Supporting Expectant Mothers in Tanzania: Shinpuku Yoko / Midwife / Professor, Global Health Nursing, Hiroshima University

"Direct Talk"

Our guest today is Shinpuku Yoko, a midwife.

She's also a professor of Global Health Nursing at Hiroshima University.

As a graduate student,

she observed firsthand the challenges faced by expectant mothers in Tanzania.

She's been working ever since to foster a safe environment for mothers and their newborns.

In 2020, the bicentennial of Florence Nightingale's birth,

Shinpuku was recognized by the World Health Organization

on its list of "100 Outstanding Women Nurse and Midwife Leaders."

It was the culmination of many years of research and fieldwork.

Shinpuku pours her heart and soul into raising awareness

about the importance of midwives.

She shares her vision for maternity care.

Midwives can be like a family member or a close person, or a partner

who can provide care and support for every aspect of childbirth.

Hiroshima University is a national institution committed to nurturing global leaders.

Shinpuku was named Vice President of International Public Relations in April 2022.

And she's busy teaching the next generation of researchers

as a professor of Global Health Nursing,

a new department the university created in 2020.

67.7% of the women had a nuclear family in the experiment group

and the 66.0...

Her students come from all over the world.

I came from Egypt.

I selected Professor Shinpuku

because she has a well-known

and highly ranked record of research.

I am an assistant lecturer in my university

in obstetrics, gynecological nursing and maternity care.

I'm from Bangladesh.

I want to learn from her how can the effective health education or health system

among the vulnerable groups, that means developing countries like Bangladesh.

Shinpuku works as a midwife and educator.

But initially, she wanted to become a nurse.

When I was a junior high student, I was about 14 years old,

my father became sick and was hospitalized.

I was kind of afraid to talk with my father when he was sick.

But a nurse talked to me,

like a very normal conversation.

So, it was... made me feel,

I can talk anything to my father.

After he passed away, my mother showed me his diary.

And he was writing that if I can become a nurse in the future,

he will be very happy.

So, when I saw that line,

I thought that would be my dream job in the future.

Shinpuku decided to enroll in a Tokyo nursing school.

During her clinical internship, she attended her first childbirth.

She had a miscarriage four times before that birth.

And the birth took a very long time, like three days.

I was a student so I could do like only

rubbing the mother's back

or giving her some foot bath.

But a midwife could do many other things.

By law, midwives were given the autonomy to

judge the condition of the mother and the baby

and decide when and how to deliver a baby.

That kind of autonomy I really admired.

That made me feel a midwife is really a profession.

After graduating, Shinpuku began working as a midwife.

Then at 26, she traveled to the U.S.

to further her research at the University of Illinois at Chicago.

In 2008,

a professor offered her an opportunity to join a research trip to Tanzania

to survey a local hospital in depth.

I went to a very rural hospital.

Technology was not available.

So, there was a shortage of medicines,

a shortage of materials, a shortage of staff, a shortage of everything

but their birth rate was very high.

So, they have many pregnant women

and a lot less midwives.

One midwife was delivering

15 to 20 babies per shift.

So, most of the time, a mother was sitting on the bed alone

and having pain.

They wanted to ask for help, but nobody could go to the mother.

So, it was very chaotic when I saw that situation.

Shinpuku saw that some mothers ended up giving birth without a midwife present.

In rural areas, only about half of expectant mothers would come to the maternity hospital.

Among the half that gave birth at home, mortality rates were high.

The main cause of death of mothers in rural Tanzania

was postpartum bleeding.

Women can bleed a lot after birth.

When I was talking with local people,

they were talking about many very bad situations,

like losing a baby or losing the mother.

I felt like it was meant to be.

So I must do something for the mothers.

She decided to interview about 30 local mothers

in order to learn more about the birthing experiences of Tanzanian women.

That would become the focus of her doctoral dissertation.

At that time, there are no such studies

among rural Tanzanian women.

Much of the research focused on emergency obstetric care,

or statistical analysis of the conditions.

But nobody was really focusing on the experience of the mother.

As a midwife, what I mostly cared about

was the experience of the mother -

how they felt during the delivery,

how happy they were about having a baby.

Shinpuku learned the Swahili language

and then began interviewing local mothers with the help of an interpreter

fluent in Swahili and English.

However, getting the mothers to open up was easier said than done.

Most of the mothers said they were OK with their experience because they survived,

and their babies survived.

But from my point of view, they didn't get enough support.

But it was kind of difficult for them to talk.

So, I continued to interview,

and I think when our relationship became more trustful,

they started to tell me that

a midwife didn't come to them when they called the midwife.

They didn't want to have a baby anymore, because nobody would help them.

And that kind of voice, little by little, I got from the interview.

I had two implications.

One was listening to women's voice.

The second implication was involving family members

during pregnancy.

After finishing her Ph.D.,

Shinpuku began working to improve the quality of midwifery care

for mothers and newborns in Tanzania.

She approached the country's top medical school,

Muhimbili University of Health and Allied Sciences.

In 2011, she and a professor named Sebalda began laying the groundwork

for a master's program in midwifery.

I invited some of the teachers, midwifery teachers, to Japan,

then made them observe the hospital or clinic

or midwifery maternity home in Japan.

Then they were kind of shocked that

"Ah, now I finally learned that midwifery is this."

Then they said,

"We wanted to do this kind of study in Tanzania."

So, we decided to do like a seminar in Tanzania in 2012.

And they learned that the care that the midwife will provide

makes the birth humanized.

It is important for mothers to relax and relieve

and have a very stable condition.

Then they can be relaxed enough

to deliver a baby in a normal condition.

In 2014,

Shinpuku launched the country's first midwifery master's program.

Prior to the coronavirus pandemic,

she traveled frequently between Japan and Tanzania,

to teach students the latest in maternal and infant health.

But, determined to do more, she developed an app to bridge the knowledge gap.

So the first application I developed was the midwifery education app.

So, midwives can download the app and use it for their antenatal care.

I made the quiz for midwives to check their knowledge.

And some parts, I translated the contents into Swahili.

Sometimes I made a movie.

"She had had her first baby at a hospital."

On each page,

there is space for participants

that they can write any comments.

And other participants also can comment or push "Like."

They can interact using the app.

The success of the app has been encouraging.

Shinpuku began developing a digital handbook on maternal and child health

to provide information on childbirth to expectant and nursing mothers.

When a pregnant woman comes to the antenatal care,

a midwife examines her,

then puts the information, like weight or blood pressure,

or any other information they should examine according to the gestational weeks.

There are more than 700 women who already downloaded the app.

There were some fathers who wanted to download the app also.

Then they download the app and seriously read the contents.

And I think it's important,

the implication I made from my dissertation study

was the involvement of family members in pregnancy and childbirth,

and this app can help others

access the mother's data

and also information about the baby.

In recognition of her efforts,

the World Health Organization named Shinpuku on its 2020 list

of "100 Outstanding Women Nurse and Midwife Leaders."

She was the sole Japanese honoree.

It was very surprising to hear that I was selected

and I was not noticed by the organization,

but my name was on the list on their website.

So, my former student, she texted me and said,

"You are selected! Congratulations."

And I was, "What?! What was I selected?"

In 2021,

Shinpuku and her Tanzanian husband welcomed their first child, a daughter.

The experience has deepened her resolve

to make life better for mothers and their newborns.

I experienced the contractions indeed for a week.

But during the whole days, a midwife was always there.

During the contractions,

I often remembered about Tanzania mothers,

their voices, they are saying, they don't want to give birth anymore

because nobody will help them.

That was very shocking to me

because I understood more

that this pain cannot be overcome

without proper assistance.

So, I kind of strengthened my belief

that midwifery is very important for pregnant women,

and we need every woman to have midwifery care,

regardless of their place or background.

(Do you have any words to live by?)

"If you want to go fast, go alone. If you want to go far, go together."

This means that one person can do very small things.

But if you want to make a larger change like social change,

you need to collaborate with other people.

You need to involve other people,

so that we can actually change the society.