University of Hertfordshire 2017

Midwifery, Sri Lanka Anuradhapura

Emmerson, Claire

I chose Work the World after I did some research and looked at various companies, and their website and options available sold it to me. An opportunity like a Work the World placement, to go abroad for when training, doesn’t present itself very often, and I felt it would be a once in a lifetime experience. I knew I had to take advantage of the opportunity! Growing up in the UK, I was very familiar with the NHS and how it worked. I felt a placement with Work the World was an opportunity to better understand the healthcare systems of countries that aren’t as fortunate as the UK. Before choosing Sri Lanka, I researched all the locations and case studies on the site!

Emmerson, Claire

I’d never been to Asia, so those destinations stood out to me the most. I wanted to go to a country that would be very different to the UK, not only within the hospital, but also the experience of the culture outside the hospital. All the countries in this part of the world are amazing, and I couldn’t wait to go and explore!

When the time for my trip finally came around, I flew from Gatwick, stopping over in Dubai to stay with a friend for a couple of days. I met three others girls from my course back home at Dubai airport, and we flew together from Dubai to Sri Lanka. They upgraded my flight to first class, and not wanting to leave my friends behind, the airline kindly agreed to upgrade us all together!

Emmerson, Claire

When we arrived at the airport in Sri Lanka, I was really excited to finally be there, explore the country, meet people, and kickstart my placement! We were collected from the airport by a member of the Work the World team, and we had quite a long journey to Anuradhapura, meaning we were absolutely exhausted when we got there. It was quite late when we arrived at the house, so it was still dark, but very hot and humid. We met a few people at the house, but as it was late, most were asleep - however the chef, Uncle, had laid on a welcome meal for us. After this, we were shown around the house and went to bed. I shared a room with my friends from home. In the morning, my immediate thought was about the heat — it was 35 degrees!

In the morning we met the other students; midwives, med students, nurses, dentists, and physios, from all over the UK, Belgium, Australia, and the US.. Over breakfast, we talked about what they did, how their placement was going and what we should expect on our first day. Following breakfast we had a city orientation, which meant we got to know Anuradhapura a bit better, as well as how to get to and from the hospital. Shashini, the Assistant Programme Manager, showed us all the transport links, where to buy a SIM for our phones, where to find tourist info and more.  We were really set up for the rest of our time there!

Emmerson, Claire

The house was lovely. It really was a home from home; simple, but with everything you needed. It was very clean and in an open plan style. There was a garden to sunbathe, and we used the nearby hotel pool for a small fee. Staying in the house I found it really friendly, relaxed, and the staff were so helpful. We enjoyed the weekly BBQs, themed nights and parties!

When I first arrived at the hospital, I was full of awe. Because it was so hot, the building wasn’t fully enclosed in some places, including outdoor corridors. Everyone was interested in us, in a friendly way. There were lots of kids pointing, waving and smiling! Even though local people weren't necessarily used to seeing foreign people, they were very welcoming of us, and within the hospital a lot of people were aware of the new Work the World scheme.

Emmerson, Claire

Stepping out of the hospital, it’s like going back in time completely. We are very strict on infection control at home, and in Sri Lanka, the sinks have just a bar of soap for handwashing, and no towel or paper, you have to just let your hands dry. Medicine bottles stored in glass cabinets with labels on in English. Urine testing for glucose, in the UK we use strips that dip into the fluid and change colour depending on the result, whereas in Sri Lanka, they use bunsen burners and test tubes.

I found the whole hospital experience fascinating. The hierarchy is very present, the Sister of the ward was in charge. Of course, doctors and consultants are at the very top. For us it was fantastic because they saw us as a learning opportunity as much as we saw the same in them. The language barrier was a challenge, but we had Sinhala lessons in the house twice a week, so always tried to use that. Some nurses and sisters didn’t speak any English, so the language lessons were really useful. Doctors and consultants spoke English because they had trained in UK, and some of the Sri Lankan students were also learning English on their courses. I had some great experiences, where the sisters would take me under their wing and show me around the ward, the new equipment in the hospital, and things they were trialling. One of the ward Sisters brought her actual sister into the hospital to meet us. She really wanted to meet “the British students who had come to work with my sister!”

Emmerson, Claire

I can’t stress how different the OB-GYN care is there. The level of antenatal care is not at all the same; in the UK, we have a set number of antenatal appointments for women in the normal, low-risk, bracket, and a set amount for high-risk mothers, who also have additional appointments. Antenatal community care doesn’t exist, as such, in Sri Lanka, especially as women live so far away from hospital and there’s no community midwife delivered care to speak of. If women don’t have complications, they are admitted for a very long time because the journey is so far from home back to the hospital, so adding in extra journeys could mean they don’t deliver in the hospital. Labour care is also very different,there’s almost no pain relief for example.

In the UK, everything is about choice. We promote choice to women, and their experience is all about their right to choose how their delivery happens. The  midwife offers evidence based information so women can make an informed decision about their care. However, in Sri Lanka, it’s less about choice, and the focus is more on delivering a healthy baby, quickly and effectively. For the most part, women remain on the bed, on their back, without pain relief and encouraged to express pain as little as possible. The labouring women are very compliant with what they’re told to do, which shows just how much they respect the midwives. Sometimes you feel like it’s the doctors and the nurses in charge of the birth rather than the women, which wouldn’t be the case in the UK. I was also surprised with just how many women deliver at that hospital. There were often (non-related) babies lined up in cots and on beds, who were all kept safe, but because of the lack of space it was necessary to make the most of the beds and cots available.

Emmerson, Claire

We had an amazing experience in the cesarean theatre. By far the most amazing experience was witnessing the planned lower segment caesarean section of a woman with a bicornuate uterus (heart-shaped with a full septum segmenting it into 2 cavities) at 32 weeks gestation with a twin pregnancy in the left horn of the uterus. This woman had been admitted to hospital for the past 2 months so that she could be observed due to the rarity of this condition. The consultant performing the surgery was very proud to be conducting this surgery and gave explanations throughout. Two healthy babies were welcomed into this world in this way!

It was fascinating to see things that were so different to our practises, and it was important to understand that things were done differently — that we weren’t there to interfere, but to learn. Sri Lankan staff were happy to explain why they did things in a certain way, however as a guest in the hospital, I knew it was important never to impose my own preferences on the care we delivered.

Emmerson, ClaireDuring the afternoons after placement, we would go to the pool at the nearby hotel. On the weekends we travelled away from Anuradhapura to see the rest of Sri Lanka! We went to the beach, on safari, and did as much as we could to see beautiful Sri Lanka. After I had finished my two week elective, my friends and I did another two weeks travelling the country. We saw the ancient village in Anuradhapura, which is so big we needed a whole weekend to see it all! We also enjoyed a tuk tuk tour with a guide who took us around temples, which were truly beautiful. I loved watching the people worshipping at the temples, and the flowers and monkeys!

I have so many memories of my time in Sri Lanka, but my favourite is seeing wild elephants. I had expected to have to go on safari to see elephants, but they walk by the side of the road! They’re such beautiful animals. Anuradhapura is an amazing city in a wonderful country.

Emmerson, Claire

My advice to someone considering a Work the World placement is “absolutely do it!”

It’s one of the most amazing experiences, and you can do it really cheaply. Including accommodation, food, and the planning and organisation that Work the World put in, it’s really worth it. The Work the World house is a really safe place to come home to, we always felt well looked after and secure. Sri Lanka is cheap to travel around, and you can indulge in real luxury for cheap when travelling, too. I enjoyed beach cabanas for less than £20 a night! The Sri Lankan food is beautiful, and the people are so friendly and lovely. Just embrace it!

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