by Carleen Jones.

When I imagine a South Pacific island I visualise white, sandy beaches, beautiful scenery, hot, sunny weather and even though I was visiting for an elective placement, I was secretly hoping Tonga would have these things.

My initial experience of Tonga could not have been further from this idyll, arriving at 3am, in the middle of a tropical storm with torrential rain, no street lighting and total disorientation. Being an independently arranged elective, I did not have the relative luxury of a supportive travelling group and I was therefore already nervous about arriving in Tonga – the bad weather, darkness and poor Tongan roads added to my trepidation. Thankfully, my nervousness soon vanished once the sun rose and I quickly settled into the most amazing Tongan way of life, with the most amazingly friendly people, on the most amazing island.

I spent two unforgettable weeks at Vaiola Hospital on the main island of Tongatapu. This small hospital serves the island’s population as well as being a referral centre for the 40 plus inhabited (of the 176) islands. During my time here, I worked alongside midwives, nurses, student midwives and doctors in the maternity and reproductive health departments, where I experienced midwifery care and practices in some ways very different to those of the UK, yet in other ways very similar.

This article can only give a snapshot of my time and experiences in Tonga but one of my most enduring memories was formed whilst working in the antenatal clinics. The sight of a hot, uncomfortable room full of women at various stages of pregnancy, many with their other children, who simply arrived, sat down and waited patiently for their turn, was extraordinary. No appointment system existed and typically over 60 women were seen in a morning. Initially the senior midwife would welcome the women, they would all join together singing their beautiful cultural songs, in beautiful harmony and this was followed by communal prayers – Tonga is a very religious country. These inspiring activities were followed by a public health talk on issues including sexually transmitted infections, healthy eating and exercise. Tongan midwives are not afraid of discussing sensitive issues. Although clinical procedures were similar to ours, their equipment wasn’t – the maternity department had one Sonicaid, but never any batteries and one CTG machine but never any paper!

The delivery suite was one large room with four curtained off bays. Women turn up, and simply sit and wait to be called in to be seen. Tongan women are the most patient and obedient women I have ever met. A typical Tongan woman presents in advanced labour and within no time is fully and spontaneously pushing. The midwifery care is very hands on (no fundal pressure thankfully) but regular internal examinations – I secretly called it ‘fiddling’ as they just seemed to be prodding and poking, stretching the vagina and perineum to watch progress and direct the woman’s pushing. Routine enemas, almost routine episiotomies, no fetal heart monitoring and no pain relief was used, silence was encouraged, even demanded! Most women were told to ’sshhhhh’ and/or a dismissive hand gesture used, which the women obeyed – this was unsettling to witness as it contradicts everything taught within the UK on how to communicate with women. There was little initial skin-to-skin as babies were taken straight to the ‘warmer’ – yet the majority of Tongan women breastfeed, without problems!

Any student contemplating an overseas elective should stop contemplating and just do it. Despite witnessing some upsetting things during my visit, it was a truly amazing and rewarding experience which has provided me with lifelong memories. It was a privilege to be with Tongan women during childbirth, yet I will remember most the incredibly friendly midwives and nurses who work long, hard hours, in relatively basic conditions, for little pay, yet remain happy, motivated and non-complaining. An inspiration.

Tonga is a long way from the UK and I would have struggled to fund this trip without the generosity of the Iolanthe Midwifery Trust (in association with MIDIRS), for which I will be forever grateful. I would also like to thank Bournemouth University for the award of the Global Citizen Competitive Award 2011.

About Carleen Jones

Carleen Jones has been working as a Registered Midwife at the Royal Hampshire County Hospital in Winchester, part of the Hampshire Hospitals NHS Foundation Trust, since qualifying with a First Class Honours degree from Bournemouth University. Carleen’s clinical training was undertaken at Portsmouth Hospitals NHS Trust, mainly being based at Queen Alexandra Hospital in Cosham, Portsmouth.

Carleen is married, lives in Titchfield, Hampshire but originally hales from South East London, moving to the South Coast four years ago when her husband’s job relocated. This proved an opportune time to change careers, something she had been thinking of doing for many years. Having spent 20 years forging a successful career as a Personal Assistant/Office Manager she had always felt becoming a midwife was her vocation and at the ’young’ age of 42 re-trained. She reports that the three year training as a direct entry midwife was understandably tough but also immensely rewarding and she is looking forward to an equally long and rewarding career as a midwife.

Contributor: Carleen Jones
Photo Credit: Carleen Jones