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20 December 2021 | Story Elsabé Brits
Dr Elgonda Bekker, from the University of the Free State (UFS), completed her doctoral degree in nursing in 2020, with a practical, transformative thesis to improve the education of midwives in the country.

Midwives who are properly trained and acknowledged for their skill and experience do not only save lives but make a huge contribution to maternal health in South Africa. However, there is a dire need for professional midwives and competent educators. 

Dr Elgonda Bekker, from the University of the Free State (UFS), completed her doctoral degree in nursing in 2020, with the title: Competencies of South African midwifery educators: a transformative framework. It is a practical, transformative thesis to improve the education of midwives in the country. Sadly, just months after she received her degree she passed away. Yet, her colleagues at the School of Nursing at the UFS continue to build on the foundation she laid.  

Too much too soon, too little too late 

The World Health Organisation (WHO) states that 10-15% of births may need intervention through caesarean section. A recent analysis, however, found that private hospitals had a caesarean section rate of 73.6%, compared to 26% in the public sector.

Although the public sector rate is higher than the WHO target, the private sector rate is not justifiable, Bekker writes. The case fatality rate for mothers who died after a caesarean section had been performed showed an increase. That is one of the statements indicating that not all medical interventions are of benefit to mothers.

A focus on too much too soon or too little too late in the Lancet series on midwifery of 2014 indicated the need for better-quality care. In South Africa both manifest because of the disparity between private and public healthcare. According to Bekker’s research, the high caesarean section rate in the private sector is a classic example of over-medicalisation of obstetric care, whereas the public healthcare system follows a midwifery-led model of care.

“Midwives are a vital solution to correct this disparity. Competent midwives, educated to standards, can prevent interventions without indication, provide service in rural settings and advocate for the rights of the childbearing family,” she wrote.

Midwifery is a disempowered profession 

Winnie Moroa Motlolometsi, a midwifery educator, explains that professional nurses in the country have a dual registration with the South African Nursing Council as a nurse-midwife. This leads to many qualified midwives not necessarily practising as midwives. It is therefore very difficult to calculate the number of practising midwives. 

Furthermore, the conflation of nursing and midwifery requires training as a generalist practitioner. Depending on the institution where they are trained, professional nurses may or may not comply with the International Confederation of Midwives’ Global Standards for education and regulation of the midwifery profession. 

Nevertheless, according to Dr Bekker’s research, midwifery is a disempowered profession, because the global guiding documents are neither considered by the regulatory authority nor the National Department of Health. There is a triple gap for competencies, coverage, and access: 

  • Insufficient numbers of competent midwives 

  • .. who can cover maternal health services 

  •  …who render services that address the needs of women 

There is a dire need for competent midwives in the country, but the predicament is that whilst midwifery educators are qualified, they are not necessarily clinical specialists, which ultimately jeopardises the quality of maternal healthcare. 

What was also clear from Bekker’s research is that although South Africa has a progressive constitution, gender equality has not materialised on grassroots level. Violence is ever present. Women are viewed as weaker, vulnerable, and less suited for the workplace. Nonconformity to sexual gender norms, based on cultural or religious bias, creates conflict for some women.  

Dr Deidre van Jaarsveldt, senior lecturer in the School of Nursing at the UFS, said Bekker’s study highlighted that feminism is a strengthening agency for women. In this study it was important to frame the context of midwifery as a disempowered, woman-led profession, caring for women who are still finding themselves in a society where there is gender inequality. 

The research indicated that there were many challenges: 

  • Lack of autonomy for midwives 

  • Non-compliance with the global midwifery standards 

  • Conflation of nursing and midwifery 

  • Midwifery regulated by non-midwives 

  • Lack of direct entry into midwifery education in the country 

  • High litigation in maternal and child healthcare – there is fearfulness among practitioners and reluctance to work within the midwifery profession 

In practice it is difficult to distinguish midwifery specialists from nurses who are practising as generalists and are expected to offer maternal healthcare services. If something goes wrong, the midwifery profession is held accountable, but practising midwives were not necessarily involved. 

Reproductive, Maternal, Newborn and Child Health Hub 

There is a dire need for midwifery to become an autonomous profession guided by global standards. Membership should be based on advanced qualifications, which strengthen midwifery as a speciality. This can only be attained through education and maintained by a regulatory body, as well as the de-conflation of midwifery from nursing. When this happens, midwives will know who the actual midwives are and be able to hold one another accountable, Motlolometsi adds. 

Dr Bekker advocated for the “decolonising” of midwifery, which means restoring the knowledge to the profession. To allow midwives to receive quality education, midwifery should become an independent profession that is guided by global standards and regulated by midwives.  

Van Jaarsveldt says the School of Nursing at the UFS endeavours to offer quality midwifery education. Students learn in a high-tech simulated learning environment where they can become competent before working with actual mothers and babies. The educators are clinical experts, supported by a team of midwifery practitioners who act as preceptors for the students. 

Before her untimely death, Dr Bekker started establishing a Reproductive, Maternal, Newborn and Child Health Hub in the Faculty of Health Sciences, which is continuing under the leadership of Dr Cynthia Spies, supported by a team of interprofessional experts.  

“Through research and continuous improvement of education and practice, this group of professionals envisions optimising and strengthening reproductive, maternal, newborn, and child health competencies so that current maternal and child morbidity and mortality trends can improve resulting in surviving and thriving childrearing families.  

“The goal is to develop partnerships and opportunities for collaboration and research with colleagues in healthcare disciplines and to extend beyond healthcare to include innovative interdisciplinary partnerships,” says Spies. The objectives include:

  • Practice development with implementation of evidence-based practice and positive experience of the childbirth and child health continuum; 
  • Clinical competency development through training and the development of short learning programmes; 
  • Clinical research that addresses the current reproductive, maternal, neonatal and child health mortality, morbidity and health issues in central South Africa.

News Archive

Traffic in translation between French and Afrikaans follows unique direction
2017-11-21

 Description: Traffic in translation between French and Afrikaans  Tags: Traffic in translation between French and Afrikaans

At Prof Naòmi Morgan’s inaugural lecture were, from the left:
Profs Corli Witthuhn, Vice-Rector: Research; Morgan;
Heidi Hudson, Acting Dean of the Faculty of the Humanities;
and Angelique van Niekerk, Head of the Department of Afrikaans
and Dutch, German and French.
Photo: Stephen Collett

Translation is normally done from a so-called weaker language into a mightier one. This is one of the ways, according to author Antjie Krog in her book A Change of Tongue, which is used by a ‘weaker’ language to help it survive.

However, according to Prof Naòmi Morgan, Head of French in the Department of Afrikaans and Dutch, German and French at the University of the Free State (UFS), this is not the case with French, which is the mightier language, and Afrikaans.

Influence of translators on Afrikaans

“The number of translated titles from French into Afrikaans, from ‘great’ into ‘lesser’ language, is far more than the other way round, almost as if the translators wanted to make the Afrikaans-speaking readers literary self-sufficient, but did not feel the same need to extend the Afrikaans literature into other languages.”

This was Prof Morgan’s words on 8 November 2017 during her inaugural lecture entitled, Van Frans na Afrikaans: 100 jaar van byna eenrigting-vertaalverkeer, in the Equitas Auditorium on the Bloemfontein Campus. A PowerPoint presentation, with a symbolic background of the South African and French flags and relevant texts, formed part of her lecture. She also played video clips and pieces of music to complement it.

Among others, she has a doctorate in Modern French Literature from the University of Geneva, and her translations have earned her a French Knighthood and various prizes. She is also well-known for her translations and involvement in dramas such as Oskar en die Pienk Tannie and Monsieur Ibrahim en die blomme van die Koran.

Greater challenges in this direction

In her lecture, she looked at the two-way traffic from French into Afrikaans and from Afrikaans into French.

Three French citizens, Pierre-Marie Finkelstein, Georges Lory, and Donald Moerdijk, have translated from Afrikaans into French. Of course, their background and ties with South Africa also had an influence on their work. “In Moerdijk’s case, translation from Afrikaans, his second language, was a way in which to recall the country he left in his mind’s eye,” she said.

Prof Morgan is one of only two translators who translates works from Afrikaans into French, the other being Catherine du Toit. However, translations in this direction pose greater challenges. She said it involves “not only knowledge of the language, but also knowledge of the French target culture and literature”. In addition, there aren’t any good bilingual dictionaries, and the only Afrikaans-French dictionary is a thin volume by B Strelen and HL Gonin dating from 1950.

Prof Morgan still believes in translation

She believes there is a need to hear foreign languages such as French in the form of music in Afrikaans, and the speaking of a language alone might not be enough to ensure its survival. 

She still believes in translation, and quoted Salman Rushdie’s Imaginary homelands: essays and criticism 1981-1991 in this respect: “The word ‘translation’ comes, etymologically, from the Latin for ‘bearing across’. Having been borne across the world, we are translated men. It is normally supposed that something always gets lost in translation; I cling, obstinately to the notion that something can also be gained.”

Click here for Prof Morgan’s full lecture (only available in Afrikaans).

 

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