Midwives task-sharing in providing advanced obstetric care in hospitals in rural Liberia

David Southall MBBS, MD, FRCPCH, OBE
Professor of Paediatrics and Honorary Medical Director MCAI

Professor David Southall travelled down from the NW Highlands of Scotland to talk to the medical society about the groundbreaking work of his charity MCAI (Maternal & Childhealth Advocacy International) and the quite amazing results achieved so far in Liberia.

Dr David Southall

Images on page (except map) Copyright © MCAI

Founding MCAI

Dr Southall had worked for many years in the NHS as a consultant paediatrician with a special interest in detecting child abuse.
In the 1990s he worked in the former Yugoslavia treating children who were victims of the war, for which work he was awarded an OBE.
In 1995 he founded the charity MCAI of which he is the medical director. The charity is currently directing a task-sharing programme in Liberia aimed at the training of midwives in advanced obstetrics including abdominal surgery, and the training of nurses and midwives in advanced neonatal care.

Neonatal challenges in Liberia

David graphically displayed the horrific maternal and neonatal death rates: 1072 maternal deaths /100,000 live births.
Neonatal death is so common that often the dead baby is just buried with no record kept.
It is not uncommon for girls as young as 10 years to be mothers.
One of the main problems in the provision of hospital care for pregnant women and newborn infants in low-income counties is the lack of appropriately trained doctors.
The Liberian figures are amongst the worst in the world.
The few doctors that are available become exhausted with the huge numbers and relentless pressure and are quickly liable to 'burn out' and to quit obstetrics, making the situation worse. This leads to less opportunity for young doctors to be trained.
This is where David's charity MCAI comes into play.

Role of MCAI in Training Midwives

Experienced midwives and nurses are carefully selected to undertake extensive training and undergo rigorous continuous assessment, to become qualified obstetric clinicians (after 3 years) and qualified neonatal clinicians (after 2 years).
Now in its fifth year, this landmark project in advanced obstetrics has led to significant achievements:
  • 2 qualified obstetric clinicians
  • 9 current interns who have completed 2 of the 3 years of training
  • a new intake of 10 additional trainee obstetric clinicians on 1st February 2018
The success of this project led to the task-sharing project in advanced neonatal care, which is in its first year and supports 4 trainees.

Celebrating the graduation of Hanna and Naomi - the first to qualify under the MCAI scheme

Truly Impressive Results

What MCAI have already achieved is truly impressive.
From October 2013 to November 2017 1,654 caesarean sections have been undertaken by the first 11 trainee clinicians.
From 1/8/17-30/11/17 65 babies have been treated with nasal CPAP for respiratory failure. These babies would otherwise have died.
This has all been achieved despite the widely publicised Ebola outbreak.

Supporting MCAI

David's talk was enthusiastically received and MCAI certainly seems to be charity worthy of support.
There are major problems with the availability of vital equipment and essential emergency drugs, medical and surgical supplies, and funding is always an issue.

If any of our members would like to support MCAI, their “Regular Supporter Form” is available here…

The vote of thanks was given by Dr John Broomhall, retired consultant paediatrician, who not only thanked Professor Southall for his excellent and inspirational talk, but also thanked him, on behalf of all paediatricians, for the work he had done in detecting child abuse, work that was at tremendous personal cost.

Review by Lorraine Roberts