Chapter 7: 1969

I took a taxi to Penang from Kangar. I was met by a nursing sister at the nursing quarters. After directing me to my room and introducing me to some members of staff and the attendant in-charge of the nursing quarters, she told me to report to the matron's office the next morning.

The Nursing Quarters were located in the Hospital compound. The Quarters were shared by the general nurses and midwifery students and staff. The General Hospital next to the General Hospital and the Midwifery Hospital was across the road from the Nursing Quarters so it was quite convenient for me to go to work. I was given a white uniform to wear for my midwifery training. The course was one year long and comprised of three months work experience in a rural setting and nine months of work experience at the maternity hospital and theory. The English syllabus was followed and a English text adapted for the training. A midwifery trained nurse was the only tutor for the course. There were twelve students at the course. Besides ante-natal and post-natal experience, we were required to gain outpatient and labour room experience. Every student was required to perform at least 50 deliveries during training. It was a big requirement but we all usually had more than the required number of deliveries at the end of the course. During those times, family planning was nonexistent. I remember we had to allow patients to lie on a draw-sheet with a mackintosh on the floor to labour. There was many a time when babies were delivered in the enema room. The labour room was full or the nurses were too busy to deliver or had forgotten their patients in the enema room. Frequently we did not have time to wear gloves before attending to the birth of the baby. The mothers gave birth to their babies as soon as they were admitted or before. The risk of accidents to the newborn and midwives was great. We could only do what was possible and reasonable under such resources and circumstances. Midwives delivering babies with their bare hands could run the risk of infection and babies could have skull fractures without careful protection and guidance through the birth canal. To think today of the risks that the midwives were subjected to is quite frightening. We could have easily contracted diseases such as AIDS, Hepatitis, and Herpes through direct contact with the patient's blood and placentae with our bare hands. We were very, very lucky.

The training curriculum covered a large body of knowledge to enable the midwife to work independently in the community setting. The contents covered were conception, pregnancy, ante-natal care, labour, post-natal care, maternal nutrition during and after labour, diagnosis of complications of pregnancy, foetal status and complications of labour. Our clinical midwifery experiences were extensive. Besides assisting doctors during the complications of labour, we had to assist or perform episiotomies, forceps and vacuum deliveries. Most of the normal labours were performed by midwives. The midwife had to recognise any complications during pregnancy, labour, and the postpartum period and refer the patients to the doctors before any complications or problems arose. We had to be supervised for at least two perineum incisions and suturing before we could do any on our own. We were required to do six weeks of labour room experiences and two months at the ante-natal wards. Most patients admitted to the ante-natal wards were patients for observations when it was thought they were at risk during their pregnancy or had complications during their pregnancies and were ready for delivery.

Some patients were also admitted when doctors wanted to induce labour on their patients' pregnancies for a planned birth for their own reasons. At the post-natal wards we were required to train for the same amount of time as the ante-natal wards. Usually patients were admitted for at least forty eight hours after labour before discharged home. At home the midwife would perform a follow-up check on the mother and baby. They referred the patients to the doctors when they observed any post-natal complications. The student midwife was also required to do six weeks of nursery. There was a premature nursery besides the normal baby nursery, with six cribs at the premature nursery. In those days newborn babies were not allowed to be nursed with their mothers. The babies were brought to their mothers to be fed only. Mothers viewed their babies at other times through the nursery glass window. There were shifts that we were required to work at the nursery where there were often crying hungry babies all at one time. I hated night duties, but it was a part of our training.

We were required to do six months of hospital experience before we could be posted to the rural areas for our community midwifery. Most student midwives commenced their community midwifery towards the end of their midwifery training. There were four rural areas from which we could choose our rural experiences. I chose to go to Tasek Glokok. This was a small rural Malay village near Butterworth. I remember having a great experience at Tasek Glokok. There were two student midwives posted at Tasek Glokok at any one time. As students, we worked with two trained staff-nurses with midwifery experience at the community centre. There were times there was no trained staff working with us on duty.

We were put on call after our regular office hours. Each one of us took turns to be on call. As a student midwife, we were expected to carry the responsibilities of a trained midwife and medical officer. We were required to have a body of knowledge to assess, analyse, diagnose and treat. If the treatments were beyond our legal responsibilities, we were required to refer the patients to the medical officer who came to the clinic once a fortnight. At that time I enjoyed the challenges given to us, not being aware of the risks we faced or having the patients subject to those risks. Thinking back, the patients were treated as guinea pigs. If there were complications, like placenta praevia, we could subject the patients to great danger delivering the babies at home with no medical support or back up. There were guidelines given by the Health Ministry for us to follow, but even then the distances to the nearest medical facilities were great and transportation was poor. I remember I was taken to a home delivery by the patient's husband on his bicycle. I had to sit on the back of the bicycle and was carried into the village along a narrow path amongst padi (rice) fields. In those days we had to be so trusting of the patients and their family members who provided us with transport. There was no fear of dangers or harm that could happen to us; everybody lived by trust and faith in those days with great confidence.

All pregnant mothers were given multivitamins, vitamin B, folic acid and iron tablets during their pregnancy. We advised pregnant mothers to have enough iron and calcium in their diets and ikan belis and green leafy vegetables were encouraged for their high content of calcium and affordability. Ikan belis were the cheapest fish for the rural folks to buy then. Vegetables were cheap to purchase at the markets too; for thirty cents Malaysian, one could buy a kati of vegetables at the rural markets. At the padi (rice) fields, farmers could catch small fish for their meals. We were required to know the geography of the area, the culture of the patients and the habits and beliefs they held so that we could advise them in a culturally appropriate manner. For example, Malays preferred their "kampong midwife" (untrained midwife) to deliver their babies. The Health Ministry saw the dangers which this led patients to be subjected to. The Health Ministry passed a ruling that no birth certificates were to be given to patients if the birth of the babies were not conducted by a qualified midwife.

Besides being understanding, nurses were required to be courageous. We were alone many a time when we were on call. In rural areas, patients were expected to provide transport and bring midwives to their home to assist with the delivery. So we were often taken by the patient's husbands to their home for the birth of their baby. Sometimes they came with their bicycles or motor-bikes to fetch us. During the night, crossing the padi fields in the dark and alone with the patients husband could be very scary. In hindsight we could have been attacked by anyone or the patients' husband could take advantage of us. But we were required to be trusting during our duty when we were called.

I found the Malays to be very grateful, simple and neat people at the kampongs (villages). I was offered baskets of local fruit from their garden or eggs from their chicken pen on many occasions after attending to their families. Often we were called to attend to the birth of the baby and on arrival the babies had already been born with the umbilical cord and placenta attached. All we were required to do then was to cut the cord and examine the mother for any retained products to prevent post-partum haemorrhage or bleeding. Often among the presence of the mother would be a "Kampong Midwife" who had attended to the birth of the baby. Since the baby would not be issued a birth certificate without a qualified midwife, the family often called us to complete the "birth" of the baby and this was cutting the baby's cord and cleaning up the mother. Besides completing the birth of the baby, we also needed to follow the mother's post-partum period for six weeks. The baby was observed for normal development and given the necessary immunisations. TB injections were given at birth as well as the triple antigen. The “Kampong Midwife' would also monitor the baby and mother along with the qualified midwife. Malays' belief of having one of their religious "Kampong Midwife" for the birth of their baby was strong. Many Malay homes had a birthing room in their house for deliveries. I respected the patient's beliefs and closed my eyes to their wits and made sure that patients were not subjected to dangers and they were not at risk.

At the end of home delivery the blood was washed down through a hole in the birthing room to the ground and after a religious ceremony the placenta was buried under the house as it was believed the placenta is part of the person. Malay houses were built on stilts so the blood washed away easily. The birthing room had a hole in the centre to facilitate cleaning up, unlike Chinese houses which were untidy with an accumulation of junk around the place. It appeared the Chinese seemed to hoard items more than the Malays in the rural areas.

My year of Midwifery Training soon came to an end. I submitted an application for a transfer from Kangar Hospital back to Ipoh General Hospital. Just a couple of months before the end of the training, I had a reply to my application that I had been successful in getting a transfer back to Perak State and the posting that time was at Kampar District Hospital. I was overjoyed to receive the news. But soon after I read the letter from the Ministry of Health, I had a letter from the Matron at Kangar Hospital that I had been refused the transfer by the Hospital. I had served two years in a rural area soon after my training and I felt I had already served and contributed to the hospital. I should not have been withheld by the Matron just because she needed me to do more time.

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