Rwanda: Ensuring safe pregnancy and childbirth even during the pandemic

The beginning of 2021 was one of the most trying times in Rwanda’s fight against  COVID-19 with nearly 7,000 new infections and 104 fatalities confirmed in just one month. For the first time since outbreak of the pandemic, Rwanda was reporting average daily positive cases of 270 and an average of 4 daily fatalities. The Government’s leadership effectively responded by immediately putting in place several preventive measures that have reduced the number of new cases and deaths from February 2021. 

Since March 2020, UNFPA through the One UN in Rwanda is supporting the National COVID-19 Preparedness and Response Plan with a focus on continuity of sexual and reproductive health services, including the protection of the health workforce, addressing gender-based violence (GBV), and ensuring the supply of modern contraceptives and other reproductive health commodities.  Some of the UN-staff were deployed to Rwanda’s National Command Post Centre to support the Covid-19 response in their respective fields of expertise.

Frida Temple is an International UN Volunteer, Expert Midwife that joined UNFPA Rwanda team from her native Sweden in January 2021.  Through UNFPA’s assistance she has been deployed to Rwanda’s National COVID-19 Command Post Centre to support case management particularly for pregnant women.

“We deeply appreciate the support of the Government of Sweden to UNFPA to enhance the quality of midwifery profession in Rwanda. With this deployment of a practitioning midwife, UNFPA contributes to the government efforts to ensure every pregnancy and childbirth is safe during COVID-19 pandemic.” Said Mark Bryan Schreiner, UNFPA Representative to Rwanda. 

 

Ms Temple during home visits

Ms Temple started working at the National Covid 19 command post centre in the beginning of February 2021.  She shares her experience.

• What is it like to join the UNFPA and directly be deployed to the COVID 19 Command Post?

When I arrived in Kigali with my family I was very eager to see and serve the country of Rwanda. Unfortunately, the country entered a stricter curfew the day we arrived and a complete lockdown about a week after our arrival. 

I met my new colleagues at UNFPA through digital meetings and my original assignments were a bit delayed due to the lockdown and inability to move around. So when the opportunity to be deployed to Command Post came I was very excited. I had just come from a country that was very badly affected by Covid-19 and I had worked with the Covid-19 response there, so now I had the opportunity to use my experience, support the Covid-19 response here in Rwanda, and also get to meet people at the same time.

So even though it was a bit scary that my first encounter in Kigali was with the Command Post, I was very happy about the opportunity. 

• Describe what your day looks like at the command post

Each day is very different, however they are all very busy! 

A normal day begins with finding out about the number of new patients in each district, and specifically the cases enrolled in Home-Based Care. We check if any of them are in need of a home visit. 

Some days of the week, I have meetings with the Technical Advisory Group where representatives from the partner organizations, Rwanda Biomedical Center (RBC), and the Ministry of Health meet to discuss important issues related to Covid-19.

After the meeting I have lunch and then I usually go out for fieldwork. If any pregnant woman needs an assessment, I go there together with a colleague. We also do home-visits to other patients that need an assessment. Our drivers drive us as far as they can and sometimes we need to walk the last bit up or down steep hills to reach the homes of the patients. I also visit health centers to ensure that the testing and assessment of suspected Covid-19 cases are done safely and that the health centers have the essential equipment that is needed. I have been able to mentor some of the new health care workers during the home visits. Any time I have left is used for reading and revising guidelines and treatment plans as well as supporting in other areas. 

• As pandemic rages, women and girls face intensified risks. What is your contribution at the command post, to ensure pregnant women safety? 

The risks that women and girls face during a pandemic are many. Firstly, pregnant women are at higher risk to become critically ill during covid-19. Also, due to the fact that only 40% of pregnant women go to all four AnteNatal Care visits in Rwanda, many pregnant women are unaware of possible comorbidities they have that are caused by the pregnancy, such as high blood pressure, gestational diabetes, increased BMI etc. This is something that pregnant women need to be made aware of. During my time at Command Post, I have been continually ensuring that pregnant women are perceived as high risk and also that they are being informed that they are high risk.

While visiting health centers, I have informed the community health workers about the increased risks of pregnancy and the measures to take. I have also partaken in revising WHO-guidelines and other clinical guidelines in terms of pregnancy and covid-19 specific for Rwanda. We have discussed essential care, for example family planning, and the importance that it will continue to be provided. We have also discussed the risk of an increase in GBV, especially during lockdown.

I am passionate about informing the frontline health workers of the high risk groups and co-morbidities. Most of the front line health workers are women and in reproductive age, so therefore it is important that they have the right knowledge about Covid-19 as well as the proper equipment while caring for patients with covid-19. 

Ms Temple supporting in vaccination of Moto drivers in Kigali.
 

• Pregnant women with Covid-19 are at increased risk of developing severe illness, including a heightened risk of death. How do you keep track of pregnant women who have been tested positive? And how are they helped?

The pregnant women with Covid-19 are called every day to have their state assessed. If their condition decreases or if they need a physical assessment, I go with another person for assessment. If the woman needs evacuation to the hospital, we make sure she is picked up by an ambulance and taken to the right facility. If there are needs for obstetric consultations during the period of quarantine, we provide the right hospital for her to go to. I have also been to a few district hospitals to talk to them about the different cases they have had and how they were managed. When I first started at the Covid 19 Command post there were around 10-20 pregnant cases to check up on daily, however as the cases in Rwanda have decreased during the last few weeks so have the pregnant cases. This makes us now able to follow the pregnant cases closely as well as focus on visiting health centers to educate and also do home visits to other cases. One woman I visited was Covid-19 positive and she was feeling weak but alright, however she didn’t feel the fetal movements as consistently as usual. When we went to her house, the woman’s vitals were good and I was able to assess the baby. The heart rate was good and the baby was responsive. The woman was very relieved that the baby was fine, and after a few days the mother was also feeling better.

• What does the UNFPA’s support to the National COVID-19 Response focus on? 

In general, the UNFPA support to the National COVID19 response plan focuses on: (i)Continuity of SRH services and protection of frontline health workforce, (ii) GBV Prevention and Response and (iii) Continued supply of modern contraceptives and RH commodities. Personally, I support case management particularly for pregnant women, ensuring safe pregnancy and childbirth even during the pandemic.

• How is this experience building your skills/capacities? How is it contributing to your volunteer experience in Rwanda.

This has been an amazing opportunity for me. I have learned so much. I have been able to represent UNFPA and present the things that I am passionate about. I have gotten to know a lot of people from hospitals, health centers and different partners and Ministries that I will be partnering with in my coming assignments as well. I have also been able to see the country, understand the challenges as well as see the strengths and opportunities, and as a bonus I am also learning more and more Kinyarwanda each day!

I am very impressed by how the country and all of its different partners and Ministries have united and worked together during this pandemic to serve the Nation. Rwanda has some amazing people! I am more excited than ever to take on my mission as a UN-volunteer and serve this beautiful country. Together, we can conquer anything!