EP 124:The Intersection of Traditional Knowledge and Modern Maternal Healthcare in Africa with Dr. Maurine Musie

Today, we engage in a conversation with Dr. Maurine Musie, the youngest PHD holder at the University of Pretoria Nursing Department, South Africa. Her groundbreaking work as an advanced midwife specialist and lecturer at the University of Pretoria, opens up a fresh dialogue on the confluence of traditional medical wisdom and modern healthcare practices. 

Twitter: @MaurineMusie
LinkedIn: Dr Maurine Musie, PHD
Facebook: Maurine Princess Musie

Transcript

Anne Chisa: 0:15

The Root of the Science Podcast with your girl, Ann with an E. Hello everyone and welcome back to another episode of the Root of the Science podcast with your girl, Ann with an E. If you are new here, welcome, welcome. It's always such a pleasure having new listeners of the show and, of course, if you are regular, thank you so much for returning. Use your reminder to follow this podcast on wherever you listen to your podcast and make sure to hit the notification button so that you're well aware that a new episode has loaded. We are also on social media such as Instagram, twitter and TikTok at the Roots of the Science pod. We are on LinkedIn, Facebook and, of course, YouTube at the Roots of the Science podcast. And also, if you think you should be on the show or you know somebody who I should chat to, please feel free to send me a message on the various social media platforms or send an email directly at rootofthescipod@ gmail. com. Now let's get into today's episode.

Anne Chisa: 1:24

Maternal health in African countries is still a significant concern due to high rates of maternal mortality. Despite progress being made in recent years, Africa still faces numerous challenges in ensuring the well-being of pregnant women and new mothers. To address these challenges, experts in this field, are suggesting an incorporation of indigenous knowledge, collaboration between midwives and traditional birth attendants otherwise known as TBAs and prioritizing women's opinions in maternal health initiatives. Our guest today for STEM solution stories is Dr Maurine Musie. Dr Maurine is an advanced midwife specialist and midwifery lecturer at the University of Pretoria in South Africa. She is the youngest PhD holder in the nursing department at the same university. Dr Maureen will help us understand the possible outcomes of indigenous knowledge and collaboration with traditional birth attendants in maternity care.

Anne Chisa: 2:30

Tune in for all of this and so much more on STEM solution stories, where solutions become stories, let's go. Good morning, Dr. Maurine. Welcome to the show. Thank you, and good morning. It is such a pleasure to have you on the show with us this morning. So before we get things started, can you just give us a brief background on who you are and, just briefly, what you do?

Dr. Maurine Musie: 3:01

Okay, I am Dr Maurine Musie. I'm currently the youngest PhD holder at the University of Pretoria and also the youngest woman in science. I'm currently a midwife specialist and also a midwifery lecturer at the University of Pretoria. I'm teaching third year students midwifery, maternal and child healthcare and yeah, that is me.

Anne Chisa: 3:33

Amazing, amazing and what wonderful achievements. Congratulations for all of those achievements. It's something to really really be proud of, and, speaking about you being the youngest PhD holder at the university, in your department of nursing at the University of Pretoria, and also the youngest woman in science, I think let's start from the beginning. What motivated you to advance so quickly in your particular profession?

Dr. Maurine Musie: 4:06

Thank you for that. I think what motivated me to progress so fast is that I had clear goals in mind that by the end of this year or by 2023, I would like to have finished my research, which was my PhD study. So I think that helped me focus to really progress in my studies by having the clear goal sets. And I should say that it was not easy. It was challenging because I started my PhD journey during the.

Dr. Maurine Musie: 4:38

COVID times you know, in 2020, when there was the hard lockdown restrictions. However, with so many hurdles or challenges that I encountered during my journey, I really had my goals in mind that by the end of in 2023, I would like to have completed my studies. So that really motivated me. And also being afforded the opportunity like having a research grant from the National Research Foundation it was called the Black Academic Advancement Program, which is BAP. They clearly indicate that you need to do your PhD study in three years, which is the record time to finish your PhD. So also from the research grant as well.

Dr. Maurine Musie: 5:24

Having that in mind, it really assisted or propelled me to really progress that quickly. And also having a support and mentorship from experienced professors, like my supervisor, Professor Amoebis Melawizi. She really significantly impacted on my progress because she really kept on pushing me and reminding me about the goal that I had in mind and I should say also have a personal drive and a good work ethic to really advance in my career. I think that is what really pushed me, and the patient that I have from midwifery really assisted me to progress that quickly.

Anne Chisa: 6:04

Fantastic, fantastic. And speaking on your area of specialization, you did mention that you are an advanced midwife specialist. So what does this mean for somebody who is like, okay, you are this amazing person who is advancing, but what does that mean? What exactly do you do and what is your in terms of your specialization?

Dr. Maurine Musie: 6:33

Okay. So in nursing you get to complete your four-year degree, then you get your bachelor's degree in nursing. So after that I went further in my studies and went and did an advanced diploma in advanced midwifery, meaning that I specialized in advanced midwifery, meaning that I now deal with cases that are more high-risk. I'm able to manage more complex and more obstetric complications and emergencies. So I'm more capacitated to deal with those emergencies because I have specialized. So I've went further in terms of my training. So you can do it at a college or at any university, but I did it at the university where I did it at the same time with my master's. So I got the master's in terms of the research and then I also completed the clinical or the advanced midwifery, which is a postgraduate diploma that you get to do to advance your studies.

Anne Chisa: 7:40

Oh, wow. You know my mom is actually a midwife, so this is pretty special to my heart and when I told her that you're on the show, she was really excited. So you are inspiring really amazing people. So, in terms of maternal health care, you are an expert. Like you said, you've advanced. Some people stop at a four-year degree, but you've advanced and you've become an expert in your field. So in Africa, from your expert opinion, how worried should we be about the maternal health care in our continent as a whole, and why is it so important that you decided this is your area of focus?

Dr. Maurine Musie: 8:31

I think that I just knew it from my undergraduate study that I really want to work with them, mother and their child. Like having to see at the end of you know, after I assisted the woman during the delivery and all seeing an alive mother and a live baby at the end really gave me you know, it was what I saw that this is what I was going to do. So I think, in terms of maternal health, we need to know that it is a critical issue in Africa because we're not only dealing with the mother only, we're also dealing with the child as well. So in Africa, I should say that there are so many several challenges and disparities that we can see in terms of maternal health and, as a midwifery lecturer, what propelled me to actually look into, you know, the study that I did is that when I was still working in clinical practice so I worked in one of the hospitals in Tawane. I worked for like three to four years During my service I found that a lot of pregnant women utilize, you know, both streams of K.

Dr. Maurine Musie: 9:42

They go privately to a traditional health practitioner or a traditional Beth attendant and also come to our Western health care facilities and you find them coming to the world, you know, carrying your, you know a bottle with a mixture or, you know, have a concoction called Isislambeza to the hospital, and we, as midwifery, know that Isislambeza is known to precipitate labor and which can even end up, you know, causing a lot of complications during labor. So I really found that we really need to look at maternal health and know that women do seek both streams of K. So what we really need to look at is that currently, you know, in South Africa, africa as a whole, we're experiencing a very high rate of maternal mortality. Some of the mentalities can be linked to factors such as limited access to quality health care and also inadequate of sensory care and socioeconomic disparities. So you find a lot of women, you know they are women who still, you know, believe or who still believe in your traditional values, you know cultures, and you find that they delay seeking your health care facilities, you know, due to certain cultural beliefs. So I really think that it's very important not to turn a blind eye to the fact that they also do consult other forms of health care, and other problems that we're experiencing in maternal health is also access to health care. You know, my study was actually done in places like Mopanisosyanguze, where you found that a lot of women were not had limited access to those facilities and sometimes they only come to labor. You know, maybe they even deliver at home what we call born before arrival BBA, just because of certain cultural beliefs that are associated with pregnancy. So we really need to look at that in totality.

Dr. Maurine Musie: 11:47

You know, in we have a holistic view of how our maternal health care system is currently situated. You know we have women who have social and cultural. You know the social and cultural factors that really impede a woman from seeking health care. You know being afraid of being bewitched. You know things like that which really affect them and affect the decision making that they make around pregnancy and childbirth. So I should say that, in terms of maternal health care system, there are so many challenges that we are experiencing that really requires a multifaceted approach.

Dr. Maurine Musie: 12:27

We cannot turn a blind eye and think that they are not consulting traditional or better attendance or your traditional health care practitioners.

Dr. Maurine Musie: 12:36

They are.

Dr. Maurine Musie: 12:37

We live in a society with where women have pluralistic health needs, where they can consult both.

Dr. Maurine Musie: 12:43

However, these systems are not working together Somehow.

Dr. Maurine Musie: 12:49

There is no recognition of the other and we know that the current dominating system is the Western health care system.

Dr. Maurine Musie: 12:57

However, it means that if we don't go in depth and find out if they go to a traditional, better attendant, what is it that gets to be done and look at, maybe, if the things that we need to correct in terms of their practices you know, because we hear a lot of news that say that traditional, better attendance or traditional health care practitioners, most of their work or their practices is associated, you know, with bad, with, you know, negative outcomes. But we really need to go and look into into that and to find out if really it is associated with negative outcomes and then what do we do about it? Because we can't just see that their practices is is associated with negative outcomes and also contributes to our maternal mortality rates. So this is what really assisted me to go forth and go and look at is there something that they are doing which is good for maternal health and what they're doing which is not good for maternal health, and find ways to, you know, sort of bridge that gap.

Anne Chisa: 14:06

Amazing and I like what you said about that that it's such a complex issue. It's not just black and white. There's the issues of accessibility, there's the the, the societal aspects. You know there's a fact that maybe she might want to go, but maybe her husband does not believe in it or her family, so there's it's very multi layered and I think it's so wonderful that you are looking at that intersection. So, in terms of your research, have you come across any innovative approaches, or rather interventions that you know you were able to successfully integrate this? Traditional practices, because I think in some elements they do have their spaces right, as well as the modern health care systems and in order to help improve the maternal health outcomes?

Dr. Maurine Musie: 15:07

I, you know, from the findings of my study, I we ended up having what we call a nominal group technique, where you know there were various multiple, you know, stakeholders that were involved. You know people from the Department of Health, people from the, the, the directorate of traditional health, health medicine. You know where we set, you know, is sort of like a round table to discuss what are that we can collaborate, what are the ways that we can integrate them into our health care system, and we found that it is something that is still, you know, beyond, beyond reach. But, however, it was proposed that we can maybe look at, start looking at, maybe including them in sort of like an inclusive framework of collaboration. This is where we recognize that they are there, you know, but not to say that we are working hand in hand, but we just the health care, the Western health care system recognize that THPs, which include traditional health care practitioners you know your traditional health care staff, you know, you know you have a better attendance, you have a list. We recognize that they are there in our communities, where the very women reside. We recognize that they are there. However, what can we do to sort of like empower them? So we thought we can have what we call capacity building for them, just to train them on certain aspects that we really think that is very crucial in terms of our maternal health care system, like we want them to be able to recognize that.

Dr. Maurine Musie: 16:44

You know this patient that I'm dealing with is a high risk patient. You know these dangers that are associated or risks that are associated in this woman's pregnancies. Like, for an example, they get somebody who is presenting with hypertension, for an example. They do not keep such a patient with them but recognize and refer them to their child because this woman they trust. You know your traditional better attendance so they would really listen to the education that they're giving them. So recognizing those dangerous signs and then referring them to our clinics. And we also we are not going to turn them back because you find that the clinics, the nurses, will be saying no, if you consulted other forms of health care, you know they would want to tell them. So we, we were urging to saying that this is how we can really recognize them, because sort of like having a fully integrated system is still something that is difficult to say. Then how do we say they can be integrated into our healthcare system?

Dr. Maurine Musie: 17:50

So what we're doing as a university is that we have introduced what we call transdisciplinary module. We, when a student is, you know, in whatever like we normally do it in all the, in all the year groups, first year, all the way up to fourth year. They have a module where we call in our traditional health practitioners, our indigenous knowledge holders, our traditional better attendance, where they come to the university they share, you know, with our students what are the practices that they are doing. And we also have days where we take them for site visits. You know places like in Mami Lodi, where they go and actually go and see that when a head-by-list of the traditional better attendance is consulting with the patient, what is it that they are doing in their, in their in Dumba, which is their sacred healing hearts, with the consult with the patients, we also developed a project where, as I was saying, talking about capacity building, where we are training our traditional health practitioners and TBAs and issues such as, you know, CPR and first aid. So those were some of the things that we we indicated and saw that if we can also train them on such issues, then it can also assist.

Dr. Maurine Musie: 19:08

And then currently I'm working with the department, the national department of health where we saw that the traditional better attendance are in the community. They are residing in the community, they do see the women during her pregnancy. So in that guidelines we want to develop community guidelines, where, in those guidelines we have, I have to clearly indicate what is the role of a traditional better attendant in terms of assisting the women during her pregnancy, labor and childbirth. What is their scope of practice, what is it that they will be expected you know to do when they are managing or working or assisting a pregnant woman? And you know that we're moving towards what we call your NHI, which is your national health insurance, where we thought of maybe, if, if they can get you know, like extended roads, like things, like they can be a doula or a birth companion, where they are allowed to after they've seen a woman, they've seen that they are dangerous, and then they come with the woman to the, to the clinic and you know, sort of sort of accompanying the woman to the facility. Those are some of the ways we thought that maybe we can integrate them. We thought that they can be integrated at an antenatal level, so where the women is still pregnant.

Dr. Maurine Musie: 20:30

However, for issues such as labor. We thought that, you know, with labor there are so many complications and we can be having women that are not giving birth in facilities where there's access, you know, to your theaters, you know where, if, if they can be in emergency, that can arise. So we're still talking about skilled birth attendants. You know, looking at the safe motherhood, we really still advocating that women should give birth in a facility where there's access to those emergency services. So we thought that that attendance can assist us, maybe at an antenatal level and also at a postnatal level. So postnatal, this is after the woman is given birth. They can do things like your home visits, you know, in the community now we have our warbots or our community health care workers. So because they are also trusted in the community, they can assist us, you know, with our postnatal visits giving the health education to the woman, encouraging breastfeeding, you know things like that. So those were some of the ways that we thought of integrating them into our health care system.

Anne Chisa: 21:39

Yeah, Fantastic work, fantastic work that you're doing. Yeah, I use you mentioned about capacity building with the, with the indigent, the traditional birth givers, for example, but I wanted to ask you, on the other hand, on the other hand, what is the role of the indigenous knowledge that maybe you, as the medical practitioners, have learned during that process? Because I think you touched a lot on how you have equipped to them and you are equipping them, but there's also that indigenous knowledge. Has they been? What is that? What, what, what are some things that you've learned? Because I think it's also very important to talk about that indigenous knowledge aspect.

Dr. Maurine Musie: 22:31

Yeah, yeah, yeah, definitely, yeah, I really, you know, from the traditional best attendance that we interviewed, we also saw that we can't. We can see now that the Western health care system is sort of superior to the traditional health care system because there are so many things that we can learn from our traditional best attendance, which I also learned during the study that I was doing. We are African and there are some conditions, some traditional conditions such as rigoni or ibala, that when a new unit has that reddish mark behind them on the head In the Western health care system we can't explain that. We always confuse it with meningitis, things like that, but whereas it is like a sacred traditional condition that the new unit is presenting with. So I actually learned that there are conditions where we really do not have an answer in terms of Western health care system, where the traditional best attendance they can really assist us in such cases.

Dr. Maurine Musie: 23:53

What I also learned from them is that nowadays there are so many issues that women are facing in terms of their reproductive. There are a lot of cases where we are finding a lot of women having infertility issues. What I found out from my studies that some of the infertility is not. It can be answered medically, you'll be giving the woman the hormones, you'll be going to the fertility clinic, whereas this infertility actually is actually associated to traditional customs or traditional causes that could have contributed to that. So they can really assist us in such cases as well, where we really can find an answer to such sacred conditions, then they can really assist us in those ways. I think also during the COVID we learned a lot about traditional health and traditional medicine. I think all of us during the COVID we wanted what we call ingana.

Dr. Maurine Musie: 24:59

All of us now wanted to prepare that, just to prepare ourselves from getting the COVID, the flu. So there's really so many things that we can learn from traditional health. In Western health, we use those herbal medicines or those herbal plants and we prepare them in our Western way and without really acknowledging that it's coming from them. Such practices are coming from them, so we do go to them, we do research, things like that, and we really don't give them the honor or the gratitude that they are supposed to get in this process. So I really learned that there's so many talks that they're associated with harmful but others really they are doing good practices and their conditions where they can really assist us, as I was saying. So I think those are some of the things that I learned during this journey.

Anne Chisa: 26:06

Interesting.

Anne Chisa: 26:07

I've also learned some things, and you're right that I think we do not honor indigenous knowledge enough in terms of the role that it plays in Western medicine, but when we were at a crunch time during COVID, we all quickly remembered that. So I like the idea that, even with this, with your study and with the approach, the idea of the transdisciplinary approach taking in multiple stakeholders, including the people in the community, is very, very important. Just one last question as we wrap up what best practices do you want to see in future among midwives in Africa or South Africa, to be more localized, that you believe are essential in enhancing maternal health?

Dr. Maurine Musie: 27:04

So the best practices that I really think is really important is that there are so many.

Dr. Maurine Musie: 27:13

Right now I'm busy with another study that I'm currently embarked on, where I'm now advocating for what we call respectful maternity care. So what I've noted is that there is so many mistreatment and there's so many obstetric violence that women have succumbed to. In our facilities, for instance, you find that a woman is in pain, she's feeling those labor pains, and then you would find, maybe, a nurse saying that labor is supposed to be painful, whereas that is not the case. You know, there is pain that is really bearable and there is pain where you can see that the woman is no longer being able to bear this labor pain. So I'm really looking into, and I would say that the best practices would be looking at, respectful maternity care, respect the woman and also respect the decisions that she makes in terms of, you know, allow her to have autonomy, allow her to have to make decision making in terms of her birthing process. So that is very important. And also, you know, in terms of our practices as a med-welfth, we are governed by what we call better birth initiatives, where we really want to make sure that whatever practice that we are doing is really for the benefit of the woman and also for the child as well, looking at also patient-centered care. So let us treat the woman, you know, as an individual, because all women have, you know, unique needs. So really promoting patient-centered care.

Dr. Maurine Musie: 29:02

I think it's also very important and I would also want to say to med-wifes to also apply, you know, evidence-based care because during the theory, you know we teach them the different evidence-based practices. That needs to be done, you know, in order to ensure, you know, positive outcomes for the woman. So what I would, what I also did in terms of my masters, I found that you know med-wifes just follow what is done. You know they do what is done in Rome, you know where. They just put the woman on the docile, supine position, which is, in terms of my study and in terms of evidence, it says that the woman should be allowed to adopt any various living positions that she wants to adopt, because it comes to her, naturally, you know, to really change and change positions. So that is very important to make sure that the practices that we are doing as med-wifes is evidence-based and is for the good of the mother and the baby, and also I want us, as med-wifes, to enhance our antenatal education. It's very important that we teach our woman you know what to expect during their pregnancy, what to expect during their labor, because it doesn't really we can say, if a woman is not in her first pregnancy, then we won't, you know, we won't share with her or we won't educate her. It's very important that we educate at whatever chance we get, let us educate our woman, because of when we're offering comprehensive education to the woman, they really get to be informed and they know what is happening in terms of their pregnancy and also their birth as well.

Dr. Maurine Musie: 30:46

And one of the things that I wish we could adopt, you know, in South Africa, is what we call continuity of K, where it is done, you know, internationally, where you find that a midwife really takes care of the woman, you know, throughout her all stages. You know of stages of K, from the antenatal all the way to labor and all the way up to postnatal. Currently our system is a bit, you know, fragmented. She goes to the clinic for antenatal camps, the hospital, to give birth postnatally, we're discharging her back to the clinics. So if really we could look at continuity of K, then I would think that that would be, you know best, to ensure that we have good and positive outcomes for our women and help reduce your maternal mortality and therefore also contributing to our sustainable developmental goals. So I think those are some of the best practices that we, as midwives, should continue and to really enhance and follow those practices. Then we will achieve good and positive maternal outcomes.

Anne Chisa: 31:59

Yeah, for sure.

Anne Chisa: 32:00

I mean, you've raised so many you've raised so many important points and I think we still have a long way to go as a continent and I hope that some of these points that you've raised you through your research and other researchers and other stakeholders who are involved the change and the solutions can can be implemented, because you know you'd want somebody. You know. Childbirth or giving birth or giving life should be ultimately a really wonderful experience and it's a pity that some people do not experience that due to things that could be avoided. So thank you so much, dr Maureen, for chatting with me today.

Dr. Maurine Musie: 32:46

It was amazing hearing about the work that you do yeah.

Anne Chisa: 32:51

I learned so much, and I'm sure everybody else learned so much. And to everybody else who's tuned in, thank you for listening to another episode of the Root of the Science podcast with your girl and with an E. Until next time, goodbye.