University of Bedfordshire 2009

Midwifery, Ghana Takoradi

After a few months planning my midwifery elective with the team in the UK I was jetting off to Ghana.  I was so excited on the plane, and kept having to pinch myself to make sure it was really happening.  When I arrived it was late, dark, and hot and my luggage took AGES to arrive. I thought I was going to be lost in Ghana on my own... But no, Prince was there waving frantically at me!!!

The next day I was shown around the hospital and introduced to the maternity ward staff... 45 minutes after being introduced and having just said hello to everyone I was hands on conducting a delivery with a midwife by my side. Promptly followed by another 2 deliveries which is not bad for a first day I thought! 

Like many other countries there is a sense of importance attached to childbirth but maternity care in Ghana is very different; the health service offers public, private and faith-based health facilities.  In 2003 the Maternity Exemption Scheme was implemented which allowed all women free access to maternity care including medication. However, because of a lack of financial resources, equipment and personnel it cannot be increased to correspond with the high delivery rates. In some areas this has led to a shortage of staff, equipment and beds in both district and regional hospital.

I spent 2 weeks at one of Ghana's regional hospitals, in Takoradi. It is a large hospital, which is one of the most developed in the region.   Even here the incidence of postpartum haemorrhage is extremely high.  Grand multiparity and anaemia appeared to contribute significantly to the incidence of postpartum haemorrhage.  The number of eclampsia cases is also high.  I personally witnessed two eclamptic fits on the same day within the space of a few hours.  No analgesia is offered in labour. Nitrous Oxide is not available and there is no Pethidine stocked in maternity. Only Paracetamol may be offered if a woman is in pain following a traumatic delivery - for example in the instance of perineal trauma. If the woman has no purified water with her for administration of analgesia then family must be contacted to buy some, the hospital cannot provide it.

Like many other countries there is a sense of importance attached to childbirth but maternity care in Ghana is very different; the health service offers public, private and faith-based health facilities.

Women are required to provide their own polythene sheet for delivery, as well as 2 cotton sheets for the bed and 2 sheets for the baby.  One sheet she would deliver on, the other is used to cover the floor mattress / bed in the postnatal ward.  On admission the expectant mother would make her own bed up for delivery, the sheets are arranged very much in a similar way to how we do here. It wasn't a sterile environment for delivery, but it was the best method available.

Noise in labour is discouraged as it may distress labouring women in the same room. It is not uncommon to see a midwife shout at a mother if she makes noise. The midwife often will nudge the woman and give her a stern talking to; the women rarely make a sound after that. It is important to remember that this is the way midwifery is practiced in Ghana, and the culture in Ghana as in many other countries, is different to the United Kingdom. 

The midwives in Ghana were extremely skilled and they had developed the ability to manage many situations effectively without the luxury of medical equipment and personnel. Some women are admitted in a poor state of health, and it is to the midwives' credit that so many of them had a positive outcome from the pregnancy.  I feel that the fact that their maternal mortality and morbidity rate is 2% reflects this.  This was on average 4-5 maternal deaths a month.

Talking with the local midwives, we noticed many differences and equally as many similarities between Midwifery in the United Kingdom and Ghana which we all found interesting.  It was insightful to be able to experience firsthand where these differences occur and the theory behind it.  It was a situation where we could educate one another.  The most valuable lesson I brought back, is that you can only do what you are equipped and trained to do at that time. So long as you know that you did your best, even if that was just holding somebody's hand you cannot fault your actions.  The stories you read really do happen in front of your very eyes, and being a student trained in the UK where we have the privilege of drugs and medical equipment, it's very difficult to accept that sometimes there really is nothing more you can do. It is important to separate yourself from how you would manage an emergency in the UK and how you can physically and realistically manage it in a developing country.

Although I was involved in many distressing cases, there were equally as many happy and enjoyable cases, which all included fantastic learning opportunities. However, due to the nature of the cases observed, it was vital that I had learnt the management of obstetric emergencies before I went. I cannot express enough what a memorable and educational experience I had. I was completely taken out of my comfort zone but the experience showed me you can take midwifery knowledge and skills anywhere. It was the most rewarding experience and I would like to thank everyone in Ghana for making it so amazing. I met some remarkable midwives and women who were an inspiration and who I will never forget.  By the end of the two weeks I was proud to be able to say 'push, breathe, well done, sorry, please and very good' in Fanti.  This went down very well with the women.

Work the World provided me with a fantastic placement. It met my criteria and learning objectives perfectly. I learnt more than I could ever imagine and had so much hands on experience. The midwives are absolutely fantastic and so welcoming to a new friendly face. Manners go a very long way, and if you are hard working you will be greatly respected.
I would advise anyone going to take your own gloves aprons etc, as the hospital does not have a large supply. I took out with me baby clothes, gloves, aprons, scrubs, alcohol gel, pinard stethoscopes and tempadots. Whatever I had left over I left with the hospital and I know it will be used and definitely appreciated. I would just advise that you learn all your obstetric emergencies before you go, and maybe read up a bit on malaria in pregnancy, as I saw a lot of this but didn't know a huge amount about it

Ghana itself is a beautiful country; there is so much to see during the weekends such as the beautiful Butre Beach, which is set just next to a village in the middle of nowhere! The views are breathtaking, I remember on my last weekend, lying on the beach writing up some notes and thinking to myself "I could get used to it here!!!" The culture is unique, and the people are always so interested as to why you are in Ghana. The food is just great but not for the faint hearted and the weather is amazing - just don't forget to take sun block!

I had such a fantastic time, the support is brilliant and the cook, Ophelia does not let you go to work until you have at least eaten an Omelette.  There is always drinking water in the house and the rooms have fans and mosquito nets.  I met some remarkable women who I will not forget, and some midwives who were just such lovely people.  I felt totally accepted into the labour ward and am touched by how much faith the staff had in me.  I was so upset when I left; I cried the whole flight home.  Not because I was distressed by what I'd seen, but because I felt so accepted and welcomed by the staff and it tugged at my heart strings!

I felt 100% safe and supported during my trip and would encourage other student Midwives to do an elective placement if it appeals to them.  You will see things you may not see again in Midwifery, and it is an extremely humbling experience. I cannot complain, I would go back tomorrow!  I flew to Ghana with no expectations and an open mind, and returned home extremely humbled with memories of people and events which I will always cherish.   I can't wait to get back out there.

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