Dr Ntirushwa on changing the ‘labour ward experience’ for African women

Dr Isabelle Kayitesi Ntirushwa’s passion put her at the forefront of championing maternal health. As the managing director of Iranzi Clinic, a faith-based private clinic that focuses on maternal health, she believes in empowering women in the most difficult times. Ntirushwa and her team are dedicated to making the delivery process a bearable one, by ensuring that expectant mothers get what they need throughout pregnancy until after delivery. We met for the interview at the clinic in Nyarutarama. Dressed in navy-blue pants and a colourful chiffon blouse, the doctor led me to her office, and after a few minutes of light chat, we got into her line of work. Soft-spoken and articulate, her words seemed well thought out, and she had a presence that every now and then added ‘colour’ to the conversation. Ntirushwa has always been passionate about women; it is transparent in the way she speaks about them. She vies for their empowerment. Her desire to support women was stirred when she joined a friend and missionary midwife to start a community outreach programme, where they offered free antenatal and postpartum care to expectant mothers in Nyabisindu, Gasabo District. This was in 2011 after she quit her job at Oshen-King Faisal Hospital to stay home with her first born. She had worked in the emergency and paediatric departments. “Our approach with the outreach programme was very unique; it was holistic, not just a five minute consultation. We gave the women enough time; we looked into their social and economic situation,” she says. With that experience, her desire to reach out to women grew even deeper, leading to the decision to seek training in obstetric ultra sound. She wanted to do more and needed the right skills. Birth of Iranzi Clinic The community outreach programme was part of the activities of Christian Life Assembly (the founder of Iranzi Clinic) and with the inception of the clinic in 2013, with a focus on maternal health, Ntirushwa didn’t hesitate to take a step further. “I have been part of this project from its inception and as a Born Again Christian and a medical doctor, I always had a passion for people generally, which blends well with my career because medicine is about people, and so when I realised that the church wanted to set up a project that would reach out to people, to me, taking part was the best expression of my faith,” she says. As a medical doctor, she applied for the post and became the managing director of Iranzi Clinic. Helping women was what she was doing and she wanted to go further. “I love the work we do here; it’s about empowering people, women in particular, because we are the most vulnerable. And so being able to empower a woman in the most difficult time of her life for me is a joy and I love that it is our focus.” Though the clinic offers other medical services, their focus is maternity. A new approach to the labour ward Women are given multiple choices on how they want to deliver. They can stand, sit, squat because they are not limited to only having their babies while positioned on their backs. They are also given access to equipment that helps regulate labour pain. They can sway on rubber balloons or a birthing ball when the labour pain sets in, or use a tens machine (a portable device used on the body), this is placed around the lower back and has small electrical pulses that are transmitted to the body that ease the height of contractions. When a woman is pregnant she is vulnerable, this is why having somebody who listens and understands what she is going through and responds with empathy matters a lot, Ntirushwa says. She adds that this is why their approach goes beyond a woman being pregnant, and all the way by supporting her in every way. A woman is given psychological, emotional and spiritual support. “Women go through so much, a lot affects the way they handle their pregnancy and how they manage labour and delivery. This is why we go beyond pregnancy, our staff has been trained to do more than just the medical; they are able to offer counselling. And being a counsellor is not about giving advice, it’s about being present, and I think that’s quite unique because then you get to dig deep,” she says. The postnatal programme Every woman who delivers is visited at home after her delivery. This is termed as ‘a home visit’ or ‘postnatal visit’ and it entails proper consultation to ensure that the baby and mother are all in good and healthy condition. The home care is done in the first week after delivery and after that, the mother is expected to come back for check-up up to six weeks. The other important aspect is the emotional support rendered to the mother by the midwives during the home visits. “When we visit these women, we provide medical support, but most importantly, we listen to them. At times this is all one needs; don’t just hurry to treat but be part of her life, that’s how you develop a trust relationship with your health care provider.” Ntirushwa says the clinic also plans on introducing a child wellness clinic this month where they will follow up on babies till the age of five to monitor their development. “It is going to be a follow-up on the child’s development and support to the mother such that they are not alone in raising this child,” she says. Need for more research on women’s health Ntirushwa hopes to grow more as a supporter of primary health care. She also plans to focus more on research about women’s health that will eventually lead to favourable policies and procedures that will strengthen empowerment all through pregnancy and delivery. “Though we do have research around reducing maternal and child mortality rates, we don’t have a lot of research about women’s health in Africa, and we need it; we need to know how pregnancy is for them, how their bodies usually handle pregnancy, how labour usually is for them,” she says. With this, she says, African women will have a chance to go through labour their way and not just go with what western culture says. She adds that there is need for evolution of the environment to make it more investing to women and also, help them feel secure about pregnancy. “We can’t stick to everything we learn from the West, we have to see what works for us by finding out the best ways to support an African woman in labour, for instance, does she need drums or a calabash around? We don’t have research on these kinds of things but this is all necessary if we are to empower the African woman,” Ntirushwa says. Ntirushwa also points out that even though implementation of all this doesn’t come easy since Africa struggles with resources, “if we dig deeper, we might find that we have our own resources, that we can figure it out and incorporate all that and make maternity more manageable for a woman.” The importance of maternal health care This is one of the many projects that we have as a church because our vision is to transform communities through the love of Christ. Our focus is mothers and children because they are more vulnerable in our communities. We hope that the services will help identify the critical needs in our community such that the psychosocial and economical livelihoods of the people are improved. Pastor Andrew Mukinisha, Senior pastor, Christian Life Assembly - The Iranzi model of care is quite unique with an emphasis on personalised holistic care for the mother and baby. In addition to excellent pre-natal and delivery services, Iranzi Clinic has put emphasis on postnatal care and check-ups for the family. From the Rwanda Demographic Health Survey 2015, postnatal attendance was a major gap since over 81% of new-borns and 57% of mothers did not receive postnatal checks within the first two days after birth. Iranzi has come in to fill this gap and so far, 100% of all clients have received adequate postnatal services, both at home and in the clinic. The clinic also offers pre-natal education classes that give parents and intending parents, information and skills throughout planning for pregnancy, delivery and post-delivery. Dr Brenda Asiimwe-Kateera, Board member, Iranzi Clinic - The well-being of mothers and infants has always been a core aspect this is why a well-established maternal and child health care system is a very crucial facet that concerns all, as it curbs issues such as maternal and child mortality rates. Maureen Katushabe, Businesswoman - A stable maternal and child health care system is very important because caring for mothers is crucial. It also ensures that mothers and their children access good quality services, which in the end, will guarantee good quality of life. Pie Kombe, Therapist - editorial@newtimes.co.rw

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Dr Ntirushwa on changing the ‘labour ward experience’ for African women