Reflections on supporting midwifery training in Gondar

Rebecca Crook, a Midwife from University Hospitals of Leicester (UHL) NHS Trust, reflects on supporting midwifery training in Gondar

I have been a midwife for just over two years and currently practice in an obstetric led maternity unit in Leicester, which is the home of many diverse cultures and religions. My role involves caring for both high and low risk women during the intrapartum and immediate postnatal period. Saving women’s lives through safe holistic practice is a key area in my passion for midwifery, therefore travelling to Ethiopia to share my passion with others and transfer our knowledge through a pioneering Midwifery training course was an outstanding opportunity that I had to grasp.

It was evident that the customary teaching methods in Ethiopia are directive, where the students acquire prescribed subject matter, rather than being self-directed and student-centred learning. The course we delivered introduced experiential learning and alternative teaching styles through role-play, active discussion and student-led group work, thus attempting to adopt student-centred approach. I fell strongly that practical immersion is key in influencing practice. 

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This experiential learning often created debate and discussion in the group, which enabled us to obtain information about current obstetric practices in Ethiopia and therefore allowed our teaching to be relevant and contemporary. During the four-day training period it became apparent that the two vital concerns were the theory - practice gap and the communication between families, traditional birth attendants (TBA's), health extension workers (HEW's) and midwives.

Many of the midwives had a significant theoretical background and could answer the academic questions, however application to practice was somewhat disjointed. We felt this may be related to poor practical exposure during their student training.

Occasionally we visited the labour ward where the situation looked rather dire. Yet in the midst of grime and pain, the women’s resilience shone through.
 They smiled and invited us into their lives. The women were not given analgesia, as pain is viewed as a part of life, and limited funds need to contribute towards other vital medicines and equipment. However, in the UK much of my practice involves pain management, as women consider analgesia to be  part of their childbirth package.

A particular heart-breaking case involved a woman, who had an emergency caesarean section for uterine rupture and foetal death of her first baby. She cried out in pain. She was placed in the same room with other women and their newborns; she had no analgesia, yet I think the physical pain was not as deep as the emotional pain of losing her baby and being exposed to other live newborns. She lay empty and childless. In the UK stillbirth is approached with much sensitivity.  The woman is allocated a separate room, free access to visitors, a memory box, professional photos and time with her deceased baby at her discretion. However, stillbirth and neonatal deaths are more common and so are normalised in Ethiopia.

So the situation is not approached in a woman-centred fashion.  This left me feeling raw and that her rights to basic needs had been violated. Emotional wellbeing and mental health wasn’t talked about, yet in the UK the woman would be offered counselling, follow up and subsequent pre-conceptual advice. I just hope that the women in her village care for her closely, as it is common for women to be ostracised due to childlessness, whether that be through infertility or loss.

I want to highlight that this is not a reflection on the staff, as it was evident that staff morale was low. They are aware that the care and facilities are dangerous and poverty is causing their jobs to be strenuous and demanding. Indeed practice could be improved through training. The nurses and doctors are willing to learn, which is encouraging for the future. What I witnessed in Ethiopia will live with me forever and it has positively affected my overall perception on life and encouraged me to be thankful for the outstanding work of the NHS.

I feel I have developed more in the two weeks in Ethiopia, than I ever have before. I hope I will continue to develop and grow and Ethiopia will always be a tangible part of my life. I have learnt that I could continue to give aid, however aid isn’t sustainable. What the team and I gave to the midwives were tools, to plough the field of their expertise. It is the transfer of skills and knowledge that will equip them and improve their practice. This in turn will ultimately affect women’s lives in a positive way. Through the partnering of education, we have given midwives the tools to empower other healthcare professionals in disseminating their knowledge and skills.  Also we hope they will empower women and their families towards achieving a safe birth.

Many Thanks to the Leicester-Gondar Link for Inviting me to be a part of this inspirational and influential journey to Ethiopia.

Written by Becki Crook

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