June 01 2020

A Midwifery placement in the Philippines

Leticia was a midwifery student at Middlesex University in 2018. She spent two weeks in a Philippine hospital to see the differences between the delivery of care in The Philippines and the UK.

Leticia, a midwifery student from MDX smiles to the camera surrounded by two midwifery nurses from the Philippines
Leticia (in the middle) joined by two of her fellow midwifery nurses from the Phililippines.

The hospital

I chose Iloilo for my midwifery placement as it was recommended to me by two of my co-workers who had done their elective placement in the same hospital. I’d always wanted to travel to The Philippines and it seemed like a good opportunity to gain a different perspective for my job, and learn about the country and culture.

The placement hospital was the only government hospital within the province and provided free care to patients; therefore, it was extremely busy.  I remember being impressed with the facilities, as although it was a smaller hospital compared to where I work in the UK, it had many specialities and different wards which allowed it to provide many different services.

I was based in the maternity department where I saw the many differences between the care we provide in England. This was mainly due to the great number of patients seen in the hospital; it was impossible for staff to provide one to one care. The wards and clinics were usually overcrowded, and two or more patients would be sharing one bed. I was amazed at how much the doctors, nurses and midwives could do with the limited resources. 

The learning environment

My placement was very flexible. I was able to agree with my supervisors which areas I wanted to experience. My rotation was mainly in the delivery room and the obstetric theatre but I also experienced the obstetric ward, obstetric emergency room, the young parent clinic, NICU and human milk bank. This rotation gave me a full view of the maternity services in the hospital and helped develop my knowledge in different areas. 

From my rotation I was able to note that their clinical practice was a bit old-fashioned in some ways as for example, they used fundal pressure during the delivery of the fetus and they routinely performed episiotomies to aid and speed up the delivery, which you wouldn’t see in England.

All the staff were very welcoming and helpful, and they didn’t mind explaining things to me, letting me observe interesting cases or answering my questions. After the staff in the hospital got to know me, they were very keen to let me participate and assist in simple tasks such as measuring vital signs, fetal auscultation, or preparing medication with supervision.

The patients

I was able to observe many interesting cases. I saw emergency caesarean sections and intrapartum management of a patient with cardiac problems and high-risk pregnancies, such as women who developed pre-eclampsia or twin pregnancies. 

I also observed many minor cases too, such as repair of lacerations in the obstetric theatre or routine follow-ups in the clinics. Besides the great number of patients, the follow-ups were very similar to the ones back home in England.

One of the most interesting but saddest experiences I had during my placement was the delivery of a stillborn whose mother came in as a transfer from another hospital. Although the baby was resuscitated, and all the procedures and the resuscitation itself were completed effectively, the outcome was poor and sadly the baby passed away.  I guess the unavailability of a free theatre in the original hospital and the delay with the delivery due to the transfer did not help. It made me realised how lucky we are back home where we have many resources available and cases like this one can be avoided or have less of a fatal outcome for the baby and its parents.

The study/life balance

The Work the World house was really good. It was in a great location and had many amenities close by; a launderette, supermarkets and big malls where you could go and spend your free time in the evening. Also, the food was amazing! The team in the house were really welcoming and adapted meals and suggested activities to suit you. 

Our evenings varied. Once a week, the Work the World team met together and had a big dinner with the students at the house and we all sang on the karaoke! This allowed us to all get together and spend time with each other. The rest of the week, myself and the other students got together and went swimming in the local pool, went to Zumba classes, or out for dinner and drinks. 

The weekends were also for you. I used them to travel around the island and visit some of the touristic places in West Visayas. The team at the house gave recommendations on the best places to visit and the best transport to get there.

The placement learning experience

I would really recommend this placement. I have learnt many things from the people I worked with and the placement itself.  I would recommend students to have an open mind and be non-judgemental; as they do have different practices but it’s because of the reduced amount of resources and the number of patients they see during their shifts. 

I think this placement has helped me to grow as a professional and as a person. I truly appreciate and value the huge effort that all these professionals do to maintain their health system and provide good care to their patients.

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