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Guest Writer: Alexandra Lindholm -Midwife Internship in Kenya during the pandemic

My name is Alexandra and I´m 24 years old. I was born and raised in Finland but I have recently moved to Skövde/Sweden where I work as a midwife at Skaraborgs hospital. Things that bring me joy and inspiration are: spontaneous adventures, circus acrobatics, good friends and creative people. My topic for this guest writing is Midwife Internship in Kenya during the pandemic.

As I mentioned before my name is Alexandra and I have recently graduated from Novia University of Applied Sciences in Vaasa, Finland in December 2020 as a Registered Nurse and Midwife. Becoming a midwife in Finland requires 270 credits or 4,5 years of studying. As a midwife student you receive two degree titles upon graduation; Midwife and Registered Nurse.

As a midwife you become an expert in sexual and reproductive health. In other words midwives work with women who are pregnant, in labor or who have recently given birth and the people close to them. Apart from that, midwives help customers of various ages about matters related to sexual health and act as experts in female health and gynecology.

Before applying to the studies I didn’t know much about pregnancies or deliveries, and I had never even held a baby! Crazy? I was just fascinated about the human body and wanted to help people. I also thought “ you never know before you try” and today I´m very satisfied with my choice to become a midwife. As many midwives say; “the best work ever!”

When I started my studies I wanted to take the opportunity to go abroad. In my opinion living in a foreign country as an exchange student is an extraordinary opportunity to combine studies with experiences from other countries. I find it really interesting to meet new people and to see and learn about other countries and cultures. I just love the whole process and journey of discovering something new. In addition to my interest in nursing and midwife work. I think it’s important to be open minded to the aforementioned. Especially nowadays in this global world.

At the end of January 2020 me and two classmates of mine started our adventure to Kenya and the Fatima Mission Hospital in Nairobi, where we did eight of our forty mandatory weeks of midwifery. The staff working at the hospital were friendly and we felt welcome right away even though it was a new world for us!

A new world? There were a lot of differences compared to what we were used to at home in Finland. For instance, At Fatima Mission hospital women don't have the opportunity to get medical painkillers like epidural anesthesia. Husbands are not welcomed at the delivery unit, and they have no access to cardiotocography (CTG) . CTG is a machine that records the fetal heartbeat and the uterine contractions during pregnancy. Instead, to provide information about the fetus, the hospital only had one doppler fetal monitor (a hand-held ultrasound transducer) and a pinard horn (a type of stethoscope). With the doppler and pinard instead of the CTG, the doctors did not have the same possibilities to monitor the fetal wellbeing. As a result, many deliveries ended up being cesarean sections (C-sections).

Cesarean section or not, in Kenya in many of the hospitals you have to pay for your delivery. At Fatima Mission hospital a vaginal delivery cost around 200€ and a cesarean section 500€. In other hospitals a vaginal delivery can cost around 600€ and cesarean section 1000€. The reason for this is because Fatima hospital is a mission hospital.

The labor ward was different from the ones we were used to back home in Finland. At home we sometimes question if it's ethically right to care for gynecological and post-labor patients at the same ward. One 's integrity is always a priority in our mind. In Kenya integrity is also valued. But the culture and the possibilities are different.

One day we found four strong women in the labor ward, all in different phases of their life. One who had had a stillbirth during the night, another who just had given birth to a baby boy, a third one who focused on her contractions and a fourth one who had a missed abortion and was coming in for a manual vacuum aspiration. Nevertheless they supported and had empathy for each other. That day we were once again amazed about our choice of profession. One second we were grieving with the mother who lost her child, the next second we were all dancing to reggae music with another mother who was in labor. At Fatima Mission hospitals both men and women worked as midwives.

One unique thing about Nairobi is that you can come across different realities within just a couple of meters. Seeing the contrasts of richness and poor in one day can challenge our view of justice. One day we visited the biggest urban slum, Kibera, in Africa. About 1 million people are living there, most of them are living in extreme poverty. The possibilities of going to school and having access to clean water, electricity or medical care is not available for everyone. In addition to this, the rate of HIV is high. Still this is some people’s daily life and they still smile.

After a few weeks in Kenya, Corona was just around the corner. While people back home were fighting for toilet paper, me and my friends were still living in our “midwife Kenyan bubble”. Until one day the first corona case was discovered in Rongai in Nairobi where we were working. Suddenly, we were only allowed to go to the hospital and straight back home to the family we stayed at. Like at home in Finland, Universities closed, people started using masks, even churches, a big part of everyday life for many people in Kenya, cancelled their church services.

At the hospital we noticed that pregnant women were afraid to come to the hospital because of the virus. Many women skipped coming to the antenatal clinic, for ultrasound, doctor’s visits and so on. Many people got scared.

The weekend before we were supposed to travel back to Finland our flights got cancelled. Luckily we got our tickets rebooked. Furthermore our Kenyan adventure just became three days shorter than planned, but we can’t complain about that. In the end we all came home safe and even though we had to stay in quarantine for two weeks, it was totally worth it! We all appreciate that we got to experience this, especially now in this strange world!

I´m so grateful that I got the opportunity to go abroad during my studies and share this Kenyan adventure with my amazing friends and classmates. Not to mention that even during this pandemic, we all got to continue our studies and work today as midwives.

Last but not least, I would like to end with my favorite quote: “Be yourself, everyone else is already taken"

If you want to know and read more about me and my friends’ midwife adventure in Kenya you can find us on Instagram @symbismission and for those of you who wants to know more about my passion for circus acrobatics, you can follow my blog https://nouw.com/cirkusakrobatik


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