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Tackling maternal mortality in Ethiopia

Only 51% of Ethiopia’s hospitals provide full emergency obstetric and neonatal care, so when birthing complications occur, it can often result in loss of life. Dr Kate Darlow spent 6 months as a VSO volunteer at Felege Hiwot Hospital in Bahir Dar, Western Ethiopia, training medical students and sharing emergency obstetrics skills with local health workers to help reduce the country’s high maternal mortality rates.

Dr Kate DarlowMy work here in Ethiopia is different in every way that you can imagine to what it would be in the UK. My day is much more flexible and unpredictable. We don’t have the same staffing here as you would expect to have at home. There isn’t always the same senior support, so a lot of the junior doctors do more advanced things than back home. The type of pathology we see here is so much more complex… so you have to work out where best you fit in and where you can offer the most support.

When I arrived and was doing ward rounds, I did a small audit, just to try and prove to the department that we weren’t doing very well on documentation, which everyone found quite amusing because it was very shocking. So I’ve designed an operation note that just needs to be filled in. It’s a prompt to remind you that you need to write important details at the time of an operation. And it’s great to see it’s now being used by most of the doctors most of the time. It helps to link in with the paediatric team because you find the information that you need much more quickly at hand.

I set up some workshops with another VSO volunteer paediatrician based at the hospital where we worked with some selected members of staff, so that they could become trainers. Those we trained are now rolling out the training to other staff from various disciplines across the hospital. The workshops deal with emergencies related to giving birth, and neonatal resuscitation as well as the basic care that’s required when a baby’s born. Its great those skills are being passed on by the trainers. And others have learnt new skills. One of the doctors who did the workshop – Rahel, one of our trainers – was anaesthetising a patient that I was doing a caesarean section on, and once the baby was delivered, it was handed over to the midwife. The midwife was trying to resuscitate the baby, but there were poor signs of life. Rahel, our trainer, stepped in, and was able to provide resuscitation and save the baby that might otherwise have died. So there was a good outcome in the end, as a result of her attending our training workshop.

I’m on the RCOG and VSO Fellowship Scheme, which means my placement is supported by the RCOG and it’s accepted that the experiences I receive here are valuable towards my training. It doesn’t directly count towards my years of training in the UK, but it’s invaluable in terms of seeing complications that you wouldn’t often see, and developing management and interpersonal skills. This experience provides you with things that you would never get from your UK training programme. There’s a wealth of clinical situations to learn from on a daily basis, so it counts for so much more than you would ever learn in a year at home.

I trained as a doctor in Scotland; and now I’m in my 5th year of the 7-year training programme in Edinburgh to qualify as an obstetrician/gynaecologist.

My dad was a VSO volunteer in the 1970s in Zambia, so it’s kind of always been something that’s talked about in the family since I was young, and I went to primary school in Somalia. To do VSO as an obstetrician gynaecologist, you have to be at the level that I’m at now. You require a basic set standard of training before you can be any use in this sort of setting; so now that I’m at the right level it seemed like the right time to do it as well.

Trying to tackle maternal mortality is a big job, and so, just to make small changes always helps. The service provision that you can offer makes a difference, but I’ve also been trying to improve some of the care and monitoring of patients, as well as training some of the staff to improve the emergency care they offer, both to mothers and newborn babies. In addition, I teach medical students – who will be the doctors of the future.

Although it’s a really challenging job and you deal with really grim things every day, the staff are amazing and really friendly, and they’ve totally accepted me in the department and are really warm.

The medical students here are taught in a slightly old-fashioned and didactic kind of way. So I try to vary it a bit and try and have a bit more active participation and make it fun. We discuss cases more and get medical students to work out exactly how they would manage a patient. I also try and give a perspective of what happens outside of Ethiopia as well, which they really value.

I’m learning about things that I’ve never read about in textbooks or, that you’ll only see in an old textbook. Every complication; we have it all on the ward rounds just to learn from.

I make a very strong point of accepting where my skill levels lie and accepting that many Ethiopian doctors are very highly skilled and that often know better how to manage complex cases they see all the time. I don’t just throw myself into operations and think that I’ve been sent by VSO to do these things. You just have to work out what you can offer and they might be the simpler things, but they’re the things that aren’t thought of here. Comparable to the UK, the population is so massive, there’s just not the volume of trained people that there needs to be.

Bahir Dar is a great place to be. There’s always things going on, so you’re never short of people to be with. We might go out for a boat trip to the Blue Nile during the day or, in the evenings, we might go out to the Ethiopian Shola dancing club. There are about five other VSO volunteers here, so we have quite a close group.

I think everybody has barriers to overcome to do VSO. It’s always a big step to make the decision, for your family to accept that you’ve made that decision, and then to leave behind all the things that you’re doing at home. The mortgage... it can be paid later. And staff at work just thought it was a brilliant idea, so I was really supported in my work. My training programme is basically on hold and I’ll just come back to it when I come back to the UK. I think my colleagues all recognise that I’m learning so much from being here, and most of them are very envious.

If you’re thinking about doing VSO, then you should do it, because you’ll regret it if you don’t. The hardest jump is just getting yourself organised and getting out here. And once you’re here, that’s the easy bit. So once you’ve sorted out your life at home, and your mortgage or whatever your issues are, then you’re here and it’s brilliant…you forget about everything at home. Life experiences are worth so much more than a salary.

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