Fiona is a 3rd year midwifery student from the University of Central Lancashire (UCLAN). She recently travelled to Peru on a two-week midwifery elective to see the differences between healthcare in the UK and in the developing world.
I had always wanted to go abroad for my Midwifery elective. It was my chance to experience a completely different healthcare system and to travel before starting full time employment.
Arequipa, Peru immediately drew me in, and I was fascinated by the country’s history. Work the World (an overseas elective planning organisation) organised the experience for me and provide detailed placement plans within the best departments for my discipline. For someone doing an intensive healthcare degree, this took the stress out of organising my placement.
Finally, the day of my departure arrived. My friend and I travelled to Peru via the United States and Peru’s capital, Lima. When we arrived in Arequipa, someone was waiting to meet us along with two other arrivals (some of my new housemates). They accompanied us back to the house we’d be living in for the next few weeks.
The journey from the airport to the house was interesting to say the least. Very few people seemed to observe the traffic rules, but the constant horn beeping was something we quickly got used to.
We arrived on a Sunday, which was a quiet day in the house. Many of the other students who were already living in the house were away on weekend trips. We took a tour and then underwent our scheduled welcome briefing. The afternoon went on, and we were welcomed by many of the other housemates as they arrived home.
My elective experience
Monday was my first day on placement. In some ways, it was similar to a UK birth centre where low risk women go to give birth. But nothing could have prepared me for the stark differences between care when compared with the UK.
I witnessed my first birth that morning. The woman birthed alone, as men were not allowed to attend in Peru. The woman was on her back and, as with most women, received an episiotomy.
With three beds in the open delivery room, there was little privacy. The ‘obstetras’ (local equivalent of midwives) and obstetric doctors were friendly and happy for me to watch and ask questions. Local staff also enquired about midwifery practice back home, and were surprised by our use of pools, and standing and squatting positions.
All of the women I came across in clinic were extraordinary. Their resilience during childbirth was amazing to observe. This was especially true when considering that practices in Peru differed greatly to those in the UK. Some local practises were difficult to accept. I remembered, however, that I was there to learn and not to judge.
But there were many positive aspects to the local approach to care. The obstetras use of natural methods to induce contractions were something that, in the UK, we tend to forgo in favour of medical intervention. There were few problems during labour, such as excessive bleeding or neonatal difficulties, and the women progressed quickly.
One contrast to women’s experience giving birth in the UK was the lack of support from partners in the delivery room. Men in Arequipa paced the corridors of the clinic occasionally peering through windows to try and catch a glimpse of what was happening. The obstetras quickly shooed them away when they cottoned on. Birth, it seemed, was something only women were involved in.
Women were required to provide all supplies for their postnatal stay — food, nappies and hygiene supplies were not supplied by the clinic. Once mothers-to-be were transferred to the postnatal ward, partners and families cared for them.
I have a renewed appreciation for the abundance and sterility of equipment we have back in the UK. The swabs in Arequipa were packaged using old sterile glove packets and a member of staff wearing a pair of gloves. Sterile gloves would be used one at a time for examinations and left on the side until the next woman came in, sometimes hours later. Despite this, Peruvian sepsis and infection levels following birth seemed low.
It was great to see a high breastfeeding rate in Arequipa. I witnessed women breastfeeding very openly across the country, in cafes, the airport and even at the top of Machu Picchu! This may have been down to the open attitudes towards this way of feeding, the large amount of publicity in the form of posters around the clinic, and the lack of affordable formula milk and hygienic ways to prepare it.
Arequipa and further afield
Arequipa was a beautiful city, with plenty of history along with modern Western conveniences — the former offering a stark visual contrast to the historical buildings they stood beside.
The people were friendly and welcoming, and the city itself felt very safe. On my last day in the city, I attended the Arequipa Day Parade, which showed just how proud of their city the people of Arequipa were.
One weekend, my midwifery colleague and I travelled to Machu Picchu via an overnight bus and train. It was one of the best experiences of my life. Despite seeing photos and having some idea of what to expect at the summit, I was unprepared for the magnitude of the awesomeness of the scenery. It was breathtaking. I’ll admit I was a little emotional after such a long journey to get there. But even the three–hour train journey from Cusco to Aguas Calientes had the most amazing views as the train travelled through farms, over riverbeds and through jungle forests.
In the afternoons following placement, groups of us visited local attractions in Arequipa. The museum of the Ice Maiden ‘Juanita’, Chaqchao Chocolate factory, where we made our own chocolates, and Alpaca Mundo to name a few. Most housemates would head into the city on a Tuesday and Thursday evening for cocktails, bachata and salsa dance lessons, which was always a fun night. We met a lot of local people this way.
Speaking of people, the friendships I made with people from all across the world will stay with me forever. The trips and activities wouldn’t have been half as fun without the amazing housemates I lived with.
The trip was a once in a lifetime experience and I enjoyed every single second of being in Peru. I still think about my experience now with laughter, joy and amazement. I can’t believe I actually did it!
Work the World specialise in tailoring overseas physiotherapy placements in Asia, Africa and Latin America. Their destinations provide eye-opening insight into the challenges associated with delivering healthcare in the developing world.
7 October 2019