I was in Ethiopia from 1 to 10 June.
The country was calm, after an extended period of crisis resulting from ethnic conflict, which made travelling around the countryside nearly impossible during the past year.
In August five more ‘Adopt a Midwife’ students graduated. They are all doing well. This brings the total number of graduates to 41.
Three other students are starting their second year.
The most important goal of this visit was to visit the Health Centres where the ‘Adopt a Midwife’ graduates now work.
On our trip, we took a lot of materials with us for the Health Centres. We also took baby clothes, baby blankets and soap.
After giving birth, the mothers all receive a box containing a blanket, a set of baby clothes and soap. Hopefully, this will encourage more women to give birth in a clinic.

Preparations:

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Photo 1: For each Health Centre we prepare boxes containing a hand-knitted blanket, a set of baby clothes, a nursing bra and pants for the mother, and soap.
After giving birth, each mother receives our box.
We hope this will encourage more women to come to the Health Centres to give birth. (a happy box 🙂 )

Photo 2: We brought a suitcase filled with supplies that we had been asked to bring. The suitcase contained blood pressure monitors with a stethoscope, a watch with a seconds’ hand, a headlight and/or solar powered flashlight, plastic aprons, safety goggles (used when giving stitches), soap dispensers, a nail brush, bulb-syringes (used to remove vernix), a thermometer, a tourniquet and beautiful work t-shirts).

Visit to Dakuna Health Centre near Endebir, which is run by Franciscan Sisters.

Sister Wengelawit has been in charge of the Health Centre for two years. She’s an extraordinary woman; the centre is clean, well-maintained and organised. Three midwives currently work in this Centre. Amongst them is Sr. Kebebush, who graduated in 2014 in Wolliso and with whom I have worked and studied a lot. It was great to see her again! The other midwives, Tarikwa (‘Adopt a Midwife’) and Senait come from the 2016 group.
The delivery rooms are currently in the main building, which is not ideal, seeing that it increases the risk of infections. Sister Wengelawit is presently working on a separate building for mother and child care. Perhaps ‘Adopt a Midwife’ could help her.

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Photo 1: The two young midwives: Tarikwa and Senait
Photo 2: the delivery room (currently about 35 deliveries a month)
Photo 3: Sr. Kebebush and I on our way to the Mother Waiting Room. The compound is clean, and there are many flowers. In every room, there is a vase with flowers in it. Sister Wengelawit takes care of the flowers and claims they help to heal the people visiting her Centre.
Photo 4: The Mother Waiting Room: this is a place to stay for mothers who live far away from the Centre. This way, when they go into labour, they are already in the Health Centre.
Photo 5: The three midwives of the Dakuna Health Centre.
Photo 6: Waiting Room Mothers are sitting outside.

Jilela Health Centre is located 9 km off the paved road between Addis and Wolliso.

It took us 2,5 hours to travel this 9 km stretch, even with our four-wheel-drive car! Perhaps it’s faster to walk but it was raining, and we were carrying supplies.

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In the pictures, you see Sufe, who graduated in 2016. She has lost both her parents and is from a poor family. She calls me her mother. We brought all the supplies she needs: a good blood pressure monitor, aprons, protection goggles, soap and a brush, a headlight because there is no electricity, a beautiful working t-shirt, a watch and a tourniquet. We also gave Sufe a solar flashlight. In the picture, you also see the delivery room, the office where check-ups are held and Sufe’s (bed) room.
She has tried to make it a pleasant space with a candle and glitter paper on the windows, but during the day, all staff drinks coffee in this room, so she has little privacy. The cardboard box contains her personal belongings. The circumstances in which people work here are really incredible, but everyone remains dedicated with a smile on their face.
Outside, in front of the Health Centre, the water reservoir lies on the ground. We will try to restore the water supplies of all the Health Centres.

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The biggest surprise was waiting for me in Amaya Health Centre.
Last year I visited Mergitu, who also graduated in 2016.
She works in Amaya Health Centre together with another midwife, and the Centre is already quite well organised.
Last year I entered her office as she was examining a pregnant woman. The woman thought I was her mother because Mergitu was so happy to see me!
That’s funny because we look nothing alike!
This time I especially noticed the nicely coloured fabric that was covering a little table, perhaps with medical equipment, or so I thought. I wondered why Mergitu would have this beautiful fabric in her office, where she carries out check-ups.
When I asked her about it, she pushed back the fabric and looked at me with a happy but shy expression.
‘A baby! You have a baby!’ I cried out! ‘Enkwam desalesh!’, ‘Congratulations’.
I had already noticed as I entered that the breast-size of the slim Mergitu had increased quite a bit!
Ha, a 3-month old daughter, being able to take her to work and to breastfeed her all day, what a luxury!
The father of the baby turned out to be a nurse from the same Centre. His name is Dawit, and he personally nursed his wife during the delivery.
‘We were together’ Mergitu commented, ‘the others all had a day off’.
Like the other midwives, Mergitu was very happy with the supplies we brought for her.
See you next time!

Last year I also visited Samuel and to be honest, I have been quite worried about him this past year.
He was not doing very well last year, and he had some difficulties finding his place in a team where most people had already been working together for a long time.
His work conditions were also far from ideal: much if the equipment was old, dirty or broken.
He was also quite insecure, and he told me he always worries that a day will arrive when a woman is brought in who he cannot help.
I realise that this is what ‘Adopt a Midwife’ asks of people: to work in remote areas, often under challenging circumstances.
A Dutch midwife wouldn’t last a day.
Luckily, I sometimes got some news about Samuel via Melaku (see ahead), but I honestly was not expecting him to still work in the Health Centre.
I was surprised to see an entirely different Samuel as I arrived in Dalidakt.
Proud and confident, but still so humble and friendly, he showed us around the new ‘Mother and Child Clinic’.
In agreement with the health agency, he has been able to start working in a brand new building, in which he has now found his own place.
With a small budget, he tries to keep everything neat, for example by covering the floors with linoleum and plastic sheets around to mattresses for protection.
Some things that are so self-evident here can be so tricky there.
A few days ago a new midwife started working at the Dalidakt Health Centre. She is a recent graduate and does not have a lot of work experience yet. Still, it is nice for her and Samuel to share the responsibility.
Samuel recently followed the Basic Emergency Obstetric Care (BEmOC) training, as well as some other courses, which help him to be better prepared for his job.
He told me which complications he has treated and how, and that it all ended well. One woman whom he had to refer to the hospital in Woliso (several hours by car, Samuel often gave her two IV drips before the trip), recently visited Samuel in the Clinic to thank him and to tell him she was doing well. That’s fantastic!
Because Samuel did not yet have a proper cooking stove to disinfect his instruments, we bought one for him in the capital. He proudly posed with his new cooker for a photo.
For the coming months, he plans to open a ‘Mother Waiting Room’ for pregnant women who live far away from the clinic. This will certainly be used, keeping in mind the approaching rainy season.
He has already bought the beds and the matrasses, and we have chipped in for the sheets and blankets.
Like in Jilela, we will also solve the water problem in Dalidakt.
Samuel was thrilled with all the supplies we brought for him, including the solar flashlight.

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Melaku is another of the ‘Adopt a Midwife’ graduates, he graduated in 2014.
During his studies, I immediately saw that he has exceptional talents: he is intelligent, polite, friendly, a good colleague, and curious. During his studies, it became evident that he is also very capable of transferring both theoretical and practical knowledge to others, thanks to his calm and non-imposing behaviour. Like father like son: his father has worked as a teacher and a school principal all his life.
I really wanted to keep Melaku close to me and hoped he would follow a teaching course so that he and Selaam could take over my role.
In September he enters the fourth and final year of his studies. His results are excellent. Every weekend he follows classes in Woliso and during the week, he teaches in delivery rooms and maternity wards.
When I was unable to travel due to the crisis situation in Ethiopia, upon my request he maintained contact with the ‘Adopt a Midwife’ graduates. During this visit, Melaku officially accepted his new role as my intermediary.
Together we are now looking for appropriate workplaces for five third-year students who will graduate in August. We also follow the three first-year students who will hopefully start their second year soon. In addition, we plan visits to several Health Centres to take stock of the supplies and training they may need. I am so happy about this collaboration! And I have always been!

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Visit to the Fistula Hospital in Addis Ababa, Desta Mender (Village of Joy), and the Hamlin College of Midwifery.
In the capital, we visited Fistula Hospital, also known as ‘the hospital by the river’.
I was lucky to briefly speak to doctor Catherine Hamlin, whom I have known for 25 years. I gave her some typical Dutch ‘stroopwafels’ (syrup cookies), that I know to be her favourite.
From the Netherlands, we also brought a lot of adult diapers, which the women in the hospital have to use before their surgery.
Doctor Catherine is now over 90 years old and has been working as a gynaecologist in Ethiopia for over 60 years. She and her husband (who has passed away) dedicated their lives to helping fistula patients in Ethiopia. A simple medical procedure can help patients to lead dignified lives again.
Before returning home, the patients live in Desta Mender, a village just outside of the city, where they learn to handle their colostomy.
In addition, they can pick up some new skills in the village such as working in a vegetable garden or a restaurant. This helps them to regain their independence when they return home.
In the village, we ate an excellent plate of spaghetti with fresh tomato sauce and freshly baked buns.
We were also shown around in their school for midwives, where we discussed the differences and similarities between their programme and ‘Adopt a Midwife’. A beneficial exchange.

www.fistulahospital.nl

In August and December 2017, the first four students graduated in the south of Ethiopia. Armie Ayika, who graduated in Arba Minch is now working in South Omo. Netsanet Abebe, Jemilla Seid and Elshaday Anteneh, who graduated in Mizan Aman are shown here in the photo together with Lode van Reedt of the Bilma Foundation, and Ato Adane, his Ethiopian counterpart. The graduates from Mizan Aman all work in Bench Maji.
Two of the four graduates were able to study thanks to an ‘Adopt a Midwife’ scholarship.

This book was published in December 2017: “100 Dagen Dichten” (100 Days of Poetry). In the book, I share my memories of my life and work in Ethiopia. The money raised by the sale of this book is for ‘Adopt a Midwife. You can order the book via info@adopteereenvroedvrouw.org. The book costs €15 plus €4 for delivery.

I have not been able to visit the project for a long time because of the state of emergency declared by the government in Ethiopia last year. In addition, communication via email was not always possible. For these reasons, during my most recent visit I was very pleased to see several positive developments. I will shortly list them for you in the report below:

1. Eight of the ten students that graduated in 2016 have found a workplace in the countryside.

We have visited two of them: Mergitu and Samuel. Both work in health centres that are a two-hour drive away from Wolisso, over unpaved roads and only reachable in a four-wheel drive car.

Margitu works together with another midwife and the centre where she works looks clean. Issues such as sterilisation of equipment and supply of medication all seem to be in order. However, there is no electricity or running water at the centre.

Samuel, on the other hand, is in a more difficult situation. He works alone, meaning he is always “on call”. However, this is not even the most difficult part of his job. What he misses most is the possibility to discuss with a colleague before making a difficult decision, for example the decision whether or not a patient needs to be transferred to a hospital. Furthermore, he fears that there will be some difficult cases he can’t possibly treat by himself. Samuel’s workplace is clearly not as pleasant, also because the staff that has been there for a longer time (such as the cleaning staff) do not always want to follow his instructions. As a result, he often has to clean his own workplace. He also lacks materials and means for research and maintenance.

During our conversation, and even now, my heart goes out to him. I realise that this is what we ask of our graduated midwives: to work in the countryside, under circumstances that are much more difficult than they are used to and with a big responsibility. Young people, away from the familiar surroundings of the St. Luke school and hospital, often alone and with little support from the government they now work for.

Together with Melaku (a teacher), we have discussed our students’ situations and advised Samuel to visit Mergitu, to see how things are organised at the centre where she works.

In addition, we have concluded that it is important for our students, including the ones that have already graduated, to follow a BEmOC course (Basic Emergency Obstetric Care). I will go into more detail on this point later in the report.

The good news is that by now, the government is convinced of the fact that every health centre needs at least one, and preferable even two midwives. This means that in the future, there will be enough jobs for our students. Especially since the midwife programme at St. Luke has a good reputation.

2. This year, all third year students followed the previously mentioned BEmOC course. In this intensive three-week Basic Emergency Obstetric Care course the students learn all the necessary skills for emergency obstetric care. They work in small groups of six students, supervised by a teacher specially certified to teach this course.

The six third-year students of the ‘Adopt a Midwife’ programme are the first to follow this course. They have all signed a contract, declaring that they will work in the countryside for at least two years. This is no problem for these six students, as all of them originally come from the countryside.

3. We are still discussing whether or not we admit new students for the year of 2017-2018. If we do admit new students, we would want to focus especially on the admission criteria. If we only admit students from the countryside, there is a higher chance that they will return to the countryside after they graduate.

4. We are also still discussing the idea of getting our own car. There are some difficulties associated with car ownership, such as high taxes, maintenance and safety. As a result, we might again opt for a two-year contract to rent a car with a driver.

5. Melaku (graduated ‘Adopt a Midwife’ student) is now in the second year of his teacher training, again sponsored by us. He travelled with us to the health centres and proudly presented us his results from the previous semester: ‘excellent’ in every subject. When I complimented him on his achievements he said: “I am doing my very very best”.

6. We have received a donation of underwear for mothers and small cups to feed the new-borns. The cups were immediately taken into use by the neonatal unit.

The graduation ceremony of our third year students will take place on 5 August 2017. If they all graduate, the total number of ‘Adopt a Midwife’ graduates will be at 36.

We would like to thank everyone who has supported us during this year!