Perspectives
Profile Address Malata: advancing nursing and midwifery in Malawi As a former nurse and midwife, and currently Principal of Kamuzu College of Nursing (KCN), part of the University of Malawi, Address Malata knows the health-care landscape well in her home country. Some half a century after independence from the UK, Malawi is struggling to cope with high maternal and infant mortality, 10% adult population HIV prevalence, and a median life expectancy of under 60 years. “Malawi is a beautiful country, with its stunning lake, peaceful population, with everyone smiling, even when it’s raining”, she says. “Yet we are still reliant on overseas donor funding. This reliance perpetuates our weak infrastructure, which partly explains our poorly resourced health-care system.” The quality of midwifery care, in addition to access to services, is a key focus for Malata’s work. Stillbirths, the focus of a new Lancet Series which Malata has contributed to, are a common occurrence. She is very clear about the role that midwifery has to prevent stillbirths, including the promotion of appropriate nutrition during pregnancy; infection prevention; HIV testing; assessing women in late pregnancy; and educating women to attend a health centre for delivery. “Women should not give birth without being supported by a skilled health worker”, Malata says. “I visited a remote area recently where heavy rains prevented an ambulance from reaching a pregnant woman, who later died, along with her unborn child. Everyone, myself included, just broke down and cried. Our government has to invest more in our health system, and in the training of more nurses and midwives so that we can offer quality obstetric care right across our country, not just in urban settings”, she says. Gender inequity is a key driver of poor obstetric health in Malawi. “It is common for women to avoid seeking birth control in a clinic as they fear their partners will find out”, Malata explains. “Often girls do not attend school, get married very young, typically around 12 years of age; this contributes to the horrors of obstetric fistula, an inevitability with pregnancy occurring too early”, she adds. Malata believes the only way to overcome such deep-rooted cultural gender inequity is through education: “We have to do everything in our power to help girls get educated, as we know that it is educated women who are more likely to control their reproductive health, and will be more likely to leave a relationship if it becomes abusive.” Brought up on a church missionary station where her father was a Presbyterian pastor, Malata’s parents encouraged their children in all aspects of education. For Malata, this resulted in 3 years of nursing training, followed by a year’s midwifery training, both at KCN. After rural nursing and midwifery postings, Malata gained a BSc in nursing from the University of Malawi, before taking www.thelancet.com Vol 387 February 6, 2016
a government-funded 2-year masters programme at Edith Cowan University in Perth, Australia, where she studied the information expectations and cultural attitudes of first-time mothers. Malata continued her studies there in a 3-year PhD programme, developing an educational framework for Malawian women about childbirth and HIV prevention. Back home, Malata piloted the programme. “It became so clear to me how mothers used information and, as a result, their knowledge and decision making improved”, she says. Malata began teaching at the University of Malawi in the Department of Maternal and Child Health; soon afterwards, her PhD programme was adopted by government, and Malata found herself dividing her time equally between academia and policy work. In 2008, Malata took up her current position as head of KCN, and began to expand and diversify its academic output. “There are great opportunities for a career in midwifery now”, she says. “I have worked hard to secure donor funding from agencies such as USAID and the UK Department for International Development.” The college has trained 32 faculty to PhD level in Malawi, and offers international training to other African countries, including Sierra Leone, Zambia, and Ethiopia. In 2012, the college was designated by WHO as a collaborative centre for interprofessional education and practice, of which Malata is justly proud. Professor Ellen Chirwa, currently Vice Principal at KCN, first met Malata in 1983 when studying for a diploma in nursing, and says: “Address is rightly recognised for her success in leadership excellence in academia, in nursing and midwifery, research, and resource mobilisation. Her professional leadership path starts from a sister-in-charge of a maternity ward, to a Vice President of the International Confederation of Midwives. She has tirelessly advocated for quality midwifery care to save lives of mothers and babies in Malawi, and globally.” Since becoming Vice President of the International Confederation of Midwives in 2014, overseas travel and her work at KCN has limited Malata’s relaxation time with her family. Faith plays an important part in her daily life. “I always find time to pray, to take time out from my work and to combat stress through prayer”, she says. “I do not take work home, so I can really enjoy time with my family, going to Lake Malawi, walking, singing gospel music, or watching the Williams sisters playing tennis on the television. For me, family is everything, and the support of my husband and daughters over recent years has given me the strength to expand nursing and midwifery education, which will hopefully help build health-care capacity in my beautiful country.”
Published Online January 18, 2016 http://dx.doi.org/10.1016/ S0140-6736(16)00040-4 See Comment page 516 See Series pages 574, 587, and 604 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(15)01020-X, and http://dx.doi.org/10.1016/ S0140-6736(15)00954-X
Richard Lane 527
Profile Address Malata: advancing nursing and midwifery in Malawi As a former nurse and midwife, and currently Principal of Kamuzu College of Nursing (KCN), part of the University of Malawi, Address Malata knows the health-care landscape well in her home country. Some half a century after independence from the UK, Malawi is struggling to cope with high maternal and infant mortality, 10% adult population HIV prevalence, and a median life expectancy of under 60 years. “Malawi is a beautiful country, with its stunning lake, peaceful population, with everyone smiling, even when it’s raining”, she says. “Yet we are still reliant on overseas donor funding. This reliance perpetuates our weak infrastructure, which partly explains our poorly resourced health-care system.” The quality of midwifery care, in addition to access to services, is a key focus for Malata’s work. Stillbirths, the focus of a new Lancet Series which Malata has contributed to, are a common occurrence. She is very clear about the role that midwifery has to prevent stillbirths, including the promotion of appropriate nutrition during pregnancy; infection prevention; HIV testing; assessing women in late pregnancy; and educating women to attend a health centre for delivery. “Women should not give birth without being supported by a skilled health worker”, Malata says. “I visited a remote area recently where heavy rains prevented an ambulance from reaching a pregnant woman, who later died, along with her unborn child. Everyone, myself included, just broke down and cried. Our government has to invest more in our health system, and in the training of more nurses and midwives so that we can offer quality obstetric care right across our country, not just in urban settings”, she says. Gender inequity is a key driver of poor obstetric health in Malawi. “It is common for women to avoid seeking birth control in a clinic as they fear their partners will find out”, Malata explains. “Often girls do not attend school, get married very young, typically around 12 years of age; this contributes to the horrors of obstetric fistula, an inevitability with pregnancy occurring too early”, she adds. Malata believes the only way to overcome such deep-rooted cultural gender inequity is through education: “We have to do everything in our power to help girls get educated, as we know that it is educated women who are more likely to control their reproductive health, and will be more likely to leave a relationship if it becomes abusive.” Brought up on a church missionary station where her father was a Presbyterian pastor, Malata’s parents encouraged their children in all aspects of education. For Malata, this resulted in 3 years of nursing training, followed by a year’s midwifery training, both at KCN. After rural nursing and midwifery postings, Malata gained a BSc in nursing from the University of Malawi, before taking www.thelancet.com Vol 387 February 6, 2016
a government-funded 2-year masters programme at Edith Cowan University in Perth, Australia, where she studied the information expectations and cultural attitudes of first-time mothers. Malata continued her studies there in a 3-year PhD programme, developing an educational framework for Malawian women about childbirth and HIV prevention. Back home, Malata piloted the programme. “It became so clear to me how mothers used information and, as a result, their knowledge and decision making improved”, she says. Malata began teaching at the University of Malawi in the Department of Maternal and Child Health; soon afterwards, her PhD programme was adopted by government, and Malata found herself dividing her time equally between academia and policy work. In 2008, Malata took up her current position as head of KCN, and began to expand and diversify its academic output. “There are great opportunities for a career in midwifery now”, she says. “I have worked hard to secure donor funding from agencies such as USAID and the UK Department for International Development.” The college has trained 32 faculty to PhD level in Malawi, and offers international training to other African countries, including Sierra Leone, Zambia, and Ethiopia. In 2012, the college was designated by WHO as a collaborative centre for interprofessional education and practice, of which Malata is justly proud. Professor Ellen Chirwa, currently Vice Principal at KCN, first met Malata in 1983 when studying for a diploma in nursing, and says: “Address is rightly recognised for her success in leadership excellence in academia, in nursing and midwifery, research, and resource mobilisation. Her professional leadership path starts from a sister-in-charge of a maternity ward, to a Vice President of the International Confederation of Midwives. She has tirelessly advocated for quality midwifery care to save lives of mothers and babies in Malawi, and globally.” Since becoming Vice President of the International Confederation of Midwives in 2014, overseas travel and her work at KCN has limited Malata’s relaxation time with her family. Faith plays an important part in her daily life. “I always find time to pray, to take time out from my work and to combat stress through prayer”, she says. “I do not take work home, so I can really enjoy time with my family, going to Lake Malawi, walking, singing gospel music, or watching the Williams sisters playing tennis on the television. For me, family is everything, and the support of my husband and daughters over recent years has given me the strength to expand nursing and midwifery education, which will hopefully help build health-care capacity in my beautiful country.”
Published Online January 18, 2016 http://dx.doi.org/10.1016/ S0140-6736(16)00040-4 See Comment page 516 See Series pages 574, 587, and 604 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(15)01020-X, and http://dx.doi.org/10.1016/ S0140-6736(15)00954-X
Richard Lane 527
