Dar es Salaam — "When an overworked nurse uses foul language, it is likely to add salt to the injury in an already frosty relationship with patients"
Florence Nightingale would turn in her grave if she heard some of the stories circulating in Tanzania about how nurses treat their pregnant patients.
Tales of bullying. Scolding. Verbal abuse, face slapping and of women being tied to their beds, such is the breakdown in trust between some hospital nurses and those in their care.
"I don't want to remember that day. Only God knows how my baby and I survived," said Rahel Gunze, recalling how she gave birth on a cold tiled floor at the capital's Palestina hospital.
It was two years ago but the memory remains vivid; Gunze calls it the most traumatic experience of her life.
"I was desperate and needed urgent care but I did not get it," she told the Thomson Reuters Foundation.
Gunze said she got to hospital close to midnight, racked by labour pains and gripped with an irresistible urge to push. Her husband Emmanuel tried frantically to find a midwife who would help his 28-year-old wife, only to find the staff had reconvened to a nearby cafe, where they sat cracking jokes.
As Emmanuel and one of the midwives rushed back, they found Gunze upright but semi-squatting, already pushing out a baby girl who fell to the floor in a gush of blood and shrill tears.
Gunze's husband watched the midwife slip into disposable gloves to save the baby, who was engulfed in blood from the raptured umbilical cord.
Mother and healthy baby were discharged three days later.
Long enough for Gunze to see how the nurses ran their wards.
"I saw one nurse slapping a pregnant woman who was refusing her orders," Gunze said.
She recalled seeing one woman tied to her bed with a khanga - a traditional piece of cloth worn around their waist - so she could be examined and deliver her baby safely.
The hospital's chief medical officer denied the allegation.
SALT TO AN INJURY
Tanzania has one of the world's highest maternal mortality rates at 556 deaths per every 100,000 delivering mothers, according to the 2016 Tanzania Demographic Health Survey, which was conducted by the government.
Relations between staff and patients are also shaky, with horror stories circulating that contradict the hallowed reputation nurses enjoy in most societies.
Palestina Hospital's Chief Medical Officer Mariam Maliwa said any patients who claim to have been mistreated should have voiced grievances through "official channels".
Karim Mizungumiti, a public health expert working with Management and Development for Health Organisation - a local health charity - said poor communication was to blame.
"When an overworked nurse uses foul language, it is likely to add salt to the injury in an already frosty relationship with patients," he told the Thomson Reuters Foundation.
Nurses in public hospitals admit there are some uncaring - or worse - members on their teams but cite low pay, a poor working environment and scarce supplies as factors.
Wages are low - the equivalent of about $200 a month for a qualified nurse, some $45 less than a teacher earns each month.
Because of staff shortage in many public hospitals, most nurses work long shifts in ageing infrastructure, and some feel they get scant respect from the public.
Most nurses are not promoted and get no bonus, said Agnes Mndallah, a seasoned nurse at Dar es Salaam's Police Hospital.
"Some nurses do a really good job and take their responsibilities very seriously," she told the Thomson Reuters Foundation.
"But there are few bad nurses who are not God-fearing."
CURSE OF THE NURSE
Maria Teweli was put on bed rest at Mwananyamala hospital in Dar es Salaam while waiting for her due date a month ago. Teweli accused one nurse on the ward of "cursing" the expectant mothers rather than helping them prepare for labour.
"She said I was lazy and that I would certainly give birth to a stillborn baby," she told the Thomson Reuters Foundation.
According to Dar es Salaam's Aga Khan University, patient neglect after birth is the major cause of death to mothers and their newborns in the week after a delivery.
Adelvina Temu, a member of Tanzania Midwifes Association, a local charity founded in 1992, said some nurses use harsh language because they lacked ethics and communication skills.
" A trained nurse should always listen more and talk politely with a patient," she said.
But Magdalena Kalewa - who stopped taking her anti-malarial medications once pregnant - said she was verbally abused by a nurse during a routine check up at Palestina hospital. "She told me: 'You do not deserve any mercy because you did not take your medications, people like you should be left to die'," Kalewa said.
Kalewa said even heard talk that some pregnant women diagnosed with sexually transmitted diseases were branded as 'prostitutes' by the nursing staff.
Rebecca Nyoni, a midwife at Palestina hospital, denied the allegations, saying no nurse took delight in abusing patients.
"Nurses are also humans, they have emotions, they get tired or may use harsh words to force patients to comply with treatment requirements," she said.
Some nurses admit they have colleagues who pale next to Nightingale, considered the founder of modern nursing for her pioneering work in the Crimean War.
But Agnes Mtawa, director of nursing services at Muhimbili National Hospital, said any nurse found guilty of abuse deserved a fair hearing before any disciplinary action, including dismissal.
And, she said, nurses often feel obliged to have all the answers though their most important skill is to listen.
"When someone is in pain, sometimes they don't want solutions, they just want to be heard," she said.
- Reporting by Kizito Makoye Shigela. Editing by Lyndsay Griffiths