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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

Researcher part of project aimed at producing third-generation biofuels from microalgae in Germany
2016-05-09

Description: Novagreen bioreactor  Tags: Novagreen bioreactor

Some of the researchers and technicians among the tubes of the Novagreen bioreactor (Prof Grobbelaar on left)

A researcher from the University of the Free State (UFS), Prof Johan Grobbelaar, was invited to join a group of scientists recently at the Institute for Bio- and Geo-Sciences of the Research Centre Jülich, in Germany, where microalgae are used for lipid (oil) production, and then converted to kerosene for the aviation industry.

The project is probably the first of its kind to address bio-fuel production from microalgae on such a large scale.  

“The potential of algae as a fuel source is undisputed, because it was these photoautotrophic micro-organisms that were fixing sunlight energy into lipids for millions of years, generating the petroleum reserves that modern human civilisation uses today.  However, these reserves are finite, so the challenge is marrying biology with technology to produce economically-competitive fuels without harming the environment and compromising our food security.  The fundamental ability that microalgae have to produce energy-rich biomass from CO2, nutrients, and sunlight through photosynthesis for biofuels, is commonly referred to as the Third-Generation Biofuels (3G),” said Prof Grobbelaar.

The key compounds used for bio-diesel and kerosene production are the lipids and, more particularly, the triacylglyserols commonly referred to as TAGs.  These lipids, once extracted, need to be trans-esterified for biodiesel, while a further “cracking” step is required to produce kerosene.  Microalgae can store energy as lipids and/or carbohydrates. However, for biofuels, microalgae with high TAG contents are required.  A number of such algae have been isolated, and lipid contents of up to 60% have been achieved.

According to Prof Grobbelaar, the challenge is large-scale, high-volume production, since it is easy to manipulate growth conditions in the laboratory for experimental purposes.  

The AUFWIND project (AUFWIND, a German term for up-current, or new impetus) in Germany consists of three different commercially-available photobioreactor types, which are being compared for lipid production.

Description: Lipid rich chlorella Tags: Lipid rich chlorella

Manipulated Chlorella with high lipid contents (yellow) in the Novagreen bioreactor

The photobioreactors each occupies 500 m2 of land surface area, are situated next to one another, and can be monitored continuously.  The three systems are from Novagreen, IGV, and Phytolutions.  The Novagreen photobioreactor is housed in a glass house, and consist of interconnected vertical plastic tubes roughly 150 mm in diameter. The Phytolutions system is outdoors, and consists of curtains of vertical plastic tubes with a diameter of about 90 mm.  The most ambitious photobioreactor is from IGV, and consists of horizontally-layered nets housed in a plastic growth hall, where the algae are sprayed over the nets, and allowed to grow while dripping from one net to the next.

Prof Grobbelaar’s main task was to manipulate growth conditions in such a way that the microalgae converted their stored energy into lipids, and to establish protocols to run the various photobioreactors. This was accomplished in just over two months of intensive experimentation, and included modifications to the designs of the photobioreactors, the microalgal strain selection, and the replacement of the nutrient broth with a so-called balanced one.

Prof Grobbelaar has no illusions regarding the economic feasibility of the project.  However, with continued research, optimisation, and utilisation of waste resources, it is highly likely that the first long-haul flights using microalgal-derived kerosene will be possible in the not-too-distant future.

Prof Grobbelaar from the Department of Plant Sciences, although partly retired, still serves on the editorial boards of several journals. He is also involved with the examining of PhDs, many of them from abroad.  In addition, he assisted the Technology Innovation Agency of South Africa in the formulation of an algae-biotechnology and training centre.  “The chances are good that such a centre will be established in Upington, in the Northern Cape,” Prof Grobbelaar said.

 

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