Hebamme - Afghanistan

The international Midwife is responsible for the autonomous management of all midwifery activity, and patient care in the delivery room and operating theatres.

BACKGROUND AND ORGANISATION OF WORK

The international Midwife coordinates, supervises and works alongside the local personnel (over 30 nurses and midwives). For specific clinical needs, she will work with the international or local Gynaecologist or Surgeon in operating theatres.
She is responsible to the Medical Coordinator, who is in charge of the management and organisation of the project.

The main areas of work are:

• OUT PATIENTS DEPARTMENT: treatment room and ultrasound room;
• WARDS: 61-bed ward;
• DELIVERY ROOM;
• OPERATING THEATRES: equipped to carry out the main obstetric and gynaecological emergency procedures.

The international Midwife is present in the hospital 6 days a week, with on-call duty in rotation with the other international colleagues. Working hours and on-call requirements may vary depending on the clinical needs and organisational set-up of the hospital. The staff management plan provides for two international Gynaecologists and two Midwives, alongside local Nurses, Midwives and Doctors. The international Midwife is, however, required to be available 24/7 in case of emergency.
Alongside the national personnel, she will conduct the daily ward round of patients in the labour room and maternity ward, while the Gynaecologist and/or Surgeon (national or international) will be present for the ward round of patients admitted for caesarean section or gynaecological interventions. She will supervise the national Head Nurse in the organisation of the local midwives’ and nurses’ rotation.

DUTIES AND REPONSIBILITIES

All EMERGENCY international staff is expected to know and follow the hospital admissions criteria, guide lines, protocols, and the diagnosis and treatment standards in use in the Centre, and to ensure the correct compilation of clinical records and statistics in both computer and paper formats.

The main duties and responsibilities of the international midwife are:

• management of obstetric and gynaecological patients in the emergency department and outpatients department (examination of pregnant women, obstetric-gynaecological ultrasound, family planning…);
• supervision of care during childbirth, in the delivery room and operating theatre;
• management and coordination of care in the labour room;
• management and coordination of care in the ward;
• assisting in clinical research and record keeping as required by the scientific programmes of the specialist sector of the Medical Division of EMERGENCY.

MANAGEMENT AND TRAINING OF LOCAL PERSONNEL

The international Midwife works with the Gynaecologist to provide on-the-job training in theory and practice to the national trainee medical colleagues, midwives and nurses. This is achieved through working alongside the national staff on a day-to-day basis, and constantly monitoring the level of clinical independence achieved. There is also provision for more specific teaching activities, managed by the international specialists, in accordance with the clinical protocols in use and as agreed with the Medical Coordinator.

CASELOAD AND EQUIPMENT

The technological level of the equipment available is suited to the clinical and managerial protocols in use, and the level of professional autonomy of the national staff, with the aim of achieving – and sustaining – high standards of care. Diagnostic equipment, basic laboratory tests, technical and auxiliary services are always available.

MATERNITY CENTRE – Anabah, Afghanistan

The Maternity Centre is the only facility in the region specialised in Obstetrics, Gynaecology and Neonatology. It is open 24 hours a day for emergencies, and 6 days a week for clinical services. The Centre is the referral point for a network of First Aid Posts (FAPs) and Health Centres operating an antenatal care programme.

In December 2016 we inaugurated the new Anabah Maternity Centre. The old centre, which opened in 2003, had become too small to cope with the increased number of births, which had risen to over 500 per month. The new centre has four delivery rooms, two operating theatres, a neonatal intensive care ward and step-down unit, an intensive care ward for women suffering birth complications, four clinics, a gynaecology ward, an obstetrics ward, a follow-up area and a labour area.

To make treatment more accessible, check-up and follow-up examinations are performed in the EMERGENCY FAPs and Health Centres in the Valley: in 2016, 609 women were referred in labour and 13,120 obstetric and gynaecological examinations were provided.

The midwives frequently face pathologies of a significantly different nature from those encountered in their professional experience: eclampsia, uterine rupture, placenta praevia (including undiagnosed grade IV), placental abruption, breech presentation, ante- and post-partum haemorrhage etc. This caseload is due to the sanitary conditions in which the population live, and the high number of pregnancies (multiparity).
The available equipment include: ultrasound with vaginal and abdominal probes; vacuum aspiration; Kiwi ventouse cup; Doppler foetal monitor.
The operating theatre is always available in case of emergency, and is equipped to carry out caesarean section, hysterectomy, curettage, and other obstetric-gynaecological procedures.