UTS:Midwifery in Bali

By Allison Cummins

Lecturer, UTS Faculty of Health
Course Coordinator, Graduate Diploma of Midwifery, UTS Faculty of Health

A few weeks ago, I accompanied twelve UTS midwifery students on a UTS:BUiLD (Beyond
UTS International Leadership Development)
trip to Bali, Indonesia, where we
learnt about maternity services in developing nations.

Bali is a
beautiful island that enjoys a tropical climate. Our trip took place during the
wet season and we experienced high temperatures in the low thirties, high
humidity around 80% and regular tropical showers.

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Our tour
began on the morning of February 1 2016.
I met the students at 8am in our hotel lobby in the beachside town of Sansur
and we headed off to visit the Yayasan Rama Sesana Clinic in Denpasar with our
local tour guide Mr. Dewar Merta, an expert in local history and culture.

This clinic
is situated above a busy marketplace frequented by local women and women from
rural and remote areas further afield.
Women visit the markets to gather their families’ needs and are able to
access health care at the clinic, which provides family planning services,
counselling for sufferers of HIV and other sexually transmitted diseases and
screenings for breast and cervical cancer.

The clinic
also has 17 mobile clinic vans that travel to different regions throughout Bali
to offer mobile services.  The doctor and
her team did incredible work and provided an excellent opportunity for outreach
to low-income women in remote areas, given the clinic’s strategic location.

We learnt that women in Bali (particularly those from rural
areas) often have limited access to education and therefore are forced to
survive on low incomes for most of their lives. When women marry, they move
into their husbands’ homes and often begin childbearing early in life.

Women’s health issues generally take a lower priority in this
patriarchal society, receiving minimal funding from the government’s health
budget. The work of clinics like Yayasan Rama Sesana is very important in
empowering low-income women to take care of their own health and to seek
assistance when they need it.

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Doctors and midwives outside the Yayasana Rama Sesana clinic


From
Yayasana Rama Sesana, we travelled to the Kasih Ibu Hospital, where we were
exposed to ‘VIP’ maternity facilities reserved for wealthy Indonesians with
private health insurance.

We were
given a guided tour of the delivery unit and the neonatal nursery. Before entering these units, we were asked to
remove our shoes, presumably for infection control purposes.

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The students and I were surprised by this
request, as shoes are worn for protection in Australian hospitals.

The third
stop on our tour was the RSUP Teaching Hospital in Denpasar, a 765 bed hospital
opened in 1959.  This hospital accepts
all women with complicated pregnancies from the nine regions of Bali.

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Doctors and midwives at the RSUP teaching hospital


Here, the
students learnt about the importance of family support when a woman is
hospitalised for birth. For example, the father’s presence at the birth is
embedded in Balinese culture.

They were also exposed to the Indonesian tradition
of cleaning and burying the placenta in the family home with pencils and books
to enable the growth of a bright, intelligent child.

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A placenta pot


The hospital’s mission is based on a Hindu
belief: “Tat twam tasi”, which translates as “treat others as you want to be
treated.”

Our next stop was the Midwifery Academy of Kartini, Bali.  We were greeted with generous, warm
handshakes and dressed with sashes upon our arrival before being entertained
with traditional Balinese music and dancers as they began the afternoon
proceedings for the annual International Seminar called ‘Midwifery
Complimentary Therapies’.

I was asked to deliver a presentation on complementary
therapies in midwifery practice.  I
explained the different kinds of therapies available before providing an
overview of the evidence for the use of complementary therapies throughout
pregnancy, labour, birth and the early parenting period.  My presentation was followed by an Indian
Ayurveda practitioner who explained the concept of Ayurveda.

Ayurveda is a form of ancient Indian healthcare therapies
based on the understanding that life is a combination of mind, body and spirit.
Ayurveda can be applied to preconceptual care, antenatal care, postnatal care
and childcare.

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UTS:Midwifery students with the Midwifery Academy of Kartini, Bali


Before we left, our hosts provided us with a delicious
Indonesian lunchbox and drink and expressed their gratitude for our attendance.

The following day, we checked out of our hotel in Sanur and
began our day with a visit to the Rumah Sehat Madani Clinic.

image

Ibu Budi and Allison Cummins discussing midwifery education in Australia


The Madani Clinic
is funded by Dompet Sosial Madani, a non-government agency for the
underprivileged.

The clinic encourages natural birth or ‘gentle birth’,
implementing a range of strategies and equipment to help women deliver
naturally.  General medicine is not
practised at the clinic. Instead, women are offered herbs and natural medicines
for pain relief and induction.
Acupuncture, massage and hydrotherapy are also applied during pregnancy
and birth.

Next, we travelled
to the mountainous rice-paddy region of Ubud to visit Yayasan Bumi Sehat
(Health Mother Earth Foundation). This organisation provides maternal and child
care to disadvantaged families suffering from poor nutrition, poverty, natural
disasters and terrorist attacks.

We were
greeted warmly by the organisation’s founder Ibu Robin Lim, who explained the
services offered to women at the facility, which delivers 30-60 births a
month.

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The Buma Sehat logo


The students were inspired by
Robin’s work and discussed how they could integrate the values of love,
inclusiveness and gentle birth into the professional hospital setting in
Australia.

The Manani
and Bumi Sehat clinics were our highlights for the trip.  We learnt so much about providing care to
women from low-income areas and we left these two sites very inspired.

Finally, we took
part in a prenatal yoga class at the Yoga Barn, Ubud.

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Practising prenatal yoga positions


The whole group thoroughly enjoyed the
experience and the students and I now have a deeper understanding of the
benefits of prenatal yoga.  Yoga helps to
improve breathing, stamina, strength, relaxation and bonding between mother and
partner.

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In amongst the
facility visits, we found some time for a sight-seeing tour to Tanah Lot temple,
which is a temple located on a small island of volcanic rock on the coast
approximately 20km from Denpasar.

We also went
on a bike tour of Ubud, stopping at various temples, a coffee plantation and a traditional
homestead along the way.

image

First stop at a Balinese Hindu temple on our tour


At the coffee plantation,
we tried Lewak coffee, made from coffee beans digested and passed by the native
Lewak cat! The beans are washed, roasted and ground, making for an excellent,
albeit expensive coffee.

Our trip to Bali was an unforgettable learning experience for
all involved.  I would highly recommend
this experience to future midwifery students.

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Our farewell dinner


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