by Joe Jamieson

Midwifery, Nepal Kathmandu, Where Are They Now?

Amanda Green travelled to Kathmandu, Nepal in 2019. She now works as a qualified midwife in the West Country, and says that her trip with Work the World was instrumental in helping her get to where she is today.

We caught up with Amanda to find out more.

Green, GemmaSo, what was it that made you want to study midwifery?

Well, I lost my husband when I was quite young, and that changed my whole outlook on life.

At 42, I was bringing up two kids on my own, having nursed my husband through a terminal illness. I got to a point where I thought, “What am I going to do with my life now?”

I waited until the kids were a bit older and thought if I don’t do something now, I never will. So I went and did an access course, applied for a midwifery degree and now here I am — a qualified midwife!

You studied at Plymouth — can you tell us a bit about your time there?

It was amazing. I’ve got no point of comparison, but I loved my experience there. It was tough though — midwifery is one of the hardest degrees you can do in terms of time. 

Students on other clinical degrees like medicine and nursing don’t have to do as many practice hours. We had to do 2800 hours of practice over the course of the degree and that’s on top of the course itself.

Green, Gemma

And how did Plymouth support you when it came to undertaking your trip with us?

I did some fundraising and applied for grants and bursaries to help pay for my trip. One of these grants was a fund set up by the widow of a professor who worked at the university.

The grant is for students who want to get experience outside of the university structure to develop whatever it is they’re practicing.

They awarded me £900, which was amazing.

I was scheduled to give a talk to the second year Plymouth midwifery students to tell them about my experience, but covid scuppered those plans!

Green, Gemma

Turning to your clinical experience in the hospital in Nepal now, can you tell us a bit about the difference in care between there and the UK?

Something that struck us was that in the low-risk birthing centre there was absolutely no intervention.

You’d never see anyone breaking a woman’s waters, for example.

In the UK, if a baby’s head isn’t coming down and the woman isn’t able to empty her bladder to help make room for the baby, we often pop a catheter in.

But we saw one woman pushing for an incredibly long time without any intervention like this. What local staff did was pop an ice pack where her bladder would be, which they said was supposed to help. Even if they had chosen to intervene in the way we do in the UK, they wouldn’t have had the sterile catheters to do it, resources were so low.

Green, Gemma

Another case that has stayed with me happened on my first day in the hospital. There was a woman who was in preterm labor, though I can’t remember how premature the baby was — maybe 31, 32 weeks.

In the UK, that baby would have every bit of available support. The neonatal team would be there, the mother would have been given steroids to help with the baby’s lung development, magnesium sulphate to help the baby’s brain, and the resuscitaire would be ready with oxygen and suction.

But in Nepal they didn’t have access to those things. In this case, the mother had to go it alone. She gave birth, but the baby wasn’t breathing and they didn’t have any oxygen for it because the hospital’s one working resuscitaire was in use.

Green, Gemma

The staff didn’t do anything like inflation breaths the way we’re taught to in the UK. In the end, they had to take the other baby off the resuscitaire and swap the new baby in. But there was a 6 minute delay in getting the baby in there. It was hard to watch, but we were there to observe and not intervene.

Another big difference was that in the high-risk birthing centre, women had to labour on their own. They weren’t allowed anyone in with them, and there was no pain relief at all. Labouring women’s mothers were allowed to run in with a bowl of soup — they were given a liquid diet during labour — but that was it.

Green, Gemma

But in the low-risk birthing centre, they were starting to allow partners to come in. They’d started seeing the benefit of that and how it can help the women in labour cope.

While I was there, we taught some of the dads how to do back massages to help with pain. You could sense that they were terrified to even be near the women, because it’s not a cultural norm. We had to reassure them, but they started to get the hang of it.

Green, Gemma

Do you feel like experiences like that have changed your approach to midwifery now that you’re back at home and qualified?

Well, it made me realise the importance of things like the yearly skill updates NHS midwives get. There’s a lot to them — you’ve got to do your e-learning, training days and all that sort of thing. You’ve got to stand in front of someone and explain what you’re doing, you have to do a written exam after, you then have to update that every three years.

You dread doing them, but you need them because you could find yourself in a situation like the one I described above.

They didn’t have much in the way of that sort of training in Nepal. And they often didn’t have the drugs or the equipment they needed even if they did.

Green, Gemma

And do you have any words of encouragement or wisdom for students who might be hesitant about undertaking a placement like this in a country they’ve never been to before?

I would just say absolutely go for it. I travelled with somebody, but even if you're going on your own, you do get to know the other people in the Work the World house and you’ll make friends quickly enough.

And when you get there, the Work the World staff meet you at the airport and take you straight to the house. We all felt completely safe while we were there and we were well looked after the whole time.

Green, Gemma

When it comes to the placement, you know where you’re going to be before you even travel.

I’d just say take full advantage of it — it’s a once-in-a-lifetime experience.

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