5^th and 12^th May 2020

As I wrote in a previous post about the history of Sri Lankan midwifery, it is necessary to train the doctors and nurses in the maternity hospital for them to gain knowledge in the care of birthing women in water.

From what I have found and observed, the curricula of Sri Lankan medical schools are purely theoretical, and one could say that they are outdated. They learn pure facts without the possibility of discussion and understanding why things work.  Such curricula would require individual thinking, collective discussion and independent decision-making, which amongst Sri Lanka’s workforce is largely unheard of and is historically left to the high powers; you do what you are told by your superiors without question.  A revised curriculum would help to understand anatomy and physiology, combine theory with practice, and learners would have a better foundation for the safe care of women that is expected of them as a Professional.  This is at least the case in the UK, where midwives are responsible for care and decision-making and are experts in normal pregnancy and childbirth.  As soon as the midwife encounters a deviation from normality, she works with a consultant to decide steps to take and then works as an empowered member of a team to act on the decisions. Here in Sri Lanka in the private sector, pregnancy and childbirth are led purely by a doctor, where nurses and inexperienced doctors follow their orders. The orders are individual, with each doctor doing what he/she wants and disregarding protocols, so you can imagine the chaos and inconsistency in different maternity hospitals.

Armed with this information, I had to prepare for the two-day course not only as an explanation of theory for a new topic (water birth), but also to repeat the basics of midwifery and communication – the latter being a topic that is missing amongst Sri Lankan health professionals.  I started with the basics such as the mechanism of childbirth, hormones during childbirth and how they affect the psyche of a woman, and the behaviour of any medical staff; how to approach them kindly and respectfully, how to talk to them positively and explain what is happening, and how to face difficult situations.  In short explaining how together they can do it but that the woman can have an amazing experience and remember a positive birth experience for ever.

Thanks to 5 years of experience when I worked at university as a lecturer, I had the opportunity to improve my pedagogical methods, approaches to students and practice theories to get the most effective teaching; motivated students who remember as much as possible thanks to proper understanding.

The two-day presentation had 120 slides (I know, hours of work!) with lots of pictures and minimal text. I briefly tried to explain the facts associated with practice and had prepared practical tasks in which they had to speak and demonstrate the situation in role play.  Each was given a 20 page workbook with questions and tasks about water birth that I designed for them in advance, filling it in as we went along to help them gain new knowledge.

The first day of training, Tuesday, May 5, 2020, was the International Day of Midwives – a day that I celebrated truly internationally. I had an art project ready for them; a tree of life on canvas that they completed with their fingerprints.  The result was very effective and looked artistic.  I decorated a giant 2Kg cake, which I let someone make for me on this occasion, so we could celebrate.  Staff working on the other levels shared it too.

The second day of training, Tuesday, May 12, 2020 was International Nurses’ Day so I baked English scones with strawberry jam and had an activity of painting a colourful abstract picture of how they feel after a successful task. The creativity and talents among the medical staff were unbelievable.

I think we had a successful two days, which I enjoyed immensely. Even though I had spent hours and days of extensive preparation I believe that those present enjoyed it and they learned something new. When I asked one of the male doctor at the beginning of the second day of training if his practice had changed as a result of a new knowledge, he bravely admitted that he had more sympathy for women, how he no longer talked with them using a directive approach, and is more empathetic. My heart jumped at his confession and I think I achieved something.

Even if I changed only one person, it was all worth it.

Two executive directors came to congratulate everyone and present them with a beautiful certificate, and I received a large fruit basket from the head nurse and a nice card from the staff together with a Sri Lankan key ring.

I am planning to go to the maternity hospital for another two-hour training session as the nurses want more scenarios to practice role playing, especially when there is an emergency.  I will have to run the workshops several times to train all the nurses and doctors so they are all knowledgeable with the care of women who want to use the water for labour and/or birth.

Please wish me luck to achieve something, even a small positive change is an achievement.

Rennie