Name: Antonina Odema
Occupation: Midwife, Nurse, Public Health Expert
Age at interview: 60
Country of residence: Kenya
Languages spoken: English, Swahili, Dari
Advice to other women: "The sky is the limit. They should just not limit themselves from a midwife first off, you can do other things. You can go do psychiatry so that you're able to help women when they are in labour, they can go through a period of puerperal blues. If you like psychiatry, you can do that. If you like ICU nursing you can do that. So you're always doing something extra to improve on your care."
In a career spanning more than 35 years, Antonina has worked in midwifery, nursing, and public health in countries such as Kenya, Afghanistan, and South Sudan. Her expertise and dedication have seen mortality rates fall, and she has worked tirelessly to educate and equip a new generation of nurses and midwives with the skills needed to adequately assist local mothers. But now, I will let Antonina take over. So, welcome Antonina. Could you please introduce yourself and give us a rundown of your career today?
My name is Antonina Odema with a background of nursing, midwifery, and public health, and most recently I did an MS in Global Management at Manchester University, UK. For the first 20 years of my career I worked in Kenya in the Reproductive section of health, mainly maternities as in - charge of these institutions and in the community teaching health education, family planning, breastfeeding among other health training. And I've also held different chairs with those portfolios at one time as the National Breastfeeding Committee Chairperson. In early years breastfeeding was not well-taken by mothers. There was a very high mortality rate of babies due to diarrhoea and vomiting from bottle feeding contamination. Since the introduction of rooming, (this is the introduction of women staying in the same bed with their new born and abolition of baby cots and milk formula supply by companies to maternities and instead fixing the babies on the breast immediately after birth). Breast feeding was taken up by mothers after a lot of campaigns across Kenya which greatly reduced morbidity and mortality from diarrhoea and vomiting and the resultant malnutrition. Exclusive breastfeeding for the first six months is the best cure of neonatal morbidity and mortality for countries that are developing and have no infrastructure for clean water and sanitation for mothers immediately they have had their babies.
So, these are among the things that I have been doing apart from just working in different institutions. That was my passion; in family planning, in breastfeeding, health education, and more so training young midwives on how to monitor a mother before she gets her baby - during the antenatal and during labour using the partograph. After the delivery when I have one to one with the mother, on her hygiene, breastfeeding, Family spacing and how she's going to go back to the community, the kinds of foods that are going to make her not become anaemic and make her better. By better, I mean as the family backbone to be strong for her newborn and the rest of the family members and in so doing preserve the life of the newborn.
Domiciliary midwifery prepared me on how to deal with women in the community and community work that saw me take up humanitarian jobs in Kabul in Afghanistan, and in South Sudan, countries with the highest mortality rates in the world. In Afghanistan I worked at a tertiary hospital the highest level of a referral hospital in a country. This one was situated in Kabul and referred complicated cases from countryside. I was employed by an International Non – Governmental Organization to train civil servants employees of the government with limited Knowledge, Skills, and Attitude (KAS) of taking care of the women, especially the ones with complication in delivery. So, I was specifically employed to teach them theory in class, but most of the time in practical. All this was achieved by the use of the partograph which is the newest method adopted by WHO (World Health Organisation) standards of taking care of a mother without missing any of the important parameters. So that in case, during labour, she gets any complication, with one glance at that one paper, you are able to advise either the doctor or the person next to you that this mother has complicated and she needs either caesarean section or she needs another further level of management.
So, I was able to use and emphasized on the partograph. It was already there, by the way, but most people don't even know about it, but it is the best items to use when teaching labour management. The hospital reduced the mortality rates in Afghanistan from being the first to the third, so that was a big achievement in Kabul. But later on, I was again called by the same international organisation to South Sudan. South Sudan has as we speak, still has the highest (mortality rate), with civil wars, conflicts and cattle rustlers. So the mothers are dying in the forests, they are dying in the hospital, they're yeah ... So, I managed to introduce an additional school in the western part of the country, which was an Arabic colony. I had an English curriculum, and these girls spoke Arabic, but somehow between us, we managed to do the curriculum and these girls sat for the exam and actually passed.
They were very determined. So, that was my first bunch of midwives - there were 24 of them. To me, it was a great number because we went to look for them and worked on their English, maths and science. They were not all girls. At first, the majority were girls. The training for enrolled midwifes normally takes two and half years but I had to take more than three and a half years because the curriculum was in English and girls spoke only Arabic, with Arabic pattern of education. I looked for the army people from the Kenya Defence Force. I requested their commander for English teachers among the platoon. The commander permitted three teachers who taught English grammar, comprehension and literature. They also gave a math and public health trainer.
So, we started off with classes first like in secondary school as the girls never went beyond tenth grade. And when they did tenth grade, none of them wanted to do any math or sciences. The volunteer trainers taught the students sciences, English, and math to enable them to calculate drug and intravenous dosages for patients/women. The basic fundamentals of nursing were essential before midwifery training and this was a tall order.
We finished training this first group after three and a half years, but within that time I had lost six teenage girls to pregnancy. As they received allowances during training they improved in looks and dressing and looked nice, they could speak a bit of English and therefore all the motorcycle guys were all surrounding my school - and in the process (we) lost six female students to pregnancy. I asked the county governor to make it a boarding school. Otherwise, I wasn't going to have any girls left to train. I also asked the funders if I could keep the pregnant girls. After all, the training was about pregnancy and all about babies and if (they) discontinued it would be a waste of funding and time. So, I had them in and out, having their own babies and coming back again. I am proud about them because they eventually became midwives with nursing skills too.
Due to early marriages for girls in an Arabic colony, I enrolled boys for safety of maintaining a class forum and they proved to be very good midwives, very good indeed. The insignificant setback for the male students was that they called themselves doctors when they are on maternity floor. I didn't mind what they called themselves in that country that is full of war; I just wanted them to go to the most extreme parts of the country and save those women in the bush. Most of the students are in the community as I constantly communicate with them on messenger and Facebook.
Then luck was on my side. I even got a few of the policemen from the bush coming in to enrol. So, when they went back to the bush, they had the knowledge, skills and better attitude to take care of the women in the community and in the bushes. These are the achievements from 2007 when I entered the Humanitarian sector until 2016 when I completed the same in South Sudan. Then, I came back to Kenya.
I had a lot of experiences in Kenya as (I was) in charge of midwifery schools in Nyeri and Kisii, and in between in charge of the maternity centres in the same localities. I also belonged to the Nurses Association of Kenya as a Secretary and the Midwife Association. Yeah. It has been fun administratively and also dealing with the community.
You've had an extensive career, and you're obviously a truly amazing woman. As you said, a lot of the countries you're working in are experiencing political problems and war zones. So, obviously there's a lack of safety for the women on the ground. Have you ever experienced any concerns for your own safety while being in these places?
It didn't occur to me. I think I was a little bit naive. All I was thinking about is just midwifery and how to impact it. I had a lot of students; students in their internship, doctors on the internship when I'm teaching midwifery in Kabul, Afghanistan. It didn't occur to me that the places will be dangerous. And true to the fact I accidentally left the Nairobi airport with no visa and arrived in Kabul without one and the head at the airport just confiscated my passport. When I asked my colleagues in Kabul team why these people had taken my passport, they rushed back to talk to the official and we couldn't communicate. He was talking in Dari, a native language for Afghanistan. I was talking in English. Then, I was told, "Nina, you have come up to Kabul, and you don't have a visa for entry." But that official said, "Buru, buru, buru, (the word buru means go, go) she's going to Rabia Bakhi Women’s Hospital to take care of our women. Just let her go in. But, you as the organisation have to come and negotiate to sort out this passport of hers."
And of course, there were a lot of kicks backs, a lot of monies exchanging hands. So, either way, they still had to give the money anyway. So, they had to pay for that visa. I didn't mind, but the official was wearing like ten stones on his shoulders, and he was so big. He even offered me a cup of tea. It was greenish, and I was not sure what he was drinking. There was hardly any airport, but I arrived. (Now as we speak there is a modern airport in Kabul) I was very inappropriately dressed. I thought my skirt was long, just to see everybody; their skirts were on the floor. They had these big things on their head. I had like a small scarf, like a handkerchief over my head. And they didn't bother me or ask me what I'm dressed or why, everybody stared at me curiously. They reminded me several times just go to Rabia Bakhi. So, they were translating to me. The superintendent is saying, "Just make sure you get into Rabia Bakhi and deliver those women properly. That's all. You know, you'd expect in a country like that to get into a lot of trouble. No. So, even in South Sudan when in 2014 when there was a big war outbreak I was able to travel back to Wau midwifery school in time for opening day and was able to commence studies regardless of the civil war.
I just boarded a plane and came back just to reach Juba (the capital of South Sudan). There were no planes in the airport. There I was standing wanting to go to Western Bahr el Ghazal, the Wau area. Then, a commander comes along and says, for World Food Programme, "How are you, madam, you want us to take you where? Huh? You want us to take you where? Well, get in. Get in. There's nobody here, so you might as well go." So, there's a UN field there, so he was saying, "Ah, we will go and stay in the UN a bit. We'll drop you." Yeah, so he even took a direct route ... because you're supposed to pass through other stops, but we went directly to Wau, and they took me to the Wau airport.
The security in those countries is not very bad as portrayed. I mean, when it comes down to it, you're a midwife, a nurse, or a doctor, you're good for them. They need you. Yeah, and if anything and they ask you to help them and you don't, then they just shoot you. There's a colleague who was a national staff from South Sudan. So, when there was shooting between the army and the civilians, they came for him to go and stitch the rebels. He refused, so they just killed him.
Oh, my goodness. That's a lot of pressure to work under. Can I ask how many languages do you speak, Nina? I mean, you're working in different countries…
Yes. I speak English and Swahili. I learnt a bit of Dari. Then, I had to learn some few words in Arabic. But, what I used (to do) is to pick one of the best students who can understand English properly, train them and they become my translator.
Ah. Good choice.
Yeah. I had to get a doctor and a midwife called Meela in Kabul. She knew a bit of English. She called me, "Nina Jan, teach me English." I would teach her day and night. There was no way out, I had to teach Mila. So, Mila picked up my English very quickly. They're all like sponges. They pick up (information). And I knew I will not be able to do anything with the older civil servants. They were hundreds of them. I divided them into four groups. I taught them over a period of a year. But, somebody had to speak English to me and translate to the students, and she did a very good job. Since the organization left, they have never gotten another trainer. Meela is carrying on. If there's any resource material she needs, I still send her by email. We chat. We are on messenger, and that's good because she can now speak English. And we make sure that we exposed her (to more training and opportunities). She went to Switzerland for midwifery seminars and classes. She became the senior trainer, and I am excited about it. Now, my students are online. We chat with the Arabic girls, and they chat in English. They say, "Teacher, how are you?" And I'm like, "Really, this is not happening."
But, they are very good. These children (the students), most of them are young. They are just from school. They really wanted to learn English… and that’s why almost the whole class got pregnant because the men were all over - they wanted to get the girls who can speak English.
After they delivered their babies, they still came back, but the beauty of it all is that they were so willing to learn. They knew the anatomy of the brain more than me. The students were able to read medical words, they are read like in Swahili. You read what's written and the same applies to Arabic. So when it comes to Anatomy of the uterus (how the uterus is made), and the mechanism of labour, (how the baby comes out and how the baby moves through the delivery tract). They were so good at cramming those things assisted by dolls and artificial pelvis. Students stood in front of the class and were able to demonstrate mechanism of labour. One such visitor was a minister for health who was a doctor and he said, "This is remarkable." People said there is nothing that can be done for Wau as an Arabic pattern of Education County. It is truly an Arabic County that was forgotten.
Many Counties in South Sudan opened schools, these were in Yambio, Yei and Juba, but could not open schools in Arabic speaking counties like Wau. Instead said, "Who's going to struggle with this Arabic ways, they don't even go to school” When the minister came to open the Wau midwifery school he was expecting Arabic presentations. But everything, their presentation, poems even when they later on went to do their presentation nationally in Juba, it was done in English. We even had to buy them air tickets from Wau to join the rest of the country in Juba for the national presentations. The founders of the midwifery schools in South Sudan were impressed by the level of the student’s education. They were so articulate. They said, if there is anything that you have done, is to teach midwifery in English in a purely, purely Arabic speaking county completely.
And what about yourself? When did you learn English yourself? You've taught many, many people how to speak English. Did you learn to speak English at a very young age?
Yes. I was brought up speaking English. My dad was working for the Railway Training Institute. My mother taught in a kindergarten and she stopped teaching the moment she had 12 of us as babies. As young as I can remember, I can't speak my mother tongue fluently. My mother comes from the border of Uganda, the side of Uganda. My dad is a Kenyan but from the border. And we all spoke English. When we were growing up, we stayed in Mombasa for a long time. I speak very fluent Kiswahili (Swahili). I spoke English from a very young age and then I also went to good schools.
So you're obviously a very good leader and educator of these women and men that you've managed. Do you enjoy that role of teaching the people that are coming up and trying to learn?
I do love it. As I sit there and I see the students, I see the different schools opening up in South Sudan. I keep on saying, "God, just make me well. Just make me get well soon”. I have been unwell for a full year but now am well to start humanitarian work again. The humanitarian world called me last week, they called me to go and teach somewhere on the border, a little bit risky, the Taliban area. I see today there a quite a bit of bombing. They were thinking I could reinvent the wheel on the teaching of the midwifery, because they're still having very high mortality, but this time it's on the Pakistan side.
Pakistan is still having their moments. There are incidents of kidnappings of medical workers especially midwives and medical staff for ransom. While we had fewer incidents of such acts in Afghanistan but they'll want to spare the ones that are bringing in knowledge. Afghanis love books; they steal books if one left books lying around. They steal notes. The doctors are always stealing the midwives notes, because they didn't have a foreigner trainer. They would eavesdrop at the windows to listen, “what is Nina teaching?” And then during lunchtime the trainer for the doctor will want me to teach her/him important things but small procedures like vaginal examination, we would lock ourselves in the private classroom and taught them how to insert an implant as family planning is forbidden in the Islamic world. The only way is to quietly and secretly teach the trainers how to do a tubal ligation (tying of the female tubes as a means of permanent sterilization). The Muslim girls do get pregnant and are sometimes killed by their brothers. This is called honour killing in the family. I love teaching that makes a difference and improve the value of life.
I enjoyed every moment when they asked me, can we do this, how is this done, and so on. The doctors don't have a pathology lab. They only go by the exercise books and by the other experienced senior doctors. They still need a lot of instruction on practical hands on skills. The surgical skills were in dire need and they loved practising these anytime there was an opportunity.
Oh gosh. The women that you treat, do the conditions and treatment that they face ... Is it different in each country or is it unique? Is the way women give birth different in each country?
It's more or less the same because what happens is that the mother-in-law is the one who escorts the daughter in law when in labour to the hospital. She is the one who gives instruction whether they should go and have the baby in hospital or not. But the husbands are caring in their own ways too. In Kabul, the mother-in-law has to come with you, the setup is made in such a way that the mother-in-law has a place to sleep where you go into the maternity and the husband waits outside. The setup is in such way that it offers shelter for those people who have to travel very far from the mountainous area. The decision lies with the mother – in law as to the type of delivery. They don’t favour Caesarean - sections, this makes mother in laws to favour home deliveries with Traditional Birth Attendants (TBAs) whom they trust more than the hospital workers.
The setup is a little bit different in South Sudan where a mother goes on foot for very many hours alone looking for a maternity (clinic) to deliver her baby. So the mothers who are coming out from the rural areas are really in trouble when it comes to having babies. Their mother-in-laws will act as Traditional Birth Attendants (TBAs). Traditional Birth Attendants are untrained trusted women in the community who assist women in labour. This is something we tried to remove from Afghanistan. These women are still important in the community though. Most governments’ medical workers use them after training them as referral agents to hospitals and on how to recognise Obstetric and Midwifery Emergencies and on how and when to refer.
In Kabul we worked with the Traditional Birth Attendants (TBAs) and for every patient they brought in the hospital, some tokens were given to them as incentives. In South Sudan, women walked for three to five days trying to reach a medical facility. There is one we met on the road from Raja to Wau. This was on a very lonely road, she was almost unconscious by the time she arrived in a private missionary hospital in Wau. She had taken 5 days walking. It took her exactly two weeks to get better. The women are strong and resilient. She still got better and went home. It was amazing that this particular woman made it. The setup for women in South Sudan need to be improved. But if these women reach hospital in time they get good assistance. Afghan are mindful of their pregnant women and the mother-in-law can assist in escorting her daughter to the hospital, but she can also decide to tell her that she delivered all her favourite sons in the house so she (daughter-in- law) can do the same… but by the time I left we had spread the word that made big news, on antenatal care and breastfeeding including baby care and immunization.
On family planning, most women did these in privacy and were scared of the complications of bleeding. Though the best option was Depo- Provera (a contraceptive injection for women), and implants because they do have complications. So the few that come for services used the excuse of coming to the market, then pass through the maternity downstairs where the injections were kept. Most of them did well but a few started bleeding. When they started bleeding that's where the problem began bleeding for close to three months continuously. Now the husband and the woman arrived and the first question was “what did you do to my wife?” For us, we had to move away from secret Depo Provera injections, we moved onto teaching them about exclusive breastfeeding. And to them they believe that breast milk, especially the first three days colostrum was puss and the same thing for the Africans breast feeding women in South Sudan. You can't believe it! This prompted training women on the components of breast milk and the importance of Colostrum. Breastfeeding is a method of family planning and also helps the mothers not to bleed after delivery, (prevention of postpartum haemorrhage). So that by the time they have the next baby they are stronger and are able to go through subsequent pregnancies well.
And what about the babies themselves, nutrition wise. What happens in a case where a mother can't breastfeed? How do they feed their children? Is formula readily available?
If a woman cannot breastfeed, we teach her how to use the formula or how to dilute the full strength milk from a cow to a ratio a new born can digest. If the woman can afford, they can feed their baby on formula. The women may get sick like raised blood pressure at birth commonly known as pre -eclampsia. Then we’ll advise the mother to use a formula for the baby and then teach her how to mix the formula. What usually happens to women who are financially constrained is that they will take one spoon and put it in a full bottle of water and do that for months to sustain an illusion of feeding the baby on formula milk. So the baby ends up with severe malnutrition, commonly known as Marasmus and Kwashiorkor. After the first and the second months the baby's all dry up with red hair. The traditional Dinkas cows are local breeds that do not have enough milk to sustain long time feeding of newborns therefore we encourage mothers to breast feed as much as possible.
The education is centred on the diet of the breast feeding woman’s diet. We encourage plenty of fluids in the form of millet porridge and special native vegetables that provide iron and induce production of breast milk. After six months the baby is weaned on cow’s milk mixed with finger millet flour. This is nice food porridge for the baby with a bit of sugar. It has got Vitamin B12. It keeps the baby healthy and avoids growth retardation and malnutrition because most women can't afford milk anyway. That's where we concentrate on, mother drinks a lot of porridge and eats plenty of native iron packed vegetables gotten locally. The combination gives a good flow and supply of breast milk. A particular vegetable “tsisaka” triggers the pituitary gland to produce lots of milk. Most mothers in Kisii on discharge from hospital go back home and make sure they eat “tsisaka”, and “managu” Most women are aware but we emphasize this for new mothers. Even these mother who are coming from specific areas, we try and find out from them what they like eating. Look for an old lady - she'll always tell you what they used to do for a mother that does not have milk. Because there's no milk, there are no cows in those war torn areas and most of them cannot afford formula. In Afghanistan there are children with red hair and a lot of sick children. There are a lot of orphans; their fathers died from blasts and perpetual wars. There is a very big population of malnourished and abandoned babies.
What happens to those abandoned babies? I imagine there would be places for them to go?
There is apathy and poverty with street children. Widows work in expatriates homes. Especially the baby girl is abused. The abused girls are on the streets begging for food. The mothers and their children are on the streets begging too. There are a lot of orphans.
How do you cope with that? You obviously work in a very stressful job. You've seen some very stressful events, I imagine.
It never occurred to me to be a stressful condition because one moment with the students in class laughing and making hilarious mistakes and learning about, the anatomy of the vagina, uterus and breasts, so one is always laughing when they say something wrong. So it's like some relief. When with the students showing them something in maternity.... It is very refreshing being with students. Time flies by - it's only when they defy instructions and they do something drastic and you actually lose a woman’s life... then you feel like you want to kill one of them ... those a tough learning moments......
Here is an example of a labour room scenario whereby a mother who had had 10 deliveries arrives in labour room with her baby’s head hanging out... When you look at them all you say “don't pull in that manner, the head is almost out but you had ten children, just get a doctor” and they'll open up and say, "Oh, because now the head is hanging out”. You know? Those kind of arguments and then somebody pulls and then actually the uterus, actually tears..., you can actually hear it giving way... and she's bleeding and you don't have blood ready, you're not expecting something like that. So this had some stressful moments, but when you go and you discuss with your colleagues, you kind of, yeah, we grew from it. After every ten weeks (we leave) – it used to be 12 weeks, they were reduced to ten weeks. There are times when you do really need to get out of there for breaks at home.
I can imagine. For yourself, as a woman working in this career for a long time. Have you seen improvements to opportunities available to women working in your field?
There are improvements, there are people getting promoted, but not as many as expected after working for this long. If anything now they are looking for us, the older ones. I think, yeah, there are improvements in midwifery, and they are bringing in more machines, better sterilization and equipments in the maternity units. There should be more attention and Focus paid in Ante natal Care and bring on board the pregnant women as partners. People are assuming if you are a nurse and you are in labour you cannot die this way we are losing a lot of nurses and doctors women of profession in labour.
There is something that I cannot really put my finger on, but medical personnel, the midwives are more negligent. I don't know. They just want the baby to drop out, but that doesn't work like that. The baby has to come and you have to be monitored, e.g. that foetal heart has to be listened to half hourly, you really have to take care of the woman till she gets a normal baby. But they'll do anything else, they'll be on their chat, they'll be on their phones, they'll be somewhere else other than where that woman is. And when the woman is calling, regardless of where she's travelled from, she's in labour, she all over the floor. You should rush there and actually find out, why is she calling, why is her voice high pitched. In Kenya, we have incidences with people with mobiles now where relatives take pictures. They have taken pictures of their relatives delivering on the floor when the midwives aren't paying attention. And people have been sued in court.
Midwives have gotten into a lot of trouble because now relatives of the women have evidence on camera. There are midwives not really being diligent at work. Midwives diagnosed positions and presentations of babies and were able to determine if a baby was going to be born normally. Now our midwife can't tell you much about the history of a woman’s labour. But, with woman - the word midwife means “with woman” - that being with woman, you mean the midwife is with the mother and we want a beautiful baby and see a baby crying and the mother’s happiness on the face. That's enough to remove all ones stresses. When one understands, when one sees a mother with ten children survive complicated labour. When the baby comes out and the mother is happy, and they are both alive and you're quickly running a blood drip replacing her blood loss, already you feel like you've done a million jobs.
That must be so rewarding for you. What about your relationship with the doctors that you work with? Do the doctors treat the nurses well and vice versa?
It's the midwives who are adamant sometimes because they feel they know it all. And then at first there was some rivalry in between. Present situation has improved. The midwives feel it's their area, and then the doctors are the other guys, they don't talk much but save lives.., But, what I know for sure the midwives always like the doctor, and the doctor because they are young, they're new, they'll always be very appreciative of the midwife.
Sometimes the midwives are so good, once you've called for a foetal distress she'll not go back to the ward she'll just run to the room change into scrubs and wait for the baby to be removed. That's how good the midwives are. And that's when they're having a very good relationship, but when they are not rubbing well with each other, ah, they will be comments like “let her come and diagnose herself”. If you get a doctor who is low enough to work with the midwife, they work very well. If they get one that's very high handed and look down at the midwife, they're going to give the doctor a hard time.
Moving on just a little, how many children do you have yourself and how have you balanced this work away from home and having a family?
I have four children. Victor is a doctor, doctor pharmacist. Angie is a doctor pharmacist. Brian is a Plant Engineer. Shirley is a medical doctor who has just finished her internship and residency.
Wow. Very high achieving.
Yeah. They were schooling as I was also schooling. They were working as I was also working. Their father being a quadriplegic in 1999 before they left school. So had to learn quickly to work and support him. He's almost like 71 years or so. And then the children also had to go to school, they had to go to college. Of course, my husband minded a lot, he said, "Now you are going to Kabul, they will kill you there. They will kill you there. I'm quadriplegic here. What will be left of the children?" I said, "No God can't allow that to happen. I'll come back." And I did come back. I managed to balance it well with God’s Grace. He is well and Hemiplegic now and able to get about and do his chorus. We are all blessed.
Obviously, your children have followed in your footsteps in their taking on the medical field by the sounds of it.
Yeah. Yeah. My husband was a teacher in one of the biggest schools in the country. He was a teacher for Mathematics and Geography. Nobody followed him, but I'm sure if they grow they might want to teach in their profession.
Absolutely. What about for you? What do you enjoy most about your job?
What I enjoy most is when I see improvement and value for women and children’s lives. When I see Afghanistan now as a normal country like the fifth, sixth, they are no longer the first ones on the Global map leading in Maternal and Neonatal mortality. I can’t see Afghanistan advertise a job for a midwife or a nurse now. I am very happy to see Afghanistan has Midwifery and a Nurses Association. I enjoy seeing my students online boasting how they are in different counties, how different agencies have employed them because they are the only qualified midwives... By the time I left Wau and went to Kajo Keji, Central Equatorial, and South Sudan to manage yet another diploma school, where I graduated about a hundred students. And now in South Sudan they can only employ qualified staff nurses and midwives. So this is great. I enjoy seeing a country adapting to something more for qualified midwives and saving lives.
I got talking with the Minister of Health when he came to Wau, and I explained to him that South Sudan can register with another country, like Canada. There are strong midwives there. The Canadian Midwives Association can work together to bring harmony and strengthen the existing midwifery association in South Sudan. The Canadian midwife can go to South Sudan and spearhead this midwifery section. I look back and I feel so proud. I keep on saying, wow; I was able to do this!
When in Nyeri I was able to nurse a one kilogram preterm baby without an incubator, til she went home at 2.5kg, and I was like, oh, Nina you can do this! It makes me happy, I enjoy the satisfaction I get out of my career and the community work as a whole. When I look back, there are colleagues that I closely interacted with from Kabul; I managed to recommend a senior midwife, Pashtoon. She's now sitting in Amsterdam. She is one of the senior midwives, International Federation of Midwives team member. So when I talk about Pashtoon, I gush at my kids and say “look! Look!”, you know you feel good that you're able to mentor somebody to that level. So when they requested me for a recommendation, I was able to tell them how much Pashtoon was able to do. The good thing about Pashtoon was that she spoke English. She was also in charge of the Midwifery Association of Afghanistan. I said “let's go see the minister, let them understand what midwifery is”. Let's have a bill in parliament; I can be able to draft for you, some policy for you on midwifery... sky was the limit
I feel so proud when I see there are some footprints left behind and I can mention them to people who are well placed that we worked together from zero to what they are now. After the six years in Afghanistan, I was able to leave an established country with midwifery. They don't know much about nursing, they think nursing is inferior, but I always tell them that without nursing you cannot be a very good midwife. If the patient (woman) gets sick you should be able to nurture her back to life. If a woman gets very high blood pressure they get what is called preeclampsia, she comes to you and she's been beaten up by the Mular,(Muslim priest), as they believe fits are caused by demons, or Pre-Eclampsia are demons and therefore women are first taken to the Mular before being brought to the hospital (usually the Mular beats the stomach to remove the demons). The midwives are supposed to resuscitate her get her to an ICU even if the baby's dead. But at least give back the mother’s life. These are the kind of milestones that makes me proud. Pashtoon can say “Nina was here!”. When I go to South Sudan in Wau many qualified midwives can say “Nina was here”, she brought us a curriculum for the enrolled midwives, she also worked on the curriculum for the diploma midwives, and now we have 124 midwives just from the two classes she taught”. Now you leave others to continue, you leave documents where other colleagues can come and continue the work that you started.
Wow. You are certainly an accomplished woman. You have so much to be proud of, and I like that you're leaving as you said, a footprint behind so other people can follow, which just sounds incredible. Off the back of that, I was also wondering ... Obviously, to be a leader and having worked in the role for as long as you have, you have to be confident. I was wondering how you encourage confidence in yourself?
Doing your work well gets one confidence. It's possible to believe in yourself and whatever you want to do you must have that knowledge. That knowledge, skills, and proper attitude then you'll be confident. To have that confidence you must have it made. I just made sure that I was the best nurse, I was the best midwife. If I want to do something, you do it properly and you do it lovingly - like if you're taking care of that patient just love them as you take care of them as you may love yourself and this positive feeling gives you confidence. The moment you are taking care of that woman in labour and you know that you are using the partograph, you can't go wrong and if there is a problem it will be detected. You are very confident, you know, because you have the knowledge, you have the skill, and then you're doing it to the right attitude. That confidence is overwhelming, but come to think about myself I think I was a little over confident. You have to adjust sometimes. I always feel I have to do things properly. I kept on imagining that I can't fail, I can't fail as a nurse; maybe in something else…
The other day I was doing my MSc in global management, I was almost like what did I get myself into? But, if you give me anything in midwifery, nursing, I always come out shining, because after all of what I know about labour management is good. Of just knowing what it's supposed to be when it's supposed to be, quick movements, very assured, and then good communication skills with the people around you and if their soft skills are right and there's a flow with the people you're working with those who make you confide. There should be no friction. Those friends should have good communication and they should like you. This way they also boost your confidence. If you're with the people whom you feel comfortable with, they also help in your confidence, they always tell you, "Oh, Nina, you are doing the right thing." The right comments from the right friends carry the day.
What would be your advice be to other women who are hoping to follow a similar path? What would you say to them?
The sky is the limit. They should just not limit themselves from a midwife first off, you can do other things, you can go do psychiatry so that you're able to help women when they are in labour, they can go through a period of puerperal blues. If you like psychiatry, you can do that. If you like ICU nursing you can do that ... So you're always doing something extra to improve on your care. Yeah. And the other people when you do nothing and just sit and wait that's the end of the world, they should be able to get out and do more courses. They can even go do oncology, like now I was thinking about it today. I wish I did it because oncology….but lots of training I've done mental health, I've done ICU I've done public health. So it was like I was always doing something, I can be confident in every field when I start giving health education, I'm good. I can talk about nutrition, types of food; work on management, clean hands.
And then when I get into midwifery I'm able to tell you all types of complications, bleeding, how they are managed. So you're always confident because the skin fits you well. Whatever you go you have that knowledge. What I'm going to tell the nurses they shouldn't just get a diploma, they should go back do a degree, do a master, and then balance it well with the family. The family also respect them for it, and then the children will also want to compete with their mother. It's like a nice roller coaster. But you should also want to do something.
I should asked this at the beginning, but have you always wanted to be a midwife?
I wanted to be a nurse. And then I went to paediatric nursing at Gertrude's Gardens, the biggest children's hospital in Kenya. But after that, I'm always doing something, I finished nursing and immediately went to try midwifery because it all has to tie up together. A nurse should also know how to be their mother, it's not like you people abroad can just be a nurse, can just be a practitioner, practitioner only. But in Africa the hospital always got in pregnant mothers so if you're a nurse and you can't deliver, you are useless. Yeah. So I went to do my midwifery quickly after nursing and I found what am I doing in nursing? This is the real place to be in, I want to be a midwife. I thought then in midwifery, but when the nights became so long and many I was like okay, let me try public health and get out of here. This little boat is going to make me have grey hair very early. And then I wanted to do management, I wanted to be in charge of districts, I could see people in nice blue uniforms with lace. “Okay”, I said to myself, “I want to be a public health nurse”. I got a sabbatical leave from the maternity when I was in Kisii back to Nairobi and did my midwifery. It was very exciting. I did my public health in Nairobi.
When I came back, I wasn't so much excited about the public health, but it got me out of maternity. I was able to go to the district rather boring, to go and inspect butchers and not thank, it was not my thing, but I had good knowledge on how to work with the community and research. And now I'm back. I went back to research. I did HIV research, managed to collect almost 11 orphans in the house because people died, they want to kill the orphans then I will adopt them. And then I was like, oh, Nina, what have you gotten yourself into. But they'll all big and grown. The only remaining two left babies. Otherwise, everybody grew up and left and they're all well except we lost a girl, she took to drinking was not taking the antiviral, she eventually died in July 2016 just the other month. All is well.
That's very sad. But so many success stories though.
Yeah. I look at my life and I'm so happy to have lived such a busy life. But I was telling God, you should spare me I should not die now because I still feel young. I should do something more for a year or so before I settle down.
Absolutely. Is that your plan once you're given the all clear? Are you going to go back to work?
Yes. I would like to go back to work. They have quite unfinished affairs that I started, and I feel I'm strong and I feel I'm healed. And then I'm just going home to rest for 3 months and come for a check-up. Come to some more weddings in Nairobi then go back to Nakuru again. As I wait for my next mission.
You are amazing! It's been so inspirational to talk to you. Thank you so much, Nina.