It is a bright sunny day in Dar es Salaam, and my contact Lulu Kansary welcomes me to the Aga Khan University. I am here to interview Loveluck Mwasha, a senior lecturer in midwifery who earlier in July received the Midwife for Life Award 2017.
The award was given by Save the Children and the International Confederation of Midwives at the latter’s 31st Triennial Congress in Toronto, Canada, earlier this month. Ms Mwasha is also the vice president of the Tanzania Midwife Association.
After a short tour of the university’s skills lab, library and the lecture rooms, my photographer and I are ushered in to meet Ms Mwasha.
She was friendly and chatty as she welcomed us and engaged us in small conversation. We were instantly at ease with her, her age and the high regard everyone at the university accords her notwithstanding.
As we started the interview, she was eager to dwell on the work, her students and the patients she serves rather than herself. At age 57, Ms Mwasha has over 30 years’ experience in nursing and midwifery.
Her professional life started at the Muhimbili Medical Centre (currently the Muhimbili University College of Health Sciences) where she graduated with a diploma in nursing and midwifery in 1983.
Back then, three months of national service was compulsory for all post-secondary school graduates and Ms Mwasha was posted to the Ruvu JKT clinic. It was at this clinic that she delivered her first baby.
The expectant mother arrived at the clinic in the early evening. There was no clinical officer or doctor on call and Ms Mwasha had to deliver the baby. Since the clinic had no electricity, she had to make do with light from candles.
She recalls being nervous but quickly got down to work as she had a mother in distress who needed calming. The birth was natural and went smoothly. However, when the baby arrived, she was hardly breathing and Ms Mwasha had to resuscitate her. Luckily, the baby responded with a sharp cry and was fine.
Ms Mwasha is clearly still moved by that event and goes on to sum up the story: “Five years later, the mother of this baby found me in Dar es Salaam where I was working. I was living with my brother and his family then. One day after work as I walked into the compound, the children came running and excitedly saying ‘Aunty, Aunty you have a visitor.’
“I walked into the house and found this lady with a young girl of about five years old but I couldn’t place her… She introduced herself and said, ‘I know you will not remember me but if it were not for you, this little girl would not be here today. You delivered her and saved her life, so when I found someone who knew you, I knew I had to find you and thank you.’
“She brought me some cassava and a chicken. That was the most precious gift that someone had ever given me.”
After her national service stint, she worked in several hospitals in Dar es Salaam including Muhimbili, Hindu Mandal and Aga Khan Hospital as a nurse and midwife for 20 years before deciding to go back to school to pursue a Bachelors degree in nursing and midwifery at the Aga Khan University in Dar es Salaam.
She graduated, went back to work for another five years and then went back to school again, this time at the School of Nursing and Midwifery in Karachi, Pakistan for a Masters degree.
Throughout her professional life, she used her affiliations with agencies such as the Tanzania Nursing and Midwifery Council to volunteer in a number of rural medical health centres in Mwanza, Mara, Bukoba and Morogoro.
“We provide skills and mentorship to nurse midwives, who are working in reproductive health sectors, giving on site training,” she said of her volunteer work.
One can tell that this profession means everything to Ms Mwasha and that she has high regard for it.
She said: “A midwife is not someone who just catches the baby. It is someone who has undergone specific training recognised at national and international levels to fulfil certain competencies, and is registered and licensed to practice as a midwife.”
Personal drive and choice matter for Ms Mwasha, who says: “Being a mother is something that has really helped me because in our profession, personal integrity and values are very important. Otherwise it can be difficult for you to give quality care. Since my children are very important to me, whenever I am interacting with a pregnant woman, especially a young one, I reflect back on my own journey. When I think of how much I treasure my children, I feel that every mother deserves a safe delivery and TO go home with her baby. No woman should lose life while giving birth and no woman should lose her baby.”
A mother of three, Ms Mwasha was born and grew up in Machame, Moshi, in the northern region of Tanzania and raised by a single mother (her mother was widowed young). She was one of six siblings.
Despite the family’s humble existence, she recalls her mother’s generosity especially towards women and children, who fondly called her Mama Mwema (kind mother).
She recalls that one day a group of children from the village were late for mass and the priest asked them why they were late. “They all said they were helping Mama Mwema. The priest asked who she was and they described my mother. Later the priest came by our home and told my mother, ‘You have inspired these children because now they call you kind mother.’”
Ms Mwasha says that her mother’s kindness and commitment to serve, and the hospitalisation experience she had when growing up helped her want to help others too and inspired her to choose nursing as a career.
“My mother was always by my side and of course the nurses were really good to me.” It made her realise the caregiving profession was exactly what she wanted to do.
State of maternal health
Tanzania faces critical challenges in its reproductive healthcare; according to the African Report on Child Wellbeing 2016, over the years 2010-2015, only 49 per cent of pregnant women in the country gave birth with the assistance of a skilled health worker and only 15 per cent of births in the country were registered as of 2016.
According to the Tanzania Health Demographic Survey and the Tanzania National Bureau of Statistics survey, the maternal mortality ratio (the death of a woman while pregnant or within 42 days of termination of pregnancy) as of 2015/16 was 556 deaths for every 100,000 live births.
That was a minimal improvement from a decade ago, with the 2004/5 ratio being 578 deaths for every 100,000 live births. In 2010-12 the ratio improved to reach 400 per every 100,000 live births.
The figures for neonatal deaths (death during the first 28 days of life) as of 1991/2 were 40 deaths for every 1,000 live births; a decade later in 2010 the numbers were halved at 21 deaths per every 1,000 live births, and five years later in 2015/16 the numbers had worsened to 25 deaths per 1,000 live births.
Ms Mwasha has been in the thick of maternal healthcare for the past 30 years and I took the opportunity to find out how Tanzania and the region are faring.
“Our fertility rate is 5.2 per woman, which is quite high, so health facilities in the country cannot cope. Bearing in mind that when someone comes to a health centre they expect to be received well and treated with dignity, the reality on the ground is that many health facilities are understaffed and lack supplies. This is demotivating for the few staff present and frustrating to the patients who eventually see no point of going to the health centre.”
She went on to state that it is conditions such as these that push women, particularly in rural areas, to resort to the services of traditional birth attendants.
As much as the latter have been and continue to be important in society, she insists that they lack proper skills and equipment to help pregnant women. Her recommendation is sensitisation to educate the public to seek professional medical care.
She says traditional birth attendants are best placed to know the risks and complications involved in child bearing and will make the perfect target group for sensitisation.
Ms Mwasha cites lack of higher learning institutions to teach future nurses and midwives. She attributes this to a growing population mismatched with available educational services.
The Aga Khan University offers undergraduate nursing and midwifery courses through a special programme for those already holding diplomas in the subject.