When I embarked on my midwifery elective to Dar Es Salaam, I was unsure as to how it would apply to my current practice within the NHS in England. What I was sure of was that it would be an eye-opening experience. In fact when I stepped into the hospital on the first day I realised that even this was a huge understatement - it was under resourced, struggling with funding and had huge cultural differences.
Southampton, the city in which I am a studying, has a growing population of ethnic minorities and I've found that we are caring for more and more African women within the maternity service. I was keen to learn more about the cultural practices around pregnancy and childbirth so that I could feel more prepared to care for them.
In Tanzania there are huge differences in the treatment women receive in comparison to that of England. Women in England are generally helped through their labour with positive ,kind words and have a midwife in attendance for the majority of the time, however in East Africa the women are left to labour on their own and are expected to be quiet and to ‘just get on with it’. Initially I was surprised, but spending time with the midwives, learning Swahili and taking part in the day to day routines really helped me learn about the culture and accept the differences.
Another benefit of this elective was around the issue of emergency procedures. Due to the lack of equipment, and in some instances, knowledge, there were quite a few emergency procedures that I witnessed. This was mainly fetal distress, breech delivery and twin/triplet deliveries. In the UK these emergencies would have resulted in a very quick caesarean section, however here they were dealt with very calmly - usually with just with one midwife present and no doctors! Surprisingly there were no adverse neonatal outcomes, and although some of the neonates needed resuscitation, they were fit and well and were still surviving upon discharge from the hospital. Although what I saw could be considered as basic midwifery skills, these foundations have been subject to the skill fade in England. This was especially evident when watching the midwives deliver breech babies - rather than get the obstetrician involved it was done by one midwife only as a routine. These situations have taught me to be calmer around emergency situations and to place faith in midwifery skills and to get stuck in!
My elective in Dar Es Salaam will stay with me forever, it was so eye opening and I can honestly say I felt every emotion whilst out there! I wouldn’t change my experience for the world and I only wish I could have stayed longer.
Based on a blog by Kaleigh Hitchcock, midwifery student, University of Southampton