Protecting midwives on the front lines of the Ebola response

A simulation of childbirth in an infection prevention and control situation taking place in an environment sensitive to the Ebola virus. © UNFPA DRC

22 February 2020

NORTH KIVU AND ITURI PROVINCES, Democratic Republic of the Congo – The Democratic Republic of the Congo remains in the grip of the world’s second largest Ebola epidemic on record, although the incidence of cases has slowed. Since the outbreak was declared on 1 August 2018, there have been more than 3,300 confirmed cases and over 2,200 deaths.

"The Ebola Virus epidemic is not sparing anyone,” said Professor Steve Ahuka, the general coordinator of the Ebola response.

Supervising midwives conduct an inspection of the admission protocol of a maternity unit at risk of Ebola virus disease. © UNFPA DRC

Among those most at risk are health workers, who place their lives on the line as they provide care to others. Health workers made up about 5 per cent of Ebola cases, according to July estimates.

Personnel in reproductive health settings face especially high risks. “Obstetric care and more specifically, childbirth, an act of giving new life, carry a very high risk of contamination with the virus through biological fluids,” said Dr. Monique Kapamba, a national reproductive health expert.

“Pregnant and breastfeeding women, as well as health personnel operating in maternity wards, need protection,” said Dr. Ahuka.

UNFPA is working the World Health Organization (WHO) and the Ministry of Public Health to strengthen infection prevention and control (IPC) measures in reproductive health facilities in the Ebola-affected areas.

Giving life under the shadow of Ebola

Dr. Polycarpe Takou briefs gynaecologists, midwives and birth attendants on infection prevention and control in Butembo. © UNFPA DRC

The needs of pregnant women have been underserved in earlier Ebola responses, analyses indicate. Strengthening IPC in reproductive health settings will help ensure health workers can meet the needs of all women, whether they are seeking gynaecological check-ups, prenatal consultations, labour surveillance, childbirth care, or post-natal care.

IPC includes the use of masks, gloves, gowns and goggles, the sterilization of equipment and routine use of disinfectant, as well as the implementation of isolation spaces for patients or staff suspected of having the virus.

UNFPA, WHO and the health ministry are providing training in IPC measures for 400 midwives in more than 300 health facilities.

“It is urgent and important to strengthen preventive measures in maternity hospitals located in risk areas,” said Dr. Kapamba. She leads the team of midwifery trainers who are carrying out this work in North Kivu and Ituri provinces.

Peer supervision

In addition, the programme is deploying IPC focal points to health facilities to monitor how IPC measures are being implemented. “The supervision of IPC activities in maternity wards is crucial,” Dr. Kapamba said.

Routine disinfection and proper disposal of medical waste are key components of infection prevention and control. © UNFPA DRC

Since October of last year, teams of midwifery supervisors have been touring high-risk areas in Ituri and North Kivu. Recruited by UNFPA, they supervise deliveries and other reproductive health services to ensure their peers are not at risk of Ebola infection.

Peer monitoring is helping to ensure ICP standards are maintained well after the training sessions have ended. “The initiative aims to ensure that the application of preventive measures becomes a reflex,” said Dr. Polycarpe Takou, UNFPA’s humanitarian coordinator for Ebola response.

“In addition to the training and related supervision, UNFPA provides maternity wards with essential equipment to ensure full implementation of the IPC measures and render them Ebola-free places,” he added.
– Theophane Patinvoh