May 04, 2012


Elizabeth Ramlow, a midwife from Massachusetts, was seven months into a nine-month assignment with MSF in Luwingu, Zambia, when visa problems cut her time there short. Rather than returning home, however, she went to work in South Sudan’s Doro refugee camp in Maban, where an MSF emergency team had set up a clinic to care for tens of thousands of refugees fleeing conflict just over the border in Sudan.
I arrived in Zambia in April 2011 to work in the hospital in Luwingu, in Zambia’s Northern Province. I worked in Luwingu for seven months, delivering babies and helping to run a sexual and reproductive health project. At the end of December, when I was unable to renew my visa to stay in Zambia, I was faced with a choice. My family and I had agreed that I would be gone for nine months, so I didn’t really want to come home until that time was up. I thought it over, and decided to try to find another MSF project to work in for the last two months of my time abroad. 
From Zambia I went to France, where I spent some time practicing my French and searching for a new project. It took some time, but eventually a position opened up in MSF’s new clinic in the Doro refugee camp in South Sudan. 
Doro was a very different situation from the hospital in Zambia. Resources were scarce in Luwingu, but it was an active hospital. When I arrived there were physicians working there, and a pharmacy with a stock of medications. We put out an advertisement for midwives to work in our project and got a huge response; we were able to more or less pick and choose from a pool of skilled applicants. In contrast, Doro had no skilled medical care providers. Before MSF arrived, the closest doctor for the tens of thousands of refugees in the camp was a physician who had also come as a refugee from Ethiopia and set up a small surgery facility 40 minutes away in the town of Bunj. 
What Doro did have were traditional birth assistants (TBAs), refugee women who used traditional methods to help with births but who had no formal training as midwives. Together with Carolina, an MSF midwife from Kenya, I worked to set up a hospital for the camp’s many pregnant women. We put up tents, and the two of us began recruiting and training the TBAs to work in our new hospital, teaching them how to use drugs and give injections, and how to work as a team.
Carolina and I split our shifts. Carolina worked during the day and I covered the nights, with teams of TBAs as our support staff. Every day I relieved Carolina from her shift at 5 p.m. and spent the night in the hospital, sleeping when I could on the examination table. The TBAs worked very long shifts as well. One team worked with Carolina from 8 a.m. to 6 p.m., and another helped me from 6 p.m. until 8 a.m. 
It was a joy to know that we were providing a safer setting for women, a setting where expert care and medication were available if needed, and they didn’t need to make a 40-minute trek to give birth. We created a safe space where women knew they could come, women who had been living as refugees for years, women who were not at all used to delivering in a facility. The vast majority of them continued to deliver at home, in their tents, but if they were having their first baby and knew that it would be tough, or if they were having their seventh or eighth and knew they were at risk of hemorrhage, they knew they could come to us.
The hospital grew steadily, and as it grew, the TBAs became more knowledgeable and more confident. At first it was hard for them to take ownership of the work because they were so unfamiliar with it, but by the end of my stay, they were very experienced and self-sufficient. During night shifts they would say, “Liza, why don’t you get some sleep? We’ll call you when we need you.” 
The TBAs were so eager to learn, and they brought an important enthusiasm and sense of community to the hospital. The trained midwives in Zambia were very competent, but they weren’t members of the community the way the TBAs in Doro were. 
One night in the hospital, I was at the end of the delivery table waiting for a baby to emerge, and I looked up, and the woman laboring was surrounded by all these people—family members and two or three TBAs. All of them were holding her and touching her gently and talking to her, even singing to her. And she had this huge smile on her face as she was giving birth. In our little tent hospital in Doro, where people were camping beneath trees with what few belongings they’d been able to carry, the TBAs and the community were one of the few available resources in what was otherwise a very difficult situation. I thought, “Please don’t let’s ever lose this. This is precious.”

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