Midwives on the Frontlines: Saving Lives During Jamaica's Hurricane Melissa

Hurricane Melissa was bearing down on St. Ann's Parish, Jamaica, but 11 women were still in labor, and the three midwives on duty barely had time to look up from their work.

"It was like a conveyor belt" of newborn babies, said Deveree Stewart, president of the Caribbean Regional Midwives Association, remembering the stories a midwife on duty had told her about that October evening.

Another midwife told her about caring for a patient throughout her delivery at Cornwall Regional Hospital in St. James Parish - even though Hurricane Melissa was tearing the roof partway off as she worked.

"This is where one could say that the art of midwifery came in," Stewart told Direct Relief. "You're in a space [where] you do not know what is happening to your home, but you have to give care."

In the aftermath of the Category 5 storm, which cut a wide swathe of devastation across western Jamaica, Jamaican midwives were horrified by the damage. Black River Hospital, in the parish of St. Elizabeth, was all but gone. Noel Holmes Hospital in Hanover had been so severely damaged that pregnant women couldn't safely deliver there.

The health centers where many midwives worked were flooded out or extensively damaged. Facilities that could still see patients were overwhelmed with pregnant women who'd traveled to seek maternal healthcare. Some midwives had been displaced or lost their homes - or couldn't be reached at all, because telecommunications in western Jamaica were largely offline.

"We were grappling with the effects of having midwives who had lost property, who were affected psychologically and otherwise," Stewart told Direct Relief.

Jamaica's midwives swung into action, she recalled. They formed makeshift maternity clinics and wards in tents, or in small, empty corners of undamaged facilities. Retired midwives went back to work in shifts to provide some relief to staff clinicians. Even midwives who'd been displaced or lost their homes went quickly back to work.

Direct Relief supported the Caribbean Regional Midwives Association with a $50,000 emergency grant, which the association used to meet immediate needs for patients and midwives - part of a larger regional response to Hurricane Melissa. In addition, Direct Relief funds resilient infrastructure and provides emergency support for tropical storms across the Caribbean.

The CRMA purchased portable ultrasound devices and privacy screens for women receiving care in temporary settings like shelters and tents; funded shifts for midwives who came out of retirement to provide relief to working colleagues; and distributed emergency funds for midwives with damaged or destroyed housing.

Stewart said this support allowed midwives to respond to complications, navigate temporary care settings, and identify women or infants in need of transfer to working local hospitals.

"We had no maternal deaths because of the storm, or neonatal deaths," she told Direct Relief.

The island states of the Caribbean are on the frontlines of climate change, facing an ever-growing threat from frequent, severe tropical storms.

Pregnant women and newborn babies are among the people most vulnerable to the impacts of hurricanes and other severe storms. A catastrophic storm can cut off access to a midwife's care, cause stress-related adverse outcomes, increase exposure to infectious disease, and make food insecurity a dangerous likelihood.

The Caribbean Regional Midwives Association, which includes 14 member states, including the Melissa-battered nations of Jamaica and Haiti, is working to ensure that maternal health is protected, even amid severe damage and downed communication lines.

That means being prepared for future hurricanes - and continuing to train and prepare fellow midwives as emergency responders - will be key.

What lessons did midwives learn during Hurricane Melissa? First and foremost, Stewart noted, midwives need to be agile and ready to mobilize.

"I would love to have a group of midwives who are ready to respond during this time," she said, observing that midwives who traveled to Jamaica quickly from the Bahamas, Grenada, Barbados, and Saint Vincent and the Grenadines to support were key to providing continuous midwifery care amid Melissa's damage. "Psychological first aid [needs to be] an active part of their continual education."

While regional emergency preparedness is widespread across the Caribbean - Direct Relief, for example, works in partnership with regional authorities to stage large-scale caches of emergency medical supplies at strategic locations throughout the region - Stewart is keen to increase midwife members' access to emergency supplies.

Direct Relief is shipping field medic packs designed for emergency in-the-field care to the Caribbean Regional Midwives Association, allowing midwives to reach patients in hard-hit communities and offer care in fragile settings.

With caches of supplies for the association's midwives in place, "as soon as this hurricane passed, these things would have come in," Stewart said. "We are pre-positioning at all levels."

Finally, she said, it's important not to assume that anything will be in place, from regular communications channels to safe water, after a severe storm.

Key to the success of Jamaica's response to Hurricane Melissa was responders' well-trained ability to work with whatever was available, Stewart explained. Emergency workers carried portable radios as they did "in the very old days." Water storage tanks were commissioned into use, as safe water was needed across the affected areas. And backup generators were ready to power health facilities as soon as the danger passed.

"What was left, they could work with," Stewart said. "They could give lifesaving intervention."

Direct Relief works actively with partners across Jamaica, including the country's Ministry of Health and Wellness, and has provided $3.9 million in material medical aid and more than $950,000 in funding to Jamaican partners since Hurricane Melissa.