Elizabeth Green completed an elective placement which allowed her to study in the location of her choice. After much deliberation she decided to visit Queen Elizabeth Hospital in Blantyre, Malawi, where her lecturer was working.
This is Elizabeth’s account of her trip:
Our objectives for the visit included time on the postnatal, antenatal and delivery unit sections of the hospital. However, we also wanted a deeper understanding of the social concept of childbirth in Africa. We felt an in-depth understanding of this would be beneficial to our careers as practising midwives, due to the diverse, multi-cultural nature of the United Kingdom.
Me with some of the children at the orphanage- they loved my sunglasses!
Antenatal care: Within the ante-natal clinic we saw how women were unlikely to receive more than around four antenatal appointments; many women only had one or two contacts with the midwife. Frequently women travelled for miles to receive care, often with other children strapped to their backs and carrying heavy loads. In many cases women had not had blood pressure checked due to the lack of equipment. This meant that many cases of high blood pressure would not be detected, which really made us appreciate the NHS system.
A lady carrying twins on her back at the local market
Intrapartum Care: We spent the majority of our time within the delivery suite setting. Here we saw stark differences in the care received in England, to the care in Malawi. The hospital beds were often dirty and old with bed sheets not commonplace within the unit. Women would bring material with them to lay on top of the bed, which would not be changed throughout labour. The women were, in general, a lot less vocal throughout labour, we presumed this was because almost every women brought a guardian with them, usually a female relative who would support them throughout the duration of labour. We tended to gravitate towards any women who did not have a relative present and hold their hand or rub their backs. At times this felt like a positive experience as often in England we are taken away from caring for the women in this way and distracted by endless paperwork and machines.
As there were no facilities to scan throughout pregnancy there were more incidences of fetal anomalies and stillbirth. Fetal heart auscultation and maternal observations were also not completed regularly, this also led to a higher incidence of fetal asphyxiation at birth. The staff were not familiar with electronic methods of fetal heart auscultation, which is commonplace within England. We gained experience of using the manual pinnard while teaching the staff at Queen Elizabeth hospital how to use the electronic device we had brought, this felt like a real sharing in knowledge. Cephlo-pelvic disproportion was a regular occurrence, therefore a full pelvic assessment was undertaken within the triage. Women were often a lot younger when having their first babies, with many first time mums around 14 to 17 years of age, with many of these already married. These young girls were often required to mature before their time, with many not being able to complete education.
Cleaning the hospital beds
Postnatal care: Although there were World Health Organisation breast feeding promotions in and around the hospital this appeared unnecessary as every mother breast fed without aid and it seemed a large part of the culture. Exclusive breast feeding was promoted to prevent transmission of the HIV virus. The other large difference from England was the successful Kangaroo Care ward. In Malawi, the mothers would use material to tie their infant to their chest and nurse them here for long periods of time. This enabled a precious bonding experience, research suggest this is the most appropriate place for the infant to thrive.
During our visit we had the opportunity to visit an orphanage, barter within the local markets and shadow charity workers developing local communities. I feel the experience we had in Africa was undoubtedly a ‘once-in-a-lifetime’ experience which would have been impossible without the financial support of the Uclan Travel Bursary Scheme. We have now had the opportunity to experience poverty and work with minimal equipment and resources, this will ensure we can appreciate the NHS and its ability to give a good standard of care for all. I feel this will stay with us throughout the rest of our careers.
Me, Jessica (student midwife) and Pat (university lecturer in Malawi)