July 8 2015
Wellbody Hero of the Week:
Hannah Charles – Traditional Birth Attendant
Seijiro Takahashi - June 11, 2015
The first of this month-long series features Hannah Charles, an experienced Traditional Birth Attendant who was recently hired by Wellbody Alliance. She grew up near Koidu Town, in Gbense Chiefdom. Hannah is 45 years old, and has three children – one girl and two boys – and her husband works as a tailor.
Why her work is heroic:
Traditional Birth Attendants, or TBAs, are respected members of the community, who assist women during childbirth. As a seasoned TBA, Hannah has been helping women in Kono District deliver their children, both before and after joining Wellbody Alliance. As an employee of Wellbody, she has been trained to provide medical care in a variety of areas besides delivering infants, and has become equipped to assist in the delivery room alongside nurses, midwives, and doctors during the ongoing Ebola outbreak, which requires the proper use of personal protective equipment (PPE).
Hannah Charles (center) with other traditional birth attendants (TBAs)
I was fortunate to have the opportunity to Skype with Hannah and Wellbody's Partnerships Liaison Edna Bondu Bona (who was there to interpret Hannah's responses from Krio into English), in order to discuss Hannah's personal experiences as a TBA and as an inhabitant of Kono. Here is what she said!
How did you first become a Traditional Birth Attendant (TBA)?
There was a TBA that worked in my area, whom I admired. I visited her one day and asked her to train me as a TBA. Although she questioned my request at first, I confirmed to her that I wanted to be trained, so I became her apprentice. I then started to visit her whenever she would deliver a baby, observing the process as I sat on the floor next to her and the woman giving birth. I eventually moved out of my house and into this TBA's house when I was 25 years old, and lived with her for one year as her apprentice. After that, I started working on my own as a TBA when I was 26 years old.
What was your first experience of delivering a baby like?
I delivered my first baby on January 6th, 1996. The pregnant woman walked to my house, where I checked her and confirmed that she was fit for labor. Then I spread a mat on the floor of my house, and delivered the baby. Before I began, I prayed first, because it was my first time delivering a baby, and I did not want to make any mistakes at all. So I said, “So God help me,” and I tried my best. Then the baby was delivered successfully, and I was very happy.
How or why did you become involved with Wellbody Alliance?
Before I became employed by Wellbody, I walked around and performed many deliveries as a TBA. I then trained at Doctors Without Borders (MSF), and then applied for a job at Wellbody Alliance. In 2011, I started as a fieldworker for Wellbody, traveling from the clinic to surrounding communities in Kono, where I spoke with pregnant women and encouraged them to come to the clinic to give birth, rather than having their babies at home, where birth attendants are less equipped to perform safe deliveries.
Beginning this year, I became a TBA staff member at Wellbody, and I now work mainly in the newly-built Delivery Center. With Wellbody, things are better now, since women can deliver their babies safely at the Delivery Center, instead of at home. This has significantly decreased the infant mortality rate in Kono.
The Delivery Center (Rugart Family Center) where Hannah Charles delivers infants
Hannah Charles - Wellbody TBA
Please describe to me what you do on a typical work day, from start to finish.
I leave the house at 7:30 am, and arrive at the clinic at 8 am sharp. I then clean the labor room, visitor room, and equipment room, to make them safe to work in, and when pregnant women come in to the clinic, I help with delivering their babies. Pregnant women arrive throughout the day at any time – they may come in during the night, and be there in the early morning when I arrive for work. So there are medical staff present at the clinic around the clock. I also check the women at the clinic to see if they are ready to go into labor.
At 12 pm, we all have a lunch break, and at 2 pm, my shift is over, and a Wellbody vehicle takes me home.
Arrive at clinic; clean rooms; assist with infant deliveries; antenatal clinic; check-ups with pregnant women; visiting and encouraging community members to come to clinic
Lift back to house in Wellbody vehicle
My duties also include going out into the community and informing pregnant women during their first trimester, suggesting that they join the antenatal clinic, which has also helped to reduce the previously high infant mortality rate. Tuesdays and Thursdays are antenatal clinic days, so the clinic is very busy on these days.
I also talk to the ill within the communities that I visit, and encourage them to visit the clinic instead of relying on traditional medicine. Most traditional herbal remedies do not contain the correct dosage, whereas at the clinic, the sick are given directions on how to properly take their medicine.
If a woman who is HIV-positive or who has Ebola goes into labor, I must follow strict protocol to put on and take off personal protective equipment (PPE). I wear PPE for HIV-positive patients and for patients with Ebola to protect myself from contraction. Although I have never personally delivered babies for pregnant women with Ebola, the clinic receives about three to four HIV-positive pregnant women per week. Overall, the clinic deals with up to six deliveries per day.
Sister Gladdis Boyama Katingo (in white), Hannah Charles (right - in maroon), and other Delivery Center staff
What is the most rewarding part of your work?
I am happy to deliver babies, and to see them alive and healthy. I am happy to see women deliver their babies safely, and I am happy to see women bring their children in for antenatal check-ups and immunizations. I am also happy to see that many women do not deliver their babies at home anymore, but at the clinic instead.
Pregnant women around me have confidence in me. They call me, even at midnight, if they need help, and I assist them by calling the sister-in-charge, who immediately dispatches an ambulance. Once the ambulance arrives, I ride with the patient to the clinic.
I am also happy to encounter the children that I have delivered before I started working for Wellbody as 20, 19, or 18 year-old grown ups. I am happy to be at Wellbody, where I use sophisticated machines for delivery that I had never seen before becoming an employee at Wellbody, and I am happy that there are donors that send such machines. I am also happy that Wellbody Alliance came into being, because before, TBAs were not recognized by Sierra Leone's government. We used to work independently. But now, Wellbody has gathered the local TBAs, and are paying us salaries.
What changes have you seen since you have started working for Wellbody?
There have been so many changes since I have started working for Wellbody. I now work with many different people, and am helped by them, and am trained by the people around me. At the clinic, there is no segregation – we all work together, and I have learned a lot in the past two months, especially because of the mentorship system, in which I work in the different Wellbody facilities, such as the triage area and the antenatal area, where I see lactating mothers come in for immunizations. I am not stuck in the Delivery Center, but am called to help in these areas because of the high numbers of patients that come to the clinic. On some days, we receive up to 170 patient visits per day, and the patients must wait outside of the door at times, because of the high volume of visitors. So, TBAs are also trained in many other skills besides delivering babies.
I have never worked at a place like Wellbody – there is electricity 24 hours a day here, and the rooms are clean and nice. I also appreciate how a vehicle takes me home after my work shift. Lunch is provided for all workers at 12 pm, and everybody – including the clinicians, cleaners, and security guards – receives the same meal break. I have never had a job before that provided me with a meal.
I am happy with Wellbody.
Sister Gladdis Boyama Katingo (in white), Hannah Charles (in maroon), and Wellbody nurse-midwives
It's been great learning about the positive changes and improvements that you've brought about in Kono through your work with Wellbody. Usually, when you overcome one challenge, you are able to gain a better view of the next challenge.
In your opinion, what does Kono need most in terms of healthcare right now? What personal advice do you have for those who want to help individuals in Kono District?
What we need is a bigger hospital facility to carry out a wider range of surgical operations and to conduct biochemical tests in labs. I would also like to see a nursing school built in Kono, so that the local youth can be trained to become nurses. I would also like nurses' quarters to be built, so that they have better housing to live in.
We also need more food for malnourished children, who come into the clinic. We need to feed them high-protein meals, and need to give them food with their medication. Some children cannot afford three meals, or even one meal per day. Many children don't eat before going to school, where they are hungry and daydreamy during class periods. I want to see a school feeding program established in Kono, in order to feed the students.
I also expect you, Seiji, to come to Kono to help.
I hope to go to Kono to help and learn, especially after I have obtained clinical skills from medical school.
I am not educated, but I was trained at the clinic, and now I am helping women as a TBA. You don't have to have gone to school to help the community – you help in any way that you can.
What do you enjoy doing for fun? It can be anything - in or out of work.
I enjoy swamp rice farming, and working on my backyard garden. I also like quietly talking to my children. I tell them to take school seriously, because I did not go to school, and I want my children to be educated.
I am also very happy when I am holding newborn babies.
What is Kono like?
The people in Kono are very hospitable, and they like strangers.
Also regarding Kono – in Kono, there are many diamond mines. Many of our youth do not go to school, but instead work in these mines. Historically, girls have especially been prone to influence by diamond dealers and miners, who tend to be wealthier than the girls, causing many of the girls to partner with these men, and to become pregnant at a very early age, and to drop out of school. In addition, girls from poor families often carried food to sell to these miners, which also exposed them to these men. Then there was the civil war, during which time many girls were taken away by rebels. Most of these young women could not engage themselves in any form of education or training throughout the eleven years of war in the country, which lasted from 1991 to 2002.
I want to see vocational programs being set up in Kono, so that the children can obtain other skills, instead of working in the diamond mines. In terms of the women in the area, many of them do not have husbands after losing them during the civil war. Women need to gain skills in order to be self-sufficient, so that they can earn money for themselves.
Although Kono is the breadbasket of Sierra Leone because of its diamond mines, the money is taken away from Kono, and the area is left decimated. For example, safe drinking water is hard to come by, and there are no taps here – instead, people drink water from wells in Kono.
Sierra Leone's government is trying to help with the situation in Kono. The government has started maintenance projects on major roads in the township. The Ministry of Health and Sanitation is fully engaged in immunization, especially for children under five years of age, for killer diseases such as measles, and they provide free tests and supply drugs for HIV and tuberculosis treatment. Also, a distance education program has been introduced, in which lecturers come to Kono to train under-qualified teachers, and two proposed teacher-training colleges are under construction.
Nevertheless, in Kono, we really need help here. We really need help.
Would you send to me a photograph or video of one thing that you would like the audience to see, and explain what it means to you?
This is a photo of me measuring a pregnant woman's belly to check the height and the position of the head of the unborn baby, which allows the nurse to know the correct term or the number of weeks or months of the pregnancy. You can see that I am wearing PPE (personal protective equipment).
This is a photo of me listening for the fetus's heart rate, to confirm that the baby is alive. I have chosen to share these photos of me examining a pregnant woman to let the public know that 100% attention is given to maternal and child health at Wellbody, and that pregnant women are being monitored to ensure safe delivery. Many local women don't give accurate dates about their pregnancy. Measuring the belly to check the height and the position of the head of the unborn baby allows the nurse to know the correct term or the number of weeks or months of the pregnancy. Therefore, the correct treatment would be given to the woman in question, and the appropriate time of referral would be stated for the next visit.
Who are your own heroes? How come you admire these people?
I admire my supervisor, Gladdis Boyama Katingo, who is the sister-in-charge. I admire her because she is active, does her work well, and because since she has been in charge, there have been no children that have died from the deliveries. Sister Boyama has also worked in many other organizations including Doctors Without Borders (MSF), and these organizations keep praising her, and regret that she does not work for them anymore.
I also appreciate how the nurses work as a team – they support each other, and the work goes smoothly.
I have also been improving since arriving at Wellbody. I admire myself because I have gone through training and challenges, and am proud of myself for being able to handle different situations. I do not hesitate to handle difficult problems, and I do my work with confidence, because I am trained to deal with complications.
I am also thankful that I was given the chance to speak with you [Seiji] via Skype and through Wellbody.
I also admire Wellbody for its Community Health Worker (CHW) program, which conducts visits from village to village, searching and referring patients, and often treating them, free of charge.
Wellbody's Partnerships Liaison Edna Bondu Bona (left with black shirt) next to Executive Director Raphi Frankfurter, Hannah Charles (center-right), Sister Gladdis Boyama Katingo (in white), and other Delivery Center staff
What are your plans and aspirations for the future?
I would like to start a clinic of my own in my own village. I want to help pregnant women in and around my village, and I want to develop the community and other villages nearby through opening this clinic. I also want to start a school in the interior communities, to provide education for underprivileged children who do not have access to education. I want to help the vulnerable.
I also strive hard to educate my own children, and I want at least one of them to become a medical doctor, to take after me and care for the sick.
Do you have any personal advice for someone who is interested in a career path in healthcare? Or for someone like you or me, who likes to help people?
I advise those striving for a career in healthcare to put attention into your work. I encourage people to join the medical team in Kono, and encourage anyone interested in contributing to the global health movement to press on, so that we have more medical personnel in Sierra Leone.
Regarding patients with conditions such as measles or Ebola – I advise people to not be afraid of treating them, since we have PPE (personal protective equipment), and won't be in direct contact with the pathogens. I also advise my colleague nurses to always wear their PPE.
Thank you very much for your time, Hannah! I've learned a lot today.