This evening, the normal start to my updates REALLY isn't happening for me, or should I admit this is my fourth 'start'?
So, a different course of action is needed. Had I just got down to it and updated my blog like good girls do, when I returned from Nepal at the end of March, I wouldn't now find I have such an explosion of events, and emotions to set into words. My brain is less like sawdust than it was four weeks ago, but I still find the enormity of events on and since 25th April hard to take.
So, I'll talk you through a picture show. That way, I hope there will be some kind of order to my spewing of facts and feelings.
This is the scene that welcomed Sarah, my midwife companion and I to Fulpingkot, Sindhupalchowk, where we spent a short time with the nurse-midwives employed by PHASE Nepal (http://phasenepal.org/). This village, at 1854m, is lower than neighbouring Hagam, where we intended to move on to afterwards, and has a completely different feel to it. I'm pleased to say there were fewer dogs around, and those we met were very friendly. There was an incredibly relaxed atmosphere here. It was such a joy to wake up to baby goats scrabbling up the tiny wooden stairs, and the chuck parading her chicks around the 'patio'.
The bus journey up the hill was uneventful, and we felt pretty used to it by now. We took a translator with us this time. Dipshikha was very useful. Her English was everything we needed to continue our training sessions, and her knowledge and thirst for learning was excellent. She is from a rural background north-west of Kathmandu, so she settled into life with the nurses very quickly (Her family home is damaged and they, too, are sleeping in tents).
This photo was taken on the way up to Fulpingkot. The view was stunning. It'll be somewhat different now. Sindhupalchowk was one of the worst hit areas, and I believe the house we spent our time in has since fallen. Let's hope the monsoon season will be gentle on Nepal this year. if it isn't, increased landslides and flooding will add to troubles.
The girls were lucky enough to live just a stone's throw from this health post. When there are more than one family in a household, privacy goes out the window. Most UK residents would throw a fit at the door to a GP room being left open, let alone two consultations going on at the same time. But this level of care from the nurses is new to this community, and they are genuinely grateful for their healthcare. I'd say we could learn a lesson from them....in more ways than one. The nurses know all their patients, and practice holistically knowing the family/individual situations.
We walked quite a distance, on a scorching day, to provide antenatal care to this woman. If I remember right, it was her ninth pregnancy, she was 40 already, and previously had twins. She had never had skilled support for any of her births, and the nurses Indira and Bedika didn't doubt she would call them this time. It made me question who we are, to label this woman as a high risk grand multiparous aged mother, when the figures in my very own trust suggest at least two of those births should have resulted in C section? Should we encourage hospital when she is so fit and able? Look at her. She has more life in her than most of us will ever read about. BUT she is a mother and, as such, she is precious. She is also lucky. The nurses were prepared for her birth. Her baby was pretty much due when the earthquake struck.
These pics were taken on the highest point of the area, where a Buddhist monastery was four years in making. We had walked to a more remote health post to hold a clinic, and detoured for a spot of 'sightseeing'. The building work was taking so long because of the difficulty getting the materials up the 'hill'. Bad weather and landslides each year mean travel for many villagers is nigh on impossible.
We were treated to tea and biscuits. All the workers put down their tools and brushes, too. The love going into this place was evident. it will be a beautiful, heavenly place to worship when it's completed.
I wondered why, in such a poor and hungry community, so much time and effort would be channeled into one exquisite building, set far away, up a hill, for few to admire. Since the earthquake, I can better understand the need for these guys to nourish their faith.
What of this stunning building, and all their hard work? Can somebody answer, is it still standing?
Back at home, a meeting of community health workers was held to discuss International Water Day. The little pots, in the centre of this pic, are samples from all of Fulpingkot's 'taps'. The water runs close to the surface in this area, and therefore is easily contaminated. Every single sample (except one with filtered water!) indicated fecal contamination. Fulpingkot had not one water source safe to drink from. Filtering is essential, and the community health workers will take this message with them.
A quake of 7.8 is sizable enough to change the course of this water. The dust needs to settle, but maybe this water source will change for the better.
It didn't become evident until later, either, that while we slept at dawn, water was being fetched from a more distant source. Even with a good translator, so much information is lost in conversation.
Electricity and a small amount of internet coverage were good, but there was the usual load sharing. We found the solar charger pack I brought from UK very useful.
This water hole was a short cross country walk away from our home, and where our 'emergency' source came from. After such a (self imposed) meagre volume of water to wash in back at the house, both Sarah and I thought we'd died and gone to heaven as we plunged our heads under the cold flow to wash our hair.
During my very first trip to Nepal, I was shown an unfinished building in Tribuvan University Teaching Hospital that was to be a Birth Centre. I was only just realizing their idea of a birth centre was very different to mine. We chatted about this new concept, and what would have to happen for it to work. Eventually, after much continued and repetitive input from all, MIDSON and RCM volunteer midwives not least, we have a real Birth Centre. These ladies should be very proud of themselves.
There is so much I want to share with you regarding this wonderful centre, and how things are moving on for midwives in Nepal. The figures for the births that have taken place already, are amazing. These midwives are doing it! And I feel so happy for them.
I can go into more depth later.
It was also lovely to be part of the meeting of MIDSON educated members, to discuss their potential change of premises. Their plans to hold antenatal and women's health clinics are fantastic. Midwifery in Nepal needs to practice what it preaches, and that's incredibly difficult when a doctor is stood over your shoulder waiting to take all power and skill from you.
Here, MISDON hope to work with Paropakar Women's Hospital, just along the road, to provide good quality midwifery services. Being financially independent and therefore free from influence is challenging for a small organization like MIDSON. Much work needs to be carried out on the building, and it will only be given temporarily.
Stop press.....Oh yes, an earthquake happened.
We also managed to fit in a visit to Kirtipur Hospital. Again, during my first visit to Nepal, I was treated to discussions on how to kit out a building planned as a Birth Centre. The building, pictured here with an enchanting tree trunk in the middle of the room, hasn't changed in these years. The C Section rate is high and costly, and there aren't enough beds. Now the TUTH Birth Centre is doing so well, Kirtipur need to move on and open this building. Sarah and I will work on a feasibility study, inclusion criteria, and guidelines for the eager staff to use to convince management this has to happen.
Below, is the current maternity ward.
Finding these stones at the peak, quite obviously also meditating, made me chuckle. I suspect gravity and a bloody huge shake up means they are now sprawled in a horizontal and drunken fashion, waiting for some kind and patient soul to replace order. I also suspect their place in the list of priorities isn't very high.