Dear Dr Woo and BC Women’s Medical Staff Association,
I would like to thank you for awarding me a bursary towards my global clinical placement in midwifery. This summer I had the opportunity to travel to Nepal (April 3-May 14) and Uganda (May 15-June 26). There were significant differences between the two placements and I am so grateful to have received funding that enabled my to travel to both sites. In Nepal we travelled to the rural community of Sautang and spent time with the midwives and physicians there doing teaching workshops, learning about the challenges they face as a remote, isolated community, and the ways in which we could support them. In Uganda I spent time in Hoima on the labour ward, and in Kchangwali, a refugee settlement a couple of hours north west, near the border with the Democratic Republic of the Congo. We took a tour of several health care facilities and spoke with the midwives and other care providers again about the challenges they face and how they manage with the resources available to them. I had several opportunities to don our home-made “birthing pants” and “birth” our training doll in a breech presentation, as well run teaching activities where our colleagues estimated blood loss, and practiced helping babies breath.
In Hoima there are many challenges. The existing hospital organization is not conducive to effective communication between different wards of the hospital and one of the changes we helped implement were regular rounds and morning meetings. It was very encouraging to witness the improvements in quality of care and moral over the course of a few weeks. Another challenge is staffing. At times the labour ward was not staffed with skilled birth attendants, and there were only junior students caring for the labouring women. There is a shortage of experienced birth attendants with appropriate training. In contrast to Hoima, the midwives in Masaka were more plentiful, and highly experienced and skilled. There was a much higher level of overall functioning of the Masaka hospital, even though there were similar resource shortages at times. In a way this was also encouraging, because while I was seeing the sometimes overwhelming challenges in Hoima, I was also seeing the potential of the future of Hoima Regional Referral Hospital in my Masaka experiences.
I have had multiple experiences this fall semester where I have encountered a tricky clinical management decision, and have felt confident in my ability to manage it because of my global experiences and training. Particularity with my ability to manage obstetrical and neonatal emergencies such as postpartum hemorrhage, shoulder dystocia, and neonatal resuscitation. Participating in the global placements has been the most formative clinical education experience of my degree so far. Stepping outside of our high-resource Canadian context, and distilling midwifery to the universal principles of birth, and how we as midwives keep women and babies healthy through the perinatal period helped me immensely as a clinician, and as a human being. I have a better understanding of everything from physiology, to cultural context, to access and barriers to care, and I have noticed a new depth of compassion and curiosity in myself that wasn’t there before.
It was such a well supported experience I would be remiss if I neglected to mention the excellent mentorship and teaching I received from both Cathy Ellis and Mickey Rostoker. Prior to this April, I had not seriously considered my role in the global community of midwives to extend beyond Canadian borders, but after a positive experience of partnership and collaboration I am considering further global midwifery work in my future.
I cannot overstate the impact that the three months I spent in Nepal and Uganda have had on my skills, attitudes, and clinical practice. I want to thank you for your investment in my education and training, and in the UBC Midwifery global placement program.
UBC Bachelor of Midwifery Candidate 2018