Giving birth is never an easy experience, but in a region that has been ravaged by war, poverty and hardship, it becomes even more difficult and dangerous. Cathy Ellis, a seasoned registered nurse, midwife and expert in community health from Saskatchewan, recently had the opportunity to play a significant role in creating a much safer and more pleasurable birthing experience in many clinics and hospitals throughout Kosovo. By sharing their knowledge and expertise with the nurses and midwives working in the maternity wards, Cathy and her team have affected real and tangible results.

The healthcare system in the Balkans has been adversely affected by the prolonged conflict and general instability that has plagued the region in recent years. Although national healthcare systems do exist and are available to both urban and rural populations, public hospitals often lack the necessary supplies and equipment. Doctors and nurses are overworked, underpaid and lack up-to-date training. As a result, the Canadian Public Health Association (CPHA), in partnership with CIDA, is implementing a regional project in Bosnia and Herzegovina, Serbia and Montenegro, Kosovo and Albania to strengthen essential public health functions in these countries.

The goal of the project is to reinforce the institutional capacity of public health institutes so that they, in turn can provide quality training to their healthcare workers and deliver effective programs in the fields of health promotion, health information systems and essential public health functions. By using the concept of “train the trainer”, this project is expected to greatly increase the effectiveness of the healthcare systems in the targeted countries. Areas of collaboration are numerous and range from improving skills in communicable and non-communicable disease surveillance to providing technical documents and reference materials for libraries to developing training programs for doctors and nurses.

The Kosovo Maternity Project is a training program that was developed and implemented by the CPHA with CIDA support, and with the collaboration of the Canadian Nurses Association. Cathy, along with two other nurse trainers from British Columbia, traveled to Pristina in early 2001 to teach their Kosovar counterparts the latest techniques and practices for safe deliveries. A total of 30 midwives from different regional hospitals successfully completed the courses, armed with important skills and knowledge to share with their colleagues.

Cathy and her team were met by an enthusiastic group of students, eager to learn new skills and strengthen their capacity as nurses and midwives. The first step of the project involved evaluating the practices and methods of labour and delivery being used by the midwives in order to determine what the curriculum should entail and what areas were in need of improvement.

The new labour and delivery ward at Pristina University Hospital was still under construction during these initial stages of the project, leaving only one room, divided into cubicles, for use by women giving birth. There was often no running water or soap on hand and the heating system, sporadic at best, was not sufficient for new babies and their mothers. No family members or birthing partners were allowed into the labour unit and there was little interaction between mothers, doctors, nurses and midwives. Oftentimes, when no delivery tables were available, women were forced to give birth on old army cots. There was little privacy.
It With an average of 40 deliveries per day, the Pristina University hospital is the busiest maternity ward in Europe. It also has one of the South Eastern Europe’s highest infant and maternity mortality rates. quickly became apparent to Cathy and her colleagues that there was a great difference in experience and knowledge amongst nurses and midwives and that many of the practices long made obsolete in Canada were still in use here. They quickly set to work on the curriculum and developed two courses: one lasting 12 weeks and the other, a revised version with more clinical time, lasting 18 weeks. The Canadian trainers set up shop in the basement of Pristina hospital, complete with cats and the occasional crow, and got to work.

Over the next several months, Cathy and the other instructors traveled to local hospitals and clinics, advising, comforting and providing help to both the nurses/midwives and mothers. They taught new skills to their students and introduced alternative birthing positions and practices never before seen. The shifts were often long and busy with little time for breaks or sleep, but very rewarding. The students learned quickly and soon became proficient at making the birthing process more relaxed, safe and positive for both mother and baby. Specific topics covered include the theory and practice of prenatal care, safe birth and postpartum care, as well as dealing with complications and family planning. Read more