New Zealander Jacqui Jones is a nurse and midwife and is currently working as Midwife Activity Manager, in Maiduguri, Nigeria. The population of the city has swelled as people seek safety from the conflict between Boko Haram and the Nigerian Army.
My role involves assisting with managing the Nigerian supervisors, providing education to staff and assisting with difficult births or other cases. I am available on the phone to the midwives whenever they need me, as I can only visit the hospitals during the day due to security restrictions. I hope I’ve made a difference with our Nigerian staff. They are the ones who will continue the work once we are gone. If their knowledge and skills have improved while working with Médecins Sans Frontières, I think that is the greatest impact we can have. Talking to our staff I have learnt that Maiduguri used to be a bustling hub of business. Every day I drive past the train lines that are now overgrown or littered, factories that are closed and grand houses halted mid-construction. I can’t ever imagine that happening to my home city.
"Our world has us believe we are at war with one another, however working with MSF, seeing regular people getting on with their lives, you realise we have no reason to be"
Twins and triplets
The highlight of my assignment so far has been having two sets of twins and one set of triplets born in the same week. The births were not without complications (only one of the seven presented head first, and two of the mothers had large bleeds afterward) but all of them were discharged in a healthy condition. I also had a lovely case of a nun who came for help with a gynaecological problem. She was displaced after Boko Haram attacked the convent. I didn’t have the equipment to help so together we went to the Ministry of Health supervisor, who is an Islamic women who at that time was fasting during Ramadan. I watched these two women conversing, and they quickly found a solution. There was no judgement about religion or anything else, just assistance provided to someone who required it. This is what always amazes me the most. Our world has us believe we are at war with one another, however working with Médecins Sans Frontières, seeing regular people getting on with their lives, you realise we have no reason to be.
Challenges to diagnosis
The biggest challenge is not having many diagnostic tests. We send people to get ultrasounds however they are not always accurate. I have had scans reporting ‘no cardiac activity’, and then a healthy baby born hours later. It is frustrating not knowing the ‘numbers’ that we have so readily at our disposal back home. Another challenge is the language barrier. I wasn’t expecting there to be so many dialects. I often find myself asking the midwife questions who translates it to the cleaner who can then speak that particular dialect to the patient. This does create barriers to diagnosis, as you’re not always sure how words are translated. It reminds me of a game of Chinese whispers.
Traditional medicine is also very popular here. We have had patients present in a very serious condition but without a typical medical history that explains their current state. Eventually (with multiple translations and asking the question four different ways) we learn that a traditional medicine healer has given some concoction. A few times it has resulted in life-threatening conditions. Babies have also returned to us with symptoms of tetanus due to having tribal marks made on the skin with an unclean knife.