Midwives Give Blood, Sweat, and Tears in Uganda

University of Michigan students often travel to developing countries to learn about health care outside the United States, but for a group of eight School of Nursing (UMSN) midwifery students, their clinical immersion experience in Uganda was also emotionally compelling.

“We saw mothers die and we saw babies die,” says Clinical Associate Professor Ruth Zielinski, PhD, CNM, FACNM. “It’s heartbreaking because if some of these situations had happened in the United States with all the resources available, those deaths could have been prevented. But at the same time, we saw mothers and babies lives saved too.”

It’s a difficult balancing act for U-M faculty and students who are essentially guests of the hospitals and clinics. The midwifery group spent two weeks in Uganda working at three different health care facilities, which were often hot and without basic supplies or privacy for patients.

“The Ugandan midwives we worked alongside do incredible work with very few resources and little technology,” says student Ashleigh Shiffler. “We had to be creative and rely more heavily on what we saw, heard, and felt. Sometimes it was fun -- no one knew if their baby was a boy or a girl until delivery and another student diagnosed twins through physical assessment -- and other times it was very challenging,” Shiffler explained, “But, those are skills that we'll carry with us wherever we practice in the future.”

“We can learn so much from how midwives and physicians manage the incredible number of patients they care for,” said Dr. Zielinski.

Supplies are such a challenge that patients need to bring or purchase their own items such as IV tubing. The hospital staff was very appreciative of the items like tape, syringes, and medicines the U-M group brought from the U.S. or purchased from the local pharmacy, noted Dr. Zielinski. Some of them even donated blood.

Despite, or perhaps partly because of, the emotional toll and challenging environment, the group says the experience was overwhelmingly positive and impactful, including their time working with midwifery student peers at one of the hospitals. One of the most positive aspects was working in collaboration with the Ugandan midwives and other healthcare providers and students from around the world.

“Now that I have been able to work with patients from Uganda and collaborate with midwives and doctors from other parts of the world, I believe global health is a real possibility for me,” says student Elizabeth (Liz) Amaya. “We were able to reflect with local health care providers about how to improve health in a country different from our own. Themes of respect, education and compassion ran through our conversations about how to best continue this work.”

Dr. Zielinski has high praise for the way the students managed difficult circumstances. “I think everybody at one point or another shed tears, but always at appropriate times,” she says. “I was very proud of their willingness to adapt and their ability to create a safe and sacred space for these women giving birth.”

The efforts of the U-M group were not unnoticed by the Ugandan women. Two of them chose to recognize them in perhaps the highest honor a mother can give – one mother named her daughter Taya for student Taya Hamilton, and another named her daughter Ruth for Dr. Zielinski.

Many of the students said this kind of global education experience was a key factor in choosing U-M for graduate school, and they encourage other students to pursue global opportunities. “Particularly for nurses, I think it is important to take advantage of any experience to live outside of your country and your culture,” says Amaya. “Living in a world different from your own will allow you to reflect on what is most important in your everyday life and in the health care setting. I think any global experience will help you discover the kind of health care provider you want to be and will offer many lessons about patience and compassion.”  

Dr. Zielinski says discussions are already underway to make this an annual opportunity for students. She plans to hold an informal information session in the fall to share lessons learned and speak with interested students.