2019

Midwifery, Tanzania Dar es Salaam

Grieve, EmilyCaring for women and their families is one of the greatest aspects of my life. As a nurse-midwife, I’ve had endless experiences that left me feeling full of love, appreciation, and awe. Traveling abroad to experience midwifery in another country had always been a dream, but it wasn’t until I went to Tanzania that I knew it was possible to fall even more in love with this career.  

Being placed in the labor ward in Tanzania and living in Dar es Salaam were two of the most amazing experiences I’ve ever had.

From start to finish, preparing for the trip was completely hassle-free (true words from a life-long procrastinator). The MyTrip planner has absolutely everything you need, and the lovely Work the World team help you navigate each step of the way, should you need it.

There are also pre-placement calls prior to your arrival that give you an idea of the culture and atmosphere of your assigned hospital. I can honestly say that there weren’t any surprises on site after discussing what to expect with the Work the World team. All you need to do is follow the checklists, read the information, and show up to the airport. It’s that simple, which makes planning much less stressful when considering already busy workloads and other responsibilities at home.

Once we arrived at the airport, a member of the Work the World team met us and took us to the house to get settled. The next morning, we had orientation, which covered everything we needed to know to get by for the duration of our stay. We were shown how to use the public transportation system (or call an Uber) to get to the hospital each day, visited our hospital placement and met the staff, took a tour of Dar es Salaam, had lunch at a local restaurant, exchanged money, and got SIM cards for our phones so we could make local calls or get in touch with staff. It was a great first day and a warm welcome to the city.

Grieve, EmilyEveryone at the house was unbelievably kind and truly made Dar feel like a home away from home. We were always greeted with the warmest hospitality and had wonderful guidance. Meeting other housemates from around the world was incredible too, and it was fascinating to learn how other midwives, nurses, and med students routinely practice in other countries.  After placement each day and on the weekends, there was ample time to learn more about each other, build friendships, debrief, share life experiences, relax, adventure, and have fun. You will never run out of things to do or places to go with recommendations from other housemates and the Work the World team.

Myself and the two colleagues that I traveled with were placed at the regional hospital for our two-week stay. The department itself isn’t anything like any labor and delivery unit you would see in America, and it was palpable as soon as we stepped foot onto the unit. Not only did it vastly differ in appearance, but in supply availability, patient to staff ratios, and accommodation made for the women seeking care there. Instead of fully stocked private rooms that were freshly cleaned, there was one large room divided by curtains that provided women with minimal privacy. The curtains harbored and separated the several beds that lined each side of the room with space in the middle to walk through the department. Some beds were in slightly better condition than others. Women had to bring with them what they needed: linen, medication, gauze, syringes, umbilical clamps, a razor blade, food, and water.  If they didn’t bring it, most of the time, it could not be provided. The labor ward turned over at lightning speed and was almost always full. Typically, there were two permanent staff members and during the day, midwifery and nursing students were learning how to take on their new roles. As soon as a woman gave birth, her placenta was delivered, lacerations were repaired with what supplies were on hand, and she got up, changed her kanga and left the ward to make room for the next laboring woman.

Yes, supplies were short and usually absent, but the resourcefulness that they used was astounding.

Grieve, EmilyTo anyone, that description is a somber one, but there was also so much good and so much love present. The physicians that did the ward rounds, the nurses and midwives that looked after the unit, and the students that were learning how to listen to fetal heart tones using fetoscopes, catch babies, repair perineums, and resuscitate newborns all had good intentions for each woman who was there. Yes, supplies were short and usually absent, but the resourcefulness that they used was astounding. They welcomed us visitors, and as each day passed, we were able to talk more, gain their trust, and care for women side by side. We all learned from each other. We often heard, “would you do this in America?” or “How do you take care of x, y, or z?” And when we’d answer, we’d describe how to do a procedure or maneuver using what was usually (hopefully) available to them. In the next breath, they’d give us insight into the reasons behind the care they provide and how they perceive it helps women.

While there, we assisted in catching twins; experienced aiding stoic women birth their stillborn children; observed infants being resuscitated; assisted with breech babies; managed eclamptic seizures; and supported countless women with normal, physiologic labors and births.

Grieve, EmilyI took a personal liking to explaining to local students how we would carry out procedures in America. In return, I would learn Swahili from them and was delighted to see them each day. And although the days were long, emotional, and sometimes tiring, they were also unmeasurably rewarding. I felt prepared for what I witnessed and sincerely appreciate the care given in Tanzania and the care given at home.

It’s funny, but one difference in our cultures that struck me the most was the pace of our lives and reactions to specific situations. In America, we react fast, show up at a specified time, and get things done. In Tanzania, there really never seemed to be stressful vibes in the air from locals, at the hospital or anywhere else. One man said, “Are we talking American time or Tanzanian time?” when talking about plans.

One of my favorite days at the hospital was one for which I am still grateful and think about often. It was an oddly slow day at the hospital, and a young woman came in laboring with her first child. Her broken English could dance circles around my Swahili skillset, but despite the language barrier, we managed to communicate with each other all day long. We laughed together, she cried, I was able to give her labor support that she otherwise wouldn’t have had, and I didn’t leave her bedside. Her labor started as many do, and as hours passed, she grew tired and had thoughts of self-doubt about her strength and ability to birth her baby. She was in pain and she was scared. She knew it was getting late and said, “Don’t leave me; nimechoka (I’m tired).” I squeezed her hand, stroked her cheek, and looked in her eyes. I didn’t say anything, but she knew I was staying. More time passed, and she summoned the courage she needed to give birth to a beautiful baby boy, whom we named together at her request. She was able to engage in immediate skin to skin contact with him and breastfed within 20 minutes of his debut. It sounds so simple, and it was. We were two women coming together with completely different backgrounds getting through the exhaustion of labor. Even when words couldn’t relay what we really wanted to say to one another, we spoke and responded to each other through the entire process, for labor and birth have a language of their own, no matter where they occur on the globe.

Grieve, EmilyMy advice to everyone is this: if you’ve considered going to Tanzania, do it. Experience all you can, learn all you can, soak up the culture, and get to know some of the most endearing people you will ever meet. I could not have had a better experience through Work the World.

Tanzania is a beautiful and lively country, and I am so thankful it was shared so openly with me. The women of Dar es Salaam are strong and inspiring, and I was truly honored and humbled to have had the pleasure of working with them, caring for them, and learning from them. When people ask if I liked Africa, I tell them I’d move there tomorrow if I could. This entire experience helped me find a piece of myself that I didn’t know was missing until I found it.  Dar es Salaam will always hold a special place in my heart, and I long for the day I am able to return.

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