Birmingham City University 2019

Midwifery, Nepal Pokhara

Rachel, Hannah, Sonia and Caroline from Birmingham City University travelled together for their midwifery placement in Nepal.

Green, RachelNamaskar!

We chose Pokhara because we wanted to go somewhere none of us had been before, and somewhere that wasn’t a city location. 

We also wanted somewhere that was completely different to the UK so that we could compare the midwifery practice. 

Rachel, Hannah and Sonia spent their placement in a teaching hospital in Pokhara, a 15-minute taxi ride away from the Work the World house...

Green, RachelWhen arriving at the hospital for the first time, the culture shock was felt by us all. 

When we compared the hospital with the ones we were used to back in the UK, it was very different. Even the size of the hospital was bigger than we expected. 

The hospital’s Chief of Nursing, along with other staff, welcomed us and informed us that in the hospital they had nurses who were “skilled birth practitioners”. 

It was interesting to see the resources they had and the type of equipment they had available. The maternity department was split into delivery rooms, labour rooms, postnatal and antenatal wards. 

We definitely all became more resourceful after our time in Nepal and it really got us thinking about how the UK and NHS use up resources without thinking about it. In the hospital in Nepal, they only had one or two dopplers and gloves were sterilised and reused. 

We also had the opportunity to practice manual blood pressure and develop the basic training skills that we may take for granted due to the advanced equipment we have available in the UK. We also developed our non-verbal skills because some of the patients and their families didn’t speak English.

Green, RachelAll of the cases we saw were very interesting. The fact that women didn’t get pain relief and most ended up with episiotomies was not something we were used to. But most of the women were extremely brave and for some, it was hard to tell they were in labour! They remained so calm and quiet; it was culturally not appropriate to be noisy in labour. 

It was interesting to see how involved and supportive families were before and after the birth. It is the culture in Nepal not to allow anyone in to watch the birth. So, it was lovely to be able to hand the newborn to their loved ones waiting patiently outside the room and congratulate them.

We helped the doctors to monitor contractions and auscultate the foetal heart. We witnessed vaginal births and caesarean sections amongst a mix of high- and low-risk women. 

Most women that arrived in labour were assessed and regardless of progression, were usually put on an oxytocin drip to increase contractions and speed up labour. They were also given a drug, not used in the UK, to ‘ripen the cervix’. 

One aspect we all found challenging was watching women in pain on a ward with other women, with minimal privacy and minimal support from staff. However, it was normal for most women to have no pain relief. The families were the backbone of providing compassionate and supportive care, and this was lovely to watch. 

Green, RachelBecause the hospital was a teaching hospital many of the local students spoke good English and helped to explain the goings-on in the hospital. We were told the episiotomies were performed on women because they believed them to be easier and neater to repair than a potential tear. 

In the evenings we socialised with our other housemates, discovering why others chose Pokhara and listening to their experiences so far. We played card games and listened to music and got to know each other authentically without the use of the ‘usual’ technology. 

Each week we had language lessons in the Work the World house which really helped us in the hospital setting. 

At the weekend some of us went on treks around the local area and did overnight stays, witnessing some of the most spectacular views and sampling the local cuisine (for a price you could only dream of in the UK)! We would definitely recommend exploring as much as you can. 

Caroline spent her placement in another teaching hospital in Pokhara, a 10-minute bus ride from the Work the World house...

Green, RachelI was so nervous about meeting everyone on my first day, but the nurses and doctors were so friendly and welcoming. 

I thought the language barrier would prevent me from getting involved, however, this was not the case, and the nurses encouraged me to join in. The nurses were interested in finding out about how we practice in the UK and I wanted to find out as much as I could about the care provided in Nepal. 

Throughout the two weeks, I managed to see both low- and high-risk women and went into theatres. I saw both normal vaginal deliveries and caesarean sections. 

It was incredible to see how the care differed. I discovered that all primigravida women were given routine episiotomies and the majority of the time, this was with no pain relief. 

Green, RachelThe labour ward was well staffed, but they had little resources. For example, they had one sonicaid for the whole labour ward and they re-sterilised gloves. Women delivered in the same room and skin-to-skin was not offered as the newborn went straight to the family due to cultural beliefs. 

Alongside my placement, I was able to undertake outdoor activities, ranging from white water rafting to paragliding. It was a once in a lifetime opportunity and the best two weeks I could have wished for and I met some incredible people and had incredible experiences. 

It has altered the way I wish to practice midwifery and was a life-changing experience. If you are questioning it, don’t! Just do it!

All of us had the most amazing experience and it’s not something we will ever forget.

All of us had the most amazing experience and it’s not something we will ever forget. It has brought us closer together as friends. 

It has solidified the type of midwives we want to be and has made us all feel more determined to be able to give every woman the care they deserve. 

Green, RachelTrips like these make you grow as a person, and as a healthcare practitioner. Like Caroline said, if you are questioning it, don’t, it really is an unforgettable experience and something you will not regret. 

For those of you who embark on the adventure, we hope you enjoy it as much as we did.

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