Ahentia, Ghana: 57-year-old Monica Effinah has worked as a nurse-midwife for over four decades. She assisted her first birth when she was just 15 years old, and it was triplets. “What drew me into midwifery is the miracle of how nature does its work,” Monica says.
We are sitting in her classroom, which is also her office, in a small town just off the N1 Highway, west of the capital city of Accra. The steamy air in the room does not move. She sits at a desk piled high with papers—a mode of recordkeeping that’s less and less critical here. Rather, her medical tool of choice these days, for data storing and sharing as well as patient care, is tightly clutched in the palm of her hand. It’s her mobile phone.
How Giving Birth in Ghana Has Changed
The business of birthing babies has changed dramatically during Monica’s career. Ghana’s Ministry of Health made family-planning education and services so readily available, that Monica’s seen a huge decrease in the number of births she assists: from nearly 100 to about 30 births per month. (Population has fallen from 27% in 1970 to 2.9% in 2014.)
And in 2008, the government outlawed the practice of traditional birth attendants’ assisting births in homes, in a push toward modern prenatal healthcare and clinic/hospital births.
That’s when Monica joined the “Mobile Midwife” program, a system of apps connecting field nurses to a centralized call center that allows Monica to upload and track patient records and appointments, and to send voicemails (in their local language) to pregnant and lactating women tailored to their stages of pregnancy, birth, antenatal care, and infant care.
Each patient has a private PIN and can access voicemails on her own or another’s phone and listen as often as she likes, to advice on nutrition, rest, exercise, and reminders for those crucial (and free) clinic checkups. “We teach families to rest two years in-between babies,” and to come in for regular checkups, she says. Monica is convinced that “How the mothers treat themselves is the most important issue of all.”
The Mobile Midwife program is part of the MOTECH platform of health services, is now being used elsewhere in Africa, Asia, and South America for maternal, HIV, and general healthcare, and is offered as an open-source download. A program similar to Mobile Midwife is also being launched by Johnson & Johnson in the U.S.
“We’ve seen an increase in immunization coverage . . . in the number of mothers coming to the facility to deliver. And . . . many more of the mothers are very knowledgeable about health issues,” Patricia Antwi, district director of health services for Awutu-Senya district (where Monica works) tells the BBC.
Monica’s clients call her “auntie,” and her students call her “mama.” She carries a black doctor’s bag on the five-hour bus ride home on weekends, when she visits her teacher-husband George, and her five grown children. Weekends, she becomes “Doctor Monica,” treating patients in their rural area who have no access to care.
When I ask what she does for fun, Monica looks at me as though I’m crazy. “I have a love for people and time to work,” she tells me. “I’m always working.” She beams when she adds, “A lot of babies have been named after me.”
Being the Bridge Between Traditional and Modern Medicine
Working with two attending nurses, also trained in Western medicine, Monica also maintains “close relationships” and collaborates with traditional midwives in her county: She trains them in modern medicine and hygiene practices, and they provide backup for routine care. “Relationship is very important” in bridging the gap between traditional and modern medicine in this culture, she believes. “How you talk to people matters the most.”
Monica also runs weekly support groups for new mothers and a very popular “daddy group” class.
“The husbands are very interested in Mobile Midwife,” she comments. “In fact, the program has even reunited some broken marriages” in which husbands gained respect for the process of pregnancy, childbirth, and parenting, simply because of the authority of the almighty mobile phone.
Changing Outcomes Through Consistent Care
Monica and her nurses feel they’ve made progress with access to healthcare and smaller families. They teach family planning, install IUDs, and distribute birth control pills. Still, their families face threats from chronic hunger, malaria, and Ebola.
Now that her patients understand the importance of getting to the clinic for childbirth, rather than hoping for the best at home, they face challenges with transportation. The clinic serves eight communities and it’s too far to walk—especially when you’re in labor—and her families are too poor to own bicycles or cars, and too often, even to hire a taxi.
“Many of my patients also struggle with bleeding, and with chronic hunger,” she tells me. Too poor to have a choice, they live in houses built not with cement, but sand.
“I see this as a metaphor for their lives,” she shakes her head. As we speak, young expectant mothers line up outside the door for a class on prenatal care. Maybe for them, gaining access to both the information and nurturing Monica’s team provides, will strengthen them and their families. That’s her hope.
Proud that she has never lost a mother in 42 years of birthing babies, Monica says she works nonstop for one reason: “I don’t want anyone to die.”
Feature Photo: Monica (center) with her two attending nurses assist about thirty births per year in rural Ghana. Photo by Suzanne Skees for Skees Family Foundation.