In a remote part of Liberia, the Red Cross is training a new generation of traditional midwives with a difference – these women are illiterate and learn entirely through role-play.

The International Committee of the Red Cross (ICRC) ran a pilot course with the Liberian Ministry of Health in Lofa County – one of the hardest hit parts of the country during the Liberia civil wars, which ended in 2003.The six-month course, which trained traditional midwives in 22 villages, was such a success that it has been rolled out to July 2008, with the aim of training at least 190 midwives.

Traditional midwifery 

Ruth Bullen, a health delegate from Lincolnshire, was seconded from the British Red Cross to the ICRC to supervise the primary healthcare programme, including the midwifery training.

"The programme's strength is that it involves the community, the Liberian government and the ICRC," she said.Ruth, who spent eight years with a flying doctors squad in Australia, is used to a challenge. She described how there are no qualified midwives in remote parts of Liberia.

Nearly all of them are illiterate, so the course is mostly taught in role-play.

Ruth Bullen, health delegate  

Traditional midwives are not certified in midwifery but have the skills to carry out safe, clean deliveries and refer more difficult pregnancies to the clinic.

They also promote the tetanus vaccine and anti-malarials to pregnant women and provide basic information on HIV, breastfeeding and nutrition.

Voluntary

"The midwives attend the course on a voluntary basis," Ruth said. "We provide the food and uniforms at the end of the course. Nearly all of them are illiterate, so the course is mostly taught in role-play. For example, we would explain the important points about HIV and then get them to create a play so they can remember them. We did one for hand washing and so on. They also sing as they learn."

Ruth described how some of the women walk up to six hours to get to the course.

"They are very committed," she said. "They arrive on the Monday and stay overnight in the training hall. They then walk back on the Friday because most of them work on farms."

Community respect

"When I asked why they want to do this, they said it benefits the women, the community as a whole and they have an interest in it – some of their mothers did it before them. They also get some respect from the community. As traditional midwives they don't get paid but might get a token from a family such as a chicken or small amount of money."

A graduation ceremony was held at the end of the course, which was packed with 300 family, friends and neighbours.

"The midwives performed some of their role-plays to the audience which was transfixed," Ruth said. "It was like theatre, the people loved it, and I realised the messages were getting across."

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