of Health and
(11:23):
Sanitation with all my partnersand I hope we will continue to
work hard to reduce the death ofour mothers and babies and
infants.
I have also contributed a lotto the development of additional
(11:44):
midwifery schools, because fromyears ago we had only one
midwifery school within thecountry.
Now we are boasting of three ofthem one in the north, one in
the south and one in the east asadditional to freedom and one
in the east as additional tofreedom.
(12:05):
So we thank God and we aregoing to continue working on
this line so that our motherscan have quality care delivery.
Wherever they are, they canaccess quality of care.
Thank you.
Speaker 3 (12:17):
Thank you, Matron.
I understand that the Nursingand Midwifery Office has just
finished the 2025 version of theNational Nursing and Midwifery
Office has just finished the2025 version of the National
Nursing and Midwifery StrategicPlan.
What are some of the mainaccomplishments that have been
reached since the last strategicplan and what are some
priorities outlined in this plan?
Speaker 4 (12:41):
The Midwifery Nursing Strategic Plan was developed
with support from UNFPA andthere are so many things
outlined in that.
Midwives we have to focus onthe development of the faculty
(13:04):
itself so that we don't havediploma tutors or nursing tutors
that teach diploma.
So we are working on that.
Most of them are now mastersholders, so that is one of the
achievements from the laststrategic plan.
(13:25):
Also in the strategic plan weare talking about service
delivery.
We want to ensure that thenurses give quality service
delivery to their patients.
So we are now looking at thetools to encourage them for
documentation.
So we have developed thishandbook to ensure that there is
(13:47):
continuum of care frompregnancy right down to up to
five years.
We are even envisaging that wecan bring in the HPV within that
handbook so that by 10 years,if you are a female, you can now
have your HPV within the book.
(14:07):
We also, apart from servicedelivery, the associations is
also a pillar.
On that.
We have now reviewed all theassociations they have.
What do we call it?
(14:28):
The associations we have?
So we have helped the twoassociations the nursing and
midwifery associations todevelop their constitutions.
So we have also done that,which is a plus from the old
strategic plan and now we havedone our elections as well, the
(14:49):
two.
They have got new executivecoming up.
In fact, what we did the lasttime we had interim so that we
developed their standards and soforth, all the policies and so
forth within those associations,but now we have elected the
executive for both associations.
So that is a plus from the oldone.
(15:09):
Now we want the associations todevelop their own plans and to
see how they can write their ownprojects so that they can
finance themselves Under thestrategic plan.
We also have the regulatorybody.
We have worked on the act.
It was last 2023 that it wasenacted in parliament and now we
(15:35):
have a council instead of aboard.
We are now trying to have thephysical space for the board.
So we have acquired a landspace where they are working on
the BOQ so that we can sourcefunding for the construction of
(15:55):
the secretariat for nurses andmidwives.
So that is a plus from the oldstrategic plan, plus from the
old strategic plan.
We also worked on the education.
We are now working with theuniversities to train specialist
nurses instead of just RNs, rns.
(16:17):
So we are doing specialistnursing training.
We are doing presently theuniversity commerce.
We are doing presently theuniversity commerce.
They are doing specialtytraining on medical surgical
critical care, perioperativecare, nurses and massanga.
(16:38):
We are doing tutorial fornurses.
We are doing also mental health.
They are doing physiotherapyfor nurses.
We are doing also a mentalhealth.
They are doing physiotherapyfor nurses.
So all those specialty areashave been identified and we have
started the trainings For themental health.
It's going to be next yearbecause we are now developing
the curriculum for mental health.
(17:00):
So we had a lot of achievementsfrom the previous strategic plan
, but we have already completedthis one and we hope, with the
challenges from the last time,we will be able to overcome them
.
The first challenge was likereally getting finance to
(17:20):
implement all this strategicplan that we developed.
But what happened?
We had limited partnership.
So now we are working withpartners, like for the maternal
and child health handbook.
We have few partners now withus.
Jica is one who is reallychampioning the implementation
(17:42):
of this handbook.
We have World Bank working withus also.
We have Seed Global, and SeedGlobal is not just working with
us on the handbook, they areworking with us in our training
institutions.
They bring in internationalexperts to work with us
Presently international expertsto work with us.
(18:03):
Presently we have six of themworking, two in the north the
North Midwifery School in thenorth two in the south and two
in the east.
So we are waiting to see how wecan bring the National School
of Midwifery on board this year.
Thank, you.
Speaker 3 (18:26):
Thank you, mitran.
As we talk about this strategicplan, we also would like to
talk about maternal and childmortality For our listeners that
are new to this topic.
What are the leading causes ofmaternal and child mortality in
Sierra Leone?
Speaker 4 (18:48):
The leading causes of maternal mortality are
hemorrhage it's at the top ofour list for maternal death
simply because there areunderlining causes.
Some women are anemic when theycome into labor, some women
(19:09):
cannot get access easily tocomprehensive care and some
people even fail to come untilthe last moment.
The second is obstetricemergencies is eclampsia.
(19:31):
Emergencies is eclampsia.
Eclampsia occurs normally withhigh blood pressure during
pregnancy and we have noticedthat this is linked to mental
health disorders, stress in thehome, stress in their workplaces
(19:54):
, stress with their husbands andso forth, and it's an
underlining cause to develop thepreeclampsia.
And when they develop theeclampsia, if they don't access
the facility earlier, definitelywe will lose them.
So that is another cause.
(20:17):
Sepsis is another cause formaternal death in Sierra Leone,
though on a lower scale.
But what we are seeing is thatespecially when women deliver
not in the facilities they comein with sepsis because after
delivery you have to have, youhave to use, definitely have to
(20:40):
use baths and so forth.
So normally, what we have foundout, the hygiene aspect of
maternal care is lacking,especially where you don't have
these women accessing thefacilities earlier.
So what we have said is that wenow are going to embark on
(21:03):
educating the women in theircommunities to prepare for
delivery, so that if you have touse your pad then you have to
have a clean cloth.
If you cannot afford to buy,then you can have your clean
cloth, iron it up and then youcan reduce the possibility of
sepsis.
And then sometimes these women,they also go for delivery
(21:28):
definitely at the facilities,the facilities, some facilities
at the lower level.
They don't even havesterilizers to sterilize.
You know their instrument, theinstrument that they work with.
They are now used to chlorinewashing.
So when the chlorine are notavailable, what happens?
We don't know.
But sometimes they come up nowwith sepsis and they are treated
(21:50):
in the hospitals.
But sometimes and they aretreated in the hospitals, but
sometimes even when you haveCICs done in some areas, you
have sepsis, resorting to sepsis, whether they cannot afford to
buy their dressings and so forth.
So people will end up withsepsis.
(22:11):
Or sometimes they are alreadymalnourished before they come in
, so they don't have that muchresistance.
So for sepsis.
And then we have.
I think those are the threeleading causes of maternal
deaths in Sierra Leone in SierraLeone.
Speaker 3 (22:33):
Thank you so much and you've also highlighted with
that the challenges inaddressing these issues, which
is access, hygiene, lack of theresources, lack of integrating
mental health into this, for thestressors that usually will
(22:55):
cause hypertension and otherthings in women that are of
bearing age.
So also we're looking at whatare the specific cultural and
social factors that contributeto maternal and child mortality
(23:15):
in Sierra Leone.
Speaker 4 (23:20):
For the cultural in the first place in Sierra Leone
when women, especially thoseliving in the rural areas, when
they are pregnant, they don'twant people to know about it.
In the rural areas, when theyare pregnant, they don't want
people to know about it.
So if you have ectopic and youdon't want people to know that
(23:42):
you are pregnant, so in the endwhen the ectopic rupture, you
will definitely lose your life.
So that culture of hidingpregnancies before 12 weeks is
contributing also to the deathof young women within our
facilities.
Then the polygamy alsocontributes largely to the death
(24:10):
of women within the communities, simply because when you have a
polygamous home, the head wifeis always the decision maker and
if you are not in good termswith that head wife, what
happens to you you will even beafraid to complete when you have
(24:34):
problems.
So in the end, when the problemescalates, then that's the time
you find it even difficult forthem to make the decisions.
What can we do with this woman?
Sometimes they even feel youhave something to say or you are
promiscuous.
That's why you're having thoseproblems.
You are promiscuous, that's whyyou're having those problems.
So we have that type of culturewithin our country.
(24:56):
Then the older culture is eventhe nutrition aspect of women,
especially when they arepregnant.
There's no laid down rule thatyou can get extra.
You continue to get whatever isavailable.
Sometimes you can even gohungry for the whole day, until
(25:17):
evening when the final meal isready.
So we also have to look at that.
That's why we have developedthis handbook with Victoria
where we have the nutritionalpage telling you what a pregnant
woman can eat during pregnancyfruits and so forth and a page
for even the children.
So that also can interfere.
When the woman is anemic, whathappens?
(25:40):
When you come out for delivery,no matter what happens, you
will lose blood and an anemicwoman losing blood will lead to
death if we are not careful, didnot notice it before time.
Another cultural behavior is themale decision.
(26:01):
Most men, they will not take itfrom you.
Let me say you are havingbleeding before delivery,
antepatient hemorrhage and thehusband is not there.
He goes out somewhere for two,three days.
You have to sit down there andwait, especially where you
(26:27):
cannot get coverage to that man.
Then that woman be at risk oflosing her life.
So we have a lot of thingsthere.
The women are not given theopportunity to make the decision
on their own when it comes topregnancy and delivery, so we
also have to work on that.
That's why we are pleading onthe involvement of male in
maternal and child health usingthe handbook.
Speaker 3 (26:52):
Thank you so much, mitron.
So, as you highlight thesechallenges, what are the current
strategies and policies inplace to reduce maternal and
child mortality rates?
Speaker 4 (27:10):
The ministry wants to improve on access so that,
wherever you are, you can accessthe facility when there is need
or when you are pregnant.
And, coupled with that, we wantto also improve on the quality
(27:31):
of care.
That's why the ministry havedeveloped Coupled with that, we
want to also improve on thequality of care.
That's why the ministry hasdeveloped a quality of care
directory that goes out into thefacilities to ensure that they
deliver quality of care and theyhave the instruments and the
materials, the consumables, todo that.
And we also we are working onthis maternal and child health
(27:57):
book to reach the men as well.
That's why we are talking aboutmama and papa class, so that
the antenatal clinic can nowoffer mama and papa class for
men and women to attend, so thatwe know more about the health
of the mother and the health ofthe child.
The ministry also is working onbuilding quality hospitals.
(28:24):
They are now working ontertiary hospitals within the
country itself, at strategicpoints.
Presently they are constructingone big hospital for Kudon
District, moyambadi Street andFalaba District.
(28:47):
Then they are working on a bighospital between Kenema and Bo,
so that those two districts canaccess tertiary hospitals.
They are also working on thepersonnel, now the comers.
(29:14):
They are training specialistdoctors and they are also
training specialist nurses.
The government is supportingthese trainings.
That's why they have also theyhave the Postgraduate College of
Nursing not only nursingPostgraduate College of Health
Specialties, where we have alsoa department for nursing and
(29:38):
midwifery.
So they are working on all this.
It's already established.
So it's now.
They have developed their workplan for the next five years and
they have started working.
So with the postgraduatecollege, you now have nurses and
midwives going in there todevelop their career.
The government is also workingon partnership.
(30:02):
There are so many partnerscoming in to Sierra Leone.
So many donors want to dosomething For the partners.
Now the Saudi Arabia they wantto build us a 300-bed hospital
in Longe.
We are working with the Chineseand we are working with AIDB.
(30:25):
Aidb is building the threehospitals in the three districts
.
So we are working onpartnership and we are working
with our donors to build on the.
It's not only building thehospitals but the already
existing hospitals to have lightand sanitation.
(30:47):
So the solar light project ison for 60 facilities.
We already have or not we havedone this.
Pcmh Boer Government Hospitalwas launched recently the solar
energy.
So we are working on all thesethings to ensure that we improve
(31:10):
on the quality of care that wegive our women and our children.
Speaker 3 (31:18):
Thank you so much.
So you talk about education.
We're sitting in an office atthe new midwifery school in
Kenema, which is absolutelybeautiful, and we have trainings
going on around.
Tell me a little about how thisschool came to be and why there
was a need for it.
Speaker 4 (31:39):
For years by now, we have been training in one school
that is the National School ofMidwifery, with two classrooms,
and we have been recyclingnurses.
You do your three years, youcome out, work for two years and
then you are enrolled into themidwifery and at the end of the
(32:03):
day, we don't have the midwiveswhere they are supposed to be,
because when you come out, youare a nurse and you are a
midwife.
We will send nurses to come outand you will be among them as a
midwife.
Then you will lose your skills.
So we saw that we are notgaining anything.
Who said we should have over3,000 midwives before 2030.
(32:26):
And at that time we are noteven up to 900.
And most of them were inadministrative work.
So we decided to have anothermidwifery school in the north,
sponsored by IMC at that time.
So with the school in the north, we are now doing training
(32:51):
midwives SECHNs.
These are state-enrolledcommunity health nurses that
were established with theprimary health care.
We now decided to train them asmidwives so that they can go
into the communities furtherthan the hospitals.
But we saw that again, it wasslow.
(33:12):
We are still recycling ournurses now.
We said what about the south?
Let's have one in the south.
So we partnered with Caritasand Action Mondial in Germany to
establish the school in thesouth.
Again we decided are we justgoing to be establish the school
(33:36):
in the south?
Again, we decided, are we justgoing to be training SHNs?
Let's have what we call directentry into midwifery.
So we started the direct entryinto midwifery last year but we
saw that we are still training asmall number.
What about having one in theeast?
And this project came aboutwith negotiation with ISDB.
(34:00):
They decided to put up astructure for us and we came
down to the community here, themayor and the elders, the chiefs
.
We talked with them and theygave us a 10-ton acre to build
that school.
We informed ISDB, they didtheir assessment and they agreed
(34:26):
with us.
It is a special school.
For over four years now we havebeen working on this school.
It is a very special school Infact to me.
I call it a college ofmidwifery in Sierra Leone.
We are starting as a school butwe want to develop into a
college.
It has special features.
This is the first school withits own administrative building,
(34:50):
school with its ownadministrative building, the
first school which has a skillslab well equipped and a library
plus a radio station, just forthe school to communicate with
the community.
And it goes beyond the Kenemadistrict into the Kailan
(35:14):
district and you can also focusit in Bull district.
So we are.
It is a superb.
It has it, has it?
What does?
It has hostels for male andfemale, so it's unique.
So we are hoping.
Presently we are sitting in theschool, we are doing trainings,
(35:37):
we are even going to use it asa hub for the training of
midwives, those who are alreadyqualified for their CPDs.
We are going to use the schoolas a hub because it's spacious,
it's free, it's just ideal fortraining of midwives.
Thank you, thank you.
Speaker 3 (35:59):
Thank you so much, mitron.
I can hear the sense of prideyou have in how this birthing
process of this I'll call it acenter for excellence that you
have created here.
It's absolutely beautiful andwe see how you know you have
created kind of a high standardhere.
That is incredible for us.
(36:21):
We've really loved being hereand we're very impressed with
this midwifery school.
So what are the specificinterventions that the Ministry
of Health has been doing thathave shown most promise in
reducing maternal and childmortality rates in Sierra Leone?
Speaker 4 (36:42):
One.
I think there are four keythings, four or five key things.
One, the trainings they haveinvested in training heavily.
Two, they have invested ininfrastructure.
Three, they have invested indrugs and management.
Four, in partnership we are nowdoing the PPP In partnership
(37:08):
for the provision of drugs sothat we can minimize the
stockout of drugs for ourmothers and children.
So these are the four keythings that the ministry is
investing in, and supervisionhas come up as key.
Now the ministry is planning tobe doing hard-hook supervision
(37:29):
to facilitate to district notjust facilitate to district to
see the functionality of thedistrict and see how they can
come in and survey somesituations that are predominant
in each district because we takethem as they are all quite
unique in their own operations.
Speaker 3 (37:53):
Thank you so much.
Thank you so much.
So we've been working on thetraining of skilled healthcare
(38:14):
workers.
We also are always, constantlyasked about the challenges in
retaining doing in terms ofstrategy, especially in these
rural areas that need them most,and now you're bringing up some
of the best trained and skilledhealth care providers.
Speaker 4 (38:30):
In the first place the ministry.
A year ago they developed therural retention strategy.
A year ago they developed therural retention strategy.
Our problem now is theimplementation of that strategy,
ensuring that when you go tothe provinces you will be
considered, because people areafraid when you're in the
(38:50):
provinces you will not haveopportunities for scholarship,
for even further your educationand so forth.
So we have worked on that.
We are just waiting for theimplementation from the HRH.
And the problems with most ofthese rural areas is
(39:13):
accommodation.
Most facilities.
They have only perhaps one ortwo accommodation, that is, for
the in-charge, which is thecommunity health worker and the
community health officer please,not a community health worker,
community health officer and themidwife perhaps.
(39:35):
So we have limited space inthese rural areas.
And then the other amenitiesinternet facilities, better
schools for the children.
So we are looking at all thisand sometimes most of our
midwives are women.
They complain about homebreaking, so they have problems
(39:56):
with their relationships whenthey go out into those districts
.
So what this retention plan isto provide these small, small
amenities for the EHUs, plusmaking it rotational so that at
least you go there at least twoyears and you are allowed to
return back to Freetown orwhatever big town where you want
(40:17):
to be.
So those are the things that weare planning to do.
We are just waiting for HR tosource funds to implement this
particular action.
Speaker 3 (40:30):
Thank you so much.
We're wrapping up now.
So how can we strengthen thereferral system to ensure timely
access to specialized care, andwhat are the data, gaps and
challenges in monitoring andevaluating maternal and child
health programs?
Speaker 4 (40:48):
We start with the referrer.
There's a referrer system setup within the Ministry of Health
, but they had challenges.
So now there's an interimreferral system going on and
they are working really on rulesand regulations.
They are working on how toallocate these ambulances to
(41:14):
districts and how tooperationalizeize them, because
most of the time there is nofear, there is no this.
So now they are working on thatto see how much fear an
ambulance can use for, let mesay, one quarter of half every
six monthly.
So the new interim team isworking with partners and the
(41:40):
ministry to ensure that they puttogether some literature.
And there's another big thingthat is a problem with the
referral the maintenance of thevehicles.
So it involves huge money.
The ministry also.
They gave money to NEMS butthank God for the new body that
(42:03):
is honored.
They can now plan really how toutilize this money properly.
For the For monitoring andevaluation.
Every district will havemonitoring and evaluation team.
We are now saying that the datacollection is also very
(42:26):
important.
We have to train our nurses andthese are the people who
collect our data so you canevaluate your data, provided you
have the correct data.
So we need to train our nursesand midwives on data collection.
Apart from data collection, thedigitalization of the data.
(42:46):
This is going to be a hugechange and if we succeed it's
going to be a plus, a feather inour cap in the Ministry of
Health.
In fact, most of the nursesthey don't even have computers.
Most of the healthcare workersin the district they don't have
computers.
Most of the facilitiesthemselves.
To have one computer for thefacility is also a challenge.
(43:09):
So we have to work step by stepto see how we can get our
nurses and midwives to know moreabout computer and how to
digitalize all their data beforethey can set up to the data
managers.
Speaker 3 (43:29):
Thank you so much.
So our final question that weask all guests is what are you
most optimistic about?
Guess?
Speaker 4 (43:37):
is what are you most optimistic about?
That in the next one to twoyears, cereal Young will post
off more than 3,000 nurses,midwives.
If all these four schoolstogether train, we hope to get
more than the 3,000 working inthe field, not only those
(44:01):
working in the offices, and Ihope that at the end of the day,
at the end, we will reducedrastically, we will bend, the
curve of maternal death rightdown to international standard.
Thank, you.
Speaker 3 (44:20):
Thank you so much to our listeners.
We say thank you to Matron MaryFuller, our Chief Nursing and
Midwifery Officer, who is mostbeloved.
You should see when she comesinto the room how the midwives
sing and are so happy because ofthe immense change and that
(44:40):
she's doing nationwide and herpassion for reducing maternal
and child mortality rates.
Thank you so much, Mitra Unfula, for coming and speaking to our
audience today and sharing yourwisdom and for all that you are
and all that you do.
Thank you.
Speaker 1 (45:05):
Thanks for listening.
If you enjoyed this episode,please subscribe, share it with
others, post about it on socialmedia or leave a rating and
review.
To catch all the latest from us, you can find us at Helping
Children Worldwide on Instagram,linkedin, twitter and Facebook
Hashtag Optimistic VoicesPodcast.
This is Optimistic Voices.
I'm your host, yasmin Vaughn.
Normally I host all of ourepisodes on global health, but
this week we have a reallyunique episode of Optimistic
Voices for you.
In January, helping ChildrenWorldwide collaborated with
members of the Together forGlobal Health Network to hold
another maternal and childhealth training conference.
You may recall our two-partepisode last year on the
(00:57):
training we did in Bow, where wetrained almost 100 midwives and
nurses.
This year we were asked by theMinistry of Health and
Sanitation to do the trainingagain in Kenema and we had 43
participants from Kenema,kailaun and the surrounding
hospitals and clinics.
The training is focused on twomain curricula essential newborn
care and helping motherssurvive bleeding after birth.
(01:20):
These two curricula are focusedon tackling the top causes of
maternal and infant mortality inSierra Leone, namely postpartum
hemorrhage, which is bleedingafter birth, and infant
resuscitation, which is ahelping babies breathe
curriculum.
But it also included morninglectures on burnout, maternal
mental health and respectfulmaternal care, helping to build
(01:40):
up some of those soft skillsthat are so important within the
nursing practice.
All of this was held at the newKenema School of Midwifery,
which just opened in December oflast year and is now training
the first class of midwives inthe region.
Today's episode of OV wasrecorded with the Chief Nursing
and Midwifery Officer, matronMary Augusta Fuller live from
(02:03):
the training we were doing inKenema.
Interviewing her is one of theTogether for Global Health
partners and a very dear friend,josephine Garnham, who is the
Executive Director of the HealyInternational Relief Foundation,
who is an instrumental part ofour Together for Global Health
network and the training thatwe're doing.
In this interview she talkswith Matron Augusta about the
(02:25):
Ministry of Health's prioritiesfor maternal and child health
over the next few years, thechallenges that they've had and
the successes that they'recelebrating within maternal and
child health in Sierra Leone.
Before we get into theinterview, I want to share a
little bit about the importanceof training for midwives and
nurses.
The WHO states that skilledmidwives could avert more than
(02:47):
80% of all maternal stillbirthand neonatal deaths In Sierra
Leone.
Things like limited equipment,inadequate mentorship and
education constraints mean thatmidwives sometimes don't have
the chance to receive hands-ontraining.
In fact, the Kedema School ofMidwifery was the first school
of midwifery built in thecountry with a skills lab, and
(03:10):
it's a really fantastic laballowing the students to get
hands-on training usingsimulators to practice their
experience.
Midwives need practicalexperience and support to
improve their skills and toboost their confidence, because,
in addition to knowledge,midwives have to be confident.
They have to be prepared to actdecisively and effectively in
(03:33):
life-saving situations, which iswhy often, high pressure and
resource-limited situations meanthat they lack their confidence
.
So it's essential not only toequip midwives with the
necessary knowledge, but tofoster their confidence in
performing those skills inchallenging circumstances.
(03:54):
So our Together for GlobalHealth Network members in Sierra
Leone have been workingtogether to address the
challenge of maternal andneonatal mortality by increasing
the competence and theconfidence of midwives to
perform life-saving procedures.
As a part of the conference andthe training, we also offer
ongoing mentorship and refreshercourses, and we provide
(04:17):
supplies and equipment for whatthey call low-dose,
high-frequency training, whichis where you have nurses take
the supplies and equipment backto their facility and do little
mini training sessions withother people at their facility
the other nurses and midwivesthat are working there so that
they can continue to refinetheir skills and build them,
(04:39):
with the ultimate goal, ofcourse, of contributing to a
reduction in maternal and infantmortality rates.
This collaborative effort isconducted completely in
partnership with the Ministry ofHealth and Sanitation, both at
their invitation and at theirdiscretion, to ensure that
everything that we're doing isin alignment with national
priorities and avoids theduplication of efforts, because
(05:00):
there are a lot of organizationsthat are engaged in working in
maternal and child health inSierra Leone, so we want to make
sure that everything isfiltered through the Ministry of
Health.
Now, with that introduction,you can hear from Chief Nursing
and Midwifery Officer, matronFuller, as she shares more about
the ministry's plans for SierraLeone's future in maternal and
child health.
Speaker 3 (05:23):
My name is Josephine Garnham and I'm sitting in for
Yasmin Vaughn for today'sepisode.
We're interviewing Matron MaryA M Fuller, who serves as the
Chief Nursing and MidwiferyOfficer at the Ministry of
Health in Sierra Leone, leadingand providing oversight to over
12,000 nurses and midwivesnationwide site to over 12,000
(05:48):
nurses and midwives nationwide.
She played a pivotal roleduring the Ebola epidemic,
working in the reproductivehealth and family planning
program at Princess ChristianMaternity Hospital.
In her current capacity, matronFuller has been instrumental in
initiatives such as theintroduction of the Maternal and
Child Health Handbook aimed atstrengthening the continuum of
care for pregnancy through earlychildhood.
(06:11):
A dedicated public healthspecialist, she has over 37
years of experience in the civilservice sector.
She has been a strong advocatefor the development of midwifery
schools across Sierra Leone anda key convener bringing
together subject matter expertsto develop context-specific and
(06:31):
up-to-date curricula.
Her passion for capacitybuilding among nurses and
midwives is driven by hercommitment to reducing maternal
and child health mortality ratesin the country.
To reducing maternal and childhealth mortality rates in the
country.
Mitra Nkfula, tell me a littlebit about yourself where?
Speaker 4 (06:58):
you're from and how you got to where you are now.
Hello everyone, I hail from thesouth of Sierra Leone, to be
specific Puget District, and Iwent to the Holy Rosary School
in Puget.
I also proceeded after myO-level exams at that time, so
(07:22):
the National School of Nursingin Freetown.
After my three-year studies Iwent for two years course well
midwifery within the samewestern area of Freetown.
At the end of my training asmidwife I was posted to various
areas, one to PugetongGovernment Hospital.
(07:44):
After some years I was postedto various areas, one to
Pugetong Government Hospital.
After some years I wastransferred.
That was during the war, andduring the war we were then sent
to the camp at Gundama.
We spent some time there andthere I developed the passion
for midwifery and public healthtogether.
(08:05):
To me those two are the twocareers that should match
together.
So we developed a lot of.
We developed a lot of booths atthat time, not hospitals but
small, small booths withinchiefdoms.
We divided the camp intochiefdoms and we developed
(08:26):
booths for them where we do ORT,where we do some deliveries and
so forth.
So I developed passion also forpublic health and I went to do
my public health in FurabeCollege.
I did the diploma in publichealth and was then transferred
back to a longer governmenthospital to practice and I
(08:47):
practiced at the clinical sitefor a few years, about five
years there.
I know the relationship betweenclinical and public health.
From there I was transferred toPujo as the district health
sister.
I spent some time in Pujo andproceeded to Kambia in the north
(09:08):
and then to Bombali district.
From Bombali district I wasthen transferred to Western area
.
At that time Western area wasone not OBA and rural.
So I was there as the districthealth sister, one there at the
district health system one.
At the end of five years I wastransferred to the reproductive
(09:29):
health and family planningprogram.
At that time we were atPresence Christian Mentality
Hospital.
There I worked with themidwives within that facility to
develop SOP standards fordelivery standards for the use
(09:49):
of MSOB store standards for theuse of Maxsoft.
That was at that time.
That was what we used.
So trainings and so forth.
We do trainings for ourfacility workers, for the DHMT
workers, for the peripheralhealth unit workers.
(10:12):
So I was finally transferredthere.
We had Ebola Then.
I was then transferred to theDirectorate of Nursing as deputy
and I was in charge of thetraining that we are going on
with Ebola.
So we trained before theforeigners came in to assist us.
At the end of Ebola I went anddid my master's in public health
(10:39):
and then I came back.
I was now appointed as thechief nursing and midwifery
officer in the Ministry ofHealth.
I have worked with so manypartners and we decided to
develop the maternal and childhealth handbook.
I went to Japan where I learnedabout the handbook and we, as
(11:02):
serial unions, decided todevelop our own in our own
context.
So now we are trying to rollout this handbook to all the
facilities if we can get helpfrom other people, because what
we have learned is a routinebook is not a one-off printing
book, so we need everybody allhands on deck.
I've enjoyed working in theMinistry of Health and
(11:23):
Sanitation with all my partnersand I hope we will continue to
work hard to reduce the death ofour mothers and babies and
infants.
I have also contributed a lotto the development of additional
(11:44):
midwifery schools, because fromyears ago we had only one
midwifery school within thecountry.
Now we are boasting of three ofthem one in the north, one in
the south and one in the east asadditional to freedom and one
in the east as additional tofreedom.
(12:05):
So we thank God and we aregoing to continue working on
this line so that our motherscan have quality care delivery.
Wherever they are, they canaccess quality of care.
Thank you.
Speaker 3 (12:17):
Thank you, Matron.
I understand that the Nursingand Midwifery Office has just
finished the 2025 version of theNational Nursing and Midwifery
Office has just finished the2025 version of the National
Nursing and Midwifery StrategicPlan.
What are some of the mainaccomplishments that have been
reached since the last strategicplan and what are some
priorities outlined in this plan?
Speaker 4 (12:41):
The Midwifery Nursing Strategic Plan was developed
with support from UNFPA andthere are so many things
outlined in that.
Midwives we have to focus onthe development of the faculty
(13:04):
itself so that we don't havediploma tutors or nursing tutors
that teach diploma.
So we are working on that.
Most of them are now mastersholders, so that is one of the
achievements from the laststrategic plan.
(13:25):
Also in the strategic plan weare talking about service
delivery.
We want to ensure that thenurses give quality service
delivery to their patients.
So we are now looking at thetools to encourage them for
documentation.
So we have developed thishandbook to ensure that there is
(13:47):
continuum of care frompregnancy right down to up to
five years.
We are even envisaging that wecan bring in the HPV within that
handbook so that by 10 years,if you are a female, you can now
have your HPV within the book.
(14:07):
We also, apart from servicedelivery, the associations is
also a pillar.
On that.
We have now reviewed all theassociations they have.
What do we call it?
(14:28):
The associations we have?
So we have helped the twoassociations the nursing and
midwifery associations todevelop their constitutions.
So we have also done that,which is a plus from the old
strategic plan and now we havedone our elections as well, the
(14:49):
two.
They have got new executivecoming up.
In fact, what we did the lasttime we had interim so that we
developed their standards and soforth, all the policies and so
forth within those associations,but now we have elected the
executive for both associations.
So that is a plus from the oldone.
(15:09):
Now we want the associations todevelop their own plans and to
see how they can write their ownprojects so that they can
finance themselves Under thestrategic plan.
We also have the regulatorybody.
We have worked on the act.
It was last 2023 that it wasenacted in parliament and now we
(15:35):
have a council instead of aboard.
We are now trying to have thephysical space for the board.
So we have acquired a landspace where they are working on
the BOQ so that we can sourcefunding for the construction of
(15:55):
the secretariat for nurses andmidwives.
So that is a plus from the oldstrategic plan, plus from the
old strategic plan.
We also worked on the education.
We are now working with theuniversities to train specialist
nurses instead of just RNs, rns.
(16:17):
So we are doing specialistnursing training.
We are doing presently theuniversity commerce.
We are doing presently theuniversity commerce.
They are doing specialtytraining on medical surgical
critical care, perioperativecare, nurses and massanga.
(16:38):
We are doing tutorial fornurses.
We are doing also mental health.
They are doing physiotherapyfor nurses.
We are doing also a mentalhealth.
They are doing physiotherapyfor nurses.
So all those specialty areashave been identified and we have
started the trainings For themental health.
It's going to be next yearbecause we are now developing
the curriculum for mental health.
(17:00):
So we had a lot of achievementsfrom the previous strategic plan
, but we have already completedthis one and we hope, with the
challenges from the last time,we will be able to overcome them
.
The first challenge was likereally getting finance to
(17:20):
implement all this strategicplan that we developed.
But what happened?
We had limited partnership.
So now we are working withpartners, like for the maternal
and child health handbook.
We have few partners now withus.
Jica is one who is reallychampioning the implementation
(17:42):
of this handbook.
We have World Bank working withus also.
We have Seed Global, and SeedGlobal is not just working with
us on the handbook, they areworking with us in our training
institutions.
They bring in internationalexperts to work with us
Presently international expertsto work with us.
(18:03):
Presently we have six of themworking, two in the north the
North Midwifery School in thenorth two in the south and two
in the east.
So we are waiting to see how wecan bring the National School
of Midwifery on board this year.
Thank, you.
Speaker 3 (18:26):
Thank you, mitran.
As we talk about this strategicplan, we also would like to
talk about maternal and childmortality For our listeners that
are new to this topic.
What are the leading causes ofmaternal and child mortality in
Sierra Leone?
Speaker 4 (18:48):
The leading causes of maternal mortality are
hemorrhage it's at the top ofour list for maternal death
simply because there areunderlining causes.
Some women are anemic when theycome into labor, some women
(19:09):
cannot get access easily tocomprehensive care and some
people even fail to come untilthe last moment.
The second is obstetricemergencies is eclampsia.
(19:31):
Emergencies is eclampsia.
Eclampsia occurs normally withhigh blood pressure during
pregnancy and we have noticedthat this is linked to mental
health disorders, stress in thehome, stress in their workplaces
(19:54):
, stress with their husbands andso forth, and it's an
underlining cause to develop thepreeclampsia.
And when they develop theeclampsia, if they don't access
the facility earlier, definitelywe will lose them.
So that is another cause.
(20:17):
Sepsis is another cause formaternal death in Sierra Leone,
though on a lower scale.
But what we are seeing is thatespecially when women deliver
not in the facilities they comein with sepsis because after
delivery you have to have, youhave to use, definitely have to
(20:40):
use baths and so forth.
So normally, what we have foundout, the hygiene aspect of
maternal care is lacking,especially where you don't have
these women accessing thefacilities earlier.
So what we have said is that wenow are going to embark on
(21:03):
educating the women in theircommunities to prepare for
delivery, so that if you have touse your pad then you have to
have a clean cloth.
If you cannot afford to buy,then you can have your clean
cloth, iron it up and then youcan reduce the possibility of
sepsis.
And then sometimes these women,they also go for delivery
(21:28):
definitely at the facilities,the facilities, some facilities
at the lower level.
They don't even havesterilizers to sterilize.
You know their instrument, theinstrument that they work with.
They are now used to chlorinewashing.
So when the chlorine are notavailable, what happens?
We don't know.
But sometimes they come up nowwith sepsis and they are treated
(21:50):
in the hospitals.
But sometimes and they aretreated in the hospitals, but
sometimes even when you haveCICs done in some areas, you
have sepsis, resorting to sepsis, whether they cannot afford to
buy their dressings and so forth.
So people will end up withsepsis.
(22:11):
Or sometimes they are alreadymalnourished before they come in
, so they don't have that muchresistance.
So for sepsis.
And then we have.
I think those are the threeleading causes of maternal
deaths in Sierra Leone in SierraLeone.
Speaker 3 (22:33):
Thank you so much and you've also highlighted with
that the challenges inaddressing these issues, which
is access, hygiene, lack of theresources, lack of integrating
mental health into this, for thestressors that usually will
(22:55):
cause hypertension and otherthings in women that are of
bearing age.
So also we're looking at whatare the specific cultural and
social factors that contributeto maternal and child mortality
(23:15):
in Sierra Leone.
Speaker 4 (23:20):
For the cultural in the first place in Sierra Leone
when women, especially thoseliving in the rural areas, when
they are pregnant, they don'twant people to know about it.
In the rural areas, when theyare pregnant, they don't want
people to know about it.
So if you have ectopic and youdon't want people to know that
(23:42):
you are pregnant, so in the endwhen the ectopic rupture, you
will definitely lose your life.
So that culture of hidingpregnancies before 12 weeks is
contributing also to the deathof young women within our
facilities.
Then the polygamy alsocontributes largely to the death
(24:10):
of women within the communities, simply because when you have a
polygamous home, the head wifeis always the decision maker and
if you are not in good termswith that head wife, what
happens to you you will even beafraid to complete when you have
(24:34):
problems.
So in the end, when the problemescalates, then that's the time
you find it even difficult forthem to make the decisions.
What can we do with this woman?
Sometimes they even feel youhave something to say or you are
promiscuous.
That's why you're having thoseproblems.
You are promiscuous, that's whyyou're having those problems.
So we have that type of culturewithin our country.
(24:56):
Then the older culture is eventhe nutrition aspect of women,
especially when they arepregnant.
There's no laid down rule thatyou can get extra.
You continue to get whatever isavailable.
Sometimes you can even gohungry for the whole day, until
(25:17):
evening when the final meal isready.
So we also have to look at that.
That's why we have developedthis handbook with Victoria
where we have the nutritionalpage telling you what a pregnant
woman can eat during pregnancyfruits and so forth and a page
for even the children.
So that also can interfere.
When the woman is anemic, whathappens?
(25:40):
When you come out for delivery,no matter what happens, you
will lose blood and an anemicwoman losing blood will lead to
death if we are not careful, didnot notice it before time.
Another cultural behavior is themale decision.
(26:01):
Most men, they will not take itfrom you.
Let me say you are havingbleeding before delivery,
antepatient hemorrhage and thehusband is not there.
He goes out somewhere for two,three days.
You have to sit down there andwait, especially where you
(26:27):
cannot get coverage to that man.
Then that woman be at risk oflosing her life.
So we have a lot of thingsthere.
The women are not given theopportunity to make the decision
on their own when it comes topregnancy and delivery, so we
also have to work on that.
That's why we are pleading onthe involvement of male in
maternal and child health usingthe handbook.
Speaker 3 (26:52):
Thank you so much, mitron.
So, as you highlight thesechallenges, what are the current
strategies and policies inplace to reduce maternal and
child mortality rates?
Speaker 4 (27:10):
The ministry wants to improve on access so that,
wherever you are, you can accessthe facility when there is need
or when you are pregnant.
And, coupled with that, we wantto also improve on the quality
(27:31):
of care.
That's why the ministry havedeveloped Coupled with that, we
want to also improve on thequality of care.
That's why the ministry hasdeveloped a quality of care
directory that goes out into thefacilities to ensure that they
deliver quality of care and theyhave the instruments and the
materials, the consumables, todo that.
And we also we are working onthis maternal and child health
(27:57):
book to reach the men as well.
That's why we are talking aboutmama and papa class, so that
the antenatal clinic can nowoffer mama and papa class for
men and women to attend, so thatwe know more about the health
of the mother and the health ofthe child.
The ministry also is working onbuilding quality hospitals.
(28:24):
They are now working ontertiary hospitals within the
country itself, at strategicpoints.
Presently they are constructingone big hospital for Kudon
District, moyambadi Street andFalaba District.
(28:47):
Then they are working on a bighospital between Kenema and Bo,
so that those two districts canaccess tertiary hospitals.
They are also working on thepersonnel, now the comers.
(29:14):
They are training specialistdoctors and they are also
training specialist nurses.
The government is supportingthese trainings.
That's why they have also theyhave the Postgraduate College of
Nursing not only nursingPostgraduate College of Health
Specialties, where we have alsoa department for nursing and
(29:38):
midwifery.
So they are working on all this.
It's already established.
So it's now.
They have developed their workplan for the next five years and
they have started working.
So with the postgraduatecollege, you now have nurses and
midwives going in there todevelop their career.
The government is also workingon partnership.
(30:02):
There are so many partnerscoming in to Sierra Leone.
So many donors want to dosomething For the partners.
Now the Saudi Arabia they wantto build us a 300-bed hospital
in Longe.
We are working with the Chineseand we are working with AIDB.
(30:25):
Aidb is building the threehospitals in the three districts
.
So we are working onpartnership and we are working
with our donors to build on the.
It's not only building thehospitals but the already
existing hospitals to have lightand sanitation.
(30:47):
So the solar light project ison for 60 facilities.
We already have or not we havedone this.
Pcmh Boer Government Hospitalwas launched recently the solar
energy.
So we are working on all thesethings to ensure that we improve
(31:10):
on the quality of care that wegive our women and our children.
Speaker 3 (31:18):
Thank you so much.
So you talk about education.
We're sitting in an office atthe new midwifery school in
Kenema, which is absolutelybeautiful, and we have trainings
going on around.
Tell me a little about how thisschool came to be and why there
was a need for it.
Speaker 4 (31:39):
For years by now, we have been training in one school
that is the National School ofMidwifery, with two classrooms,
and we have been recyclingnurses.
You do your three years, youcome out, work for two years and
then you are enrolled into themidwifery and at the end of the
(32:03):
day, we don't have the midwiveswhere they are supposed to be,
because when you come out, youare a nurse and you are a
midwife.
We will send nurses to come outand you will be among them as a
midwife.
Then you will lose your skills.
So we saw that we are notgaining anything.
Who said we should have over3,000 midwives before 2030.
(32:26):
And at that time we are noteven up to 900.
And most of them were inadministrative work.
So we decided to have anothermidwifery school in the north,
sponsored by IMC at that time.
So with the school in the north, we are now doing training
(32:51):
midwives SECHNs.
These are state-enrolledcommunity health nurses that
were established with theprimary health care.
We now decided to train them asmidwives so that they can go
into the communities furtherthan the hospitals.
But we saw that again, it wasslow.
(33:12):
We are still recycling ournurses now.
We said what about the south?
Let's have one in the south.
So we partnered with Caritasand Action Mondial in Germany to
establish the school in thesouth.
Again we decided are we justgoing to be establish the school
(33:36):
in the south?
Again, we decided, are we justgoing to be training SHNs?
Let's have what we call directentry into midwifery.
So we started the direct entryinto midwifery last year but we
saw that we are still training asmall number.
What about having one in theeast?
And this project came aboutwith negotiation with ISDB.
(34:00):
They decided to put up astructure for us and we came
down to the community here, themayor and the elders, the chiefs
.
We talked with them and theygave us a 10-ton acre to build
that school.
We informed ISDB, they didtheir assessment and they agreed
(34:26):
with us.
It is a special school.
For over four years now we havebeen working on this school.
It is a very special school Infact to me.
I call it a college ofmidwifery in Sierra Leone.
We are starting as a school butwe want to develop into a
college.
It has special features.
This is the first school withits own administrative building,
(34:50):
school with its ownadministrative building, the
first school which has a skillslab well equipped and a library
plus a radio station, just forthe school to communicate with
the community.
And it goes beyond the Kenemadistrict into the Kailan
(35:14):
district and you can also focusit in Bull district.
So we are.
It is a superb.
It has it, has it?
What does?
It has hostels for male andfemale, so it's unique.
So we are hoping.
Presently we are sitting in theschool, we are doing trainings,
(35:37):
we are even going to use it asa hub for the training of
midwives, those who are alreadyqualified for their CPDs.
We are going to use the schoolas a hub because it's spacious,
it's free, it's just ideal fortraining of midwives.
Thank you, thank you.
Speaker 3 (35:59):
Thank you so much, mitron.
I can hear the sense of prideyou have in how this birthing
process of this I'll call it acenter for excellence that you
have created here.
It's absolutely beautiful andwe see how you know you have
created kind of a high standardhere.
That is incredible for us.
(36:21):
We've really loved being hereand we're very impressed with
this midwifery school.
So what are the specificinterventions that the Ministry
of Health has been doing thathave shown most promise in
reducing maternal and childmortality rates in Sierra Leone?
Speaker 4 (36:42):
One.
I think there are four keythings, four or five key things.
One, the trainings they haveinvested in training heavily.
Two, they have invested ininfrastructure.
Three, they have invested indrugs and management.
Four, in partnership we are nowdoing the PPP In partnership
(37:08):
for the provision of drugs sothat we can minimize the
stockout of drugs for ourmothers and children.
So these are the four keythings that the ministry is
investing in, and supervisionhas come up as key.
Now the ministry is planning tobe doing hard-hook supervision
(37:29):
to facilitate to district notjust facilitate to district to
see the functionality of thedistrict and see how they can
come in and survey somesituations that are predominant
in each district because we takethem as they are all quite
unique in their own operations.
Speaker 3 (37:53):
Thank you so much.
Thank you so much.
So we've been working on thetraining of skilled healthcare
(38:14):
workers.
We also are always, constantlyasked about the challenges in
retaining doing in terms ofstrategy, especially in these
rural areas that need them most,and now you're bringing up some
of the best trained and skilledhealth care providers.
Speaker 4 (38:30):
In the first place the ministry.
A year ago they developed therural retention strategy.
A year ago they developed therural retention strategy.
Our problem now is theimplementation of that strategy,
ensuring that when you go tothe provinces you will be
considered, because people areafraid when you're in the
(38:50):
provinces you will not haveopportunities for scholarship,
for even further your educationand so forth.
So we have worked on that.
We are just waiting for theimplementation from the HRH.
And the problems with most ofthese rural areas is
(39:13):
accommodation.
Most facilities.
They have only perhaps one ortwo accommodation, that is, for
the in-charge, which is thecommunity health worker and the
community health officer please,not a community health worker,
community health officer and themidwife perhaps.
(39:35):
So we have limited space inthese rural areas.
And then the other amenitiesinternet facilities, better
schools for the children.
So we are looking at all thisand sometimes most of our
midwives are women.
They complain about homebreaking, so they have problems
(39:56):
with their relationships whenthey go out into those districts
.
So what this retention plan isto provide these small, small
amenities for the EHUs, plusmaking it rotational so that at
least you go there at least twoyears and you are allowed to
return back to Freetown orwhatever big town where you want
(40:17):
to be.
So those are the things that weare planning to do.
We are just waiting for HR tosource funds to implement this
particular action.
Speaker 3 (40:30):
Thank you so much.
We're wrapping up now.
So how can we strengthen thereferral system to ensure timely
access to specialized care, andwhat are the data, gaps and
challenges in monitoring andevaluating maternal and child
health programs?
Speaker 4 (40:48):
We start with the referrer.
There's a referrer system setup within the Ministry of Health
, but they had challenges.
So now there's an interimreferral system going on and
they are working really on rulesand regulations.
They are working on how toallocate these ambulances to
(41:14):
districts and how tooperationalizeize them, because
most of the time there is nofear, there is no this.
So now they are working on thatto see how much fear an
ambulance can use for, let mesay, one quarter of half every
six monthly.
So the new interim team isworking with partners and the
(41:40):
ministry to ensure that they puttogether some literature.
And there's another big thingthat is a problem with the
referral the maintenance of thevehicles.
So it involves huge money.
The ministry also.
They gave money to NEMS butthank God for the new body that
(42:03):
is honored.
They can now plan really how toutilize this money properly.
For the For monitoring andevaluation.
Every district will havemonitoring and evaluation team.
We are now saying that the datacollection is also very
(42:26):
important.
We have to train our nurses andthese are the people who
collect our data so you canevaluate your data, provided you
have the correct data.
So we need to train our nursesand midwives on data collection.
Apart from data collection, thedigitalization of the data.
(42:46):
This is going to be a hugechange and if we succeed it's
going to be a plus, a feather inour cap in the Ministry of
Health.
In fact, most of the nursesthey don't even have computers.
Most of the healthcare workersin the district they don't have
computers.
Most of the facilitiesthemselves.
To have one computer for thefacility is also a challenge.
(43:09):
So we have to work step by stepto see how we can get our
nurses and midwives to know moreabout computer and how to
digitalize all their data beforethey can set up to the data
managers.
Speaker 3 (43:29):
Thank you so much.
So our final question that weask all guests is what are you
most optimistic about?
Guess?
Speaker 4 (43:37):
is what are you most optimistic about?
That in the next one to twoyears, cereal Young will post
off more than 3,000 nurses,midwives.
If all these four schoolstogether train, we hope to get
more than the 3,000 working inthe field, not only those
(44:01):
working in the offices, and Ihope that at the end of the day,
at the end, we will reducedrastically, we will bend, the
curve of maternal death rightdown to international standard.
Thank, you.
Speaker 3 (44:20):
Thank you so much to our listeners.
We say thank you to Matron MaryFuller, our Chief Nursing and
Midwifery Officer, who is mostbeloved.
You should see when she comesinto the room how the midwives
sing and are so happy because ofthe immense change and that
(44:40):
she's doing nationwide and herpassion for reducing maternal
and child mortality rates.
Thank you so much, Mitra Unfula, for coming and speaking to our
audience today and sharing yourwisdom and for all that you are
and all that you do.
Thank you.
Speaker 1 (45:05):
Thanks for listening.
If you enjoyed this episode,please subscribe, share it with
others, post about it on socialmedia or leave a rating and
review.
To catch all the latest from us, you can find us at Helping
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Hashtag Optimistic VoicesPodcast.
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