Background As part of the ‘Jimma Exchange Scheme’, staff from Nottingham University Hospitals NHS Trust travelled to Jimma, Ethiopia to observe working practices in the Obstetrics department of the University Hospital in November 2009.

Objectives To provide skills training for residents, midwives and medical students and to audit the unit's obstetric outcomes for the preceding 6 months.

Methods Skills training was performed with small groups of participants of mixed skill levels, focusing on emergencies including neonatal resuscitation, breech delivery, postpartum haemorrhage and shoulder dystocia. Audit was performed by retrospective data collection from the theatre records and maternity unit discharge book with difficulty due to large amounts of missing data.

Audit results 1019 women delivered 1027 babies over 6 months.

14 maternal deaths occurred (1374 per 100 000 maternities).

117 fetal deaths (11.4% of births).

68 peripartum hysterectomies (6.7% of women).

390 caesarean sections (38%).

Birthweight <2.5 kg 7%.

Birthweight >4.0 kg 2.2%.

Recommendations Development of guidelines to improve practice. Change in working practices to allow greater supervision of trainees and involvement of midwifery staff, allowing better interdisciplinary working. Improvements in documentation of outcomes, facilitating further audit, establishing whether changes have improved outcomes.

Conclusions The Nottingham visitors had a wonderful and productive visit. They received a great welcome and generous hospitality. There were many positives in the visit and at the top of that list were the enthusiasm, knowledge and clinical skill of the junior doctors. We have made suggestions for future collaboration and improvement in care for pregnant women and their babies.