A salve amid Darfur woes: better midwives

International relief groups are training Darfuri women to ameliorate Sudan's maternal mortality rates – the fifth highest in the world.

Under the blazing noontime sun in this relief camp, Fatima Abdullah Abou does something she couldn't have done before the Darfur conflict began. She takes her patient, a young mother about to give birth, to get medical help at a local clinic manned by doctors for an international medical aid group, Relief International.

"She was in pain, and she's been trying to give birth for a while, so I came to this clinic to get help," says Mrs. Abou, who has been an untrained village midwife for some 25 years. As she speaks, her young charge is escorted into a waiting van for the six-mile drive to a maternity hospital in nearby Al Fasher.

It's one of the cruel ironies of the Darfur conflict, which has entered its fifth year, that it took a deadly war – that has killed 200,000 civilians, mostly of the region's non-Arab tribes – for many Darfuris to receive the first adequate healthcare of their lives.

Before the conflict, many families lived hours or even days away from hospitals. But now, as 2.5 million people displaced from their homes have migrated to camps like Zamzam, they are benefiting from the healthcare offered by groups like Relief International.

For Darfuri women – who, along with children, make up 80 percent of the displaced – the proximity of international organizations also offers a status-boosting opportunity to bring relief to others as trained midwives.

Sudan suffers the fifth-highest rate of maternal mortality in the world, with 1,700 women out of 100,000 dying while giving birth, according to the United Nations Population Fund (UNFPA). Infant mortality is even more common, with 150 deaths per 1,000 live births.

Despite a recent government push to train more midwives, the vast majority of villages in Darfur still don't have a trained midwife.

But war may be changing that. The training, which had been resisted, is now increasingly being embraced, giving women both financial independence and positions of respect in their communities.

Samia Hassan, a reproductive health officer with UNFPA in Khartoum, says that midwives have become so valuable in Sudanese society that villages that cannot afford to train one have sent their men out to marry midwives from other villages and bring them home.

"Nowadays, people want midwives in their village and there's a waiting list for classes," says Fatima Houssain, dean at the UNFPA-funded Midwifery School of Al Fasher.

In a typical year, the school trains about 30 young girls to become unpaid village midwives or salaried midwives in urban hospitals. This year, enrollment jumped to 82 students, a sign of changing attitudes among the displaced Darfuris who have flooded this oasis town in North Darfur.

"In Darfur, the rate of illiteracy is around 74 percent, so in that kind of society, midwives become role models for young girls," says Ms. Hassan.

In a classroom full of young women in white veils, Fatima Alameen demonstrates the techniques of a safe birth with a plastic dummy on a table. With rubber gloves and surgical mask, she "catches" a newborn baby – a handsewn cloth doll with an umbilical cord – wraps the baby in a towel and applies a clamp to the umbilical cord.

Married at age 10; difficult birth

All the students has come here because they have suffered complicated births themselves.

Some, like Aziza Jiddu Suleiman, were married off at an early age, a tradition that persists among the Fur and Arab tribes of the Darfur region, and have lived lives that would make Charles Dickens shudder.

Married at age 10, she became pregnant almost immediately.

The birth was complicated; Ms. Suleiman, still a child, lost her baby and suffered an injury that left her unable to control her urine.

Her husband divorced her soon afterward, citing unpleasant side-effects of her injury, and her inability to bear further children. She was just 11 years old.

For the next nine years, she sought shelter, work as a cleaner, and eventual treatment for her condition (called fistula) at the Saudi Maternity Hospital in Al Fasher, also funded by UNFPA.

Now 20, Suleiman has decided to turn her tragic life into a source of strength for others. She wants to become a midwife.

"I feel two feelings about my life," says Suleiman, smiling and cracking her knuckles. "First I felt weak because, although I was not assaulted, I was ignored by others because of my problem. But I also feel strong, because I'm going to help others to avoid this same problem in the future."

General MacArthur of midwifery

If Suleiman and her classmates are the hope of a new generation of mothers, then Zainab Juma Nimeir is their Gen. Douglas MacArthur, tough, reliable, and unwilling to just fade away.

Trained as a midwife in 1952, after her father died, leaving her in charge of her younger brothers and sisters, she became one of the first midwives in Darfur.

"I convinced myself that I could help all my Sudanese sisters, I was doing something humanitarian," says the septuagenarian, who performed her duties until retiring two years ago.

War has brought the biggest changes to the region, she says, and the same insecurity that forces families to come to relief camps – where they can at least receive some modicum of healthcare – also keeps more remote families from even venturing out of their houses at night.

"Since the war, people are afraid; even if they call you to their houses, you are afraid to go unless they come pick you up," she says.

But that doesn't keep them from showing their appreciation for her. When Mrs. Nimeir goes out into the countryside, she says, "People come up to me and say, 'You are my mother.' When I go to the village, people give me a sheep or a goat as a gift."

And this gives her an influence in villages that usually only village chiefs and tribal elders can expect. "We build on a relationship of sisterhood with our patients," says Nimeir. "They listen to us. It's a matter of trust."