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Midwife KATIE CHRISTIE, 47, was born at Vincent Pallotti Hospital in Cape Town, the daughter of a nurse and a property developer. She grew up in Claremont and attended Herschel Girls’ School for her entire school career before becoming a nurse and midwife. Here she tells KATY MACDONALD about her work in Africa, and how she survives life’s personal challenges…
Midwife Katie Christie: ‘Sometimes I screamed in desperation!’  |  Photo: Tonya Hester

‘MY SCHOOL COUNSELLOR told me I had the wrong temperament to be a midwife, but my parents said, ‘Do what’s in your heart.’ I studied nursing at UCT, and worked at Groote Schuur Hospital, then in Britain. In 1998, I started my own midwifery practice, assisting women with both home and hospital births. It’s a real high to be involved in a birth. I still find it a wonder and have to cuddle the baby afterwards! The only low is having to put your life on hold. I worked for 12 years in independent practice, then realised I had to have a change.

I had done some voluntary work in Benin for an organisation called Mercy Ships, and had heard about a maternity unit being started in Sierra Leone. Attached to it was a fistula hospital. Fistula is a birth injury that occurs when women have no access to good maternity care. They become incontinent after giving birth, leak urine, sometimes faeces too, and smell terrible. They’re rejected by their families – often for 30 or 40 years. I thought, ‘Where on earth is Sierra Leone?’ but at the same time I felt very excited. It had to be right, a kind of calling, because I also had great peace about it – and quite frankly only a fool would feel that!

Katie and staff at the opening of the Aberdeen Women’s Centre maternity unit in Sierra Leone

dinner dance

The work in Sierra Leone was not a salaried position and I was provided for in the most amazing way through the generosity of many people. We had a fundraising dinner dance at Kirstenbosch Gardens, and other friends and acquaintances sponsored me month by month. One friend was so wonderful, she gave me specific ‘G & T’ money for a pick-me-up at the end of the day! It was pretty humbling to be dependent on people, but I had to think of the end picture: the women I wanted to help.

In February 2010, I packed up my 20 kg of luggage, and set off. I didn’t feel fearful at all. I had seen the film Blood Diamond, but when I arrived in Freetown, I thought it looked just like Cape Town with its sea and mountain. I didn’t see the slums at that stage. People from the hospital met me at the airport and were kind and sweet, and even the accommodation, which was above the wards, was better than I had expected.

The hospital was called the Aberdeen Women’s Centre and was funded by a Scottish philanthropist. The care was totally free for all patients. Most of the fistula patients had laboured without access to care for at least three days, with the baby eventually dying inside them. This situation causes the mother’s tissue to break down, creating the fistula. I had never encountered such desperation as in these rejected and damaged women.

cell phone distraction

When I arrived in Sierra Leone, the UNICEF stats were that one in eight women in the country died of pregnancy-related complications. The main part of my job was to train the 13 Sierra Leonean midwives in the centre to be competent and compassionate. There aren’t enough doctors in Sierra Leone, so they needed to be able to save the lives of mothers and babies during the birth process. Training the midwives wasn’t without its challenges. There was no culture of urgency in the hospital. A mother could be haemorrhaging so badly that blood was dripping on the floor, a newborn baby could be in need of resuscitation – and the midwife would stop and answer her cell phone! Sometimes when a life was dependent on minutes, the nurses stopped for a cup of tea! At times I’d end up screaming at them in desperation.

Elsewhere in the world you’d have specialists all around you for difficult births. We didn’t even have a blood bank. I remember sobbing my heart out alone in that hospital courtyard under an African sky because a mother had been haemorrhaging in theatre for eight hours. I called people out of bed to donate blood for her. It was exhausting trying to manage everything and deal with people who had no sense of urgency. It gave me anger issues that I’m still dealing with – anger never used to be my thing!

But at the end of the day, when the midwives saw me getting involved and dirty alongside them, they started changing. They had never been allowed to ask questions, or to admit they didn’t know how to do something. I said to them, ‘I’m happiest when you say you don’t know how to do something.’ They had also never been shown how to talk gently to a patient and encourage her, rub her back, support her. I felt my job was to love them so they could love the patients.

Katie training midwives to do work reserved for doctors elsewhere in the world

cleanest hospital

Slowly, the lives of the babies and mothers became more important to the midwives. By the time I left, nearly two years after arriving, they were so capable. They were able to do everything except Caesarean sections. We were by miles Sierra Leone’s cleanest and safest hospital to give birth in. While I was there we had 1,557 births and only lost two mothers. At last count, the unit had safely delivered over 10 000 babies.

But probably my greatest joy was to see the fistula mothers after surgery when they could walk ‘dry’ for the first time. They would have a special ceremony, get a new dress, put on jewellery and makeup, sing and tell their life stories. I felt so deeply for them when the surgery didn’t work.

I experienced many things in the hospital which I view as miracles. One time, I struggled the whole day to put a drip in a baby which weighed just 1 kg. In the afternoon, a group of visitors from America walked in and it just so happened that one was a paediatrician. His wife hadn’t wanted him to come to the centre, but he did – and he was able to put the drip in for me. I said, ‘Tell your wife that you came today for this baby – and for me!’


On another occasion, a mother was haemorrhaging from being beaten by her husband in the stomach. Without a bloodbank or ICU, she went into organ failure and a coma. All I could do was say a very simple prayer for her. I know it sounds unbelievable, but once I had finished, she sat up and asked for water. The visiting UK doctor nearly had an apoplectic fit!

Something else which really encouraged me was quite personal. I remember walking through the hospital and feeling downcast, wondering if God even had his eye on me, or was He too busy doing other miracles? As I walked through the ward, I felt the most revolting cluster of warts on my elbow which had just got worse and worse over the years. I’d had them burnt off, but they kept growing back, and I hated people seeing them. I said, ‘God, what about me? You could sort this out for me!’  I then forgot that I had said that, but two days later I felt my elbow and this mass of warts had finally gone! This was a massive thing for me.

I always thought the only way I would ever feel satisfied would be to have a family of my own. That desire hasn’t gone away, but doing that job was so satisfying and made the longing much easier. It was lonely sometimes, but there was a British army base where I made some friends and there are beautiful beaches to go to when you’re not working. In the rainy season, you do a lot of DVDs!


In early 2012, after two years at the Aberdeen Women’s Centre, I felt a call to go to the state hospital in Freetown, the capital of Sierra Leone. The care, the equipment and the state of the place are abysmal. The worst cases go there, and one woman in four dies there. In myself I didn’t want to be in that kind of place, but I just felt called.

After a few months in Cape Town waiting for the paperwork, I arrived at the Princess Christian Maternity Hospital (PCMH), to work on a five-month contract with the United Nations, which became an eight-month post. I was responsible for 63 midwives and worked alongside the matron. I knew my anger would probably get worse – the hospital is over 60 years old and they have entrenched ways of doing things – and I was nervous because I wondered if I had what it took to do the job. It also meant adjusting again to being away from all those people I love in Cape Town! But it felt right to be back and I found a lovely house to stay in with a view over the city, and out to sea.

Working there, however, was the closest thing to hell I have encountered in my life. The thing that affected me most was the hospital staff’s lack of compassion for their patients. We never know what it is that makes us act the way we do, but I often wondered if it was because so many of the staff had themselves endured so much hardship and evil through the civil war in Sierra Leone. Perhaps some emotions just shut down. Again, I really felt my job was to love the midwives as much as the mums and babies.

Abortion is illegal in Sierra Leone and I have always been pro life, but I have to confess that at PCMH, God and I had many conversations as I saw 13 and 14-year-old girls die on a weekly basis from sepsis, following backstreet abortions. ‘Surely,’ I said to God, ‘it’s better to only lose one life, the baby’s, than to lose two?’

Katie working for the UN in Freetown: ‘It was the closest thing to hell I’ve encountered’

Towards the end of the year in Sierra Leone, Dr Andrew Browning, an obstetric fistula surgeon, returned to Sierra Leone to do some fistula surgery. He told me again of the project he was heading up in Tanzania, East Africa, run by a largely Australian-funded organisation called Maternity Africa. Like the fistula hospital in Sierra Leone, it was a project doing not only fistula treatment but fistula prevention too – achieved by offering good care during labour and access to Caesarean section births to all women.

Despite initially feeling I was just heading back to Cape Town, I became convinced in my heart that to going to Tanzania was the right thing to do. I was there over three years, working alongside Tanzanian midwives and mothers in the city of Arusha.

Part of my job required travelling to Ethiopia to do training with the midwives at the two maternity hospitals. One of these, in the Afar region, was the most barren and desolate place I’ve ever been to. Every time I went there, I was staggered at how people survive. The poverty was extreme and the people practised extreme female genital mutilation which led to many birth and gynaecological problems. Here was also the worst anaemia I have ever seen, with woman haemorrhaging at home then arriving with Hb levels of 1.2 g/dl (normal pregnancy levels are 11–12 g/dl). How they stayed alive was nothing short of a miracle. I’m so grateful God gave me the blood group He did, as I could donate to anyone, and at times it really saved lives.

Giving blood in Ethiopia. Katie has donated blood numerous times over the years to ensure her patients survive

In 2014 I gained a Masters degree in midwifery online through the Sheffield University in the UK. I hadn’t been very sure how I was going to fund the degree when I applied, but the college gave me a full scholarship. I was so thrilled – I have never been awarded a scholarship in my life!

The most significant and difficult thing ever to happen to me personally occurred while I was working in Arusha. A 19-year-old Masai girl gave birth at the hospital then went away ‘to have a shower’ and never returned. There were only two midwives on duty that night and they both had lots to do so I took the baby home for the night while we worked out what to do with her. I kept her a second night too and thought I felt God saying, ‘she is my gift to you’. I hadn’t been longing to adopt particularly, but always said to God if he brought a child for me to look after, I would do that. I gave her the name Matilda. She had to be put in an orphanage while the paperwork was done but I saw her five times a week for the next 51 weeks and fell in love with her. Unfortunately for me, one of the social workers wanted to wield his authority and gave her to a Tanzanian lady who’d only met her for 20 minutes. I think the expectation was for me to pay a financial incentive, though this was never explicitly said, but I didn’t feel that was right.

silent grief

My heart was broken. I took leave and came back to South Africa to be with my sister and a friend on the day Matilda was due to be taken home by this lady. We didn’t know if the adoption would definitely happen, but I then got a message that it had. It was so hard. I never thought I could so intensely love a child that I hadn’t given birth to. I’ve so many children in my life already through my sister and friends, but I loved her deeply. Some days I was okay, but others I would weep uncontrollably. Probably the hardest thing was that many people close to me hadn’t met her, so while the grief was deep, it was silent and unrecognised, and for five months I didn’t know where to put it.

Then I got hijacked at gunpoint by a gang in Arusha targeting female drivers!  Everything started to feel so bad: I think all the grief just came together and knocked me sideways. I went to a psychologist who said, ‘you don’t need me, you’re having a faith crisis.’  And it was true, I hadn’t lost my faith in who God is, but I was so angry with Him and felt he was playing games with me. When I realised this I connected with Dave, an Irish Catholic priest in Tanzania who became my saving grace. He said, ‘Katie, you have to have more fun and drink some wine!’ Through him I experienced a kind of epiphany, realising that my broken heart wouldn’t heal in isolation and I needed to come home to the support of my friends, family and church. I stayed on in Arusha another 18 months, knowing I mustn’t take the decision to move just because of Matilda as I’d be taking my broken heart with me wherever I went, but eventually it felt right to leave.

So I came back to Cape Town, where I’m currently working on a contract with London’s Royal College of Obstetrics and Gynaecology. I train midwives at nine different hospitals to educate mothers about contraception options available straight after giving birth.

Katie at work today in Cape Town: ‘The women I see have such challenges but they’re so resilient!’

I don’t always have to have my act together

Personally speaking, I feel a bit disappointed by my life at the moment, it’s not quite what I thought it would be. But I do believe that God is close, there’s a bigger picture and I need to trust Him even when I’m feeling grumpy! I’m learning not necessarily to behave as if I’ve got my act together all the time. I also know the pain I feel is nothing compared to what many women have to go through. Some of the mothers I deal with here in Cape Town come from areas riddled with gangs and drugs, and live in fear of losing their lives and those of their children. Also, with South Africa having the highest HIV rate in the world, about 25% of the pregnant women I see are HIV-positive.

But many of these women are so resilient, I see them looking so smart and proud in the clinics. It’s amazing how people cope. My own coping mechanisms are walking with a friend in Kirstenbosch [Cape Town’s mountainous botanical gardens] and being around people I love and who love me. It also helps me to spend time with God reading spiritual books and listening to podcasts or simply talking to Him which I do all the time – though I’m wondering if I shouldn’t practise listening a bit better instead!

I think at the end of the day, you’ve got to look for the joy even in times of stress. One of them occurred during the hijacking in Tanzania. One of the hijackers asked for my phone and when I gave him my little black Nokia, he said ‘No thank you, I don’t want that one,’ and gave it straight back to me!

I’m unsure what next year will hold and am looking at various options now. A passion for all women to have access to a kind and safe delivery still burns deeply in my heart. There’s much work to do, but with every little drop of change, I pray one day the tide will turn – and eventually very few women will die while bringing life into the world. If I were just starting out in life, I would do it all over again. I want my life to be something that counts.’

‘I want my life to be something that counts’: Katie with Ethiopian midwives
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