What made you want to work in the Congo?
I've always wanted to go and work in Africa. When I was a student midwife I did my elective placement in Ethiopia and I loved it—I had the best time so I wanted to work there again as soon as I could. I always wanted to work for Doctors Without Borders as well because I'd grown up seeing them, seeing what they did on TV. I grew up in France and their actions have a strong media presence here, so I saw what they were doing, where they were going, and I always wanted to work for them. Then, when I finished my three years of experience in a London hospital, I decided to apply to Doctors Without Borders—actually, I did not choose to go and work in the Democratic Republic of Congo (DRC), they sent me there. I could have refused but I decided to go because I was really excited and, yeah, really happy I did.
How did you prepare for your journey to the Democratic Republic of Congo?
When I first heard that I would be going there, I looked up everything I could about the Congo. I didn't know much. I didn't know they were coming out of a civil war, I didn't know it was the biggest mining country in the world… I knew it was a poor country, but that's pretty much all I knew about it, so the first thing I did was read a lot about the political background of the country. Then I brought myself up-to-date on all the midwifery procedures—I was reading about all the drugs and everything because I knew that I was going to be making a lot more decisions than I would in the UK, so I was trying to keep myself as current as possible.
What was the biggest culture shock you experienced?
A lot of things were very different. I guess being a woman there, and being a young woman. Not only am I young but I look a lot younger than my years, so when I first arrived I stuck out a lot. Confronting the male doctors at the hospital where I worked, for example, was a bit of a challenge in the beginning because they are used to just saying something and the nurses and the midwives doing what they are told—they are not used to being challenged. I'm always happy to challenge doctors, to talk to them, so immediately I discovered a huge difference in hospital relationships. They were shocked by me and I was kind of shocked by them.
What were your day-to-day tasks when you were working in the DRC?
My full title was ‘Midwife Activity Manager’ and I was also the head of the Sexual and Reproductive Health Department. I was mainly managing. I had three maternity centres and health centres in different locations. Two of them were about an hour away from Lulimba and only one was actually in Lulimba. At the beginning of my mission I also had the maternity unit of the hospital to manage, but within three months of my mission I handed that back over to the Ministry of Health along with the rest of my duties at the hospital. We all handed everything back over to the Ministry of Health. After that, I mainly focussed on my three other centres.
I had staff—I had to train them to make sure they were up-to-date, make sure that we were always stocked and that the ward was always properly stocked, that our pharmacies were properly stocked, and that the procedures that they were using were appropriate, and if they weren't I had to address it by either organising training or one-on-one chats with the midwives. I also sometimes assisted for difficult cases. If they had anything a bit tricky then they'd call me and I would be consulting on the difficult cases. The scope of practice was a lot wider than what we do in the UK, I was working on all reproductive health — that's all pregnancy, obviously, all post-partum, so neonatal care and pregnancy care but also family planning and also STI clinics for both men and women. We also had a special clinic for sex workers, where sex workers of the mining town where we were came and we gave them special sex education and condoms, and we would test them for all the venereal disease we could test for on the site and then treat them. That was all very interesting and not something I'm used to.
We also did a lot of normal gynaecological stuff so people would come with abdominal pain into the health centre and they would be referred to the midwives. A bit like the UK, where they just get referred to the gynaecologist. We had to figure it out with the means that we had there, so not much really. That's what I did on a day-to-day basis.
I hear you delivered several sets of twins while you were over there.
I delivered twins during the last birth that I attended in the Congo—it's a bit sad, I don't know if you want this story. I was in Missisi an hour away from Lulimba. It's a big town, and when I arrived there this woman was already in labour. It was her third pregnancy—she didn't know she was having twins. She had a fundal height of about 34, so it looked like roughly a term pregnancy. Then when she started pushing the baby that came out was very small—it was 1.2 kg—but with her fundal height we guessed that there would be a second twin coming after. The first baby was not really breathing, not very reactive, so I started resuscitating the baby with my team and two of the other midwives started helping the second baby to come. At that time, we had no oxygen, no concentrator, and those two tiny babies were coming. I was trying to pump oxygen into the first one when the second one came as well, and the first one was still not breathing so we started trying to resuscitate the second one. This baby was even smaller—it came breach—smaller than the first one, and then finally some oxygen arrived from Lulimba. It arrived a full hour after the first baby was born, and unfortunately that baby died before the end of the transfer. The second one made it though. I don't know if that's the story that you wanted. It was just horrific, there was no good outcome there.
I have another twin story—shall I tell you about the other twin story? At the hospital we had a waiting area for mums. If they were high-risk for any reason, or if they lived really far from the hospital, we would invite them to come and stay for about a month before their due date so that when they went into labour they were already in hospital and could deliver safely there. There was this woman that was referred from Mississi because she was having her ninth baby—or tenth, hang on, tenth baby, she was having her tenth baby. She was high-risk, so she was told to come to the hospital and she arrived with a fundal height of about 96. We had a scanner in the hospital but she had a very difficult scan—it was just full of limbs and we couldn't even tell which way around the baby was. So I took another scanner out and I did a scan and, lo and behold, there's two babies and they're about 32 weeks gestation. So, I try to explain to this woman—well, I knew how to count at this point so I'm telling her “there are two babies” in her language—I'm telling her “two, in your stomach!”
Her face was a picture—she realised she was having not just baby number 10, but baby number 11 as well. And so she stayed in the waiting area, she stayed for six weeks because the babies were still quite early, and she became quite a figure at the hospital. There were women coming and going and she was there for so long that she became a minor celebrity. Every time I went up to the hospital, she would say ‘yeah, I'm still here! I'm so tired! Come on, midwife, why don't you make my babies come?’
She was such a character—she was amazing. Then I went on holiday and I told her: ‘When I come back, for sure, your babies will have come.’
She gave birth the day that I came back from the holiday and she said that it was thanks to me that the babies came! She was so happy. One of the babies was called Baby Alice. She had two little girls and she was super happy in the end. The twins did really well. Then she came to the family planning the week after—we discharged her really quickly—and we put an implant in her. She was quite old—it was hard to tell how old she was but she was probably in her early 40s. She told us: “midwife, I don't want any more, I think this is enough. I think God can understand that I've done my bit.”
So we put an implant in her and she was super happy. That's a nicer story about twins.
Do you have any other good stories from your time in Lulimba?
I don't know which one to pick… what can I tell you? There is a movie called The First Cry and it shows births from around the world. I decided to organise a screening of it to show the midwives on my team how birth happened in other countries. I set them up in a room and I put the movie on. They were all busy watching that movie and I was busy looking after the ward in the meantime.
Then a woman walked in looking very cool, very composed, unlike a lot of women who arrive here in labour. She told me that her baby was coming and at that point I could speak enough of the language to understand what she was saying. I said ‘OK, right,’ and I asked her to lie down so I could examine her. She was fully dilated so we start pushing and we did the whole birth together—a really calm and quiet birth—I wasn't shouting at her as happens here sometimes. She was just pushing her baby out, breathing it out, as I would have done in the UK.
As the head came out, my team of midwives walked into the room because the movie had finished and they were asking ‘What are you doing?’I said ‘Shhhh! No speaking, no speaking! I'm just going to deliver this baby, it's OK. We don't need to shout.’ So I delivered the baby, and I put the baby on the mother's stomach. We did straight skin-to-skin—I did not cut the cord. Actually, the placenta came out before the cord was cut. It was very quiet. I was telling the mum how well she was doing, I told the mum what the baby's sex was and everything… and it just felt so different from what births there normally were. Oftentimes everyone is running around, cutting the cord really quickly, taking the baby away and wrapping it around with some old towel… But this was very chilled.
And then the mum asked me to take the baby away and to weigh it, so I did that, but not before she actually asked me. My whole team was standing by and just observing this, and it was quite nice because they had just seen the movie that showed them how birth doesn't happen the same way in every country—and it's definitely very different depending on where you are in the world—and then they come and they see in action the way that I would conduct a delivery in the UK. We sat down together and we discussed the movie and the birth that they'd just seen with me—it was a great discussion—and then I chatted to the woman afterwards as well and she said that it was her fourth baby and it was the nicest birth that she'd had—she said that she'd never felt fear at all. I was so happy! It was so nice.
What did you like most about working with Doctors Without Borders?
I think what I liked most was the relationship I built with my team of midwives. I liked the fact that they were all so dedicated and so motivated and that they were so keen to learn—and so keen to teach as well. I learned loads from them. I loved interacting with them and being around them all the time. That's what I loved the most—learning loads and being with my midwives there.
What did you struggle with most when working with Doctors Without Borders?
I think the most difficult part was not being able to come out of work and sit with people who are not necessarily from work. When you're in the field and you come out of work, then everyone who works with you is there in the compound—all the ex–pats that work with you are there and the discussions always revolve around work and around your day. Even when we try to speak about something else—because everyone goes crazy if you only talk about work—it's all a bit artificial because we didn't know each other before we came to the DRC. Sometimes you get on with people, but sometimes you just don't have anything in common with the people you work with—I never disliked anyone but there were some people with whom I didn't connect as easily, and I missed that human connection that was not work-related. I missed just having a casual beer with my friends. That was what was the most difficult—working so far away from all my friends and my family—just not having them around. That was difficult.
Would you want to do any more assignments abroad in future?
Actually, my next mission is coming soon! I'm starting on 1 May and this next mission will be very different to my first one. I will be working on a search–and–rescue boat in the Mediterranean. We roam the sea and try to find people in those dinghy boats that just sink and try to save people from drowning—a lot of those people are actually women, so as a midwife they must have you do a lot of work concerning women's health. A lot of those women are either pregnant, or have been pregnant very recently, or have been the victim of sexual abuse or sexual violence during their trip or back home. They all need medical care and psychological care so I will be working alongside a psychologist for my next deployment. The two of us will be supporting those women who try to travel across the Mediterranean.