As a midwife, I always feel responsible for two lives at the same time: the mother and her child

10 Mar 2020
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Interview with Amal, 28, who works as a midwife in MSF's nurse, mother and child hospital in Taiz Houban. Amal's hometown was formelyTaiz city, currently, she resides in Houban.

How has your life been changed by the war?

“I moved to the Houban area to work with MSF in 2017. Back then, the situation in Houban was tense, with shelling and airstrikes. But I still feel unsettled here and there is a prevailing sense of insecurity.

We were displaced from our home in early 2013 when the violence escalated. I had been living in the Kilaba area, near the frontline, but was forced to leave and move to my ancestral village. We had to leave behind our precious belongings, our furniture and our property. We left the area to save our souls – my husband, my children and myself.

I have lost some family members because of the war, and my family has also suffered the pain of separation. The health of my two brothers was affected by the explosions and violence and we had to send them to Sana’a for medical treatment.

We have been affected financially by the war, but the most significant impact has been on our health situation. The war has caused many hospitals and health facilities to shut down. If one of my family members were to fall ill, we would not be able to find them hospital care. Even if we risked our lives by taking them to a hospital, we might not find the drugs to treat them, as hospitals have suffered shortages of drugs and medical supplies as a result of the war.

The simple act of visiting my parents has also become a major challenge. In the past, traveling from Houban to my parents’ village took 1 to 1.5 hours; now it takes 7 or 8 hours. If I leave in the early morning I arrive at dusk. The road is bumpy and dangerous, a one-lane road between the mountains. You feel very close to the edge of the road and the steep valleys drop away to one side. War has forced us to use routes and choose pathways that we did not know before.”


What does being a midwife mean to you?

“I started working as a midwife after graduating in 2006. I worked in Taiz, and then in the rural area I got displaced to. The local women were happy I had moved there as there were no medical services around. To them, I was a doctor who could solve their health issues – I was never treated simply as a midwife.

As a midwife, I always feel the weight of the responsibility we bear. Sometimes I used to leave in the dark of night for remote areas to help families, but I did not mind and neither did my husband – he is very supportive of me providing medical care when it’s needed. I used to go to remote rural areas where there was no electricity and where I would have to use a torch to do a medical examination. I used to bring all my medical tools needed for a delivery and in case of bleeding. I was always prepared for any emergency. I always feel responsible for two lives at the same time: the mother and her child.”

“As a midwife, I always feel the weight of the responsibility we bear. I always feel responsible for two lives at the same time: the mother and her child.”

Why did you decide to become a midwife?

“I chose this profession for two reasons. First, because I had witnessed my mother giving birth when I was 17 years old. She was in excruciating pain and there was no one around to help deliver her baby. In the village, there was only a general practitioner, and he was called in to assist, but I felt it was inadequate for my mother.

The second reason is because I felt that there was a lack of skilled specialist midwives in the Taiz area to help women deliver their babies safely. To give birth, women had to hire a car and travel long distances. There was a need for more experienced midwives.”

What motivates you to come to work every day?

“Being able to help save a mother and her child at the same time is indescribable. A pregnant woman is in need of a midwife’s assistance if she suffers from a complicated pregnancy, when she is in labour and even after her delivery.”

I am a midwife 24/7; my role does not end with the end of a working day. Sometimes I leave the hospital after my shift ends but the pregnant woman I’ve been taking care of has not stabilised or given birth yet. I reach home and my mind is not at ease – I have mixed feelings of anxiety and curiosity. I find myself unconsciously reaching for the phone and calling a colleague in the hospital and asking: ‘How is she doing? Has her condition stabilised? Has she had her baby yet?’ I am restless until I get all the answers. The woman is my responsibility – this is what I know.”

Do you have a message on the international women's day?​

“I would like to encourage women to consider this profession. Studying midwifery is an instrument for women to help each other. You never know who you will be helping next: it could be your neighbour, your friend or even a member of your family. You will be making a positive contribution to your local area, or if you move elsewhere, then you will be providing a humanitarian service wherever you go. Wherever you go, your profession moves with you and benefits your community.”

What are the challenges of being a midwife in Yemen?

“It is challenging enough to be a woman – a working woman who has children and is responsible for a family. You have to find a balance between your job and your household. Both expect the maximum of your energy and love. I do my best to attend to both and not neglect one because of the other.

I owe my strength and success to my husband; he has been my main supporter throughout my career. He lost his job because of the war, and he has supported me at home: making sure that our children receive the attention and care they need while I am away from home, helping other women return to their families after a safe delivery.”

Interview with Wadha, 33, who works as a midwife in MSF's nurse, mother and child hospital in Taiz Houban. Amal's hometown was formelyTaiz city, currently, she resides in Houban.

How long have you been a midwife?

“I worked in Al-Kindi hospital in Taiz for around 11 years, then we were displaced to the Houban area in 2016, which was when I started working with MSF.”

Why midwifery?

“I actually wanted to study medicine. Ever since I was a child, my father had told me: ‘You should be a doctor when you’re grown up – you would be helping the family.’ As I grew up, the idea grew with me. Our society is keen on doctors and professions that can take care of the family, the household and the community. It’s a source of pride. But I was not successful in my pursuit of medicine and was left with two choices: nursing or midwifery.

I chose midwifery because of what it means in terms of the care provided to mother and child. I wanted a profession that would help my family, and after I started practicing midwifery, I got more attached to it. I helped my four sisters deliver their babies at home. I am the eldest and it gave me great joy to help them give birth to my nieces and nephews.

Knowing that I am a midwife, the people in my area depend on me. I used to receive visits here in the hospital from women asking me to come to their houses to help deliver their babies, but instead I would refer them to the hospital – telling them they would be in a safer environment if any complications arose.”

What are the main causes of complicated deliveries?

“People living in villages or remote areas with little money do not visit health facilities. They may have an ultrasound once during their pregnancy, or they may skip it altogether and wait until they deliver.

Long distances and costs are both reasons why pregnant women go without hospital check-ups, but also there is a lack of awareness, so it is important to increase education about this.”


Is there a patient who stays in your mind?

“I once received a patient who was terrified of giving birth and could not stop crying. I found out that she had lost two children after they fell into a well and died. The mother was blamed for their death and accused of negligence. This had affected her tremendously on a psychological level. She looked at me and said: ‘Help me, stand by me and consider me your sister. I lost my two children and I am afraid to lose this one. Please help me save this one.’

She was in the hospital at this critical time all alone. Her story affected me deeply. She had a normal delivery and a healthy baby and her happiness filled the room.

A while later, she came to the hospital looking for me, wanting to show her gratitude for that memorable day. ‘But I only did my duty,’ I said. She replied: ‘But it was a difficult day and I was in desperate need of hearing a good, kind word.’”

How has your life been affected by the war?

“Being the eldest, I am responsible for the whole family. We were displaced from Taiz. There were clashes between the warring parties and shelling from both sides. Our house was caught in the middle. At first, my family did not want to leave, despite the shelling hitting nearby houses. Life became extremely difficult. We were running out of food and water. We had to use torches because there was no electricity – the wires had been destroyed by the shelling.

When the shelling intensified, we decided it was time to leave. My siblings left first for Houban, where my married sister was living. My parents decided to stay on, but asked me and the rest of my siblings to leave. Eventually, the situation got so bad that they too packed their bags and left the area for good.

The ugliness of the war was most in evidence the day I lost my mother. I had a brother living in Taiz city at the time. I had heard from acquaintances that he had been shot and injured. One day, I received a phone call from my brother but he never said a word about the injury. He was asking to see our mother, insisting that she came back to the city so he could see her. I argued that it was very risky, even more so because of the presence of snipers. He was so insistent that I worried that what I had heard about his being shot and injured could be true. I told my mother and she quickly agreed to go. I was afraid for her wellbeing and decided to accompany her, and my other sister said she would join us.

After a long bus journey, we got off and continued on foot – there were no transport available after that point because of the shelling and the sniper fire. My mother walked fast in front and we marched along behind, following in her footsteps.

Suddenly, I looked up and caught sight of my mother falling to the ground. I did not hear the sound of that treacherous bullet. I heard nothing. I thought that she felt dizzy and could not support her weight anymore. We ran to her, my sister screaming frantically: ‘Mother, what is wrong? Are you okay?’ My mother kept calm and in a faint voice assured us that she was well. ‘The bullet hit me in the leg,’ she whispered.

The bullet had actually entered her abdomen and exited from her back. We ran down the street in a panic, calling for help. I felt for a pulse, a breath, a hope, but I could feel nothing. I took the scarf off my face and tied it around her wound, trying desperately to stop the bleeding.

With the help of some local people, we took her to MSF’s trauma centre, near Al-Risala hospital. I thought it was still possible to save her, but as soon as the doctors saw her, they confirmed that she was dead. I screamed in shock. I did not want to believe it. I still cannot fathom what happened, and whenever I think of it and try to understand it, I burst into tears. She died on 14 March 2016, a week before Mother’s Day.

The responsibility to become a mother, replacing your own mother, is a very big and burdensome one. I became the mother for my brothers and sisters and even for my father. But I have no mother. I am the one who feels orphaned in this family.

For a while, I blamed myself for the death of my mother, because I was the one who had told her my brother wanted to see her. But later I became convinced that it was fate, that this was her time to leave.

Even if the situation calms down, I would not want to return to our house. I would see the memories of my mother in every corner of our loving home, and this would lead me back to that same cycle: to my dark thoughts, to the acknowledgement that my mother is gone. I would go mad every time I realised that she was no longer around.”

What are your hopes for the future?

“I hope this war ends. I hope there will come a day when this war is over. I dream of having my own house and finding stability. I would like to study more and to travel outside my country – to see different places. These are simple wishes and I know nothing is impossible in this life.”

“I hope this war ends. I hope there will come a day when this war is over. I dream of having my own house and finding stability. I would like to study more and to travel outside my country – to see different places. These are simple wishes and I know nothing is impossible in this life.”

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