“Without human resources, nothing is possible.” The basic and continuing education that I received and now apply has provided me with the necessary professional skills that are expected of a state-qualified midwife—a body of knowledge, know-how and interpersonal skills—and enables me to fulfill my duty in that role.
I remember that back in 1977, a midwife was a rare commodity because very few were available in the administrative cercles (sub-regions), especially in the north of the country, and gynecologists were only found in the capital and some nearby regions.
In an effort to reduce the high mortality rate, the Ministry of Health reviewed the various difficulties of geographical accessibility, equity, and reproductive health rights, and decided to systematically assign all new midwives to these hard-to-reach areas to provide maternal and child health care. As one of those assigned to a post at that time, I am proud to have served in remote and difficult areas of the country; first alone, then later accompanied by my husband, to assist my sisters and fellow mothers.
On the sand dunes in the regions of Gao and Timbuktu, in the health districts of Goundam and Gourma-Rharous, I worked alone as a midwife, facing cases of dystocia or other complications in childbirth. I learned to gather information for myself, think carefully, analyze, and make the appropriate decisions alone, in the face of such complications, without the help of the partograph tool (as it was not yet available).
For 42 years, as much as I possibly could, I behaved in a way that avoided any abuse or infringement of the rights either of my collaborators or of women who were pregnant, in labor, or postpartum. I gave help whenever anyone asked for it, help that was based in science and conscience.
Because I love this profession, I quickly gained an understanding of the field to better understand women and their daily challenges. To do that I learned the local language, participated in the women’s peer-to-peer savings activities (tontines) of the local women’s organization, and served them in the best possible way under the circumstances of my profession.
I learned a lot with and from my sisters, elder national and international midwives to whom I owe recognition and respect, with their high sense of responsibility towards performing a midwife’s tasks, their honest collaboration, their humanism and fraternal sincerity, and their efforts to share their experiences.
I am also indebted to the fellow doctors, gynecologists, nurses, matrons, and support staff who supported and assisted me.
In developing and implementing health programs, I travelled this vast country from north to south and from east to west, at all times of the year, on roads that were passable at some times and impassable at others, to transfer skills to my colleagues and collaborators. IntraHealth assigned me to support the Ministry of Health in developing and disseminating the technique of Active Management of the Third Stage of Labor/Birth Period to address hemorrhage, the leading cause of maternal death in Mali.
Preventing obstetric fistula has been one of my main battles, which I fought by training skilled providers and community health workers in prevention (providing ANC, delivery in health facilities, and post-natal checkups). I also assisted the Ministry of Health in developing reproductive health/family planning policies, standards and procedures, organizing referral/evacuation in health districts, and with the accreditation of community health facilities.
Over the course of these 42 years of professional practice, 24 with the Ministry of Health and Social Affairs and 18 with IntraHealth International, I have received several awards: four from IntraHealth International honoring me as a model midwife, motivated, and courageous; one from the Association of Midwives of Mali; one from the Chief Medical Officer of the Yanfolila Health District (Sikasso region); and one from the Ministry of Health. The appreciation from clients has been very heartening and satisfying. My participation in training workshops and seminars at national and international conferences on reproductive health has helped me to improve my performance considerably.
Today’s young generation must remember that the love of the profession and recognition of their own value contribute to the beauty and nobility of our work: for not everyone can be a midwife. As a Bambara proverb says, “Giving life is an uncertain journey.” These past 42 years have allowed me to help women arrive at their destinations, in good health and with their babies in their arms.
*Photo Credit: Ramatou Fomba Konate
**Ramatou Fomba Konate is the Head of Clinical Training for IntraHealth International in Mali.