Ugandan Midwives in the Wake of COVID-19

In the wake of this global pandemic, we are witnessing something that happens every now and then; we obediently oblige to a cessation of personal rights, freedoms and liberties for the sake of our health and the health of others. The world has been in slow motion for close to two months now, and every aspect of our lives has faced unprecedented changes. Here we are, under the immense fear of an invisible enemy, and midwives’ practices have been beaten into submission, unsure of what tomorrow holds.

As midwives, we are headed for a very uncomfortable time of our lives as all of our work involves body contact (exposing us to the virus), lessening social distancing for own protection. Activities like fetal auscultation, palpation, delivery and repairing an episiotomy, among others, put us at a very high risk of acquiring the virus from patients and those we interact with from within and outside the hospital walls. When the pandemic broke out, the public were relegated to a life of long home stays devoid of the usual activity we are all used to and many of us have almost settled into the new schedules brought about by the crisis. But this does not apply to our profession. According to a report on lessons learned from the COVID-19 outbreak in China, published in JAMA, 1716 of 44672 (3.8%) healthcare personnel were infected in China, and in Wuhan this figure jumps to 63% (1080 of 1716), 247 of these were critical cases including those who died.

The situation continues to evolve, at the time of writing exact figures cannot be given and they change every day. What is important is not to become complacent in low risk regions where community infections have not yet “occurred”. COVID-19 has already caused more deaths than SARS and MERS combined due to its greater infectivity and pandemic spread. In Uganda, we have managed to contain the spread due to the strict measures and early intervention (thanks to the Ministry of Health under the government of Uganda), but the rise in popularity of social media has been a source of panic, spreading immense anxiety and fear as people voice their experiences, concerns and opinions. It has also been a source of information to many in places where information has been limited or complicated. Accurate information as it becomes available is vital in reducing the confusion caused by fear-based rhetoric. Untangling fear-based rhetoric from the truth is something as midwives we do daily. Various educational meetings and conferences have been cancelled which is contributing to anxiety caused for many by financial distress and feelings of isolation.

We are finding that pregnant mothers with previous loss are really afraid of being COVID-19 positive and feel insecure and anxious, especially when it comes to transport and fear of whether they will be attended to as planned during their delivery. Public health recommendations to maintain social distancing is putting both the pregnant women and the health practitioners, especially midwives, at a higher risk. Strengthening the midwifery community by sharing our individual experiences and timely access to accurate reliable resources is proving useful to reassure the pregnant women.

Thanks again to the Uganda government which has designated emergency contacts where a pregnant mother is considered to be an emergency subject. Nonetheless, other reproductive health services have greatly suffered as mothers are finding it difficult to access public transport. These include services like provision of family planning, antenatal and postnatal care. This has left the majority of midwives in Uganda wondering whether our communities will lose confidence in our services once the situation has normalized!

I have no doubt whatsoever that this global pandemic will come to an end. It will. As sure as that may be, it is certain that the world will not be the same again. We are living in a reality that is different to what we had become accustomed to. The pandemic has affected our lives in many ways, and we find ourselves trapped, stuck and not sure how to react. We are only kept alive by the hope that a lucky turn of events will bring everything back to normal.

We all need to be vigilant!

Agnes Nakyanzi RM, BScM; Mwebaza Enid RN/M, BScN, MPHL, LAMRN Uganda.