16 Nov 2011 • Health and nutrition Afghanistan

Afghanistan: At 57, she has delivered 50,000 children

- Published by Darcissac, Marion

Midwife Naseema Qochi is easily recognized when she walks into the spartan health clinic nestled beside a rose garden in the dusty warrens of Qlia Bakhtyar. The health officer examining a small boy greets her warmly: Salaam alaikum. Qochi has helped three generations of women in this community give birth. “Naseema is the doctor,” a visiting midwife says by way of explaining Naseema’s primary role here and the respect she commands.

Meeting the women, despite the everyday hardship in their families

In this impoverished, conservative area, families are reluctant to have their women give birth in a health facility where complications of birth can be handled expertly and lives can be saved. It’s a reality that the veteran midwife deals with daily. “I encourage them to go to the clinic. I talk to their husbands. I tell them about the risk of pregnancy… but they refuse”, says Naseema, a member of the Jhpiego -supported Afghan Midwives Association. “In one case, a lady fell down from the top of the roof, even in that case they didn’t bring her to the health clinic.”

So Naseema goes to the women. She educates them on nutrition, the danger signs of pregnancy, the ways to care for a newborn and breastfeeding and provides skilled care in the months before birth. Naseema and her partner, midwife Golghotia Mosleh, arrive at a home, carrying a leather case filled with the tools of their profession: blood pressure cuff, vitascope, iron pills to prevent anemia, syringes, scissors, clamp, chlorine, clean cords, emergency drugs and other supplies. The midwives work for the Terre des hommes delegation, notably involved in child and maternal health in Afghanistan.

Convincing families to take good care of their women and children

On this fall morning, Naseema and Golghotia visit a married teenager who lives with her mother, younger brother and husband in one spare room of a neighbor’s house. The girl is seven months pregnant and this is Naseema’s third visit to the girl. In addition to examining her, the two midwives will explain to her mother what to do in case the baby comes unexpectedly or the mother-to-be can’t get to a health facility in time.

With deliberation, Naseema unfolds a grayplastic sheet and places it on the floor mats. She ties a clean white scarf around her head and asks for a basin of water. Naseema shows the mother how to properly wash her hands, lathering soap between her fingers and scrubbing up to her elbows. She then opens her black bag and pulls out several props: a baby doll and small box covered in material that resembles a split curtain. Naseema directs her lesson to the girl’s mother and begins an elaborate simulation of birth, proper cord clamping, care of newborn and delivery of the placenta.

“If you are facing challenges, if there is no midwife or the baby comes in the middle of the night, you have to know how to do this”, she tells the mother who sighs deeply.

In the district she covers, Naseema may have a client roster of as many as 500 pregnant women and new mothers. For women whose baby is in the breech position or may face complication, Naseema will pay for a car to take the woman to the nearest hospital to give birth. After a birth, Naseema will return to the home to check on mother and child.

The main thing: to give birth in a hospital with qualified staff

At 57, Naseema has been a nurse-midwife close to 30 years. In that time, she says she has delivered as many as 50,000 babies. During those three decades, she has seen more and more women choose to give birth in a hospital or health clinic, a shift she attributes to education and the end of the hardline religious rule of the Taliban. That shift is important in keeping women alive: Research has shown that a skilled health provider at birth is one of the key ways to reduce maternal deaths.

“Before I had 60 deliveries a month. Now I have 20 deliveries at home. That’s a big difference”, she says. “Before, I remember four days when I don’t sleep. I didn’t know when was morning, when was night. Nowadays, I’m free. I have time.”

And yet the pregnant girl’s mother insists she will call Naseema when her grandchild is ready to be born. Naseema smiles, knowing what she will say: “I will encourage her to go to the hospital for delivery. This is my responsibility.”