I applied to the ESA Trainee Exchange Programme because I wanted to do an Obstetric Anaesthesia fellowship. After a tricky first visit to Lyon and a lot of emails later, I chose Leuven University Hospital in Belgium. Leuven has a big university hospital with an international obstetric department that specializes in maternal and foetal pathology.
It was my first experience working abroad and I delighted in the change in culture (apart from the cold and rainy weather). Leuven is a cosy university city in the centre of Belgium and I appreciated living there and riding my bike every day at 6:30 am to travel to the hospital. I almost felt like a university student again. I cannot say that my experience was perfect or easy; they were 3 hard but worthwhile months.
I wanted a hands-on fellowship, so I needed to have my diploma recognized in Belgium. As soon as I arrived, I started to work as ‘a local’. It is very difficult when you have a lot of responsibility and you are surrounded by a very strange and unfamiliar language and culture. This was one of the hardest parts of my exchange. I didn’t understand what everyone else was saying (Dutch is the local language). Also, I could not read the equipment and protocols. The first days were very difficult for me and I worked under a lot of stress.
The goal of the exchange was to be in contact with unusual and very sick pregnant women. This was achieved right from the start. I had the chance to do a lot of regional techniques and to see many interesting cases. This was my favourite part of the fellowship.
My daily routine was a shift in the maternity ward with another 5th year trainee, working as a team, dividing the work and helping one another with the difficult patients. I was very lucky because all my colleagues were very nice and helpful, and they did everything they could to make me feel welcome. It was very gratifying to be a part of an efficient anaesthesiology team.
As a Portuguese trainee, I was not used to having protocols for everything, but I really enjoyed working in an extremely well-organized environment where everything was well-prepared and ran smoothly. This is one of the most important take-home messages: a balance between using protocols and individual decision-making is the best for a safe and organized practice.
When I applied to a university hospital, I was expecting some theoretical teaching and support in my daily routine. I’m used to the presence of a supervisor in every room. In Belgium, the system is very different and every trainee is on their own (with supervision) from the first year. Being able to compare both systems made me realize that, in Belgium, the system is not so centred on teaching as it is in Portugal. This was disappointing. The education program is mainly based on ‘working practice’ by itself, so I was grateful to realize that, despite organizational differences, in Portugal we have a training program that focusses on theoretical and clinical teaching. The result of this is that trainees feel they have more support and less stress and fatigue.
Coming from a hospital that adopts vertical deliveries, ‘walking epidurals’, birth plans, and low levels of intervention, I was surprised to see how much intervention was performed in every labour. I wasn’t expecting that. The most scientific birth is often the least technological. So, the real challenge in Obstetric care, in a specialized centre, is to find the balance between avoiding complications using accurate monitoring and interventions but, at the same time, keeping a low level of unnecessary intervention. Proactively improving health indicators, combining all the knowledge in the evolving field of anaesthesia and obstetrics, does not imply intervention. The more I learn about Obstetric Anaesthesia morbidity, the more I compare an anaesthesiologist with the beach lifeguard: always watching and aware of everything, stepping in occasionally but only when necessary.
I hope that this experience will help me to be a balanced obstetric anaesthetist. I hope I’ll be able to approach these difficult patients in the least invasive but, at the same time, most protective and scientific way, empowering women’s rights and health during labour.