Working in lockdown

July 14, 2020
PHOTO: Smiley N. Pool

Apart from my sadness of leaving my home, I was devastated to be leaving my work at Area 25 just a few weeks before the proposed opening of the new Labour Ward. Amid all my preparation work, unable to complete the task I had started over a year ago, the conflict was overwhelming. I had invested so much time, energy, ideas, thoughts, love and dreams. I could not distance myself from the work, despite being distanced from the facility. I could not desert my midwives, despite deserting the country. I could not abandon the women and babies, and so I made a plan. Working from home as a midwife is likely not the easiest, but I could continue to support the work, the Baylor Team, the facility and the midwives.

Living in quarantine, or lockdown, requires attitudes and skills special to each individual’s personality and circumstances. Working under these conditions as a midwife seems near impossible. The daily hands-on interaction with women and babies, the caring, supporting, encouraging, assisting, problem solving and emergency response cannot be achieved in the virtual world but that is only part of my work at Area 25.

I decided to refer once more to my initial job description and realistically adapt my services to the unprecedented situation I found myself in.

Impact through leadership and consultancy.

Impact through service development and evaluation.

Impact through education, training and development.

Impact through expert practice.

Over the past year, we have looked closely at all aspects of communication. I have actively encouraged this with presentations and practical teaching sessions, introducing tools to support and facilitate this. The use of WhatsApp chats has increased greatly to the extent that every department has their own team group. Leaders groups have been set up and I am part of these. This gives me direct access to the daily activities and concerns of each department. I have therefore been in close and continual contact with the midwives both on text and video calls. I have made myself available to guide, support and maintain close involvement in all aspects of our work at Area 25 throughout my absence. I was able to initiate, prepare and lead Team Leaders meetings as if physically present. To avoid personal cost to the midwives, I organized airtime for internet data be made available.

The final stages of construction and details of decorations, fixtures and fittings are an important part in any construction project. I have continued to take part in this process for the expansion of the Labour Ward and have been able to maintain the contacts to enthusiastically share my ideas, guidance and support whenever required.

Due to the unique nature of the new ward, which provides individual birthing spaces for women, it is important that staff, women and family are well orientated in their roles and expectations. I had already been facilitating this prior to my departure. During my time away I have been in contact with selected midwives to assure that this work continued. The midwives have responded well and are carrying this out daily. We have discussed the content of the information given and the importance of women being familiar with the surroundings where they will birth. Together with the new ANC in-charge and the new matron, we are looking at incorporating unit visits into the antenatal care program.

During my frequent communication with the team leaders and in-charges about the actual setting up and day-to-day running of the ward, we discovered that the purchase of plastic trays to store consumables, hooks for hanging gowns, waste buckets that are labelled, signs on doors, extra BP machines, more fetoscopes, a call system and other small items would make a big difference. My contacts with carpenters, tailors, local shops and the prolific use of WhatsApp has allowed me to plan, organise and follow through these tasks. I have found this extremely rewarding as well as maintaining contact with my friends at home in Lilongwe. My tailor is now replacing the old, rather smelly delivery bed mattresses. We may not be able to afford new beds, but we can supply new mattresses!

As I contemplated ways of continuing to share my knowledge and skills with the midwives, I once more discovered the effectiveness of our group chats. I had already sent some basic PowerPoint presentations to the in-charges, to assist them in their on the ward teaching, and decided to create short ‘flash cards’ with relevant topics and guidelines - I am posting these daily and they have been very well received.

Not forgetting my own personal CPD, I am following the Nurses and Midwives Council of Malawi mandatory requirements for re-registration, which includes an online app. I have been able to complete five relevant topics to obtain certificates.

I am an active, enthusiastic, motivated, passionate ‘hands-on’ midwife, therefore being away from Area 25 and my home in Malawi is not easy. I have sought interesting and innovative ways of continuing my work and this has kept my life in lock down satisfying and productive.

My reasons to leave Malawi 4 weeks ago was to sort out my health issues and I have achieved exactly what I planned regarding this issue. I have proactively managed to turn the, often slow, wheels of the system through NHS and private health care to my advantage. After consulting with the local doctor who carried out a series of tests, I was referred to a Respiratory Medicine Specialist and had further investigations including x rays and a CT scan. All tests showed to be within normal limits. I commenced on treatment and after 10 days, the improvement is noticeable.

I am now actively looking at ways to return to my home in Lilongwe and my job at Area 25.

Through all this I have remained positive and motivated with much encouragement from my family and friends and hugely importantly from my Baylor colleagues and my Malawian midwives.

One of my many texts from the midwives over the past month that served to make me realize that, despite this unprecedented situation I find myself in, it has all been worthwhile.

“Waaooo, Rachel you’re doing a great job. You make me love my job more and more.”

To learn more about the new labor and maternity ward in Malawi, click here.

Post by:

Rachel Macleod, Midwife Educator at Area 25 Health Centre in Malawi