Its Stand Or Deliver
p. 35 · Read in the full issue
In Western Samoa
From FELISE VA’A in Apia
When is a midwife a midwife?
This appears to be one of those
ridiculous philosophical prob
lems, yet it is the definition of midwife that is behind the current unrest among the nurses of Western Samoa.
This unrest led to a limited strike by the nurses early August resulting in a fairly large proportion of dis comfort on the part of the Health Department—but luckily it was not a catastrophe.
The trouble began when the Nurs ing Board of Western Samoa earlier this year started to implement the provisions of nursing legislation, approximately five years after the passing of the legislation. It provides for the registration of all nurses in Western Samoa in the three special ised areas of general nursing, mater nity and midwifery.
For those nurses who qualified at the local School of Nursing, registra tion in general nursing and maternity was a comparatively simple matter.
But not so in the case of midwifery registration. The Nursing Board was of the opinion that locally qualified nurses could not register as midwives because they could not in fact qualify.
Is a midwife someone who (1) has learned the elements of midwifery during a general course on nursing or (2) has spent many years of nursing service performing duties generally recognised as midwifery ones?
If she is, then the Western Samoa Registered Nurses Association, which represents nurses, nursing aids and trainees, is right. Local nurses do qualify to be called midwives and, therefore, to be registered.
But if the definition means a mid wife is (1) someone who has attended a recognised school for mid wives or (2) someone who has learned more than the elements of midwifery, then according to that definition, the Nursing Board of Western Samoa is right. For there is no recognised midwifery school in Western Samoa and by expert opinion midwifery is much more complicated than many nurses think.
Anyway, when this problem arose earlier this year the Nurses Asso ciation agreed with a heavy heart to forget its own interpretation, provided the Nursing Board established a mid wifery school for local nurses.
The board was given three months to do this, and if it failed to do it the nurses planned to strike. The board characteristically failed to establish the school. The association instructed all nurses performing mid wifery duties in the Apia General Hospital and in the districts to cease performing those duties—which they did.
And the Health Department was forced to call in for duty all the New Zealand - qualified midwives, about seven of them in Western Samoa. Most of them went on duty in the Apia General Hospital, includ ing the Superintendent of Nursing, Miss Moana Matatumua, who is also a member of the Nursing Board.
Village trained midwives helped out in the districts.
Things returned almost to normal after about three weeks, following a meeting between the association and the Public Service Commission. The nurses agreed to resume midwifery duties—provided the commission re instated two dismissed nurses.
The nurses had been suspended for alleged unethical practices (ie, they permitted practitioners of the Samoan traditional medical art to perform for patients at the hospital). The association pointed out that (1) the World Health Organisation en courages legitimate folk medicine (2) the two nurses were among their leaders in the midwifery registration issue. The two nurses were re instated.
Some individual nurses however have indicated that they will not per form midwifery duties, and this is not the end of the controversy. The Nurses’ Association has indicated that it will continue to pressure the Nurs ing Board to establish a midwifery school in Samoa, to enable local nurses to register in midwifery. It is not satisfied with the board’s latest conciliatory measure, which consists of diplomas in midwifery for local nurses: nothing less than registration will satisfy them. It is now a matter of prestige.