CODIE KAMEKA
27 years | Kingston, Jamaica
Oh…this is a funny story. I chose midwifery out of impulse!
My sister graduated from high school and she was the one who pushed me. She wanted to study nursing at the University and asked me to come with her. At the time I was working. First in a call center, then as a medical clerk and at the time I just got promoted as a laboratory technician. I told her that University is not for me and that she should go ahead. I talked to my mom and told my sister that I will continue working and supporting her studies.
But my sister kept insisting and convinced me to come with her. That is when I noticed that the University is also offering midwifery and studying the same as my sister was a bit too much. So, she enrolled in nursing, and I applied for midwifery. I had to take an entry test and was thereafter invited to an interview. During the interview I was asked on why I wanted to enter midwifery. Everyone says because I enjoy caring for people. It is not something what I would say. Yes, I do enjoy caring for people. But it is something I have been doing my entire life – being the first child in my family – so that is something that comes naturally.
“And I waited, and I waited and I waited…and I was like: ‘Ok I am not going to get accepted…So it is no big deal. She [i.e. my sister] can say I tried, and I tried.” I expected a response by email but a friend, who was a student at the University, told me to check the post office as sometimes they send it by mail. “So I asked my sister to check by the post office because she was home and she sent me a picture of the letter and I had been accepted and I thought: ‘Whoooo!’ I didn’t think I would actually get that far but it is actually happening. ‘So what do I do now?’ And then I decided it is going to be what it is…and I resigned from my job eventually and went off to school. And here I am, four years later. And funny story: My sister left University and decided: ‘I am going to have a husband and a child and leave you after I have dragged you into it.’ And I survived…even though I was alone. I survived. (…) In the end, I didn’t lose anything, but I gained a lot!”
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"I developed a love for midwifery."
I have a screensaver on my mobile phone which shows a baby in-utero. I can’t even say liquor anymore. Whenever someone says they want liquor I think of amniotic fluid. Midwifery determines my thinking. In a few years I will do something different – but whatever I do in the future, it will always be related to midwifery; midwifery will always come first.
“I love the fact that I get to be there for women during the period of conception to birth.” For a lot of the women the only time they have someone to care for them is during their pregnancy and the antenatal care visits. “It gives me joy to know that I can have them for 10 minutes … and these are the best 10 minutes of their week. This is what I look forward to when working in the clinic. This is why I love working in the community, as opposed to working in the hospital.” They are eager to share their problems and tell me about their partners who are misbehaving, the children they take care of. And they tell me that they look forward to seeing me again. It is really uplifting and encouraging, and the women do not want to leave anymore. “Sometimes they just need someone to talk to as there is no one else they can talk to.” Some even wait for 20 to 30 other patients to pass after their visit, so they can talk to me again and even if there is no problem. “They start talking (…) and sometimes you may be having a bad day as a professional and just being there with them and (…) and they are talking to you and they are telling you everything and it turns into laughter, and sometimes tears, but at the end of the (…) session they leave, feeling better than they came and you actually gain a lot from this too and you know how to better manage them at the next visit.”
In Jamaica midwives are responsible for family planning, antenatal and postnatal check-ups, the delivery, as well as preventive services for children up to age six. If the Public Health Nurse is not around, we are also responsible for vaccinations. Midwives can also write certain prescriptions, but many don’t do this – probably because of hierarchical issues and power games. You need to know what is within your scope of practice as a midwife and make your grounds as otherwise you may be dashed and trampled upon. But in the public midwives and nurses are most of the time highly regarded. At the end of each evening or week there is a lot of paperwork awaiting you. We go through our books, need to tally it and the last Friday of each month we get together, go through the tally sheets and compile all data to send off a report.
We have only one University in Jamaica offering the Bachelor in Midwifery at the University of Technology in Kingston. There are two more government institutions, but they offer the certificate level only. In my semester we were around 40 midwifery students and I was the representative of my class and then became president at our Midwifery Student Association. Although the studies are open to females and males we only have very few male students. The public requires more information that also males can be midwives. I only recently had to explain people that “mid-wife” comes from “with-the-woman” and this is why also a male student can be called a midwife.
Our studies are four years long and include two years of general nursing together with all nursing students; followed by a 3rd and 4th year in midwifery training. In Jamaica we need to pay for the University and we pay by the number of modules we take each semester. The midwifery training includes theoretical teaching, skills lab sessions on mannequins and clinical internships. Our teaching usually started in the classroom and we had two hours of theoretical teaching through presentations, followed by three-hour long sessions in the skills lab. The teachers also gave us recommended readings, but we were responsible to organize it our own.
The final semester is completely clinical. We need to attend over 500 hours and need to first witness 25 deliveries, before doing a total of 40 deliveries as a minimum on our own. We also need to attend high risk deliveries and conduct at least five home deliveries. Following our studies, we need to take an oral and practical exam during which we solve a case study and assess a patient and answer questions on different topics. Only when you pass this oral exam you qualify to participate in the written exam at the Nursing Council, in order to receive your licence and your pin, which has your number on the back. Only then you are allowed to work as a fully certified midwife.
What I liked most about my studies? When interacting with other midwives and the patients and actually put into practice what we have learned. It gives you a whole different feeling and is simply magical!
Most definitely I also encountered challenges during my studies. Some staff at the clinics, where you do your internship, make your life hell. They are bullying you and tell you: “You will never be a good midwife.” I think they are bitter and maybe think that you may take their position, as now midwives with a bachelor’s degree are favored over those with a certificate.
I have had these moments where I thought: “Can I do this?” I cried at home and when I woke up in the morning I thought about the hospital, the ward, the people I need to work with…and this is when I texted my mentor and she send back this smiley with the rolling eyes. We did not even have to talk; I knew what she wanted to tell me. I then decided I don’t let them control anymore how I feel about my work. I went to the hospital and continued. Some of my fellow classmates came into trouble but I am good at holding my tongue, so whenever I was upset, I went to the bathroom, shed few tears, washed my face, continued and finished my shift. My mentor has been a previous educator and she is not only caring for me but for my entire class - she is guiding us.
There was one midwife at the hospital who asked me to do many things at the same time and I was not fast enough. As a result, she literally walked around the ward and told colleagues: ‘Do not leave this student alone, she is incompetent.’ Close to the end of my practice I was on a weekend shift and I delivered twins all on my own. Staff congratulated me the next day, and one of the midwives said: ‘I have been here for so long and I have never gotten a twin delivery!’ So that made me proud and compensated for the challenges I encountered.
Shortly afterwards I was called for a home delivery. I was called by a colleague who could not attend and asked if I am available. At the time I was in Spanish Town. It was in the middle of the night. I do not know the city and how to move around, except for going to school and back home. The other midwife in charge came from Old Harbour, which is on the other side of town. And we had to meet the woman in labor in the middle. I met with the two midwives in the middle of the night, the delivery went well for both the mother and the newborn. I kept my mentor informed and the next day I was even congratulated by another lecture as they seem to talk.
In Jamaica home deliveries are conducted by midwives who otherwise work at the clinic. Women have a choice, but home deliveries are not widely practiced anymore. It used to be in the past; but by now only a handful of midwives still of it. “…I posted (…) on my social media about normalizing home birth again and he [i.e. a friend] was like: ‘I thought this was something only the poor people did.’ (…) And then somebody else said: ‘I thought that was something only rich people can do. We can’t afford it.’ And I thought: what?! All of this is free though! You just have to ask about it when you go to the clinic. It is not for poor people and not for rich people. It is for everybody!” If you fall under a certain category and if you are not primi-gravida you can deliver at home in Jamaica but we as midwives need to promote it more in the future.
On the day of the first positive COVID-19 test the hospitals were closed for students and we were sent home. A week later the break was extended. We had to stop everything right in the middle and we could not go into the clinic. In the end we stayed at home from March to July. I was supposed to take my final exam at the University in July, which was then shifted to October and now takes place in February 2021. I have lost eight months of studying. “Even though it seems everything went bad for us as a class, I got to experience things many before me and those after me wont be able to experience. I saw it as a win and I accepted it to what it was and I look forward to what is coming next.”
I have so many dreams for the future! In the hospital we always have a staffing issue; we do not have one-to-one care. One midwife cares for five or six patients at the same time. I want to establish a birthing center. A place outside of the hospital, and a safe space for women. And I want to get into midwifery education and teach. We have a shortage of lecturers and the students do not get everything they need. I am already encouraging some of my friends to do the same. I am also going to take on a master in the very near future. I know the program I want to enter; but it is going to take me a year to take on the journey. And I want to have a baby; maybe I have to wait until after the master as I do not want to leave it alone for a year. So everything is in the planning stage but I have time. And I am going to get it done. “I told myself I am going to do it, so I am going to do it!”
Interview by Leah F. Bohle, 13 December 2020
Photo by Codie Kameka