Arfang Faye, 41, is a 2020 graduate of the University’s MSc Clinical Education online learning degree. Now Principal Nursing Officer-Clinical Instructor and Educator at Bundung Maternal and Child Health Hospital in The Gambia, his midwifery career has encompassed roles as both a practising clinician and as a mentor and teacher. From the earliest days of his burgeoning career, Arfang looked for an opportunity to make a difference.
“I can’t imagine, now, being anything other than a midwife,” he says. “It wasn’t my first career choice – I wanted to do something related to paediatrics – but after I got into midwifery, I came to realise that I was just cut out for it and became so enthusiastic.
“I came to understand why midwifery is so important in the context of the Gambia – we have a lot of maternal deaths and are one of the poorest countries in the world. Midwives have a huge role to play reducing maternal and infant mortality and improving the health status of especially poor and underprivileged communities. These social justice aspects made me love midwifery and I believed I could play a big part to help my countrymen and women.”
Arfang previously studied at the Gambia College School of Nursing and Midwifery, qualifying first as a nurse and then as an RN midwife. In 2012, he was a senior midwife at Bansang Hospital, the most remote major hospital in The Gambia. He also taught at their School for Enrolled Nurses and Midwives and was head of the midwifery programme.
Improving outcomes
There were frustrations with the working conditions, particularly with a lack of equipment. What the hospital had, often couldn’t be well maintained. Repairs were expensive and entailed lengthy delays; spare parts were hard to come by and costly to ship. As a result, patients suffered. Arfang felt this was often avoidable.
“Over the years, I came to realise just how important access to emergency obstetrics care, which included vacuum deliveries, was,” he says.
A vacuum-assisted delivery can be used during childbirth as an alternative to forceps or caesarean section. A ventouse suction cup is firmly attached to the baby’s head and as the mother pushes during her contractions, medical staff gently pull on the cup, helping to facilitate delivery. Vacuum-assisted delivery is a relatively safe and low-risk procedure when undertaken by appropriately trained and experienced clinical staff. It is considered especially valuable in low resource settings where access to c-section surgery can be limited or delayed and often carries increased risk.
“Unfortunately, we had long periods of time when we didn’t have a functional vacuum delivery set,” Arfang continues. “Most of the vacuum delivery sets that we bought were not durable. They were large clumsy devices and broke very easily. You could easily be left for weeks or months without a vacuum delivery set.
“That contributed a lot to bad outcomes – babies born asphyxiated who probably wouldn’t have died if there had been expedited delivery; women who had to have a caesarean section – with all the risks in a developing country – who could have benefited from vacuum delivery. These things really made me begin to think that if we could come up with something that was locally made, effective and safe, you could really save a lot of lives and improve outcomes for a lot of women.”
The EgAr device
Arfang felt sure he could make a vacuum delivery system of his own using, mostly, readily available and often reused items from around the hospital. He began to experiment. A clean, reused, plastic feeding syringe could create the suction. Common catheter tubing formed the basis of a three-way valve and connective hoses. The suction cup and simple pressure gauge proved to be the only components that had to be commercially sourced.
“I began just playing around with some of the instruments that we had, just to have an understanding of how the device could work. Through trial and error and iterative development, I was able to come up with something that was really effective.
“The device went through a number of stages of development but gradually I was able to make it more compact, durable and user friendly. What I was trying to do was to make a proof of concept – a simple design that would really help you with sustainability. This will be very cheap and inexpensive to make, repair and maintain in a hospital in a developing country because you really don’t need much. It doesn’t have many components, it’s simple and small enough to put in your pocket. It’s completely reusable – you can use one dozens of times if you take care of it.”
Arfang’s EgAr device has already been used in hundreds of successful vacuum deliveries and his belief in his invention is so strong, he happily entrusted his family’s own health to it. When his first child, Muhammad, was born six years ago, he was successfully delivered using an EgAr Device.
“I cried a lot, that day,” Arfang recalls. “It wasn’t only that my son was delivered using my device, but that was kind of emotional. Seeing something that you make without having any thoughts about how it’s going to benefit you personally actually come to be of great service to your wife and your child – that felt good. It just underscores the fact that the device is helpful because if it wasn’t, I would never have allowed anyone to use it on my own wife and my child.”
Next steps
Arfang is now fundraising to support further development and the dissemination of his EgAr device: “I am convinced that the EgAr Device, if it gets produced, could help enormously to address the problem of equipment issues associated with vacuum assisted delivery in low resource settings.”
He also hopes to be supported to study for a PhD: “My other major goal is getting a PhD in clinical education. With our very weak health systems, high quality healthcare education is invaluable in training healthcare professionals to effectively meet the enormous challenges confronting our public health services. The Gambia is a very small country and we still have a very long way to go in adequately prioritising and investing in quality education in healthcare.”
Online learning
Arfang’s current position is a first for Bundung Hospital and recognises the role he has played advocating for hospital-based teaching: “I am responsible for clinical education and continuing professional development; also mentoring, supervising, coaching and monitoring nurses and midwives involved in maternal and child healthcare. I am also a senior clinician involved in both the medical and midwifery team in providing obstetric care services, including emergency obstetric and newborn care, and ultrasound.”
He believes he is the only person in The Gambia to have qualified with an MSc in clinical education by online learning. He speaks frankly about the challenges he faced but believes his experiences were formative: “I had previously done all my education face to face, so it was something that was really new and out of my comfort zone.
“I had my regular job to perform, I had to do an extra job to add more money to support my family and also had to squeeze in learning online. That wasn’t easy and of course the use of the internet here was also very, very difficult. Many times I’ve been in a class and then my internet has gone off.
“However, I found the online course with the University was so highly organised – you could always find the teaching materials properly organised for you when you got online. If I missed a session, I could find it recorded and had a discussion board where I could discuss and catch up with colleagues. You also had very good support services, access to your lecturers, and a personal tutor who was there to guide you. These were excellent and made it easier for me.
“It required a different set of skills to direct learning. You have to take more of a personal role in online learning – you have to take ownership of it and be more assertive in the sense you have to do a lot of the learning yourself. In that regard, you have to be a lot more independent. I actually came to learn a lot of useful skills from online learning and I think those will be very useful for me to have in my career and my professional development. I would recommend it for anyone in a developing country like mine.”
Photography: Arfang Faye and Getty Images.
