Midwifery in Malawi - Lisa Drayson, Nurse and Midwifery Trainer

A shocking start

It only took a few days for VSO volunteer Lisa Drayson to detect glaring gaps in hospital care when she started her placement as a Nurse Midwife Trainer in Mzuzu, Malawi. “Patients were lying on the floor without a mattress, sometimes there were two people in a bed and two under the bed while heavily pregnant women had to sleep outside. And nurses were overstretched, there could be two nurses managing seventy patients in a ward of thirty beds.”

Ideally there should be one midwife per seven patients in Malawi, but there is only one midwife per 700 women, according to the Nurses and Midwives Council Malawi. The Council has deemed most hospital and health care facilities in the country below standard, so there is a colossal need for better qualified nurses and midwives to meet the demands of a growing population.

It’s a problem Lisa’s trying to fix, training up to fifty nursing students each year at a nearby college of nursing. Over two years, Lisa's helped train 150 student nurses and midwives, though she strongly feels quality should never be sacrificed to make up numbers.

Simple skills save lives

After a few months of college-based teaching, Lisa’s placement shifted to the hospital, where she worked closely with the sister-in-charge to bring about real changes to clinical care in the overburdened hospital, “Often people think they can change things really quickly, but I found the best way was to observe initially –you see many shocking things...but I just kept it all in my head to begin with and when the opportunity arose, I made the most of it.”

A simple but vital practice Lisa introduced to the hospital was a documentation system – recording patient details on the ward, and changing the filing system of the ward, which was later implemented by managers throughout the entire hospital. “It has had a massive impact,” says Lisa, “...there would be nothing written about patients who’d been on the ward for months, patients would die and no one would know why.” Lisa implemented this change after developing a relationship of mutual respect with the nurse management, and worked with them collaboratively to bring about this critical change in behaviour. “I would think – what can I do today to help change attitudes a little – there is the long-term change, but there are the small things too. Sometimes things need a lot of work, other things are nearly there and just need a bit of support."

Raising the pass rate to 100%

Lisa has spent the last two years of her extended placement with VSO lecturing at Mzuzu University Hospital, where 100% of students passed exams that enable them to register as nurses and midwives in 2011; a triumph after only 38% passed the same exams in 2010. Lisa believes the success is down to a succession of VSO volunteers in a similar role at the university, building upon the work of one another, “Coming from the outside to really influence the ways things are done can be difficult, which is why you need to be there long-term to bring about real change.”