Tanzania’s Dr. Godfrey Mbaruku first thought his posting to remote Kigoma in Tanzania was a punishment. The only maternal specialist for 1.2 million people with deplorable conditions and staff challenges, his situation was trying even for an experienced obstetrician, let alone a young specialist. In the 20 years he spent in Kigoma he rekindled staff morale and performance through creating a better feedback loop and celebrating staff. Giving careworkers housing at the hospital site and temporary homes for waiting mothers turned out to be a revolutionary idea spreading across Tanzania and the rest of the continent.An Introduction to Kigoma Dr. Mbaruku is currently based at the Ifakara Institute in Dar es Salaam. On the day we visited (to attend a seminar) it was hot and humid; sleep-inducing, in other words. So I sat at the back, expecting to be lulled into a torpor by the heat, and a line-up of PowerPoint presentations. It was not to be. Dr. Mbaruku grabbed my full attention by delivering a compelling account of his work in a maternity ward in Kigoma, in the remote west of Tanzania. And he did so in a quiet, modest voice. He began by showing us a picture of the fine railway station that dominates the town of Kigoma. No stats. No charts. No printed words. Just a positive image of Kigoma. An Insurmountable Challenge He had been posted there in 1988, after specialising in obstetrics and gynaecology. As the only maternal specialist for a population of 1.2 million people, and after surveying conditions in the maternity ward, he came to believe (he once told the Lancet) that the posting was a punishment. Sheets were dirty and stained; clean water and commodity supplies were unreliable. Staff were demoralised, underpaid and overworked. Mortality and morbidity rates were high. Local women - wisely - gave the hospital a wide berth. The good doctor was tempted to march straight back to Kigoma railway station, and catch the first train back to Dar. Changing Tack Instead, after taking stock, he acted resourcefully. Clean water? He noticed a big, abandoned tin barrel in the hospital yard. Somehow he and his team yanked it up on to the roof of the ward, and piped clean rain water into the wash rooms. Staff morale? Dr. Mbaruku began a series of regular meetings with staff, and listened. In response, he arranged training. But the big morale-booster was the institution of regular weekly meetings, when staff efforts in the previous week would be noted, recognised and celebrated. “The nurse that had given blood in the middle of the night when a woman was haemorrhaging” he told us, “would be praised and congratulated in the presence of the whole team. Gradually this recognition helped improve performance.” Emergency night-time care for patients? Dr. Mbaruku suggested that careworkers should be given staff houses on the hospital site, so that they could quickly assemble in a crisis. Learning from an earlier experience, he proposed that temporary maternal waiting homes be built for women at-risk – to stay free of charge. The idea has caught on, and is now applied across Africa. The Results After just four years of hard, dedicated and enterprising work, maternal deaths in the hospital began to fall - from 20 a year, to five – a reduction of three quarters. Many, many lives were saved. The ward was smartened up. Staff morale rose – and soon the maternity ward became a magnet for queues of local women. No wonder Dr. Mbaruku takes such pride in the town of Kigoma. It was the site of two decades of remarkable progress in saving the lives of women. There are many African heroes and heroines in the field of maternal health. Men and women that work in the harshest, most unforgiving conditions; that approach the challenge of saving the lives of women and newborns with intelligence, courage and above all, resourcefulness. And who, each time they save a woman’s or newborn’s life, bring relief, joy and peace of mind to families. Above all, they command the honour and respect of their communities. I was lucky enough to meet one of the finest.
Tanzania’s Dr. Godfrey Mbaruku first thought his posting to remote Kigoma in Tanzania was a punishment. The only maternal specialist for 1.2 million people with deplorable conditions and staff challenges, his situation was trying even for an experienced obstetrician, let alone a young specialist. In the 20 years he spent in Kigoma he rekindled staff morale and performance through creating a better feedback loop and celebrating staff. Giving careworkers housing at the hospital site and temporary homes for waiting mothers turned out to be a revolutionary idea spreading across Tanzania and the rest of the continent.An Introduction to Kigoma Dr. Mbaruku is currently based at the Ifakara Institute in Dar es Salaam. On the day we visited (to attend a seminar) it was hot and humid; sleep-inducing, in other words. So I sat at the back, expecting to be lulled into a torpor by the heat, and a line-up of PowerPoint presentations. It was not to be. Dr. Mbaruku grabbed my full attention by delivering a compelling account of his work in a maternity ward in Kigoma, in the remote west of Tanzania. And he did so in a quiet, modest voice. He began by showing us a picture of the fine railway station that dominates the town of Kigoma. No stats. No charts. No printed words. Just a positive image of Kigoma. An Insurmountable Challenge He had been posted there in 1988, after specialising in obstetrics and gynaecology. As the only maternal specialist for a population of 1.2 million people, and after surveying conditions in the maternity ward, he came to believe (he once told the Lancet) that the posting was a punishment. Sheets were dirty and stained; clean water and commodity supplies were unreliable. Staff were demoralised, underpaid and overworked. Mortality and morbidity rates were high. Local women - wisely - gave the hospital a wide berth. The good doctor was tempted to march straight back to Kigoma railway station, and catch the first train back to Dar. Changing Tack Instead, after taking stock, he acted resourcefully. Clean water? He noticed a big, abandoned tin barrel in the hospital yard. Somehow he and his team yanked it up on to the roof of the ward, and piped clean rain water into the wash rooms. Staff morale? Dr. Mbaruku began a series of regular meetings with staff, and listened. In response, he arranged training. But the big morale-booster was the institution of regular weekly meetings, when staff efforts in the previous week would be noted, recognised and celebrated. “The nurse that had given blood in the middle of the night when a woman was haemorrhaging” he told us, “would be praised and congratulated in the presence of the whole team. Gradually this recognition helped improve performance.” Emergency night-time care for patients? Dr. Mbaruku suggested that careworkers should be given staff houses on the hospital site, so that they could quickly assemble in a crisis. Learning from an earlier experience, he proposed that temporary maternal waiting homes be built for women at-risk – to stay free of charge. The idea has caught on, and is now applied across Africa. The Results After just four years of hard, dedicated and enterprising work, maternal deaths in the hospital began to fall - from 20 a year, to five – a reduction of three quarters. Many, many lives were saved. The ward was smartened up. Staff morale rose – and soon the maternity ward became a magnet for queues of local women. No wonder Dr. Mbaruku takes such pride in the town of Kigoma. It was the site of two decades of remarkable progress in saving the lives of women. There are many African heroes and heroines in the field of maternal health. Men and women that work in the harshest, most unforgiving conditions; that approach the challenge of saving the lives of women and newborns with intelligence, courage and above all, resourcefulness. And who, each time they save a woman’s or newborn’s life, bring relief, joy and peace of mind to families. Above all, they command the honour and respect of their communities. I was lucky enough to meet one of the finest.