Clement is the sole midwife working at the Makao Dispensary in a village in the Serengeti National Park.
It is 92 km from its referral centre, Meatu District Hospital, where caesarean sections and blood transfusions are available. The dispensary serves the village people, as well as Maasai and Taturu tribes people. There is no inpatient unit and about 55 outpatients are seen per day. Immunization clinics are twice weekly and antenatal care is provided on Fridays. There are medical emergency walk-ins and two to three labouring women to attend to each day. The hospital delivers medical supplies 4 times a year.
Government standards require properly staffed dispensaries to employ one clinician, one midwife, one laboratory technician, and two medical attendants, who are cleaning staff with no medical training. At Makao, Clement and two medical attendants are the only staff. No clinician means Clement is also a prescriber and dispenser. The medical attendants also provide clinical care. For example, when he attended the Midwives Emergency Skills Training (MEST), the medical attendants ran the clinics and delivered any laboring women. Clement works 24 hours/day, 7 days/week. He has a 28‑day annual leave, during which time there is no midwife to replace him, so the medical attendants run the dispensary.
There is no electricity at the dispensary, so one of the medical attendants holds a cell phone flashlight for Clement when light is required at night. There is also no water. The Maswa Game Reserve donated a 100,000 litre water tank, but with no easy way to refill it, the tank sits empty. The plan is to create a collection system to capture rain water during the rainy season and funnel it into the tank. Until then, Clement tells pregnant woman during antenatal clinics to bring 60 litres of water for the birth, as well as 6 kangas (cloths).
Clement enjoys his job and plans to stay at Makao. He hopes his wife, also a midwife, in the Geita region will get transferred closer to him, so that he can see her and his 6‑month old son more often. He lives in the ward office at the dispensary, because one of the medical attendants, who has been working at Makao for 7 years, lives in the house. There has been discussion at the district council about building another house, but nothing has transpired yet.
Clement would like to have a stand-by ambulance at the dispensary. Emergencies requiring transfer to the referral centre in Meatu can take 4‑6 hours as the ambulance must first make the trip to Makao when called. Then, when Clement accompanies the ambulance, he has no way to return to Makao. In rainy season the road can be impassable. Clement also feels the dispensary needs more midwives, but the district council must give approval, and this hasn’t happened yet.
Clement was very thankful to attend the MEST, where he learned to manage eclampsia, the emergency that most scares him. He will continue to refer to the manual and also teach his medical attendants.