GAIN Nurse-Midwife Stories

Stories of exceptional care at our health facilities


GAIN expert mentor, Luseshelo Simwinga, pins nurse-midwife Faith with a GAIN badge for exceptional care 
at South Lunzu health centre in Blantyre district, Malawi.

Faith and I came across a pregnant client with severe preeclampsia. Faith took the lead, using the client's presenting complaint, history, physical assessment, and investigation to diagnose severe preeclampsia. She calmly explained the condition to the patient, developed a midwifery care plan, provided pre-referral management, including administration of hydralazine and magnesium sulphate, and referred the patient to the tertiary care center. I was so impressed with how she managed the patient with so much ease and expertise, so much so that I had to put a badge on her for outstanding service as a distinctive mark for her expertise demonstrated in the management of severe preeclampsia.

Stories from the field

Baby Merab, pictured above during a kangaroo mother care session, was born premature at the 6th month of pregnancy weighing 1.1kg. Her mother was referred from a remote clinic by a midwife due to eclampsia (very high blood pressure in pregnancy), which is one of the leading causes of death among pregnant women. The baby was born through cesarean section with severe respiratory distress due to prematurity. Baby Merab was admitted to Neonatal Care Unit (NCU) at JJ Dossen Memorial Hospital, under care of GAIN mentors and their mentees. The baby developed severe jaundice and other complications associated with prematurity. The nursing team, under mentorship from GAIN mentors, provided specialized care for 77 days where the baby received close monitoring, antibiotics, phototherapy among other services. To maintain the baby’s delicate body temperature, the mother was taught kangaroo mother care, a procedure where the infant is carried by the mother with skin-to-skin contact. The baby was discharged home weighing 2.3kg. Prematurity is one of the leading causes of neonatal death. Following war and Ebola, Liberia’s health system faces serious challenges with severe shortages of specialized nurses. Through GAIN support under the nursing workforce expansion program, the NCU at JJ Dossen Memorial Hospital is now managed round the clock by competent neonatal nurses. Since its inception in early 2020, this specialized neonatal care unit has since nursed more than 300 neonates referred from within Maryland County and the two neighboring counties in southeastern Liberia. 

Beatrice delivered at JJ Dossen memorial hospital through caesarean section. During her recovery period at the ward, the midwives noticed that she was having postpartum hemorrhage (PPH)—severe bleeding following childbirth. Through the GAIN mentorship program, midwives had been practicing management of PPH through the various procedures (pictured above practicing management of PPH with a non-pneumatic antishock garment). The midwife quickly initiated the PPH management emergency protocol and called for assistance from other midwives and the doctor on call. As part of emergency preparedness, the team had prepared a PPH emergency kit (a prepackaged set with all basic requirements for managing bleeding following childbirth) during a previous GAIN training session. After attempting to save the mother through the initial interventions, the bleeding persisted so the midwives quickly applied a non-pneumatic antishock garment on the mother which helped stabilize her before the arrival of surgical team. The patient was taken to the operating theater where the bleeding was managed through surgery. Antishock garments are a cheap yet highly efficient tool for managing PPH in low resource settings. As part of the GAIN intervention, all midwives at the hospital are trained on the use of antishock garments to manage PPH. The program also provided five garments for training and use by the midwives to save maternal lives in southeastern Liberia. These garments are currently used as part of the essential lifesaving equipment for managing bleeding during and after delivery.