Kingston University 2022

Midwifery, Sri Lanka Kandy

I’m a third year Midwifery student from Kingston University, London. As part of my degree I had to complete a two-week elective placement, and I decided to go to Sri Lanka. 

I’ve always wanted to go to Sri Lanka - I didn’t specifically choose it for its healthcare system, so it was a super easy choice. 

My elective placement was booked and organised at the very last minute - from booking to departing within a month. The operations manager for Work the World’s base in Sri Lanka was very supportive and helped me every step of the way with building my placement. 

I decided to go away on my own, which pushed me outside of my comfort zone. It would have been nice to have someone with me for the flights etc., but when I was there it made me more open to getting to know people. I know what I’m like, if I had been there with someone I probably would have taken a step back and not pushed myself. 

I was only going to be on placement for two weeks, so I decided to fly out to Sri Lanka a couple of days earlier so I could explore Colombo, which was great. 

On my Work the World arrival date I then went to Colombo Airport to meet the Work the World team. They were there in their bright blue t-shirts, so it was really nice and really easy. The team knew immediately who I was and it made me feel so welcome. 

Once we arrived at the Work the World house, it was exactly the same. Everyone knew who I was, even the other students who were already on placement as we all had access to see each other’s profiles on MyTrip - the Work the World placement planner. We each knew what the others were studying, where we were from etc. It was so nice, as immediately I felt at ease. It just makes you want to jump in.

There were about 25 people there when I arrived. As it was the end of the weekend, most people were coming back from their weekend travels. Everyone was so friendly and welcoming.

On my first day on placement I was taken on a city tour of Kandy, then to my placement hospital to see where I would be based. I also got to meet my supervisors. After my orientation, my housemates came back from placement and took me out for some drinks with them so that I could meet everyone properly, it was really lovely.

After placement there was always a group of us doing some kind of activity. You could dip in and out of anything you wanted to. There was no pressure, no cliques or groups, everyone was all on the same wavelength. At the end of the day you’re all there doing a placement and wanting to explore Sri Lanka.

I was worried about going on my own and having someone to do things with but there were always people around, and everyone just broke off into smaller groups depending on what you wanted to do. 

When I first went to the hospital I couldn't believe how busy it was. Even outside the hospital (cars just appeared to be parked anywhere and everywhere!) it was chaotic. Everyone had blocked each other in.

The hospital was always busy. Beds were sometimes broken with rickety bed frames and had old bedsheets. It was immediately obvious there was a lack of resources. 

I spent my two weeks in OBG. The hospital team was so welcoming and they were so good with students. The hospital I went to was a teaching hospital and they had a lot of their own medical students there, so they were well equipped. 

We were each assigned to our own consultants for supervision and we generally followed their day. We also worked alongside the nurses and midwives, so there was always a nurse in charge. They always knew who we were and they had a sheet with each of our names and pictures on. They were always so welcoming. It was nice to know they knew who we were before we even got there and that they were actually expecting us. Surprisingly that doesn't even happen in the UK. I’ve often turned up and the staff had no idea I was about to start a placement with them.

Most of the hospital staff spoke excellent English. All of the doctors spoke only English to one another. The nurses and midwives weren’t as fluent but they spoke enough to hold a proper conversation.

Saying all that, I think it was important that you introduced yourself in Sinhalease as it showed them straight away you were respectful. You could see they really appreciated it.

The language lessons that were held in the house were really useful, it gave me the basics and really helped get over that first language barrier. As soon as I would introduce myself “My name is Charlie and I am a student midwife from the UK”, it immediately broke down that barrier.

Most patients don’t speak any English, and learning some Sinhalease from the language lessons in the house really helped with this.

In the UK, and especially in midwifery, there is a big push for patient-centred care, women-centred care and a big push for continuity. In Sri Lanka there was no patient-centred care and that was the most challenging part of my whole experience.

 In the UK, expecting mothers can often have pages upon pages of birth plans, birth preferences including what music they want, scented candles and even fairy lights! Birth is this big thing, it's a woman's choice. Birth plans just didn’t exist in Sri Lanka.

There was very little conversation being had with the patients in Sri Lanka and very little gaining of consent. It felt like we just had to get on with the job, so to speak. The women were just there to deliver. Culturally, the actual deliveries were quite different too. The women were very silent – this is all part of their culture.

One of the most interesting things to see was how they handled emergency situations. There were always two operations happening in one theatre so I would be able to see c-sections (which I’d already seen in the UK), but they had their gynae theatre in the same room, so I saw some things I definitely hadn’t seen before. In the UK both departments are kept totally separate, so for me that was really interesting.

The theatre was two floors down from the delivery room. So, when there was an emergency, trying to get a woman down for an emergency c-section was quite a journey.

One of the most useful things I did while I was there was offering patient-centred care and support for the women, because no one really did that. Just offering a little smile, speaking to the patient a little bit in Sinhalease and saying things like, “you’re doing really well”.

My role was not to try to change how things were done in Sri Lanka. And it wasn’t to tell them how I thought it should be done because that’s how it’s done in the UK. I was there to observe how their healthcare system worked and just take it all in. 

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 my housemates, and we did the Cultural Triangle, which was amazing! I definitely feel I spent my one weekend quite well, however, I need to go back to Sri Lanka as there are so many things I missed out on. 

My biggest regret is not going for longer so I could have seen more of this amazing country and to spend more time on placement. By the end of my two weeks I really felt like I had struck up a rapport with the hospital team – they were getting to know me, and really trusted me and my capabilities. 

I was fortunate enough to be able to go overseas as part of my degree, but I would recommend going overseas on a nursing placement to anyone! If you’ve got it as part of your course like I did I would say to anyone to just do it. I really feel you only have one opportunity to do this.

The whole goal is that you go and see something totally different and I genuinely think it will shape how you care for patients. You’re going to see things that you would never see in the UK, but there are things that you can bring back with you too. I learnt so many things about breastfeeding and the way culture affects their breastfeeding techniques. I brought a lot of that back to the UK with me, and it will change things for the women I’m caring for. 

I would tell any nursing student to go for it, it is the best decision. I would have been so disappointed had I stayed here.

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