University of Groningen
Safe Motherhood: Maternity Waiting Homes in Ethiopia to Improve Women’s Access to
Maternity Care
Vermeiden, Catharina Johanna
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Publication date: 2019
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Vermeiden, C. J. (2019). Safe Motherhood: Maternity Waiting Homes in Ethiopia to Improve Women’s Access to Maternity Care. University of Groningen.
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ACKNOWLEDGEMENTSLove what matters Ethiopia
We arrived in Butajira in the pouring rain. Andualem Mengistu, CEO of the hospital, you were the first to welcome us. We looked around the house and you asked: “What do you think?” With two small kids and no furniture in place, no kitchen, an outside bathroom and countless cockroaches, I wanted to cry, but realised that this was not a culturally appropriate answer. Andualem, you helped us to settle in and I am grateful to you for that. On behalf of the Zonal Health Bureau, you are also the one that asked Floris and me to help set up a maternity waiting home. This dissertation would not have come about had Butajira General Hospital not been one of the first government hospitals in Ethiopia to take that step. I express my sincere appreciation to you, the Zonal Health Bureau in Welkite and the Regional Health Bureau in Hawassa for your support throughout the project.
Akale and Beharnesh, you were there from day one and never left. Akale, you fixed everything that was broken (and everything was always broken). You knew when I was feeling down and always said: “Relax your mind!” Yetmwork, you are my Ethiopian sister. This work would have been impossible without your loving care to our family. Beletu, Nebye, Tina, Helena, you were wonderful neighbours and made us feel at home.
Dr. Gashaw Getnet, you were at the core of our research team. This book is also yours. Dr. Medhin Selamu, you were the best research assistant. Thank you for your advice and kindness! Furthermore, I feel deeply grateful that we crossed paths with you, Dr. Asheber Gaym, Prof. Atalay Alem, Dr. Abebaw Fekadu, Dr. Girmay Medhin and Dr. Charlotte Hanlon. We had limited research experience, but you invited us to present our plans, gave us your undivided attention and encouraged us to ‘Just Do It.’ Ato Bekele and Solomon, your support was also of invaluable importance. You both encouraged me not to give up for the sake of the community. Dr. Rita Schiffer and the other sisters at Attat Hospital, you provided a haven of rest and hope. Your freshly baked goodies, advice and prayers always helped. I am very proud of our data collection team, a group of mostly young women who worked tirelessly to interview women in the wards and who braved the rain and muddy roads to reach women in rural areas. There was a lot of girl power, but we also had a few good men on our team: Nebye, Dagim, Wolde and Matiwos, thank you for your hard work. Azezew, almost every day you brightened my day with ‘weteti ba buna’ and your kindness at Rediet Hotel.
ward, I hope your ceaseless loving care for women and their newborns inspires countless others. You are the backbone and future of maternity care in Ethiopia!
Dinkenesh will never read this, but she is part of us through our daughter Sara. Like all the other women I had the privilege to meet and talk to, she is the reason I am doing this work. This thesis is about and for women in Ethiopia.
Zimbabwe
Most of the data analyses and writing work for this thesis was done in Zimbabwe. I thank you Sylvia and Sister Rosemary for being my friends. Teclar and Farai, we will never forget how you took care of our family. Sigrid, I cherish our walks together. My friends Tempe, Noor and Willemijn, we share a love for Zimbabwe and specifically for Chimanimani. In 25 years, shall we turn The Farmhouse into an old people’s home and retire there?
Our teachers Zarah, Christina, Nicole and Carmen, you rock! Thanks to your creativity, enthusiasm and dedication, “Het Kippenhok” (the name of the school was Chicken Coop, since that’s what it was first) was a wonderful learning environment for Merlijn, Elin and Sara. This thesis would not have been written without your support.
‘My students’ Mitchell, Neel and Jorine. A mix of data collection, (re)writing, running and camping. I may have set the standards too high at times, but it was a privilege to see you learn.
The Netherlands & beyond
Professor Jelle Stekelenburg and Professor Thomas van den Akker, I am extremely proud and grateful to form a team with you. Jelle, it was meant to be: you happened to be in Ethiopia when I wrote to the Working Party on International Safe Motherhood and Reproductive Health in October 2013 requesting your advice in the maternity waiting home project. Despite our newly purchased, very old yet extremely expensive Toyota Landcruiser breaking down before starting our journey, we made it to Addis Ababa, ate pizza’s together and brainstormed about research questions. I admire your dedication to fight injustice and your sense of ease and basic trust in life. “Thomas, will you be my co-promotor?” was the scary question I asked you in March 2016. It felt right and still does. We share a love for Africa, English language, talking (and some dancing). The speed at which you react to questions and draft manuscripts is amazing, but what I admire and appreciate even more is your positive personality. Jelle and Thomas, thank you for being my mentors, you know me well and help me grow.
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Dr. Barbara Kwast and Professor Jos van Roosmalen, you are the “grandparents” of the Safe Motherhood movement in The Netherlands. Barbara, you are such a loving and strong woman. You were also there for me when I needed advice or a listening ear (although I have to admit that I was sometimes afraid to send you a draft version of my work because your work is of such a high standard). Jos, as non-medic you referred to me as “de vreemde eend in de bijt” (the stranger in our midst) but I have always felt your support. You both inspire me to continue to fight for women to be able to have a healthy pregnancy and childbirth. Abera, Rob, Wouter, Anke, Barbara, and my other PhD nerd buddies. I am really happy that this thesis is done, but hope you remain my buddies far beyond.Martin Weinans and Suzanne Verhees, my paranymphs and not without reason. Martin visited us in Ethiopia and Zimbabwe. You saw both ups and downs. Two things you said were often on my mind in this PhD process: 1) the story of having to choose another PhD topic after losing all your data due to a power cut in The Netherlands (lesson: things could always be worse!) and 2) it is such a privilege to do a PhD, never again will you have so much time to go into depth about a topic. Yes, you were so right. Suzanne, first my friend, then my sister-in-law. I didn’t make it easy for you when you got together with Thijs, but I’m glad you didn’t give up. This is your day to shine with me publicly, instead of as my secret third witness at our wedding. Floris, my love. This book is the result of five years in Africa together. We started this research together and I would never have made it to the end without you. Thank you for your unconditional love; your confidence in me; how you took care of the kids and basically everything in the last year; the freedom you give me; your calm when I let things get on my nerves. We will never forget those five years. Butajira was quite a roller coaster ride. In Silveira I was utterly bored at times. Together we continue to search for balance and adventure. Merlijn, Elin, Sara: “Mama is a researcher...”. “Tell me again what you do, mama, are you an inventor?” I love seeing the world through your eyes.
Mam, pap, Wout, Thijs, you are the roots from which I grow.
Suuz, Lautje, Liesbeth, Cynth, STOUT ’97, Ireen, Noortje, Kimmie, Delia, my life would be so empty without you cool chicas by my side.
Atty and Henk Hammer-Roos, a journey of a thousand miles begins with a single step. That first step was at Sibusiso. Asante sana. René and Frances, my life coaches: I’m standing in the open field of experience. Often weak in the knees, but I’m doing it.
A big thank you to the many individuals that supported us in numerous ways: Misganu Endrias, Yohannes Amado, Nina Belay, Nibret Zeleke, Doug and Tempe van de Ruit, Shane and Birgit, Dave and Irene, Ralf and Lonneke, Niek and Laura, Klaas and Gerdien, Wouter and Monique, Ad and Eva, Karen, Bram and Marit, Dominique, Roland, Coen, Luc van Lent, Renske Satijn, Liane Cats, Wendy Wetzels, Simone Dijkstra, Gert IJszenga, Mirjam Koedoot, Jos and Margreet van Heest, Marlieke de Fouw, Luc van Lonckhuijzen, Kitty Bloemenkamp, Marcus Rijken, Joyce Brown, Truus van Ittersum and Regien Biesma-Blanco.
A special thank you to the organisations that made the MWH project and research financially possible (in alphabetical order): Albert & Tilly Waaijer Fonds, Butajira Hospital, Florentina Foundation, Gynaecongres NVOG, Irish Aid, Johannes Stichting, Laerdal Foundation, staff of the Nederlandse Zorg Autoriteit, Nederlands Albert Schweitzer Fonds, Otto Kranendonkfonds, Stichting Dalayu, The Working Party on International Safe Motherhood & Reproductive Health, VSO.
Rob of the Florentina Foundation, the MWH project is also ‘your baby’. Last but not least, I thank my colleagues at VSO for supporting me on this entire journey and in getting this PhD thesis over the finish line.
The beautiful design of this thesis was done by Nina Mathijsen of Take a Detour, for which she used pictures that were taken by Gert IJszenga, plus two from my personal collection.
