January 2015 saw a team of 26 from the University of Technology, Sydney, head over to Bali to develop their understanding of midwifery from an international perspective. We spent twelve days across a variety of locations including urban Denpasar, rural Ubud, and tourist centres such as Sanur and Kuta.
Over the twelve days we visited Kasih Ibu General Hospital (a private hospital), RSUP Sanglah hospital (a public hospital) and two birth centres – Rumah Sehat Madani and Bumi Sehat. This allowed us to consider the contrasts and inequalities that exist in the Balinese maternity care system – from the private hospital’s pride in their technical equipment, to the crowded postnatal ward at the public hospital, to the blow up paddle pool that substituted for a birth pool at a birth centre run by midwives.
Students were moved by the passion and commitment of midwives in the face of many challenges, and by the way they incorporated tradition and spirituality into birthing practices. They were affected by specific encounters such as that with a 4 month old orphaned baby still at the hospital whose mother died of an HIV related condition, and a mother caring for her premature baby using kangaroo care. Many found Robin Lim at Bumi Sehat inspirational in her holistic approach to birth and commitment to women and babies.
We visited an outstanding example of primary health care – a health clinic in the largest market in Denpasar called Yayasan Rama Sesana. This clinic provided onsite general and sexual health care and education to the women of the market, overcoming issues of accessibility and pressures of time and finances for women who work very long hours for minimal return. They trained peer educators to provide education within the market on general sexual and reproductive health. We saw this in action – and met the women in the market who did this work.
Perhaps the most beneficial visit was to Kartini Academy, a midwifery training school named after a Balinese woman who died unnecessarily from PPH. Unexpectedly, this was touted as an International seminar with talks from the president of the Balinese College of Midwives, a leading midwife from RSUP Sanglah Hospital, and Dr Christine Catling from UTS. The whole event was lavish, with music and dancing for entertainment, and food provided. This visit was so helpful because it gave us an insight as to how midwives are trained in Bali and allowed us to talk at length with Balinese student midwives. It built international relationships with many who will be involved in hosting the ICM conference which is to be in Bali in 2020. On behalf of Caroline Homer and the ACM, Christine was able to offer our support and help for this conference, which was gratefully accepted.
Other visits were made to less specifically midwifery related projects, such as schools and a disability support organization. Although these were not midwifery based, they were a helpful tool for understanding the cultural context in which the Bali maternity system operates. Other cultural events and visits including temples, traditional dances and music, cycling through villages and visiting significant landmarks also helped round out our cultural understanding. We attended a Yoga class and learned more about the benefits of antenatal yoga. This was so popular that many students returned for more classes while we stayed in that area.
As in any cross cultural experience, there were some challenges. Students found the poverty and lack of access to basic health care and education distressing at times. The pride in the medicialisation of childbirth and a set of stirrups standard on every bed was disappointing. The sad state of many of the street animals was upsetting to some. A number of the team faced a variety of minor health challenges, and those missing children starting school were particularly home sick. Many were embarrassed at the constant show of hospitality and gratitude in the form of food and gifts. Tiredness, busyness, the constant presence of other people and lack of privacy, the language barrier and the ongoing demand for cultural sensitivity were draining. The size of the group was challenging to accommodate at some visits. And of course the nagging question of what we do with what we have learned? Having seen the needs, is it enough just to go home and incorporate a few useful ideas into our own practice?
Aside from a developed understanding of international midwifery, the other big advantage of the trip was the experience of collegiality. The team consisted of a mix of 2014 1st, 2nd and 3rd year BMid students, supervised by lecturer Dr Christine Catling, with ages ranging from 18 to early 50s. This varied range of life and midwifery experience created a dynamic team that benefitted greatly from the mix of unbridled enthusiasm and the grounding voice of experience and wisdom. Students identified this as a highlight of the trip. There was a natural camaraderie built between a group of women who share similar passions, and it was wonderful to be able to “talk shop” without feeling that we were boring others in our lives with yet another birth related story! Within year groups students will now go back to study together with a new passion for midwifery and depth of relationship that the joint experience afforded. Across year groups, friendships were built that will support students through hospital placements over the next few years, and be rekindled at conferences and training days for years to come. We are indebted to Christine for her gracious leadership and guidance, and to UTS for envisioning and organising such an amazing experience for us. Most of all we are grateful to the beautiful midwives and mothers of Bali for their wisdom, and allowing us a small insight into their practice and experience of birth.
Student Midwife/Registered Midwife