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The Stopgap Midwife

By Hawa Talla and Lindsey Freeze

The Stopgap Midwife: that’s what her Senegalese colleagues affectionately started calling her for her willingness to work on all fronts. Like many health workers in Africa and other regions where human resources are scarce, 47-year-old midwife Céline Nataye Sow is spread thin, working beyond traditional boundaries to fill in gaps where she can. But here, as in other countries where health systems are strained, “stopgap” means much more than the phrase might conjure.

Céline, manages the Sampathe Health Post, in Thiès, Senegal (50 miles from Dakar), which serves 16,100 people. One of only a few midwives in Senegal working as a health post manager, she usually sees 40 to 45 clients per day, while serving as a constant mentor to a busy staff of 19. And under Céline’s leadership, the post has undergone major renovations and reduced waiting times. The health post now receives twice as many clients as it did before she came in 2008.

Céline lives with her 11-year-old daughter, Mamina, the youngest of her three children, in an apartment above the Sampathe pharmacy. It is about 100 miles away from her husband who is a nurse at the Kaolack Regional Hospital, southeast of Thiès. He visits every two weeks. This living situation is not uncommon for health workers – in Senegal and elsewhere. Here’s the story of one day in Céline’s life.

6 am Céline’s day starts, like that of many mothers, rising to help her daughter get ready for school. She heats water for Mamina’s shower before school and makes snacks.
 
6:45 am Prayer beads in hand, Céline walks her daughter to catch the bus every morning, about a hundred feet away from the house. She worries about Mamina’s safety on the road. Although road safety in Senegal has dramatically improved in the last decade, Africa still has the highest traffic fatality rate in the world.

6:55 am Before returning to her apartment above the health post, she checks on the matron and midwifery intern in the main ward. To ease staffing shortages – a strain throughout the region – Céline relies on interns from private training institutions. On average, she mentors about 30 each year.

Almost one-quarter of the people who live in the Sampathe Post’s four-to-seven-mile vicinity are women ages 15 to 49, who will likely need a range of reproductive health services during child-bearing years from family planning, HIV- and STD-testing, to antenatal and newborn care.

7:00 am Céline goes back to her apartment to enjoy a cup of coffee and get ready for her day. Putting on make-up, she pays close attention to the noises below – chairs moving, doors opening, brooms falling, staff greeting each other – listening as the health post gets busier.

8:00 am Makes her way back downstairs to start her official work day.
 
8:15 am Rushing to the main ward, she is alerted by the cries of a child whose foot was run over by a car. Once the child is bandaged up, Céline urges the mother to return for a follow-up visit.

8:28 am Cleaning her desk, opening the registers, and gathering the supplies needed for morning consultations. The day quickens: Céline has 22 antenatal visits, 12 family planning clients, and four general consultations – all before lunchtime.

1:30 pm After 40 consultations, Céline passes an empty waiting room. Home for lunch, Mamina waits outside. Once upstairs, they sit at the table and watch TV; Mamina calls her father in Kaolack to let him know what she’s been up to…

3:10 pm Mid-afternoon, Céline goes to a computer class – for Excel – offered by the health committee. The classes help strengthen providers’ IT skills and improve their overall productivity. At the health post level, they generate resources which complement the funds used to pay for operating costs, including water, utilities, and stipends paid to community health workers.
 
4:15 pm  Céline attends another meeting, this time at the district health offices for a meeting on the health post’s partnership with training institutions.
 
From her mentor, Anna Ngom, Céline learns that a partner is about to allocate funds to buy new equipment for the Sampathe post – now, a spacious facility that includes a consultation room, waiting room, a delivery ward, another for critically injured patients, one devoted to postpartum patients, a pharmacy, a staff room and two observation rooms (one for women and one for men). In 2009, under Céline’s watch, the health committee renovated the health post in response to problems identified during an on-the-job training approach (called tutorat, introduced by IntraHealth through the USAID-funded bilateral project in Senegal).

5:30 pm – Thiès Regional Hospital – Céline trains future health workers in obstetrics, gynecology, and contraceptive technology. In collaboration with the hospital’s gynecologist, she facilitates participatory training sessions where students are encouraged to demonstrate individual leadership.

One third of low-income women in Senegal lack access to modern family planning, contributing to the country’s high maternal and newborn mortality rates. In Senegal, nearly 400 of every 100,000 pregnancies end in the mother’s death.

On the days she doesn’t teach, Céline helps community health workers from the health post organize special events that promote child health in nearby communities. They weigh children to monitor growth and nutritional status.

7:00 pm The day nears an end. Before going home, Céline goes back to the health post to see if any new patients have arrived and ensure that the nightshift is in place and everything is running smoothly in her absence.

7:40 pm At home. She helps Mamina with her homework. They talk about school. They cook and have dinner together. For Céline, it’s the best time of the day; she finally has time for her daughter and herself.

9:00 pm Céline’s day is finally over…unless something comes up at the health post during the night.

Hawa Talla is team lead, Health Partnership and Communication, IntraHealth International, Dakar. Lindsey Freeze is an external relations officer, IntraHealth International, Chapel Hill.