by Joe Jamieson

Midwifery, Tanzania Dar es Salaam, Clinical Features, Destination Features, Where Are They Now?

Rosie is a qualified midwife based in Bristol. She travelled to Tanzania with us in 2018 to undertake her midwifery elective and had what she describes as a ‘life-changing experience’.

We spoke to Rosie to find out a bit more about her time in our partner hospital and her travel experiences out in Africa.

If you missed the first two instalments of her interview you can catch up with part one here, and part two here.

DAR ES SALAAM DESTINATION PAGE - slider image

Aside from seeing some very stark realities within the hospital, you also got to experience Tanzania outside of placement too.

What kind of things did you get up on your weekend away from the hospital?

I went on safari which was amazing. I’ve done safaris before and I remember thinking that a two-day safari with a couple of game drives probably wouldn’t compare to the week-long ones I’d done in the past. But, actually, I think this safari experience was much more real. 

I wasn’t expecting to see as much. But I thought even seeing just one elephant in the wild is still an amazing experience. And actually, we saw everything and it ended up being one of the best safaris I’ve done. 

We had our meals cooked for us. There was a campfire, so we had hot chocolate by the campfire in the evening. We stayed in little huts that had four-poster double beds with mosquito nets. It was lovely.

Having the chance to do something like this on the weekend was in itself worth the money. 

Particularly because I was experiencing things so different from what I’d normally see in hospitals back home, it’s important to be able to switch your brain off properly. 

The chance to do something that felt so much more like a holiday meant that when I went back on placement I felt really refreshed and ready to get back to it. 

SAFARI Lion - Zebra

I think it’s part of the appeal of taking a trip like this is that the majority of the time you’re in the hospital, so you need to have an outlet, whether that’s in the evenings or on the weekends, you have a chance to reset and get back at it.

Of course, some people might find it more challenging than others, but how did you find that?

Seeing how emotionally robust the staff were made me feel brave enough to face it. 

There were of course things that surprised me and situations that I wasn’t necessarily used to seeing. The footling breech birth, for example. But I don’t think there was ever anything that I came away from and felt upset about. I actually feel like this occurs more often in the UK. 

I think we’re all much more sensitive to things in the UK because there feels like there’s a lot more pressure. But in Tanzania, I found that the women you were caring for had so much gratitude for the care provided – for safely bringing their child into the world. 

I think it’s the expectation that things could go wrong and they know that, and when you present them with their baby, they’re just so grateful. I think that outweighs anything you might see that is not what you’re used to because every single woman was so overwhelmed by the fact that they’re leaving with a healthy baby.  

Samantha  Wilkinson (WILKINSO17268)

I mean that’s the silver lining, isn’t it? That with that risk, when you have a win it’s a big win.

Yes, it does kind of feel like a risk-reward situation. There was the occasional instance of an unpleasant birth, but when it did go well it felt like a huge reward. And every single woman showed overwhelming gratitude to me for just being there to hold their hand. It’s this gratitude for seemingly basic care that made it for me. 

You never expect to get anything back from the women you care for, and that’s not why I do it. But when a woman smiles at you and says thank you, that’s all you need and that’s what makes a difference. When the women out in Tanzania were wrapping their arms around me and offering me gifts, when they have very little themselves, it was humbling. 

One woman insisted I take a gift from her. They all had these special, individually printed blankets that they wrap the babies in, and this one woman had a spare one that she kept trying to give to me saying “asante, asante”. I checked with one of the Tanzanian midwives to make sure I understood the situation and she said that the woman would be upset if I didn’t accept her gift as thanks. 

You don’t train to become a midwife for gratitude or to receive presents, but knowing that you made such a difference to these women is special – the level of appreciation you get out there is huge. When you’re having a particularly tough day and then there’s a beautiful birth and the woman is so grateful, it gives you the boost you need to go on.

PLACEMENT

It sounds like you had such an amazing experience. When you returned home, you had a year left of your degree – do you feel like your experience changed your approach to the rest of your study? 

It gave me my dissertation topic. I think finding a dissertation topic you really care about is hard. Often people will choose a topic based on the amount of research available. But I think it’s more important to choose a topic you’re passionate about. 

The experience I had in Tanzania helped to provide that passion for me. I’m still very passionate about it now. I don’t understand why women are put in a position where they are scared of having a breech baby when actually it can be a perfectly safe delivery if the circumstances are right – I’ve seen it. 

My time in Tanzania also made me hugely respectful of midwifery as a skill. It made me think more about the reliance on technology and the online systems we use day-to-day. Now that I’m qualified I place a huge amount of importance on my own intuition. If the technology is telling me everything is fine, but my instinct is telling me something isn’t quite right with a patient, I’ll go with my instinct. It’s because I’ve gained confidence in my own skills and respect for the intuition of the midwife. A computer can tell you one thing, but if you’re a skilled professional and you still have doubts, the chances are there’s something not quite right and the computer isn’t picking it up. 

It’s important to remember that midwives have been around since the dawn of time. And they didn’t have all of this technology available to them. They’d use a plastic or cardboard cone to listen to a baby’s heartbeat. 

My time in Tanzania brought that back for me. If I can trust myself as a midwife then I don’t need to be scared of the job. I can use the resources that we have to benefit my skills and to benefit the care of the woman. It’s about using technology to help you do your job better, not using technology so you can do the job.

Lotte Eyckmans (EYCKMANS17685)

And you’re a community midwife now. How did that come about? What were the steps from university to there?

Well, as a newly qualified midwife you rotate through various different areas. I did about five months on the ward, three months on the midwife-led unit and then five months on the high-risk delivery unit. After that, my next rotation was community. And that’s where I am now. I don’t know where I’ll end up and where I will stay yet. 

As a result of the trip, I am incredibly passionate about empowering women to make their own choices and believe in their bodies. I think it’s important to have someone there to tell them before their birth that they’re awesome and that they can do this. Doing so means they go in with this positive mindset knowing exactly what to expect and knowing that they can do it.

What would you say to someone who was hesitant about going on a trip like this? Are there any words of encouragement you’d give a student thinking about undertaking a midwifery placement overseas?

I would tell them that it is a once-in-a-lifetime opportunity. It is the one time you’ll have the chance to do it. Once you qualify, you’re being paid and you’re going to have to take annual leave to go and do these things. 

You’ve been given the chance, and actively encouraged to do something different with your placement and this is about as different as you can get. It will give you the widest educational experience and give you this incredible perspective on what we have. 

I wouldn’t hesitate, I really wouldn’t because you’re never going to get this chance again – just do it. 

If I was in the position again, I’d do it again a hundred times. It taught me so much. I came away from it as a better midwife than I would be if I hadn’t been and that’s what you want to get out of it.

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