Women Volunteering in Dar Es Salaam, Tanzania

Before commencing my placement I had honestly mentally prepared myself for the “culture shock”. I was prepared to see poor conditions, limited resources and poor treatment of the women. However what I did not prepare myself for was the battle to assimilate and integrate into the team of nurses/midwives. In hindsight, and overall, my experience at the hospital was incredible and I was in no way ready to leave. However at times, especially in the first week, I was very ready to book the next plane home. The first two weeks proved to be the most difficult for me. As a young midwife, I am very used to being supported by senior midwives, I am also very used to midwifery as a group practice involving team work throughout the entire shift. Coming in to the hospital as a qualified midwife had its advantages but also its disadvantages. The advantages included having the appropriate midwifery knowledge and skills to (quite literally) throw on a pair of sterile gloves and accoucher a birth as I turned around to see the presenting part on view. It meant I could decrease the workload on the local nurses/midwives by attending full antenatal assessments of women and transferring them to antenatal ward as they silently progressed through the first stage of labour (I am still to this day in awe of Tanzanian women’s pain thresholds). It meant I could receive in caesarean sections and knew the policies around sterile fields, aseptic techniques and those associated with operating theatres. It meant I could prepare a woman for a caesarean section by cannulating and commencing an IV infusion of normal saline and putting in a indwelling urinary catheter. It meant I could give IM injections, IV medication and remove urinary catheters once the woman was 24hrs post-delivery. It meant I could perform solo (in one occasion) or work with the nurses/midwives in neonatal resuscitations and make important decisions re if a newborn should be transferred, if a woman should go for a caesarean section etc. All of these things I performed on a daily basis however it wasn’t until my third week that the nurses/midwives started trusting me and my practice, trusting that I was skilled enough to work alongside them. That’s where the disadvantages come in. Being qualified meant the nurses/midwives were very unaccepting (for the lack of a better word) of me. They, at first, didn’t believe or trust I was qualified and when I began to perform tasks and use skills they would continuously tell me my practice or judgment was wrong. They then talk about me in Swahili to their colleges making my self-confidence plummet through the floor. That’s when the desire to jump on the next plane home set in. However Pearl warned me of this, she reminded me that it wasn’t malicious it was their culture and I kept that in the back of my mind the entire time. In hindsight this questioning and feeling of being a poor practitioner did wonders for my self-confidence. Confidence not only in myself as a person, but in myself as a midwife. It, strangely enough, made my love for midwifery grow, it made me back myself, trust myself and become my own hype girl because I knew what I was doing was right and I knew I was doing it because I had a burning passion to empower women. Having been trained in a tertiary (level 6) hospital, I was accustomed to clean wards, single rooms, sterile/single use equipment and unlimited resources. Working at the hospital was a big shock to that system. Women labour side by side, sometimes two to a bed. In the Labour Ward there are three beds, no curtains or any attempt to provide privacy. The door is always open. Fetal heart rates are auscultated using a pinnard, ARM’s are performed with broken oxytocin vials. There is really adequate sterile equipment and women have to supply their own cord clamps, congas, sterile gloves, oxytocin, sutures, cotton and more. Although it was a shock and hurdle to practice in such conditions, it was something that I acclimatized too quite quickly and was able to provide the best possible care in the given situation. As mentioned, overall and in hindsight my time at the hospital was an incredible experience. It changed the way I viewed myself as a person, a midwife and a member of this world. It enhanced my love for midwifery and empowered me to use my love, skill, knowledge and now determination to return to a place like the hospital and work to make it better, for both the staff and patients. Walking into Siret Hostel on arrival day was such an overwhelmingly pleasant surprise. My boyfriend and I paid for the private room and it was decorated with so much love it felt like home the moment we entered. It was spacious enough for two people, had a wardrobe, four post double bed with mosquito net, a couch, a universal power board (life saver) and a place for us to store our empty suitcases. The lounge room and dining room at Siret were also decorated with so much love they felt very comfortable and homely. The area was spacious, there were comfortable couches, access to wide range of novels and other books, a very large fridge and freezer for us to use and a water filter. The highlight of my experience was my last shift at the hospital. My travel buddy/boyfriend who is a pre-med student was working in the Minor Theatre however there were no patients. Labour Ward was busy so he came over and experienced labour and birth for the first time. There was just myself and another nurse and within the space of an hour we had three births. The first was very straightforward and he stood and observed. He learnt how and when to give IM oxytocin, how to swaddle and weigh a newborn etc. Quickly after another baby was born, the nurse called me over as the baby was very evidently premature and required full resuscitation. As the nurse and I started compressions on this baby we hear a grunt and both look left to see another woman crowning, quite literally about to deliver. I leave the nurse with the resuscitation and smack on some sterile gloves, I tell Alex to draw up the oxytocin and lay out the congas and he does. The baby is quickly born and in perfect condition (thank goodness). Alex administers IM oxytocin (the first IM injection he’s ever given), and takes the baby to swaddle and weigh it while I deliver the placenta and ensure all blood/clots are expelled. Not many people in this world can say that they delivered a baby with their boyfriend but I can, and that’s something that will make me smile until the day I die. (The premature baby was successfully resuscitated and transferred to NICU at Mt Meru). Go in to this experience with enough knowledge in that you feel prepared, but enough ignorance that you make it the unique experience that it is for each individual. Be prepared, feel supported but remember, ignorance in bliss.