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February 15, 2015

It has been just over two weeks now and I have settled back into the UK. I really have had to pinch myself several times and keep looking at the photos to believe that I actually was in Phnom Penh Cambodia in January 2015

Camboida Jan 2015 (3) 001 Camboida Jan 2015 (3) 028

It is said that volunteering can be unsettling to your normal life in the UK. Luckily my life in the UK has never been that normal and my Cambodian trip found me between jobs. So my life on return is all about looking to the future.

But in order to move on I need to reflect on my experience in Cambodia and what the challenges were and what we might have achieved.

To be honest the big impression of the Global Midwifery Twinning Project was how much our two maternity care systems share similar problems or issues.  I have put them in a table to assist the reader.

Cambodia UK
Theory Practice Gap What is taught is not practised.What is taught is not practical in all situations in the provinces. Clinically competent teachers.

Students don’t work with women till late on in their education.

What is taught is not practised. Midwives get influenced by local culture. Culture influences practise and model of care offered.Hard to maintain clinically competency as a University lecturer.
Politics Ministry of Health totally in charge of care provision. NHS subject to the wishes and whims of each government.
Funding Local NGO’s fund different aspects of care – no cohesion. Projects end and care returns to pre-project standard. Politics dictate where money needs to be spent or cut. Have to prove care is efficient and effective use of resources.
Role of the midwife Supported by evidence now in the ascendance. Drive to educate lots of midwives.  Have extended role in Cambodia , family planning, abortion and manual removal of placenta. Supported by evidence now in the ascendance. Drive to encourage women to use more midwifery led services. Move to have less intervention in pregnancy and birth.
Emergency skills Midwives being trained in emergency procedures especially important in provincial clinics. Midwives attend annual updates on emergency skills especially important in home birth, birth centre circumstances.
Hours of work 24 hour shifts the norm. Midwives often work alone in small provincial clinics. But of course only work if woman to attend to. 12 hour shifts the norm in the UK. Moves to more caseload practice – on call service.  Recognition in UK that very long shifts are not conducive to safe care.
Transportation Difficult to transport women to regional referral unit along none-adopted roads.  Minimal ambulance service in provinces.Annual flooding will change plans. Important to plan transportation in advance of emergency at home or birth centre births. Weather issues can impact on this process
Women who are poor Many lack any financial support to care for themselves or their baby.Access to care decided on ability to pay.  Poor women tend to have more health needs. Many women suffer financially and need help to access benefits and help during their pregnancy. Poor women tend to have more health needs.

It is clear to me now that we all need the support of a strong Midwifery Association to help us practice Midwifery to the best of our ability. I am proud that I have helped in some small way to move their Midwifery Strategy along.

The experience has made me realise how little I used the Royal College of Midwives in the UK and worse how little I tried to contribute to the association.  When you work with another country’s Midwifery Association that is trying to find its feet, it makes you understand how lucky we are in the UK.

So what next?

I hope to continue to provide support to the Cambodian Midwives Assoaciation from a distance for as long as they want me.

I hope to make a connection with my new RCM Branch here in the UK and try to make a bigger contribution to the general practice of Midwifery as a whole.

At the same time I hope to deliver care to the best of my ability in my new post, empowering women to achieve the best birth they can have.

Oh and yes, to continue blogging of course.

Camboida Jan 2015 (3) 08728th Jan 2014 Cambodia 09420150129_210226_1

Pictures taken with permission of the people in them.

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