Midwife

WHAT IS MSF ?

Médecins Sans Frontières/أطباء بلا حدود  بلا أطباء (MSF) is an international, independent, medical humanitarian organization that delivers emergency aid to people in 70 countries who are affected by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF offers assistance to people based on need, irrespective of race, religion, gender or political affiliation and our actions are guided by medical ethics and the principles of neutrality and impartiality.

We offer basic healthcare, perform surgery, fight epidemics, rehabilitate and run hospitals and clinics, carry out vaccination campaigns, operate nutrition centers, and provide mental healthcare. Our activities include the treatment of injuries and disease, maternal care and the provision of humanitarian aid. Where necessary, we set up sanitation systems, supply safe drinking water, and distribute relief to assist survival.

A FEW WORDS ABOUT THE PROJECT

The project started in Sept. 2013 in Shatila, where MSF currently manages an outpatient center for chronic non-communicable diseases (NCDs), vaccination services with transversely integrated mental health services and health promotion, and referrals for patients who require services beyond the scope of MSF activities. Additionally MSF opened a women’s health center with sexual and reproductive health care.
During 2018, low risk deliveries were relocated from Shatila to Rafik Hariri University Hospital compound, where MSF runs a Birth Centre. MSF took this as an opportunity to work together with external partners as catalyst for change around midwifery model of care and demedicalization of deliveries. The antenatal care services remains in the camps, to serve the most vulnerable women.
In Bourj el Barajneh camp, besides the above mentioned activities, MSF provides in addition home based care for those patients who are housebound or bedridden often due to an advanced NCD disease.

MSF BIRTH CENTER (BC)

The MSF Birth Center is unique in Lebanon, in its objective to develop a midwife led model of care. The midwives are responsible  for all of the deliveries and are only required to consult the obstetrician in case of complications. The model focuses on low risk pregnancies. There is an assesment room for all patients being followed in ANC, including the higher risk cases and they may attend at any time to be assessed. The most important role of the obstetrician is to manage any complicated cases either in BC or prior to referral to another hospital, and to be active in teaching, coaching and empowering of the midwives and nurses to help develop the midwife led model of care.

MAIN RESPONSIBILITIES

Provide obstetrical care to pregnant women and their babies, doing follow up before, during and after delivery, according to MSF obstetrical and reproductive health protocols, universal hygienic and newborn caring standards and under supervision of a specialist doctor, in order to ensure their health conditions and avoid post-delivery complications.

This position will be located in the MSF Birth Centre (located in the ground of RHUH, whilst maintaining its independence, the BC will collaborate closely with RHUH) and in the Family Center in Bourj El Barajne (OPD)  

ACCOUNTABILITIES

• Ensuring the implementation and continuity of antenatal and postnatal care, family planning, obstetrical care (BEmONC 1 and CEmONC 2), neonatal and comprehensive abortion care, management of victims of sexual violence, reproductive tract infections and Fistula care in accordance with MSF Reproductive Core Package of Activities and reinforce the implementation of standardized protocols.
• Where PMTCT is implemented, ensuring implementation of the PMTCT protocol in the ANC/delivery and PNC consultations (pre counselling, test and post counselling)
• Collaborating with the medical doctor and /or nurse in the management of Sexual Violence cases
• Assessing the feasibility for referral of pregnant women form the TBAs to the OPD/MCH for medical evaluation and/or complicated deliveries.
• Ensuring hygiene and sterilization criteria (including universal precautions) are met according to MSF specifications.
• Performing cleaning and minor maintenance for biomedical equipment used. Following the user manual and protocols and alert supervisor in case of malfunctioning.
• Guaranteeing a regular and ongoing supply of drugs and equipment required for maternity activities (including monitoring/consumption control/ordering of orders).
• Properly following up all new born babies from delivery until discharge, informing mothers and relatives about importance of breastfeeding, vaccination and possible complications resulting from harmful traditional practices.
• Ensuring patients’ right to privacy and confidentiality is respected
• Supervising that administrative procedures of admissions and hospitalizations comply with MSF protocols , as well as verify patients are properly informed and receive the documents required (birth certificate, vaccination card, etc...)
• Participating in the organization of the ward in collaboration with other midwives and the maternity ward supervisor. Ensure transfer of relevant information to the next shift team (specially identifying risk cases)
• According to MSF protocols in force, conduct normal deliveries independently, manage obstetric emergencies; identify cases needing referral and send them in time, clean up the new born, executing and registering first neo-natal medical acts (cutting and cleaning the umbilical cord, vaccination, etc.), detecting possible anomalies/infections of the new born and reporting them to the doctor, in order to ensure successful interventions Supervises the use of drugs, facilities and obstetric material, in order to ensure, in accordance with number of patients and prescriptions, a rational use as well as pharmacy stock levels are permanently updated, kept under appropriate conditions and above minimum safety point. 1 BEmONC = basic emergency obstetric and neonatal care = Administration of antibiotics, oxytocic, anticonvulsants, manual removal of the placenta, removal of retained products following abortion, assisted vaginal delivery, preferably with vacuum extractor and newborn care including neonatal resuscitation. 2 CEmONC = comprehensive obstetric and neonatal care = the full package of BEmONC Plus; surgery (caesarean section, hysterectomy, laparotomy), safe blood transfusion and care to sick and low birth weight newborns

DETAILED ACCOUNTABILITIES

Activities in OPD

Pre-natal consultations

• Questioning and carrying out examinations of patients during consultations
• Administering prophylactics to pregnant women according to the protocol defined with the Medical Coordinator
• Giving anti-tetanus vaccinations in accordance with the vaccination calendar
• Providing necessary information to future mothers according to MSF protocol (danger signs, when to go to the BC, how will be the care and delivery at BC, newborn care, breastfeeding, emergency signs for the baby, signs of infection, etc.).
• Selecting the women at high risk, referring them to the specialist doctor and introducing their treatments and appropriate follow up
• Updating the patients’ register and follow up forms

Postnatal care

• Offer a complete follow up of the mothers and their newborns according to protocols including clinical examination and preventive and curative treatments (prescribing of medicine strictly within MSF protocol)
• Ensure that routine laboratory tests are performed, interpret the results and adapt the approach if necessary
• Detect complications related to the post-natal period and adapt the follow up if needed
• Inform and refer to the gynecologist or OPD supervisor of any complications/problems exceeding one’s own competence
• Complete post-natal consult files, registers and data
• Reinforce all the information to the mother about her health and newborn care, including danger signs, according with MSF protocols

Family planning

• Ensure appropriate individual or couple counseling (information) in order for women and men to choose the method of their choice, knowing indications, contra-indications and the side effects
• Perform a basic clinical examination to exclude contra-indications
• Administer and/or provide the method of contraception according to its use and protocol
• Inform and refer to the gynecologist or OPD supervisor in case of complications/ problems exceeding one’s own competence
• Complete family planning files, register and data collection

Care of surviors of Sexual and Gender Based Violence

• Ensure appropriate medical care to survivors of SGBV according to MSF protocols including providing preventive treatments and care of injuries  

During assessment in pregnancy, labour, delivery and post-partum

• Provide the women with quality care during all phases of pregnancy, labour, delivery and post-partum period according to MSF protocols.
• Support and monitor the normal progression of labour and use non-medical interventions to help labour progress.
• Conduct normal deliveries and monitor the wellbeing of mother and baby
• Do the immidiate care of the newborn after delivery including resuscitation, physical examination and vaccination
• Initiate early breastfeeding and educate the families about the importance of breastfeeding.
• Support, educate and inform the women and caretakers about the normal process of pregnancy, labour, delivery and post-partum.
• Detect complications if they arise, inform the obstetrician and assist the doctor in treatment of the patient.
• During all patient contact show respect for the dignity, cultural and religious believes.
• Document all aspect of the work accordingly in the patient file
• Participate in detecting victims of SGBV and assist in the treatment.

Referral of high risk women / newborns

• Consult with the obstetrician/pediatrician/referral nurse when referral is deemed necessary based on criteria. Prepare the patient/newborn accordingly and complete the required documentation.
• Communicate handover with affiliated hospitals and find a place for the patient according to protocol. Administrative work regarding referral to be done.
• Inform family / caretaker accordingly
• Accompany patient / newborn when needed
• Refer for mental health or social worker support when needed.

Participates in the department related pharmacy and medical equipment control and maintenance

• Perform handover of medicines and materials at every shift
• Ensure no materials are removed from the wards withour prior authorization
• Check that the medical equipment in the department functions properly (suction pump, BP machine pulse oximeter)
• Cleans and disinfects materials after each patient.
• Monitors and records the consumption of medical materials and supplies and report to midwife supervisor about near-ruptures.

Hygiene / aspesis, waste disposal and stock keeping

• Ensure appropriate waste management and  use appropriate containers and bins (sharps, medical waste, domestic waste)
• Follow cleaning and instrument sterilization procedures
• Respect and follow all Covid-19 preventive measures
• Respect standard precautions and aspesis during procedures
• Awareness of PEP kit and follow up of AEB procedure

Additional Responsibilities

• Respect MSF principals to provide care with dignity, impartiality and neutrality and repect of confidentialities in every moment
• Respect the time schedule and be at work on time and maintain good relationship with other team members
• Rotation flexibility in IPD and OPD for the continuous improvement on the SRH activities.
• Collaborate with supporting services, i.e. mental health, health promotion, social worker, referral team on updates in ensuring best quality of care is guaranteed.
• Participate in regular meetings of the medical team and provide data collecting needed data for monthly medical reports
• Participates in all training delivered  to the department and makes an ongoing effort to maintain and update obstetrical/medical/ paediatric knowledge and skills.

REQUIREMENTS

Education : Midwifery degree + Registration with the Syndicate of Midwives in Lebanon

Desirable experience : working experience of at least two years in midwife activities related jobs.

IT skills: Essential computer literacy (word, excel)

Soft Skills: Compassion and patient friendliness , Results and Quality Orientation,  Teamwork and Cooperation,  Flexibility,  Commitment,  Stress management

N.B: 2 open vacancies, 1 full time and 1 daily worker/gap filler