As midwives, we have skills needed all over the world. If you are offered an opportunity to practice those skills in another country, you are one of the truly lucky ones. As someone who has had the good fortune to practice globally, I’d like to share some suggestions for how to optimize your experience for yourself and for those you are supporting.
Learn about the Country’s Health Care Policies
Before you leave for your trip, learn as much as you can about maternal and newborn health care in the country you will be visiting. A good understanding of a country’s health system will help provide context for what you will see at clinics or other health care sites. There are several ways to get the information you need.
- Write to the professional midwifery organization in the country you will be visiting. Most countries have one, and they can provide you with great background and perspective. Check the International Confederation of Midwives website for names and contact information.
- Talk with staff at nonprofit organizations that operate in the country you will be visiting for their thoughts on what to expect.
- Use Google! There is a lot of great information to be found online.
- Of course, if you are going as part of a group or on behalf of an organization, find out if they have sent people before or have an existing relationship with a site. If so, get all the information you can about what’s been done before and the experiences of the people who went before you.
Go with Clear Expectations
If you will be traveling on behalf of a group or an organization, have a conversation about what they envision you doing. Discuss whether you will be expected to build relationships with clinics or organizations, what kind of support you will be giving, and whether follow-up trips or continued work in the area is anticipated. For example, if the group is hoping to go on annual service trips, you can focus on identifying which services could be provided safely in short-term bursts without need for ongoing follow-up (e.g., dental care). Understanding the group’s expectations and budget will keep your expectations realistic and also allow you to set appropriate expectations at the clinic.
Let the Local Workers Do Their Work
If you are at a clinic, limit the amount of time that you take health workers away from their primary role of patient care. Rather than asking them for interviews or pulling them away for training, focus on on-the-job training, shadowing, and observation.
Think about Unintended Consequences
Before doing something that you think is clearly necessary, consider the potential unintended consequences of your actions. For example, well-meaning donors have provided ambulances to communities without planning for how fuel would be purchased and upkeep would be paid for. The result, sadly, is that unused, broken-down, out-of-fuel ambulances can be found on the lots of many health clinics. Another well-meaning but ill-thought-through example is when a facility suddenly becomes well-stocked only once. Patients who might not previously have gone there might show up and deplete the entire supply much sooner than the clinic’s carefully calculated arrival of the next shipment of supplies. In addition, the health workers might become exhausted or not able to keep up with an increased patient load.
Support – don’t Overlap – Existing Services
Determine what support, if any, the facility is getting from the government, NGOs, and other groups like yours so that you do not provide overlapping or parallel services. Additionally, try not to provide services that the clinic or other parts of the health system are already providing. Your efforts are typically best spent supporting existing services, such as working to improve the quality of services.
See Things from Their Perspective
I know from my own experience that it can be extremely difficult to go into a facility and see health workers doing things, uh, differently, from evidence-based practice. If training is something you plan to offer, be descriptive rather than judgmental about the local practices. Remember that most health workers are doing the best they can with what they have, which is often not much. They may face many significant challenges, including being poorly paid; overworked; not having essential medicines and supplies to adequately treat patients; not getting consistent training, support, or mentorship; and perhaps lacking a strong foundation from their primary, secondary, and pre-service education.
Sound Like a Colleague
Sometimes in our eagerness to make improvements and teach better practice, we are not aware that we might sound condescending to our learners. To avoid that route, I find it helpful to think about how I would feel if I were the one on the receiving end. What if someone from another country came to my workplace and started pointing out everything that wasn’t working great, especially things that I knew weren’t working well but had limited power to address? How would I feel if I thought I was doing just what I was supposed to and someone from somewhere else told me I’ve been doing everything all wrong? What strategies could that person use when assessing and communicating that would make me feel heard and understood instead of attacked or threatened?
I’ve met midwives all over the world and have been warmly and patiently welcomed by almost all of them. If you can sit back and watch and listen, instead of jumping right in, you’ll learn and understand a tremendous amount and be able to find ways to truly and sustainably support midwives, clinics, and organizations. You will have fun!
Chair, Networking Committee, Division of Global Engagement