FEATURE
RIght: Tertia van der Walt with children in Kurdistan.
midwifery on the margins Tauranga midwife Tertia van der Walt has volunteered as a midwife in several countries, an interest that began when she worked with her husband, a dentist, when he was volunteering in Kosovo. “This ignited my passion for serving marginalised people,” she says. “When I became a midwife I wanted to use my skills towards this purpose.” Tertia was a secondary school teacher before becoming a midwife and particularly enjoys the teaching elements of voluntary work. She described two of her assignments for a midwifery standards review and this is an edited version of her reflections.
KURDISTAN, IRAQ I arrived in Kurdistan on 17 July 2019 to work in a refugee camp on a placement with Frontier Alliance International, a Christian aid organisation. In my last conversation with the team at Frontier Alliance before I left home, they stressed that the health system in the refugee camps was “unstable, dysfunctional and uncontrolled” as a result of the ISIS attacks as well as regular air strikes from hostile neighbouring countries. Prejudice among ethnic groups led to ill treatment and sometimes there was no care available for the sick and for pregnant women My “job” was mainly to educate and train staff members and pregnant women regarding antenatal, labour and birth and postnatal care. I was to pay special attention to a healthy lifestyle, natural birthing, breastfeeding and identifying post natal depression (PND). I was told that as there was a lack of postnatal care, breastfeeding rates were low. The mortality rate was high because of poor birth practices, inadequate referrals, emergency obstetric care and a high incidence of anaemia. I was overwhelmed by the receptiveness of the
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women who turned up for the education and training sessions. Working with a translator was new to me and sometimes I was so carried away with what I shared with the women that I had to stop to give the interpreter the opportunity to explain. I focused on being open, present and aware of my body language and mannerisms so that I could communicate clearly and acknowledge each woman with respect. The women were eager to know more and I often wished that I could spend more time answering all their questions. They would, without being offended, interrupt me if I suggested something that was not culturally appropriate for them. For example, when I recommended that they should go out for short periods of time postnatally to get Vitamin D from the sun and to socialise, they stated that they have to stay in the house for six weeks after their babies are born. I also learned that words like bra, vagina and breast were to be used very discreetly. I met with a local obstetrician to gain more information regarding birthing practices. She explained that all women made use of obstetric care antenatally and for the labour and birth although one in five really needed obstetric care. She said that the C-section rate was about 35% because women were free to choose a C-section and with the lack of information available to them, they considered it the easiest option. She mentioned that she had done a C-section on a woman the previous day who had already had eight babies by C-section and that everything went well. That of course was an exception as placenta previa, lesions, accreta and hysterectomy rates were high.
