Strengthening midwifery through global partnership in Nepal
In April and May 2023, three third year midwifery students and three instructors travelled to Nepal for the first time since 2018 with the University of British Columbia (UBC) Global Placement Program. The goal of this placement was to help further midwifery pre-service and in-service education and training in the country, while also gaining valuable clinical experience which will apply to midwifery practice in Canada. The experience allowed the students to learn about the healthcare system in low- and middle-income countries and gain experience working in low-resource settings alongside local midwives, staff nurses, and physicians.
Throughout the trip, the group was able to spend three different periods of varying length in the capital city of Kathmandu and its outlying areas. The group did not have permission to participate in practice while in the Kathmandu Valley, therefore only observation was possible. During the first of the three periods, site visits were conducted to the Trebhuvan University (TU) Hospital for a presentation from a local obstetrician and gynecologist (OBGYN), and to the Maharajgung Nursing College to interact with their president and faculty about their education programs and progress, including their new midwifery programs; this site also included a look at their birthing center for low-risk cases. The final hospital visited during this first portion in Kathmandu was the very busy national referral hospital – Parapakar Maternity and Women’s Hospital- where their two labour wards, low risk and high risk, experience a combined 500 deliveries per month. This hospital was also a teaching site, and the group was able to interact with local midwifery students from some of the first classes of the newly minted midwifery programs in the country. The group also received a warm welcome from the president of MIDSON and received a presentation on the current status of midwifery in Nepal.
During the second period in Kathmandu, the students were fortunate enough to speak with the founder of the Global South Coalition for Dignified Menstruation, an organization dedicated to eliminating the discrimination against menstruation. During the third and final period in Kathmandu, the group returned to TU to teach low-risk birthing skills to the staff nurses and midwives. The group also visited Kurtipur Hospital, where there had previously been a birthing center which followed the midwifery model for low risk birth; the group spent time discussing with the program director why this site had failed to succeed, and also toured their current antenatal, labour and posptpartum units. Finally, the group met with the board of MIDSON for a debrief of the trip, where they were able to discuss the strengths and weaknesses of midwifery in Nepal and give feedback and insight on the different sites and programs observed.
After the first period in Kathmandu, the group addressed the rural aspect of their learning objectives. In the western region of Solukhumbu, the group visited the villages of Phaplu, Gudel and Sotang. In Phaplu, the group toured the antenatal, labour, and postpartum wards of the local hospital, and provided teaching to staff nurses. At the small health post in Gudel, the group was able to observe some antenatal care as well as conduct more teaching to the two staff nurses. This was also the first site where the group was able to meet with local dhamis - spiritual leaders - to discuss the role they play in the health of their community. In Gudel the group also had the opportunity to meet with volunteer community health workers, an initiative by the government to bring basic healthcare to the rural regions of Nepal. Finally, in Sotang, the group was once again able to observe clinic, including their use of basic ultrasound. More teaching was conducted for the staff nurses and midwives, and the group was able to meet with dhamis from this community as well. Also in Sotang, the group met with members from four different women’s groups from the region; these self-organized groups provide support to women and families in their communities, especially when it comes to women’s healthcare, pregnancy, and the postpartum. In all three of the rural sites visited, donations of medical equipment and supplies, linens, and baby cloths and blankets were gifted to the health centers and community members.
The final large portion of the trip took place in the southeast of the country in the Terai region, not far from the Indian border. The group stayed in the city of Dharan, at the B.P. Koirala Institute of Health Sciences campus, where they also worked in the labour ward and provided many days of teaching to the first- and second-year midwifery students. This was the first busy hospital site in which the group was able to be fully hands-on in the labour unit, and the Canadian students and instructors were able to participate in deliveries and properly demonstrate the low-risk birthing skills which they had taught previously in lecture to the local students. Time was also spent in the neighbouring community of Itahari, where the second-year students were placed at the local Family Planning Association. Here the Canadian students were able to observe different methods of family planning, such as intrauterine device (IUD) insertion and the insertion of the hormonal arm implant. They were also able to observe a manual vacuum aspiration (MVA) to terminate a pregnancy.
While spending time in both urban and rural centers of Nepal, the group of Canadian midwifery students and instructors were able to gain valuable insight into how maternity care can function in a low-resource setting. From busy urban hospital to rural health posts, the healthcare system in Nepal in slowly evolving to included better interprofessional communication, better distribution of their limited resources, and a large push to train more professionals to cover the growing need for proper maternity care across the country. The six weeks that the group spent in Nepal offered a chance to not only provide some aid in the form of teaching and donations, but also helped to solidify the international relationship between MIDSON and the Canadian Association of Midwives (CAM). The students and instructors were able to further understand the drive and support that is required for midwifery to survive and one day thrive in low-resource settings, a lesson which can have applications in the push to expand midwifery in British Columbia, especially in the more rural and low-resource areas and communities which would greatly benefit from midwifery care.
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