David Stanley began his nursing career in the days when nurses wore huge belt buckles and funny hats.
He trained as a registered nurse and midwife in South Australia. He completed a Bachelor of Nursing at Flinders University and after a number of years’ volunteer work in Africa, moved to the UK and worked as a nurse practitioner and the co-ordinator of children’s services. He completed a Master of Health Science degree at Birmingham University and, after a short return to Australia where he worked as a director of nursing in Central Australia, he returned to the UK to complete his nursing doctorate at Nottingham University, researching clinical leadership. He is currently an associate professor, teaching nursing at the University of Western Australia.
This article will appear in the February issue of Essentially MIDIRS.
How to prepare for an international elective clinical placement
As the global community gets smaller, it becomes increasingly important that midwifery students are culturally competent. International elective clinical placements are an excellent way of achieving this, but it is vital to make sure that they are planned and implemented with care and consideration for both the student and supervisor, and for any potential impact on the people and environment at the placement site.
This article offers practical information for student midwives planning to embark on an international elective clinical placement. Midwives who are considering volunteer work abroad may also find the content useful and informative.
If midwives and student midwives are to respond appropriately to the growing cultural diversity in society, they need to be aware both of the cultural traditions that impact on women and the community’s approach to dealing with health, illness and pregnancy (Berman et al 2012). Theoretical frameworks for addressing cultural sensitivity pale when compared with the impact of spending time with people experiencing a different way of living.
Being there, being a witness to — and participant in — another culture has the power to enhance a student’s cultural competence (Abdullah 1995, Scholes & Moore 2000, Thompson et al 2000, Grant & McKenna 2003, Beach et al 2005). Lee (2004) adds that other benefits of an elective clinical placement include personal and professional development, the potential for career enhancement and growth in personal confidence.
I’ve recently worked in Tanzania, Thailand, China and I spent two and a half years as a volunteer midwifery tutor and midwife in remote rural Zimbabwe in the mid 1990s, at a time when HIV/AIDS was beginning to grip the communities and devastate the lives of sub-Saharan Africans (Stanley 1996, 1997, 2006, 2011, 2013).
I found Dietsch’s publications about her international work with traditional midwives to be very valuable (Dietsch 2010, Dietsch & Mulimbalimba-Masururu 2010, 2011a, 2011b), but I hope my tips below may help others plan a safe and effective international elective clinical placement that enables clinical learning, cultural sensitisation and cultural appreciation to take place.
It starts with you
Cultural sensitivity begins with an acknowledgment of our own values and cultural perspectives (Scholes & Moore 2000). Blackman (2011) supports this, indicating that critical self-exploration — including a willingness to learn from others and self-awareness — is required to provide culturally inclusive care. Scholes and Moore also suggest that curricula should offer content that supports students to explore their own values and beliefs (2000), and I would argue that course content should also challenge students to reflect on where their values come from.
Before I travelled to Africa, I was required to undertake a two-week course with Australian Volunteers Abroad, which offered contact and instruction from people of many cultures, including those I would be travelling to. It prompted me to reflect on why I wanted to go, what I was going to get out of my time in Africa and how it might impact on me.
While I was in Africa I was one of very few to fulfil the contract, and most of my fellow volunteers, overcome by the challenges or loneliness, returned home early. If this initial step is neglected, internal conflict and culture shock may result. It is only by knowing our own values, beliefs and cultural practices that we can be receptive to learning about and understanding another’s culture (Berman et al 2012).
You should meet or communicate with people who have been before. They will be able to offer first-hand information and details about some of the specific logistical or cultural issues to be encountered. Before I travel with students to Tanzania, I introduce them to the students who have recently returned and, after a short presentation, there is a question-and-answer session that covers many of the issues described in this article.
I find that students are more inclined to trust fellow students, and the information offered is often more relevant or specific to their perceived needs. Meeting others with experience of the placement location and specific cultural knowledge will help begin the process of cultural sensitivity (Berman et al 2012).
How fit are you? Do you have any medical conditions or require any drugs or ongoing treatment? The placement is likely to be taxing emotionally and physically. In most developing countries there is a higher likelihood that you will have to walk or wait much longer than you are familiar with. The climate or environmental pollution may trigger chest infections, and the likelihood that unusual foods may initiate gastrointestinal complains is also high. The fitter you are before you start, the better you will be able to cope with or stave off potential illness.
Travel is not risk-free, and getting ill while away from home can be distressing and in some cases life-threatening. If you take regular prescribed medications, travel with a letter from your doctor explaining your condition, copies of the prescription sheets and a list of the medications. Finally, if you are prone to minor medical issues such as hayfever, migraine or irritable bowel syndrome, consider how the likely destination may impact on your condition and take suitable precautions or medications with you.
The full article can be found in the February 2014 issue of Essentially MIDIRS.
MIDIRS monthly journal keeps you updated with 54 pages of original articles, research and the latest midwifery news.
Subscriptions start at £6.75 per quarter for students and £12.50 for professionals.