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Strengthening midwifery in Cambodia

Strengthening midwifery in Cambodia

Strengthening midwifery in Cambodia

Madeline Jordan shares her experiences of working with the Cambodian Midwives Association.

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I’ve always been interested in working in developing countries, so when I saw the Global Midwifery Twinning Project (GMTP) advertisement, I jumped at it. I had previously completed a diploma in tropical nursing in 2006, which had fuelled my interest. I am also hoping to become a Voluntary Service Overseas (VSO) volunteer in retirement – often they want previous experience in developing countries, so I thought this opportunity would be ideal.

I took annual leave from the NHS for two weeks in March to head to Cambodia. I’d never been there before, although I had been a nursing volunteer in a village in Nepal for a few months, years ago.

I was there to work with the Cambodian Midwives Association’s (CMA) committee members to help strengthen and improve the midwifery profession in Cambodia. The care women receive in Cambodia depends on which hospital or service they attend and there is a massive disparity in maternal mortality rates between the centre and rural areas. I only visited the government hospitals and found the current standards and training to be pretty poor. Private hospitals are springing up everywhere because they pay more and can make money.

Unfortunately there is corruption, bureaucracy and a very chequered past, so there is a lot that gets in the way of change and improvement. The CMA is campaigning for better midwifery care but it’s an uphill struggle. The dual private/public health system is complex and midwives have little time to join in the association’s activities, most holding down at least two jobs. Caring and compassion are not always high on midwives’ agendas!

My experience in Cambodia made me reflect a lot on my own career and I realised how important a midwifery association is. Our education system is good and we have regulation, we also have a system that protects the public and a midwifery association that has a strong voice. The Cambodian midwives don’t have that driving force and they don’t have many good mentors and role models as students.

Back in the NHS, I feel so lucky, not just to be a midwife and someone who loves my job, but because I have had excellent tutors and clinical mentors; there are fantastic midwives driving forward change, promoting normal birth and sticking up for birth centres; I belong to a professional association that has a strong voice and I am well supported by my colleagues. It made me think about my own involvement with the RCM and since returning to the UK, I have become secretary of our branch. I’m trying to do more to support colleagues locally and of course I am continuing to support midwives in Cambodia. It is all about sharing knowledge and skills.

I often think I am not important at work, but I have realised that what I teach my students and how I mentor them and care for them while they are there is very important.

One day in Cambodia

My days were quite varied. I was based at the CMA office in the Ministry of Health and usually started about 9am. I was tasked with assisting the CMA in networking with other agencies and developing their promotional materials.

One morning I attended the opening of a clinical skills lab in a government hospital, supported by AUSAID (Australian Agency for International Development). This skills lab is to help newly qualified midwives develop the skills they need for safe practice. I also helped the CMA to write a newsletter for distribution to their members and stakeholders and co-write pieces on midwifery care in labour, and skin to skin contact, for inclusion in the newsletter.

In the afternoons, I might visit the Ministry of Health to gather health statistics, audits from the villages and provinces, and reports in which midwives themselves talked about things that would help them to improve their practice. This was to help the CMA build a picture of maternal and newborn care across Cambodia and target their interventions.

Most days I finished about 5pm and went back to the hotel – I was incredibly lucky to have a good place to stay. I’d sit working on my laptop for two to three hours writing newsletters and such, before going out for dinner, usually with some VSO volunteers who are also placed in Cambodia, supporting maternal and newborn health. They were so welcoming and inspirational to me and other GMTP volunteer midwives. It made such a difference to my placement.

Madeline Jordan

Staff midwife at Poole Hospital, Dorset