My trip to Mwanza_Tanzania
Kelly SIlk (Midwifery)

I arrived in Mwanza hot, tired and apprehensive, but James's friendly nature soon put me at ease. I was introduced to the housemates and given a tour; it was very reassuring to have staff and housemates present who welcomed me and gave me a good idea of what to expect of general life here. The view of the lake was simply stunning, and sunrises and sunsets were really something to behold in Mwanza, especially on the lake shore.

The following day I was shown around the hospital, the maternity department and introduced to some of the staff. I would be based mainly on the labour ward for the duration of my 4-week placement, although I also spent time on the antenatal, postnatal and admission areas.  

I was based in a large teaching hospital. The labour ward was bigger than I expected and almost always buzzing with activity. During my first week I played a largely observational role. The staff are used to medical students observing but the concept of midwifery was a little unusual to them; most deliveries were conducted by nurses or doctors.  

I was able to be more hands-on as I progressed through the placement however, and was involved in many interesting cases, including malaria and tuberculosis in pregnancy, twin births, breech births and numerous emergency situations such as shoulder dystocia and neonatal resuscitation.  

It was fascinating to see the differences in healthcare approaches, but also shocking and upsetting at times because I knew how differently events would be managed at home. I initially found this difficult, but I had to keep reminding myself that I was there to experience a different environment. 

Being around the housemates and knowing that they were also struggling with similar issues was a great help. Discussion of cases was a very valuable aspect to the whole experience and made the difficult days a little easier to cope with. The social side was a fantastic part of my time in Tanzania; we took a trip to one of the islands in the lake, experienced many local restaurants, explored the city, had a painting lesson and frequented some local bars and hotels on days off.  

I also managed to spend a weekend in the Serengeti on safari, which was a truly incredible experience. I really recommend it and if you can get a group of people together it's very do-able on a budget. It's also very accessible from Mwanza and is only a two hour drive away; there are companies in the city who take groups of tourists out and there are contact details for the more reputable organisations at the house.   

After the placement I also spent some time in Zanzibar, which, although beautiful, was a true tourist destination and therefore could be very pricey. However, if done in the right way it can be budget friendly, and the tropical island is unforgettable.

For those considering a midwifery placement; I would say try and prepare as best as you can. Obstetric emergencies are common place and whilst you may not always be expected to be involved; sometimes you are the only spare pair of hands. The risk of HIV exposure is also very real here; nearly every woman was positive for the virus and the bodily fluid exposure during birth can be very great! I recommend acquiring a post-exposure prophylaxis (PEP) pack before coming out and ensuring you bring your own personal protective equipment such as eye goggles and gloves.  

The most important thing to remember is This Is Africa. The level of education, training and equipment is not the same as the UK; and as such the practices can sometimes be very questionable. One of the things I found most difficult to deal with was the attitude to care from the staff, which was very different from our woman-centred approach at home. Women were shouted at, hit on occasion and only allowed to labour on their sides and give birth on their backs, no matter what their discomfort levels were. Although this seemingly uncompassionate approach was, at times, shocking, it's important to realise that the level of value placed upon patient care and upon the birth of a new baby differs from what we are used to in the Western world, possibly because of the significantly higher perinatal mortality rates.

Overall my time in Mwanza was very valuable and truly life-enriching. The hands-on care I experienced helped me develop my confidence in my own midwifery skills; and presented some interesting alternatives when the medical equipment we would have at home isn't always to hand! I made some wonderful friends and learnt about other professions too; there was a great mix of medical students, physiotherapists and nurses who bought many alternative perspectives to different situations. I feel privileged to have been able to live and work in this interesting and vibrant part of the world.