© Frederic NOY/COSMOS
04 May 18
Gillian Conway Gillian Conway IrishMidwifeSouth Sudan

Q&A: Working as a Midwife for MSF

Gillian Conway is a nurse and midwife from Co. Clare, who has travelled to the Middle East and Africa with MSF on a number of assignments including to Syria and South Sudan.  On International Day of the midwife, Gillian answers some questions about her work with MSF.
What drew you to midwifery originally? 
I had been working as an intensive care nurse in London when I started a Diploma in Tropical Nursing at the London School of Hygiene and Tropical Medicine.  After learning from global experts in the area, I quickly developed a passion for maternal and child health.  It really struck me how the burden of disease and public health issues that affect women and girls throughout their lives are significantly greater in places affected by conflict or where resources are scarce.   These women and girls suffer from high rates of maternal mortality, obstetric fistulas, unsafe abortions, female genital cutting, malaria in pregnancy, HIV/AIDS, cervical cancer and gender-based violence.  It’s tragic that so many of the leading causes of maternal death are largely preventable and globally, countless girls and women are still denied access to basic healthcare.  This inspired me to train as a midwife in the hope that I could make a positive difference to the lives of some of these women and girls.
Why did you decide to work with MSF? 
I have always had a sense of adventure and love a challenge.  As a teenager I remember hearing about the Rwandan genocide on the news and saw an interview with an MSF nurse and being incredibly moved by her testimony and the work that she did.  This was the first time I had heard of MSF, I thought they were  fascinating and started finding out more about the organisation and the work they do. The more I read, the more I wanted to work with MSF. As I was a volunteer carer of 2 little boys with profound disabilities at the time, nursing began to appeal to me.  I started studying, training and working towards my goal of working with MSF.

How does midwifery differ in Ireland vs in an MSF mission? 
The most obvious difference is the amount of resources, technology and information readily available.  Sadly, in some of the countries I have worked in, pregnancy can be a death sentence for many women as they have no access to maternity care. Also, many of the women that I have met in places like South Sudan have lost three, four or even five children under the age of five which is incredibly tragic.  The majority of these women have received little or no education and there are high rates of illiteracy, even exceeding 80% in some places.  The nexus between child mortality and maternal education has long been proven; educating mothers directly impacts the health of their babies. 
What's your first memory of your first mission with MSF? 
Assisting a mother to deliver her second twin in our little delivery room within the MSF hospital…….…… over 36 hours after the first twin had been delivered unassisted at home!  The lady lived a great distance from the hospital and had not received any antenatal care.  She had been carried for over 12 hours to the hospital as she had a retained placenta and was unaware that she was carrying a second baby.  The second baby had to be resuscitated at birth but, thankfully, the mother and both baby boys left hospital several days later, happy and healthy!
Any patient stories that stand out from your time working in the field? 
Gosh so many! Where do I begin? Time and time again I have been incredibly moved by the accounts that the patients give when they reach the hospital.  One that has stayed with me was from a little boy of about six years old who had walked alone over four days to reach our hospital to find his only surviving brother after the rest of his family had been murdered in fighting in South Sudan. 
Another was a little Syrian girl who had been shot in the neck by a sniper.  She suffered so many complications, experienced so much pain, survived meningitis and had to learn to walk all over again but yet she never stopped smiling the most beautiful smile.
What are the main challenges working as a midwife with MSF? 
Seeing babies and children die and women and girls suffering lifelong complications because they didn’t have access to adequate healthcare. Although our treatment is always free, a lack of resources, transport, poor infrastructure or conflict can mean that patients often present in the advanced stages of a disease or only after severe complications have arisen, making treatment very difficult. On a positive note, often the simplest interventions have the biggest impact.  For example, the use of the drug Oxytocin to prevent a mother haemorrhaging to death after birth

What's the best thing about being an MSF midwife? 
Meeting so many incredible women and girls who show incredible strength and courage in the face of extreme adversity and feeling like I am making a positive difference to their lives.  I have learned so much from each and every mission that I have been on.  Coming from a highly advanced healthcare system to working in a tukul in Sub-Saharan Africa, has meant that I have to constantly adapt the way I work, the way I think and have to frequently find simple solutions to complex problems. I love working with so many amazing national staff. A large part of my role is coaching and training local staff – nurses, midwives and

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assistants – their eagerness to work and learn despite facing multiple daily personal challenges because of conflict, is inspirational.  For example, two of the wonderful midwives that I worked with in Sudan had to walk for over two hours and cross the ‘frontline’ everyday to get to work but despite this they were never late and always showed immense care and compassion for their patients. 
How has working with MSF helped your career in Ireland?
I was able to develop my passion for human rights, gender equality and women’s health by recently completing an MA in Gender, Globalisation and Rights at the National University of Ireland Galway. My experience as an MSF nurse-midwife helped immensely with many of my assignments.  
What is your favourite memory of working with MSF? 
I have so many I don’t know where to start! Helping a mother in South Sudan to deliver a healthy baby after she had experienced five stillbirths was a particularly emotional and joyful experience. I will never forget the look of love and elation as she held her baby for the first time. At first her husband wouldn’t believe me when I went outside to tell him that he had a healthy baby son;  he had been certain that this baby would die like all the others. News of the birth spread rapidly and all the women of the village came into the hospital to sing and dance to celebrate the happy event – it was really beautiful! On my second mission, we had a mother deliver a premature baby boy that weighed just over one kilogram. Despite not having a neonatal intensive care unit or even an incubator, baby William survived and was successfully discharged home eight weeks later weighing over three kilograms. Kangaroo care (continuous skin-to-skin contact), two hourly breastfeeding and a foil survival blanket were key to William’s survival. William and his mother came to back to visit us three months later and he was thriving which was really wonderful to see. 
What advice would you give to midwives thinking of working with MSF?
Do it! You won’t regret it for one minute! Get as much varied clinical experience as you can and complete a Diploma in Tropical Nursing before you apply.  This experience and training will be invaluable to you for your work with MSF.  
Working as a midwife with MSF is a challenging but rewarding experience. We are currently recruiting experienced midwives, willing to work in unstable contexts. Management and training experience is essential. To find out more, please visit the working oveseas section of our website we or call Niamh Blake Recruitment and HR Coordinator Direct line +353 (0)1 660 3337
While you are here! Check out this video of MSF midwife Alice Gautreau from Huff Post UK.