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



Saturday, 7 December 2013

Diary update Sunday 1st December.

 I see things. I don’t just mean in a sixth sense kind of way. I see things on a daily basis, some of them are beautiful and some of them are sad. Some of those who have the sadness are blessed to find there is beauty in there too.

Most of the time, I’m happy in my own power. My job is to hold people, inform them, sometimes direct them, but ultimately hold them. It takes quite a lot of energy, and sometimes when I come home, I want to be held. It’s not a weakness or especially a woman thing. It’s just a way of re-fuelling. You see, if I’m running on empty, I shall have nothing to give. It doesn’t mean I want you here forever. It means, simply human to human, I want to feel safe and loved in the moment.

This evening, I held a young couple who lost their first baby. Their grief is mine, too. Communication and understanding is everything.


Update Saturday 8th December.

Don't they say you have to have the bad times to appreciate the good? Emotions/ luck/ outlook/ directions can do full circle within the space of a minute. They're mini ecosystems of life. Do you feel them? The benefit is that when the going gets tough, they have literally 'upped' and left before you have time to dwell on it.

Driving home from a birth this morning, I received my payback for the challenging time I had during the week; I'd given my all, and needed refuelling. An absolutely stunning and gentle birth, nothing for me to do except 'be' with this couple and keep them all safe. There was just a faint red glow on the edge of the sky promising today's sunlight as I pootled homewards in a bleary eyed, sleep deprived, oxytoxic state. Classic FM was playing the kind of low key but uplifting music I'd want to wake up to, but today I left a contented young family and was heading towards my bed and a WHOLE WEEK of annual leave. The chocolate biscuit I'd thrown into my basket as I left the house in the early hours had never tasted so delicious. It wasn't hard to imagine my hands around a warm cup of tea, and my grandmother's stone hot water bottle next to my feet.

I needed that hug. I actually wanted it from a gentle gorilla of a man who could hold me tight and safe for a short while. I received it from a newborn baby girl, and her parents, and one of my colleagues, who shares those life and sometimes death moments that bring such awesome transition. The sneaky suggestion of a rising sun, and the cello playing, and the chocolate melting, and a ridiculous and trivial radio fact about the average calorie consumption we attempt to achieve on christmas day made me giggle out loud.



Saturday, 9 November 2013

Hmmm, maybe I'm on a roll... two posts in two days? am I sickening for something?

I'm absolutely delighted to see that this last post has had 170 views since yesterday morning, and it's only 11am now. Isn't that fantastic. But who's reading it? I'm intrigued to know what the most important/ influential/ inspiring aspects are for you.

In the past, this blog has helped fellow UK and global midwives/students gain insight into Nepal's state of midwifery, and I've received emails requesting specific information, or just in support of networking. Almost all of those midwives have followed our contact up with a trip out to Nepal.

I've also had a few western families who are living out there and are looking for midwives to attend them during their births. This is tricky as I know of NO independently practicing midwives in the Kathmandu valley. What I suggest to these families, is that I forward their details to the wonderful nurse-midwives at APS. Rashmi and her colleagues are, time permitting, generally happy to discuss options for place of birth, and are familiar with our preferences. Water birth in Kathmandu is no easy task, but it HAS been done!

If YOU are catching babies in Nepal, and especially if you can help other western families out, please do get in touch. If you are passionate about respectful maternity care, and women's issues in general, consider getting in touch with White Ribbon Alliance Nepal. If you have a story to share about your birth experience in Nepal, what made it good/traumatic, I'd really like to hear about it.
Lad born into family of carvers at Baktapur. There are carvers,
artists painting 'Thanka', and potters. All in Baktapur belong to
one of these crafts. An amazing place to visit.


Boudhanath

View from bridge at Kalanki crossroads. This is the dirtiest, stinkiest, noisiest, most nepaliest place
 in the Kathmandu valley. And I LOVE it!
Village mass-production in a Baktapur street. There are potters and basic wheels in the back streets. These pots are laid out to dry before being fired in a massive outside kiln of wood and straw.
New baby for Keshab and Rashmi.



Near Nagarkot
Classic example of need for dignity and respect. It isn't uncommon to have a obstetric consultation with others waiting in the same room. Women and their pregnancies become public property and they leave all possibility of dignity behind at home.

One of the oldest buildings in Nepal. Few have survived onslaught of earthquakes. This is in Baktapur, and it's beautiful.

Nurses, and students, and UK student Sophie in the
 postnatal ward at TU hospital.
At Boudhanath. White lady. White hair. I wonder who's sightseeing who!

Thursday, 7 November 2013

Can I just start here? I have to start somewhere, after all. 

I’ve asked myself why start at all? Why not just uncork a bottle, put on some music, fill up the bath, and read the autumn issue of ’Country Living’? Well, it’s because I’m on that mission still (yeah, the fire hasn’t upped and left me yet). I thought, fourth trip down, I must have seen what there is to see, felt all there is to feel, succeeded in some places and inevitably failed in others. I returned this time with so much more understanding, but I also felt tiredness, a fatigue, and a desire to change my direction. As with the first trip, it’s taken me some time to compartmentalize these thoughts. I’m kind of reaching a conclusion, and as is stated in that wonderful film, ‘if it’s not alright, it’s not the end’.


So, November already! And I’m thinking again about fundraising. I need to get painting those advent candles, and get them out there by December (they’re a fiver each. Please get in touch!). But in order to ask for money, I need to explain how I want to spend it.


An original plan was to organize a project large enough to celebrate fifty whole years on this planet, by way of giving back somehow. I’d hoped that particular plan might have become clear in my mind, over time, as things do.

 There was also the faintest hope that Ewan McGregor had fallen in love with Nepal after filming the ‘vaccine run’, and would want to spend time with me saving its beautiful mothers and babies. Seems he had some fish to catch somewhere in the middle of Arabia (A likely story!!).

Truth is, there’s no definite plan yet. The only ‘definite’ is that I’m travelling back to Nepal again in March, 2014. My wider picture is, of course, to help save mothers and babies. That’s not changed. I have a fellow midwife traveller, Sarah, who intends to join me, and we’re working on how best to spend our time and efforts. It may be we’ll ‘make over’ and provide training for a particular rural birth centre. We also need to look at the possibilities of working with an NGO already out there, to provide training and support towards a specific project. The possibilities are endless. The difficulty lies in finding the most effective and efficient way to make a difference, and the more I understand about the challenges in Nepal, the more I realize there is to learn.


A bit of catching up for you...


·         Return trip. March 2013

...with Global Midwifery Twinning Project, organised by Royal College of Midwives and funded by THET. Flight = Jet Airways rather that Qatar. Delhi rather than Doha. Not quite such plush standards, but very adequate. Nice to get to Delhi with just short second flight to Kathmandu. Hotel = Hotel Clarion, Jawalakhel/ Patan area of KTM. We didn’t want for anything (within sensible range), midway between Thapatali birth centre and Patan Hospital, and office of Midwifery Society of Nepal (MIDSON). 



Twinning Project Workshop = really educational and reassuring to see how hard MIDSON had worked. Well done guys!  I understood the challenges of getting a midwifery programme up and running far greater by the end of the few days. I’d never before spent time contemplating the social, cultural, political, and therefore financial factors in play with starting a midwifery programme from absolute scratch, AND against the grain of some nursing colleagues (because don’t you just need a nurse to safely deliver a baby? Nope. You need a whole lot more than just that).


Placement = Tribhuvan Univerity Teaching Hospital. As its name suggests, it is a teaching hospital. This is where my direction shifted again, slightly (read on...).
Achievements
Curtains in labour ward (thank you and well done, Sangita and Uma).
Women off their backs during routine fetal monitoring. Yay!  A ‘trial’ of an active labour area in the delivery room (Thank YOU again, Sangita). Eager discussions with doctors regarding use of guidelines, partograms, midwives, and evidence based care in the labour rooms. Being warmly welcomed as part of the team. Several new Facebook friends. =Need for involvement/ information sharing with other NGOs. Areas for action = Teamwork; doctors in the hospitals need to be supportive and encouraging towards midwifery. MIDSON; needs to increase membership and the services it offers, student membership should  be considered, along with offering a database of reading matter for evidence based care. Encouragement for Respectful maternity Care. Guidelines outlining ‘normality’, and what action to take when needed, so that the entire team is working to the same guideline. Change of use for the spanking new ‘birth centre’ at TU hospital, from postnatal care to .....normal birth. You can do it, friends. Keep the pressure on. Present the irrefutable facts, make up the new guidelines.




Making it happen. July 2013 
I attended a short intense study session held Liverpool School of Tropical Medicine. Developed by LSTM, with RCOG and WHO. Funded by DfID to help reduce MDGs 4 and 5 (maternal and child health). The project sends teams of facilitators (obstetricians, anaesthetists and midwives) to teach life saving skills in obstetric and newborn care to over nine different countries in Africa and Asia. They take teaching equipment, and train the trainers so that those particular areas can eventually sustain a good level of training with minimal external support.

 They are already entering phase two of the project, by pulling out of some areas and introducing new countries (Nepal is to be included in this next phase).

This short study course was amazing. It was so well organized. I am committed to returning independently to Nepal in March, but going out with these guys for periods of up to two weeks somewhere like Sierra Leone really appeals. I have a bit of work to do with my teaching skills, but as the team will include a mixed bag of skills, I think it’s just a matter of ‘biting the bullet’. I need to take the plunge within the year, or I’ll have to sit the study sessions again.



·       








    
        

   International Midwifery Group, Oxford University Hospitals.
I wanted to highlight the International Confederation of Midwives 'International Day of the Midwife' (May 5th, 2013) within my trust, and have an excuse to share experiences and enthusiasm for global midwifery.
We met up for an evening of talks on Uganda, Ethiopia, Haiti, and Nepal. Unfortunately we ran out of time to show the ‘Freedom for Birth’ DVD, which highlights the dreadful plight of midwives, and therefore women, in many countries. A few of us commit to meeting up on a regular basis, within the hospital or over food at the local pub. It’s great to hear what each of us has been up to, or read up on relevant articles, learn of funded courses, and put pressure on our trust to support volunteering in developing countries. The latter needs working on (thanks to Tess for her support and recent plea to management).









Return trip. September 2013.
This trip was funded independently and, as with all the rest of the trips, it gobbled up all of my NHS annual leave. I went out there with Amanda, a colleague from Oxford.  We were happy to find it coincided with the first ever Nepal Midwifery Conference. MIDSON worked so so hard to pull this off, and it was a brilliant success. 








They’d arranged great speakers, there was a packed hall each day, and beautiful venue and food (Shanker Hotel, Lazimpat).



We stayed at this hotel for the first few days. It was average expense by UK standards, but extremely plush by Nepali standards. 


  The rest of our stay was spent in a more run-of-the-Nepali-mill guest house. Dogs barking, beggar bells and chanting, unpredictable light, now familiar less-than-goose-feather beds keeping us bleary eyed. We politely moaned and giggled our way through the duration. 
My networking very much paid off during this trip. I was able to get a UK obstetrician to the midwifery conference to talk about her fistula work.

There were two US/Canadian midwife volunteers out there at the same time that I’d had previous contact with. Lesley, a new friend here in UK was out there at the same time conducting research on women’s reasons for accessing (or not) medical establishments for birth.
Half way into our outward flight, we were befriended by a colonel from the British Embassy, responsible for Gurkha welfare. This led to a meeting with the Gurkha camp SSAFA nurse. The few births they have happen at the local Patan Hospital, but it was good to exchange ideas of expats birthing in the APS centre, Kalanki, with Rashmi.
We managed to arrange a small amount of teaching in other areas. Students in Nepal are always so eager to learn and listen. It’s an absolute pleasure to be sharing ideas and skills with them.
We visited the delightful health post outside the valley, in Pharping. Kamala has student SBAs and local family planning workers with her in this centre. Unfortunately we didn’t get to spend the time I’d hoped for in Tribhuvan University Teaching Hospital, but we managed to meet up and hand over some valuable research papers and UK examples of guidelines, both for the nurse midwives and obstetricians. APS birth centre is much like it always was, with extra volunteer support nowadays. The numbers of births haven’t significantly increased, which is a shame, and it’s hard to pinpoint the reason for this.
Overall, I have to say this trip was disappointing. There are elections being worked towards this month, and it’s been so long since there has been any one party in power (and many many political parties). I suspect focus has been unconsciously directed towards this. Money and power have an unhealthy hold over countries worldwide, and Nepal is no exception.  
My biggest disappointment was not seeing a greater presence of White Ribbon Alliance (International organization for safe motherhood and respectful care in childbirth campaigners) at the Midwifery Conference, and in the workplace in general. I think it should be a ‘household’ name in Nepal, such is the situation inside and outside of hospitals there.


So, in a nutshell...

Where I’m at right now.
Trip 1. Got an overview of the situation in Nepal. 80% births outside of medical establishments. Terrain, poverty, education, health, maternal and neonatal death all intricately interwoven.
Trip 2. Supported  MIDSON to teach MIDWIFERY. The students needed to learn skills that are transferable to the rural setting (as this is where woman and babies are dying), and not at all the medical model of care they’re taught in the teaching hospitals.
Trip 3. Understood that within the teaching hospitals, it’s the obstetricians that are denying nurse-midwives the skills and practice of real midwifery. 45-95% C/S rate in some of the private hospitals!
Trip 4. I’ve fully realized what makes the country ‘tick’. Sadly, I felt midwifery wasn’t truly on the agenda this time, despite the brilliant conference. MIDSON, keep up the FANTASTIC work. You have understanding, greater than my own, to work around the powers that be. Midwifery isn’t an option in Nepal, it’s a NECESSITY, and the only way to reduce maternal and neonatal mortality further.


Full circle then,
...a hard lesson, but fuller all the same. I’d definitely bitten off more than I can chew. I’m not a political party, and money has never floated my boat. So, how do I change things? I have a voice, and a passion, but I’m just one midwife.


All enchantment has now been stripped! I’m no longer under any romantic illusion.  The desired goal for bettering women’s health in Nepal is still a long way off (but never the less improving). For a time, I lost my focus, and the ‘elephant’ got too big. For this next trip, I need to keep it SMART (Specific. Measureable. Attainable. Relevant. Time-bound.). Measurable and attainable will be the two areas to concentrate my next project on.

During my first trip, I held one woman’s hand. I told myself that if I did nothing else during that trip, I’d changed one woman’s experience of birth for the better. She’ll remember that, possibly until her last breath.


If I hold just one woman’s hand during this next trip, and that woman tells her friends, and the attending nurse-midwives also start to hold hands, and the obstetricians see the positive hormonal effect by empowerment of all those women, who knows where it will end?

Just this evening, I saw a posting. It went something like this...



Sometimes the smallest step in the right direction ends up being the biggest step of your life. Tip toe if you must, but take the step.