Kingston University 2022

Midwifery, Sri Lanka Kandy

I was a third-year Midwifery student from Kingston University, London when I was given the opportunity as part of my degree to complete a two-week elective placement in Sri Lanka in March 2022.

I wanted to experience a different healthcare system and learn about different cultures. Sri Lanka had always been somewhere I wanted to visit. It is an amazing, beautiful country with an incredibly interesting history.

In organising the placement the operations manager from Work the World’s base in Sri Lanka was really helpful in supporting me through each step of the trip.

I decided to go away on my own, which definitely pushed me outside of my comfort zone. However, the Work the World team were so friendly and welcoming. They met me at the airport, helped me settle into my accommodation and introduced me to everyone. They couldn’t have made me feel more at ease!

Additionally, due to ‘MyTrip’ (the Work the World placement planner) the other students already knew my name, what I studied and the dates of my elective. It was so nice, as immediately I felt part of the group. On my first day, the team took me on a tour of Kandy, then around the hospital where I would be doing my placement at. I was able to meet some of the midwives and become more familiar with the Maternity unit before my first shift.

When I first went to the hospital I couldn't believe how busy it was. There was a constant flow of people, cars, ambulances and tuk-tuks! I spent my two weeks in OBG where everyone was again, so welcoming. There were a large number of students from Sri Lanka and abroad so teaching was a big priority and they really focused on expanding our knowledge and providing us with different learning opportunities.

Our placement was organised so we were able to spend time in different areas working alongside doctors, nurses and midwives. Most of the hospital staff spoke excellent English although the patients didn’t always. I think it was really important that we introduced ourselves in Sinhalese as this showed respect for the culture and people. The Work the World team organised language lessons that were held in our accommodation.

These were really useful as they taught us basic terminology and we could see the staff and patients really appreciated it. It also helped us build a relationship with the midwives and women!

The OBG unit was large and separated between three floors. Each floor was the size of an entire maternity unit in the UK, with a labour room, postnatal ward and antenatal ward. Women would labour together in one large room with multiple beds and curtains in between. This was vastly different to the UK where women have a private room during labour and birth. Even the postnatal and antenatal wards had very little privacy, with the wall on one side of the room only halfway to the ceiling so people walking down the maternity corridor could see in.

Furthermore, the operating theatres were set up to do two operations at the same time; shared between obstetrics and gynaecology, so one woman could be having a caesarean and the other could be having a hysterectomy. It was incredibly interesting to see how the lack of resources impacted the hospital and patient care.

For example, the theatre was two floors down from the delivery room so when there was an emergency, trying to bring a woman down for an emergency C-section was quite a journey.  In the UK, midwifery focuses highly on women-centred care and continuity. This differed massively in Sri Lanka and was one of my biggest challenges.

Advocating for women and promoting normality is a central part of being a midwife. However, I felt that there was very little conversation had with the women about their preferences in birth, and there was a significant amount of intervention during labour. As a lot of the placement is observational I really tried to offer support to women where I was able, even just smiling and saying in Sinhalese, ‘You’re doing really well!’.

I was in Sri Lanka for two weeks, so I had one weekend in the middle to explore the rest of the country. I travelled to Sigiriya with some of the other students, and we did the Cultural Triangle, which was amazing! 
My biggest regret was not going for longer so I could have seen more of this amazing country and spent more time on placement experiencing midwifery care in Sri Lanka. 

My experience in Sri Lanka has definitely expanded and shaped my care, specifically in regard to sensitivity and awareness of different cultures and customs, and the importance of understanding the needs of women and babies and changing their care accordingly. I was fortunate enough to be able to go to Sri Lanka for my elective placement and I would absolutely recommend it! If you have the opportunity you should go for it.

My experience in Sri Lanka definitely expanded and shaped how I deliver care, specifically in regard to cultural sensitivity and awareness of different customs, and the importance of understanding the needs of women and babies and changing their care accordingly. I am now really enjoying my first year working as a midwife! I have learnt so much and am continuing to build my knowledge and confidence. I was nervous to start but everyone was incredibly supportive, encouraging, and welcoming.

I started the year on the delivery suite I then rotated to the postnatal ward and I am currently halfway through my third rotation in the antenatal clinic. It has been very beneficial rotating between each area in order to learn how staff from across the maternity unit communicate and work together. Once I have finished this rotation I will become Band 6 and have chosen to rotate between the delivery suite and the day assessment unit.

My experience in Sri Lanka has helped me deal with scenarios I come across in the UK despite a lack of resources or staff. Also, I have been able to use the knowledge I gained from the midwives and women to provide breastfeeding support within different cultural contexts. 

In November I am planning to apply for a course in high-dependency care to expand my knowledge and allow me to work on the high-dependency unit on the delivery suite. Following this I would love to be in a continuity team and possibly in the future work abroad.

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