Sunday, 5 April 2015

'Making it Happen' in Bangladesh.

Just write for ten minutes, he said. ‘Set your alarm, and when it goes off, just finish your sentence and you’ll be started’. I haven’t actually set my alarm, but it was enough encouragement to enable me to make a start on this rather delayed update on my time in Bangladesh.

 I travelled with Alice, a UK midwife who has taught many times with Liverpool School of Tropical Medicine (LSTM). We went to Bagerhat in south Bangladesh, near the mangrove swamps, to facilitate two short courses in obstetric emergency care training in October 2014. It was my first trip with LSTM, and I loved every minute.

My first attempt at working with LSTM went delightfully pear shaped when my two sons found themselves in a cricket final at Lord’s. I had cold sweats with the dilemma of wanting to be in two places at the same time. How could I pull out from my commitment to LSTM for that initial trip to Nairobi? But how could I, after all the whites washes, tubs of ‘Vanish’, the re-used bags of frozen peas, not to mention the many miles of driving them for county matches during their early years, ever contemplate missing this once in a lifetime game? I couldn’t.

LSTM lost out this time. And so, as it happens, did my boys! They got thrashed.

Second time lucky, then. I was hoping Bangladesh would be a similar culture and climate to Nepal, which is now very familiar to me. The whole training package was going to present a fair challenge, so it was a comfort to know I’d not be out of my depth in other areas.

LSTM’s Centre for Maternal and Newborn Health run the successful ‘Making it Happen’ programme which helps developing countries work towards achieving their Millennium Development Goals (MGDs 4 and 5) for maternal and newborn health. UK obstetricians and midwives provide country specific training to health professionals in several Asian and Sub-Saharan African countries. The training of in-country master trainers means the project can move on to further areas. It is the largest DFID (Dept for International Development) funded project dedicated to maternal and newborn health, and it recently won a top award, the second year running, for its success and sustainability.

This link provides more information...

I’d been accepted onto the course and had my pre-course training a while before, but was committed to first seeing through my project in Nepal. At last, it was great to be finally putting my learning and experience into practice. Expenses were paid this time. Yay! But my time needed to be taken during annual leave... again. My hospital trust does not fund any of my trips.

My biggest pre-trip headache by far, was whether to take anti-malarials or not. Travel advice websites all state it’s a low risk country, for most parts. Hmm, well what EXACTLY is low risk? The drugs are costly and have side effects...but then, so does malaria. Fellow travellers were split in their recommendations, but most thought I was mad not to take the meds. So, bowing to peer pressure, I took them. All was well, no side effects. I also included in my kit bag a new impregnated net and enough nasty liquid to kill anything that dared think of crawling over me. I’m relieved, and slightly deflated, to say I remained absolutely bite free.


At the airport I changed enough US dollars to Bangla taka to pay my way in the sticks. I also bought a ‘Bangorlink’ sim card (passport and photo at the ready) with adequate phone time and internet to stave off the anticipated isolation. A very comfy United Nations approved hotel had already been arranged for us in Dhaka. In fact, everything had been arranged to the last detail. I felt incredibly safe and spoilt. Dhaka was warm, and more civilized than I expected. It was newer, too. On the journey from the airport to our hotel, I saw no slums. I saw little beauty, either, and no real treasures like the exquisite little ancient shrines found at every corner in Kathmandu.

The journey really started for me and Alice once we boarded the pokey little flight to Bagerhat. It was followed by a night-time bus journey with our fellow facilitators, two of whom really didn’t take well to the humid, bumpy, and rather swervy ride. They assured us it was travel sickness rather than catching. Thankfully, Alice and I are quite obviously made with sterner stomachs, much to our companions’ surprise. We both stayed well through the entire trip.


The view I woke up to.
The training centre we found ourselves in the next morning was safe, clean and friendly. We had fantastic fresh food, even if it was served up with eyes and fins (At times like this, I’m glad I’m vegetarian).  Load sharing of electricity was an issue, but better managed than anywhere I’d previously been in Nepal. Roads were better, too. Even in the sticks, they were tarmac and wide enough for some pretty fast vehicles. This made travelling a tad exciting at times but, hey, weren’t we there for the excitement? Absolute poverty was not as evident in the few areas I saw, either.  Maybe I didn’t see enough to get a true picture, but my general feeling was that Bangladesh had more money at its disposal than Nepal was currently seeing.





The course was run well, and organisation of time and duties were a priority. A course director, eight facilitators, time keepers, and the wonderful man and answer to all our problems, Tamim, all stayed within the complex for the two courses. We met for breakfast and debriefed at the end of every day. Meal times were our social, and little time was left for anything else but prepping for the next day’s work and sleep.



Our days consisted of pre and post course assessments, lectures, and practical skills work stations. One or two facilitators were assigned to each station, and teams of eight participants rotated around the stations at the call of the 20/40 minute bell. The scenarios are learned almost word for word, and the teaching is based on World Health Organisation (WHO) and Practical Obstetric Multi Professional Training (PROMPT). It was obvious the participants were keen to learn and, I suspect, wanted to do their best in quite challenging workplace situations, but their understanding of even basic skills were, at best, patchy. I’d have loved to give more time to take things right back to basics, but this was impossible in the time allocated.






While facilitating, I was able to see obstetricians, gynaecologists, anaesthetists, paediatricians, nurses and nurse midwives all working together, and also the disciplined and didactic methods of teaching. I was surprised at the level of hierarchy (doctors over nurses, men over women, facilitators over participants), and although this is evident in Nepal, it is to a lesser extent. Now, I’m relatively old and grey and, at 5’4”, as tall as most Bengali men but, with excruciating regularity, I struggled to get my point across before being spoken over. Sarcasm is my down fall, and I worked hard to remind my tongue to remain respectful of their culture and ways. Just once, I actually raised my voice. We were all aware of the strutting cockerel and the lowly feathered fowl. I think we were all bewildered as to my place in the pecking order.














As much as I laugh at my frustration, in seriousness I believe this hierarchy is having a debilitating effect on Bangladesh’s nurse midwives. They are the front line workers both rurally and in the hospitals, but they don’t feel empowered to use the skills they have learned. The nurses generally had very limited up to date knowledge, skills, language or voice, and the doctors seemed comfortable with this. Bangladesh has made great efforts with its new midwifery profession and MGDs 4 and 5, but if it wants to make further progress, it needs to recognise and fully embrace the part midwives and women play in such issues.




So, the high points.....
Wonderful food. Getting to grips with ‘Making it Happen’ teaching. Meeting Alice and all the facilitators. Getting to know rural Bangladesh, and a smidge of its language. Having my adventures so wonderfully organised by Keri and LSTM. My family supporting itself in my increasingly frequent absence. No midwife eating spiders in the toilet (yeah, a few geckos and locusts, and quite a few mozzies, but no spiders). And all importantly, using my skills to advance the health of mothers and babies.


The low points ....go with the territory. It does me anything but harm to endure the physical challenges, and the small benefit my midwifery skills bring to such an enormous worldwide issue, helps me through the emotional journey. If my time and passion send even the smallest ripple out to affect just one person, then it’s worth it, for doing nothing isn’t an option.

Wednesday, 21 January 2015

Title? Let's call it the Mother ship.

I’m sitting, with Dido and her ‘White Flag’ melody just audible over the speakers. The heaters aren’t working, but the cooler temperature is refreshing against my face. We’ve temporarily run out of words, and we sit, soaking up the relative silence. The tyres blaze through the pools of melted snow and as I sit gazing beyond the dark windscreen, the glare of random headlights fails to smack me back into professional mode. I’ve got a headache and, now I think about it, my throat is sore. I’m dehydrated. I sneak two pain killers into my mouth and feel guilty for the selfish acknowledgement of my own pain.

In the front, the windscreen wipers flash once in a while, and I vaguely wonder if I should say something. But it’s all been said, for now. I think we’re comfortable with our silence, and the milling over of our missions ahead. ‘There will be no white flag above my door. I will go down with this ship’. There isn’t any need for blue lighting, apparently. But I know every beat of her being craves to catch up with the blue lights that went before us. For this undocumented blissful half hour I am a mother holding another mother. No words. We’re  just sitting, with patience, faith and an unspoken understanding.





Saturday, 22 November 2014

Blog written for PHASE Nepal.

Apologies, there is some repetition in this, and the paragraphs in brackets simply explain the midwifery situation in Nepal.


Sarah Ardizzone and I met in Nepal during a previous project with Royal College of Midwives. We are UK midwives and were selected to promote midwifery and support Nepal’s progress towards establishing the profession by competency, qualification and regulation (Globally Recognised Standards for Midwifery, International Confederation of Midwives). Nepal has a high maternal and neonatal mortality rate, but is making great efforts to reach the set Millennium Development Goals in both areas.


 [Before I move head long into the joys and trials of our recent trip with PHASE into the Hills, I would like to just set the midwifery scene for all you PHASE followers...


Many women in Nepal give birth without the safety of a skilled attendant. The reason for this is partly cultural, but much is due to the challenging terrain of the hilly regions. PHASE Nepal works to support some of the most remote communities. They employ auxiliary nurse-midwives (ANMs) to live in those villages and provide as good as 24/7 care to the people. The nurses’ skills are wide and varied, and might be more accurately described as GP, and not simply nurse or midwife based. Through PHASE, GPs visit the villages as volunteers to provide ANMs with skill sharing and updates which are invaluable.
There has been recent midwifery training within Kathmandu for the ANMs. However, in view of the poor maternal and neonatal mortality rates, PHASE is exploring the benefits of extending this support to include more specific midwifery 'in-post' skill sharing. It is known that midwifery within a country reduces mortality rates far greater than just skilled birth attendants (SBA) alone (Lancet Series on Midwifery, June 2014). SBAs provide valuable obstetric emergency care, but midwifery helps to prevent those emergencies from occurring.]



Both Sarah and I are staunch supporters of the natural birth process, and the impact of midwifery on the whole family, not just at a difficult birth, but also through risk prevention, education, emotional well-being, family spacing, etc. So, we negotiated our return to Nepal to pilot a midwifery teaching programme with PHASE.


A few photos from my album....



   
This is the view from our window during our initial placement at Hagam, Sindhupalchok. Situated all of 2183m up, with a population of 4,000 stretched over many miles, it was simply stunning. We stayed with Renuka and Suprina, both PHASE ANMs. They looked after us well, and wouldn’t allow us to help with cooking, prep, or water collection. The facilities were basic, as we expected, but we were made comfortable. A wash bowl in the morning was really appreciated, as our skills at the public water tap were really limited and could well have left (too) much to be desired! An electricity pole (read ‘rotten tree trunk’) collapsed during a storm, causing days of darkness, and our head torches became even more precious. You don’t realize just how reassuring a mobile phone is, either, until it dies on you.



We joined Renu and Suprina for their regular community visits. Renu took with her a register, and picture books to help with health education. This woman was pregnant with her second child. She planned to give birth at home. All was well, but her first baby arrived in a hurry. I wonder if our nurse midwife arrived in time for this second birth, and how it all went...

 For nurses like Renu and Suprina, stuck in the nether regions of nowhere, prevention and early recognition of complications is paramount. They were encouraged to build on their understanding of how birth should work, and how they can support the natural process.

            

Suprina administered drugs to this woman who arrived in clinic, supported to stand by two men and hardly able to breathe for chronic COPD, caused in part by the continuous presence of wood smoke in the house. This, and childhood complaints, seemed to be the theme of the day. The few antenatal checks carried out in the clinics allowed us discussion of how listening to women and giving verbal prompts to gain information, can add to diagnosis and prevention, and then more importantly to timely referral.



 
Some visits definitely had a social slant. The community were wonderfully accommodating of our quirky English ways (I can’t say the same for their dogs. On more than one occasion I was decidedly more quaky than quirky!). Socializing and visibility are ways of building trust and connections through the village.



   We travelled on foot to an outpost for training with traditional healers. The guys, and one woman, were paid travel money to attend, but they embraced the opportunity to learn from Renu and Suprina. Still some locals would prefer to consult a healer before seeking medical help. It’s important that things like hygiene facilities, dangerous practices, and early warning signs for prompt referral are discussed openly.




    



The second part of our journey, after a brief couple of days to freshen up in Kathmandu, took us to Ryale which was nowhere near as far or nerve wracking a trek as Hagam. We travelled with several newly employed PHASE nurse-midwives, and a very big bag of training gear. 




















Rita, Sujeeta and Kriti, three of the PHASE ANMs based in the area had very good understanding of our English which, given our incredibly limited Nepali, was vital for any training work. A translator would otherwise have been a necessary addition to our provisions. Due to numbers and relationship building for the new nurses, Sarah and I were given a little room close to the village eating house. We were woken every morning by the bus letting EVERYONE know it was leaving for the city. By the end of our stay, we did appreciate the importance of this community service.



  

Our training sessions were extensive over the three-four days. Practical skills, theory, but also risk factors for prompt referral and prevention were dealt with. We used the models and talked through scenarios relating to birth emergencies within the Nepali home setting. There would be no drip stands or emergency buzzers. There would be no doctors prescribing a magnesium sulphate regime for fitting eclamptic women. There may be just ONE pair of hands to deal with a serious haemorrhage. Hygiene facilities, lighting, space, back up plans would all be limited in these homes.

As much as possible, we used the actual equipment the nurses carry in their substantial kit bags for training purposes too. We could identify, while going through scenarios, exactly what was surplus to requirement, and what might be better kept together in the different compartments, to ease finding equipment in a hurry. We ALL had fun working through the eclampsia regime, and we resorted to ‘phoning a friend’ when the dosage of magnesium sulphate couldn’t be worked out from the vials. We played with making up a homemade condom tamponade for uterine haemorrhage. It got messy (and slightly raucous)! In seriousness, this is exactly why regular training and ongoing educational support is necessary for these nurses, indeed for us all!

Overall, I felt our trip was incredibly productive and worthwhile. Short blasts of training feel the right way to go when these nurses are busy with community needs. Hanging around to support at births is probably not the best use of time as, thankfully, real emergencies are few and far between. Most births go smoothly, and the ANMs are called only occasionally.

Sarah and I look forward to repeating similar work early in 2015, and I hope PHASE will consider giving not only us another opportunity to work with them, but encourage other UK midwives to offer their knowledge and skills too. It was an honour to support those small communities, and their fantastic ANMs who are out there, away from their families, putting their hearts and souls into making a difference. Those girls are real life, every day heroes.




Sunday, 19 October 2014

Supporting Women's Project, Nepal.

22.54pm on 19th October, and time for a blog update.

Really?

Yup. Seems it won’t wait. My cup overfloweth and I must have some way of pouring out the passion fueled from the feeling of community and simply giving.

That’s not to say my cup doesn’t overflow on a fairly regular basis. It does. But just recently the leaky tap washer that supplies the elixir in generous quantities had got a bit clogged up!

I don’t need to go into depth (I’ll save that for my therapist), but the process of sending funds online to Nepal recently ended in tears. My issue is with… the bane of my life…computers. 1. Lost funds due to the currency transfer site being hijacked (do they say ‘hacked’ in the computer literate world?). 2. Virus caused my computer to crash, £110 repair and real upset of losing many stored personal photos and documents. Mmm, maybe I should have backed up (notes on a post card….what is ‘backed up’?)

Mission, however, is eventually accomplished. My dear and lovely friend, Samjhana Phuyal is now in receipt of £245 funds for her project…




“Empowerment of Kath Women through Sanitary Pad Making & Awareness Raising on Menstrual Hygiene Practice”
Social Empowerment by Empowering Women (SEEW)
facebook/seew.np




(She is also responsible for directing funds towards schooling of individual young girls from deprived families, and experimenting with the laying on of ‘pink’ buses driven by women, for women, as a stand against the sexual harassment and violence occurring on Kathmandu buses.)



Training the trainers was available just for the one week, and it was a rush to plan an event to raise such an amount. Thank you ladies, we did VERY well. A few were able to join me for a craft evening. Candle dipping, crochet, knitting, singing, dream catcher manifesting, and of course eating and drinking, were all enjoyed. Most enjoyable was the connection of women here, blessed in what we have, with women on the outskirts of Kathmandu, plagued by gender discrimination, ill health and shame surrounding menstruation. Thank you to all those who couldn't make the evening, but donated regardless.



Sunday, 4 May 2014

International Day of the Midwife 2014.




Our local event for International Day of the Midwife 2014 was pretty successful. A grand sum of £195.27 was raised for International Confederation of Midwives (http://www.internationalmidwives.org). There was very little cake or quiche left from a wonderful and massive selection. I really can’t quite believe we managed to move that amount of cake so fast. Visitors bought whole cakes or a selection of slices FOR midwives. How sweet is that? And one generous member of staff fed the whole of Delivery Suite and Observation Area.



















We also managed to arrange a display of posters containing information or personal midwife accounts from quite a few different countries and settings. I had one email/ poster arrive just the day before from a midwife describing her trip to teach at a hospital via armed guards in Somaliland.
     We also had on display a beautiful photo book of a colleague’s journey to various places promoting safer motherhood. Several young girls set to task and drew the most exquisite pictures of midwives and babies (placenta and all, in one pic!).




Thank you all cake bakers, poster makers, table bringers, trolley pushers, Ma Buck, and all those who supported us. We spread the word that worldwide midwifery matters...and we spread a lot of cake.






Saturday, 26 April 2014

International Day of the Midwife

International
Day of the 
Midwife

We’re selling Cake and Quiche
Level 2, Women’s Centre
2 pm onwards Saturday 3rd May.

Info posters. Children’s drawings. Personal stories.
Money towards International Women’s Charity.


Donations of cake and quiche welcomed.

Sunday, 20 April 2014

Working with PHASE Nepal.


I usually have difficulty starting these updates, but this evening I feel it’s going to flow (read that as long and boring). It’s nothing to do with a particular evening beverage. Yes, my glass is mostly half full, but tonight it’s just sitting here for when the inspiration dries up. Of all things, it was the washing up, after a meal and the company of family, to Barbara Bonney’s beautiful rendition of Ave Maria that did it. You don’t have to translate the words to understand it. To me, it oozes. Every note drips with heart-felt thanks for the feminine. Sorry guys, but women really rock my world.











How does that take me back to Nepal? Well, it takes me back to the feeling of being present in such breath-taking beauty and grace, of the women and the place they live. It also takes me back to a particular flight home to my family and experiencing a high level of turbulence. I closed my eyes, turned up the volume, and thought of all the things I had to be grateful for, not least my three children. I thought, if I died, my life had been blessed and I could not ask for more. Of course, I wasn't in real danger (was I?), but find me a person who doesn't question the meaning of life at such times.

Enough said!
....And I joked this time about Sarah and I closing our eyes, and singing it at the top of our voices, while winding our way in a ram-shackled and filled-to-the-brim old bus, up the sides of those mountains towards the remote area we needed to be (No, Mum, best NOT look up ‘The world’s most dangerous roads’). I had this hope that our version of those normally dulcet tones would get us a fast-track ticket to heaven should the bus lose its grip. Either that or we’d miraculously find ourselves close to a barrel of the home brewed ‘roxy’.




March 2014, with PHASE Nepal

This trip was a 50th birthday present to me! 

Thanks to a valued old school friend, I had the idea of setting myself an even greater challenge. I certainly didn't want a party. My kids don’t need me so much (I can’t quite bring myself to write ‘at all’). I have a little time to play with (yup, only annual leave, but better than nothing). I still have the skills, confidence and passion for my work, and I now know much more about Nepal and its needs regarding maternity care. Only on reflection do I see the enormity of learning and understanding I've acquired in such a short time. There really wasn't a better time to get myself on that mission.

 Quite coincidentally, I found the organization PHASE Nepal (http://phasenepal.org/) on Facebook the very same day Gerda Pohl, a GP working with PHASE, found my blog. So when I emailed her, we were already thinking along the same lines.


Just to recap after my last trip....

I returned so frustrated last September. There were just too many hold ups and obstacles in the way of getting midwifery into Nepal. No apologies for repeating myself, but we KNOW having midwives in a country brings down the maternal and neonatal mortality rates. Many more skilled birth attendants (SBAs) are being trained, thanks to funding from various government and non-government organizations, but this will only go so far towards reducing the number of deaths. In Nepal, government is dragging its feet with regards to bringing in Midwifery, and the nursing council is making it difficult on the grounds of Nepal not having a midwifery profession before, so why should it have one now! C’mon guys. Women and babies are DYING! And good money is being wasted.





I’m impatient. I want to see change. I want to see progress, even if it’s slow,... money spent in the right places,.... tasks achieved....  and dare I say performance related funding? I decided if I wasn't getting any joy at the door, I’d climb in through the window!


What peace and tranquility! Shall I spoil it and tell you
there were rather territorial and racist dogs on our trail?





PHASE stands for ‘Practical Help Achieving Self Empowerment’. By donations and volunteers and a small core of hard working individuals, it supports some of the most remote Nepal communities to take control of their own future. 






Education, health, food security, discrimination, and livelihoods are the main areas focused on, depending on that community’s perceived need.


Teaching nutrition during
community visits. Hagam.










Local anaesthetic, AS WELL!
They employ auxiliary nurse-midwives (ANMs) to live in the villages and provide as good as 24/7 care to the people. Their skills are wide and varied, and more accurately described as GP, rather than nurse or midwife based. GPs visit the villages as volunteers to provide ANMs skills sharing and updates which, given what these nurses are faced with, is invaluable. However, in view of the poor maternal and neonatal mortality rates, PHASE is exploring the benefits of extending this to include midwifery skills.

Clinic at Hagam.
This woman was weak with COPD,
likely made worse by the acrid smoke 
from inside fires.
Renuka teaching traditional healers,
Hagam.






Sarah Ardizzone and I met last March when we volunteered with Royal College of Midwives for the Global Midwifery Twinning Project. It was clear to me we had the same concerns and visions, so we planned to return and pilot a midwifery teaching programme with PHASE. Some midwifery work had been covered before, but it seemed much of it wasn't especially community based, and there was still limited understanding of the causes and prevention of emergencies. Waiting for obstetric emergencies to happen is like shutting the stable door after the horse has already bolted.



Renuka and Sabrina, both ANMs,
 looked after us so well.
The trip was completely self-funded, although PHASE covered us with its group insurance. I'd like to say a huge THANK YOU to Lisa Fitzgibbon (http://www.lisafitzgibbon.com/about_biog.php) and the Power Folk Quartet (Jane Griffiths, Colin and Johnny Fletcher) for their wonderful evening entertainment, and the donations towards the raffle by a very generous audience. Thank you, too, to all those who helped in the sale of Christmas Advent Candles. It has proved to be a very enjoyable and productive way of raising funds. Sharon Meakin, you brought a couple of very expensive candles (You’re so kind). Liz (you know who you are) managed to get her hands on a miniature model doll and pelvis perfect for my backpack. I had more hats, midwifery books and journals and many more bits and pieces donated. I had personal donations of money, from which I bought bean bag covers, pinard stethoscopes and Huntleigh dopplers. My case was every bit the 30kilos, and there wasn't a square inch left empty.



Bimala feigns an eclamptic fit. It brought such laughter,
 but also a serious side. Knowing available equipment,
and administration/route of medicines are vitally important.
Knowing there is no 'buzzer' to call for help is scary,
and these nurses want to feel prepared. Ryale.



Hmmm. I’ve written far too long a piece already, eh? And I've not even boarded the plane yet! But don't say I didn't warn you. I’ll follow this up with the report Sarah and I returned to PHASE, and I’ll fill in memorable snippets along with the photos.
Rita and Kriti attempting condom
tamponade (last resort for haemorrhage)
from the delivery kit. It wasn't successful!

Sujeeta performing and talking through
shoulder dystocia on dummy, at Ryale.
Laminated posters and prompts.
Useful when also dealing with
translation difficulty.



So, that circle I felt I was on? I'm very much back at the beginning. I get to where I aimed to be during my very first trip out to Nepal. (Forgive me for sounding a tad jaded). The story still is that women and babies are dying mostly in rural Nepal. Nurse-midwives are being trained in the Kathmandu valley hospitals. They are being taught a medical model of care, and at quite a basic level. They learn how to treat an eclamptic fit. That’s great, and it definitely saves lives. But they don’t understand which women are more likely to suffer eclampsia and therefore need more antenatal care, and they don’t always know when to refer to obstetric care.

The view from our window at Hagam  Sindhupalchok ,
2183 m up, population of 4,000 over many miles,
and simply stunning.
Nurse-midwives in Nepal know how to cut and repair an episiotomy, but they don’t know how to prevent perineal trauma. They also learn how to identify delay in labour, but they are not taught how to prevent it. Prevention is the key word. It shouldn’t just be about emergency care. Don’t get me wrong. Every nurse-midwife, without exception, has wanted to learn, but the teaching of nurse-midwives in Nepal is not at the globally recognized standard for ‘midwife'. For those nurses stuck in the nether regions of nowhere, prevention and early recognition is paramount. They need an understanding of how birth should work, and how they can support the process. Midwifery education does that.



Here’s my message for government, obstetricians, and nursing council...

 You NEED midwives. For now, you still needs skilled birth attendants, but they should be taught more midwifery based skills, because midwifery just isn’t going to happen in a day. There is still much work to do, and you all need to pull together. While those rural communities see little benefit from the time and energy and money being poured into Kathmandu, I’ll work at ground level (or should I say 2183m level?), supporting those small communities, and their fantastic ANMs who are out there, away from their families, putting their heart and soul into making a difference. Those girls are real life, every day heroes.
A well deserved and long desired 'Everest' beer, back in the dusty city, between rural posts.

But do you now want to know what our biggest challenge was?




These midwife gobbling beasts in the loos