Every 5 and 12 May, it is celebrated the International Day of Midwives and the International Nurses’ Day, respectively. These dates are celebrated in order to highlight the contributions of these health professionals, responsible entities for the welfare of people around the world.

In Mozambique, these dates are marked by moments of reflection on the importance and contribution of these professionals. The International Day of Midwives, in particular, is marked by debates and activities within the Nurses for Maternal and Child Health (ESMI).

In order to understand the challenges that these health professionals face daily in the exercise of their activities, the Citizen Observatory for Health (OCS) interviewed two nurses, who were unanimous in stating that the National Health System (NHS) needs to improve working conditions, favoring the hiring of more professionals so that the demand for maternity ward can be responded successfully.

The nurse midwives also state that they are often forced to enter delivery services in unacceptable conditions, characterized by a lack of working tools. This makes it difficult to work, although the nurses make an effort to ensure that births occur smoothly, even in the face of difficulties.

According to Cafrina Sefane, a nurse dedicated to Maternal and Child Health (ESMI) at Mavalane General Hospital in Maputo, being a midwife means assisting women during labor, “it is to be part of a special moment in a woman’s life, helping her to overcome her fears, pains and weaknesses in the process of bringing another life into the world.”

“It is a special and important role that is developed today by the maternal and child health nurse, who accompanies the woman before, during and after childbirth”, she said.

For Nurse Cafrina, the insufficiency of health professionals in health facilities is a barrier that ends up contributing to the low quality of care.

“This is also seen in maternity hospitals, where midwives work. We don’t have enough midwives and this negatively affects the quality of care, since the workload ends up being greater for the few professionals that exist”, she said.

On the other hand, the nurse reiterated that the lack of hospital material constitutes another challenge, “we know the difficult conditions that the country is facing, and such difficulties are felt in the health units and, consequently, in the delivery rooms”, she added.

There is Urgent Need to Value Nurses

Still on the challenges, Cafrina Sefane said that, despite their hard work, midwives or simply Mother and Child Health Nurses do not receive the proper value – a rather sad reality that is felt through low salaries, the lowest in the class of health professionals.

Despite the difficulties, the midwife did not fail to condemn the illicit charges practiced by some professionals in her class, stating that “It has to do with a lack of character.”

“I could say that this does not constitute the truth or that midwives make illicit charges because of the low salary that is not enough for their expenditure. But none of that justifies such practice, it is about lack of professionalism of some nurses, who end up ruining the entire class”, she mentioned.

“Both illicit charges, as well as the lack of humanization in health units harm the entire class, which is even painful for those who work with dignity”, added the nurse, stressing that “it is the patients or family members themselves who take the initiative and entice the nurses/parents.”

“We are in a country full of corruption and society has in mind that for all care in the public sector, one must bribe the professionals. But I say, the patients or attendants do it unconsciously, they do it in desperation and worry”, she said.

Cafrina made it clear that professionals must be aware of their job as well as their duties and obligations, “and at the end of the birthing process, both the parturient as well as the midwife hope for a happy ending, where the mother and baby are together and healthy, although there may be complications.”

“Often complications are unpredictable, no one expects them”, she added.

Young People Must Seek Information on Childbirth Services

The nurse also expressed the lack of humanized services, arguing that the delivery room should be a clean and dignified place because it is a crucial point for the coming of other human beings.

“We all go through that moment and nothing is better than helping ourselves. And to be seen as women who help other women”, she stressed.

The midwife also called on young women to be more informed before they go into labor, as some who go to the delivery room think that the baby comes immediately, ignoring the medical intervention.

“I see women asking the midwife for help to take the baby out at a time when dilation is not yet complete. Since the midwife cannot do it, she is seen as bad person. So, there is a need to reinforce lectures on antenatal consultations so that patients are psychologically prepared”, she said, calling on young mothers to resort to other means of obtaining information on labor, without relying on the lectures that take place in health facilities.   

“Let’s be those women who support other women. We are important and we will fight for the honor of our class”, she concluded.

Challenge is to Reduce Neonatal Mortality

Susana Magaia, who is responsible for the maternal and child nursing sector in the Maputo City Municipal Health Directorate, stressed that reducing maternal and neonatal mortality is a major challenge for the municipality, as well as for the country as a whole.

For this, she acknowledged that one of the main steps to be taken is the allocation of sufficient human resources to meet the demand of patients in health units.

Magaia also pointed to the lack of meals for the professionals themselves as a challenge.

“Regarding activities, we have the problem of transport which carries out work in the field. Since we are promoting health, we must travel to the communities to disseminate information about women’s, children’s and family health in general, as well as to offer the services themselves in mobile brigades and health fairs.”

The nurse explained that many times we depend on cooperation partners to provide transport, without which the work is paralyzed.

Susana agrees with Cafrina about the illicit charges, stating that they have to do with character, “we cannot feed the bad spirit that it is because of the conditions and that the professionals do it to supply the needs that are not met by the salary. It is rather a lack of character of the nurses who act in this way”, she stressed.

“If we look at it, not all professionals do this. The minority who does it ends up ruining the entire health area”, he added.

In this context, she called on all midwives to ensure quality and humanized care, knowing how to deal honestly with the difficulties.

“Let us offer our best to ensure the welfare of the woman as well as the child”, she concluded.

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