This book primarily details Anna Kent's experiences of working as first a nurse, then a midwife, for Médecins Sans Frontières (Doctors Without Borders). Her journey takes her through south Sudan, Haiti and Bangladesh, and describes in graphic detail some of the heartbreaking experiences of the women she encountered. The author's fieldwork is interspersed with descriptions of NHS midwifery care undertaken when she returns to the UK. While the subject matter prevents the book from being described as an ‘easy read’, it is accessible, with short, powerful chapters and strong depictions of places and people.
Given the content, the book has the potential to be perceived as an example of ‘white saviour’ literature, in which an enlightened Westerner heroically comes to the aid of passive non-white people. Indeed, when reading the opening chapter describing Kent's comfortable life in the UK and her preparation for her first ‘mission’, I did at first have a sense of foreboding that the book may present an uncomfortable dynamic between healthcare provider and recipient.
However, my fears were quickly allayed. Kent exhibits a powerful sense of insight and self-reflection throughout the book, which more than once spills over into undue self-criticism. Far from presenting herself as a ‘white saviour’ figure, the author is often paralysed by fear, and ever cautious of crossing the line from healthcare worker to moral redeemer. This is not to say that she shies away from the political contexts of the places she works; reading the book has given me a harrowing introduction to several ongoing global tragedies. The depicted fate of the Rohingya people in Bangladesh was particularly affecting. Kent barely contains her anger and disbelief at the fact that people are forced, through circumstance, to make appalling decisions. She describes one woman who discharges her ill child requiring life-saving treatment from the makeshift hospital, as she is terrified of her neighbour stealing her cooking pot. This decision may seem ludicrous until it is put into context: without the ability to cook rice, the woman's family will perish.
Kent also navigates the contrast between her fieldwork and NHS jobs with sensitivity. It would be easy to fall into the trap of comparing the dangerous birthing experiences of women in places such as south Sudan and Bangladesh with the relative comfort of women accessing UK maternity provision, and to portray UK mothers as ungrateful or overprivileged. However, Kent manages to avoid this and treats all the families she describes with dignity and respect.
Nor does she imply that UK midwives ‘have it easy’. She describes the difficulties of working in the NHS, such as staffing shortages and fear of adverse outcomes, in a way that feels very recognisable. This contributes to the fact that despite the strong focus on overseas midwifery, the book feels relevant to all midwives currently practicing. There are descriptions in the book of midwifery events and practices that are, thankfully, unimaginable in a UK context, such as maternal death from obstetric fistula or the ‘destructive delivery’ of a fetus. However, the way the author approaches the issues of professional burnout, anxiety and post-traumatic stress disorder will sadly resonate with many, if not most, current midwives. Throughout the course of the book, Kent manages to slowly turn self-criticism into self-reflection, and to find more beneficial coping strategies. The book may well help some readers to recognise unhealthy thought processes and potential signs of needing more support from friends, colleagues and employers.
This book distils the relationship between patient safety, professional accountability and emotional capacity to its very essence. This lends the book particular significance in the current climate and is sure to strike a chord with readers.