The international Midwife is responsible for the autonomous management and care of women in the reproductive health pathway, both in community and hospital settings. The role also requires managerial skills and training of health care personnel.

BACKGROUND AND ORGANISATION OF WORK

The international midwife is responsible for the training, clinical supervision and update of local health staff; she collaborates in the clinical care of the woman as a member of the multidisciplinary team; she participates in the management of the project as a whole, working with the medical, technical and administrative staff.

The midwife reports to the Medical Coordinator who has the organizational and managerial responsibility for the project.

Clinical activities take place in hospital and/or community settings depending on the project and includes the following departments and care areas:

- TRIAGE AND ASSESSMENT UNIT

- BIRTHING UNIT (LABOR AND DELIVERY ROOM, OPERATING ROOM)

- ANTENATAL AND POSTNATAL WARDS

- GYNECOLOGICAL WARD

- OBSTETRIC SUB-INTENSIVE CARE (HIGH DEPENDANCE UNIT)

- ANTENATAL AND POSTNATAL CARE IN COMMUNITY SETTING

- FAMILY PLANNING

- HEALTH EDUCATION

Working hours vary according to the workload, type and specific needs of the project; one day off per week is provided. The international Midwife is, however, required to be available 24/7 in case of need.

DUTIES AND REPONSIBILITIES

All EMERGENCY international staff is expected to know and follow the hospital admissions criteria, guide lines, protocols, and the diagnosis and treatment standards in use in the Centre, and to ensure the correct compilation of clinical records and statistics in both electronic and paper formats.

The main duties and responsibilities of the international midwife include:

- the support of national staff in the clinical management of women in all aspects of reproductive health: antenatal, intrapartum, and postnatal care; contraception; health education both in hospital and community settings

- to ensure the application of project-related protocols and guidelines

- to manage the organization of the various aspects of the projects in collaboration with the Medical Coordinator and the referents of the specialist area of the EMERGENCY Medical Division

- to conduct practical-clinical training and refresher training activities for national staff

- to participate in clinical research and data collection in accordance with the scientific programs of the specialist area of EMERGENCY's Medical Division

- to collaborate with all members of the national and international multidisciplinary team, both medical and technical-administrative, to develop and improve the project

- the assignment of specific tasks identified by the Medical Coordinator and/or MCU referent for particular project needs

MANAGEMENT AND TRAINING OF LOCAL PERSONNEL

Along with the practical (on-the-job) training component carried out during the various stages of care, the international midwife is expected to provide theoretical training and clinical updates based on the Clinical Training division's programs and tools. Regular monitoring of achieved levels of autonomy and competence is also expected.

The international midwife supports, reinforces and, where possible, trains the national staff on management and coordination aspects.

CASELOAD AND EQUIPMENT

The technological level of the equipment available is suited to the clinical and managerial protocols in use, and the level of professional autonomy of the national staff, with the aim of achieving – and sustaining – high standards of care. Diagnostic equipment, basic laboratory tests, technical and auxiliary services are always available.

MATERNITY CENTRE - Anabah, Afghanistan

The Maternity Centre is a specialized facility offering Comprehensive Emergency Obstetric and Neonatal Care.

The centre is located in a rural area and provides 24/7 care, comprehensive of elective activities and emergency/urgent ones. Due to the local health, geographic, and socioeconomic context, the international midwife is confronted with obstetrical conditions and complications significantly different from the type and frequency of those encountered in developed country settings. Much attention is paid to the containment of the cesarean section rate, in relation to the peculiar condition of the population we serve.

Cornerstones of midwifery and obstetrical care in the Anabah Maternity Centre are:

- the ‘humanised birth’ approach;

- the use of "birth technology" (induction of labour; continuous fetal electronic monitoring, etc) only evidence-based and adapted to the resources and possibilities of the specific context;

- TOLAC/VBAC; vaginal delivery in breech presentation and twin pregnancy;

- use of C-section only for absolute indication.

The maternity centre is part of a network of health clinics distributed in the catchment area. These health posts, many of which located in very remote areas, facilitate access to care for women and their transfer to the hospital when needed.

In the clinics, Afghan midwives independently carry out prenatal, postnatal (including assessment of the physiological new-born), family planning, and health education; they also collaborate with and support the paediatric and gynaecological activities that take place periodically in the clinic.

The international midwife’s role includes the supervision and support of the field clinical activities.

In collaboration with the International Field Officer, Medical Coordinator and MCU referents, the international midwife shall manage and facilitate:

The communication between community clinics and hospital; the coordination of the medical staff; monitoring and evaluation activities and implementation of any new components of the care program.

SUDAN Mayo Clinic and Port Sudan Clinic

EMERGENCY runs outpatient services located within a refugee and IDPs camp on the outskirts of the capital Khartoum (Mayo) and on the outskirts of the city of Port Sudan.

Clinical activities performed by midwives in this setting include:

- antenatal care including prophylactic preventive measures for endemic diseases and vaccinations;

- postnatal care both at home and in the clinic;

- family planning and contraception.

Much importance in this context has health education, carried out both within the clinic and in outreach settings. Special attention is given to issues specific to the local context such as female genital mutilation, teenage pregnancy, malaria prevention measures, hygiene in pregnancy, and breastfeeding support.

The international midwife supervises and supports the clinical activities carried out by the national midwives and provides for their training and continuing education; she collaborates with the Medical Coordination and MCU in the development and implementation of the health program.

GUIDELINES, PROTOCOLS AND EQUIPMENT

Further information on the guidelines, protocols and clinical services relevant to the post along with details of the instruments and equipment available will be provided at interview and during the period of preparation for the mission.

The general requirements and conditions apply to all the international staff.

SPECIFIC REQUIREMENTS

• Degree in Midwifery or equivalent diploma;
• at least 3 years of relevant clinical practice;
• delivery room experience is essential.

REQUIRED AVAILABILITY

6 months’ overseas stay including a period of leave to be taken at the end of the mission in agreement with the coordinator. Shorter missions may only be considered for specific needs as defined by the organisation.