We Must Applaud Midwives with WASH

Today, on 5th May, we celebrate the most momentous day in a century for the midwifery profession, the International Day of The Midwife, in the first ever Year of the Midwife, as the world is currently at a standstill fighting the coronavirus pandemic, an invisible enemy that has claimed hundreds of thousands of lives. It cannot be a coincidence that today we also celebrate World Hygiene Day, a day set aside to focus on hand hygiene: that simple act of handwashing with soap. Hand washing was originally propagated by the 1840 Physician Ignaz Semmelweis to midwives at his maternity wards, as the best means to prevent and control childbed fever infection—as puerpural sepsis was then known. Thus, midwives and their clean hands have established and led life-saving and life-enhancing infection prevention and control protocols for centuries. They are at the very frontlines of health, safely guiding new life, as the first eyes to see and first hands to touch a newborn child, as they stand by women all over the world in their hours of labour, delivery and need.

And they are not alone.

Health care workers, midwives, nurses, doctors, and the entire medical profession are at the forefront to save lives because they took an oath, an oath to serve regardless of the situation. They risk their lives to save the world in these unprecedented times. It is sad that during this crisis we have pushed to the background the work that we have put in over the years in various development aspects. I fear that this progress of prominence on the work we have put in reducing maternal mortality through they essential role of the midwifery profession in standing with women to ensure safer births will be threatened by a recession of recognition, and subsequent key investments as the focus shifts.

My thoughts and prayers are with the families of all the nurses and midwives who have lost their lives to Covid-19. Their deaths are a tragedy and I join their colleagues standing with midwives around the world in mourning their beautiful souls. Each and every one of them will be remembered in our hearts as a heroine.

As always in times of crisis, the most vulnerable among us will be the ones hit hardest. Women and girls will suffer the most from this disease which has already seen a rise in gender-based violence, and rights violations of pregnant women forced into giving birth alone. Some will face child-birth complications risking the lives of both the mother and child, some will have stillbirths and some others will successfully give birth to the future leaders that will hold us accountable for the lives of their mothers lost during child birth. 

The repercussions will be a constant reminder that for years we have failed and continue to fail women and children where public health is concerned. 

While the world grapples in its response to COVID-19, we must be mindful that everything else still functions as before. We still require access to SRHR, women will continue to require prenatal care and safe spaces to deliver in order to reduce maternal mortality.

For years midwives have joined the battle and reduced maternal mortality ensuring that even in the poorest communities, women still had access to safe births. This is most likely one of those challenging situations for midwives in various communities. 

Midwives continue to be an essential service in this crisis and we should do more than just applaud their hard work and dedication. How are we ensuring their access to protective clothing and reaching women in need. This is why on this International Day of the Midwife we are launching the We Must Applaud Midwives with WASH campaign that seeks to remind people on the importance of washing hands. As well as protecting frontline healthcare workers, WASH plays a vital role in stopping disease transmission yet two out of five healthcare facilities still lack hand hygiene facilities at points of care. 

Ten Immediate WASH Actions in Healthcare facilities to Respond to COVID-19

1. Handwashing: Set up handwashing facilities, like a bucket with a tap with soap, throughout the facility. Prioritise the facility entrance, points of care and toilets, as well as patient waiting areas (and other places where patients congregate). If the facility is piped, repair any broken taps, sinks or pipes. 
2. Water Storage: Consider the water requirements to perform WASH/IPC activities with an increased patient load. If inconsistent or inadequate water supply is a concern, increase the water storage capacity of the facility, such as by installing 10,000L plastic storage tanks. 
3. Supplies: Solidify supply chains for consumable resources, including: soap (bar or liquid), drying towels, hand sanitiser and disinfectant. Ensure cleaners have Personal Protective Equipment (PPE) for cleaning. If ingredients are available locally, produce hand sanitiser at the facility (or at district-level) – see WHO protocols. 
4. Cleaning & Disinfecting: Review daily protocols, verifying based on national guidelines or global recommendations for resource-limited settings and noting additional levels and frequency of cleaning in clinical areas with high numbers of COVID-19 cases, including terminal cleaning. Ensure adequate supplies of cleaning fluids and equipment, making allowance for additional cleaning requirements. Ensure handwashing stations and toilet facilities are cleaned frequently. 
5. Healthcare Waste Management: Strengthen healthcare waste management protocols by making sure bins are located at all points of care, that they are routinely emptied, and waste is stored safely. 
6. Staff Focal Points: Assign staff member(s) – cleaners, maintenance staff, or clinicians — whose job it is to oversee WASH at the facility, including: refilling handwashing stations, auditing availability of supplies in wards, reporting on WASH maintenance issues, monitoring cleaning and handwashing behaviours of staff and communicating updates to the director daily. 
7. Training: Organise training for all staff on WASH as it relates to their role at the facility, including a specific training for cleaners based on the protocols reviewed above. 
8. Daily Reminders: Remind staff of WASH protocols during morning meetings. Post hygiene promotion materials throughout the facility, particularly next to handwashing facilities. 
9. Hygiene Culture: Encourage a culture of hygiene at the facility. Emphasise that all staff members, including cleaners and maintenance staff, are part of a team working to prevent the spread of infection. Recognise individual WASH champions in the HCF. 
10. IPC Team: Work with the Infection Prevention and Control (IPC) team at the facility to make sure efforts are reinforced and aligned, avoiding duplication. Encourage WASH focal points/partners to participate in IPC meetings. Coordinate WASH/IPC activities based on plans to isolate COVID-19 patients. 

BONUS – Preventative maintenance: Check on WASH infrastructure and undertake any necessary preventative maintenance, such as repairing possible disruptions to the water supply, storage, distribution or treatment. 

There is much work to be done to ensure that the focus on WASH lasts beyond this crisis and translates into a radical change in how we understand and prioritise water, sanitation and hygiene. A key part of achieving that will be demonstrating that without good WASH standards, global health security is impossible. 

Clean water is health and security, and clean hands save lives. 

The ripple effect of COVID-19 runs far beyond the disease itself. We must stand in support of midwives, and the entire medical profession, to build a strong bridge between the global health community and WASH, in order to mitigate and heal the scars of this modern-day pandemic on medical workers, women, our newborns and humanity for the many years to come.

My prayers are thus reinforced as 2020 marks not only the Year of the Midwife but also heralds the Decade of Action and Delivery, designed for us to take deliberate steps towards the 2030 Sustainable Development Goals. Because midwives have supported women for centuries by delivering routine maternity care and counsel on a daily basis, we must use this opportunity to advocate louder and stronger together. We must mobilise women and policymakers to stand with midwives as midwives stand with women, newborns and their families. We must stand for the midwifery profession around the world to be recognised, respected and remunerated, and routinely provided with whole-system support.