Global Midwifery Twinning Project Volunteering.

 I’m bristling with far too much energy this evening and having spent time on all and sundry since my return from Nepal 3 weeks ago, I’ve ran out of excuses for not starting this update.

..... there. I’ve started. It’s going to get easier from herein.

When?

      I left at the end of September, stayed just over a fortnight, and returned mid October. The weather was wonderful. I was prepared for the end of a rainy season, but I saw far less rain this time. I took walking boots and an umbrella but needed neither. The air was cleaner, and the heat was pleasant (like UK on a warmer-than-average-but-not-scorching day). So, cotton clothes and sandals it was.

     There wasn’t much preparation time for this trip. The flight was paid for and organised by Royal College of Midwives and the government body, THET.  Hotel accommodation was already arranged. In fact, everything that I had struggled alone with during my first visit was done for me by the Global Twinning Midwifery Project organizers (and a fantastic job they did too. What a massive achievement. Well done guys!). 

Taking over equipment wasn’t so much the emphasis this time, but I still managed to fill my bag with 3 birthing balls and pumps, a fold up wipable floor mat (Honestly!), a cover for waterproof bean bag (decided against trying to fit filling into case too), laminated ‘Birth Positions’ posters, mirrors, more head torches, and any surplus equipment left over from my last trip. I managed to squeeze in quite a few recent midwifery journals that I’d finished reading. There were more hats... Hand knitted newborn baby hats, every stitch made with intent and love... what great, lightweight gifts to take over.

What will I take next time? Yes, more hats (please), but also fabric loosely woven maternity knickers (you know the ones, midwives).  The bean bag went down a treat, so there’ll be more of them. I’d rather source these things in Nepal, but that’s much easier said than done. Journals will always be snapped up by the teachers and nurses. In the hospitals and colleges, there is very little in the way of research based articles, and internet access to these is still difficult.  If nurse midwives are to be supported to change practice towards ‘evidence-based’ they need to be able to share the evidence.

Where?

       Only just down the road from the delightful APS Birth Centre in Kalanki. Julie and Jonquil, the two Scottish volunteers, and I stayed in The Grand Hotel in Saltimode, near Kalimati. It was everything it promised to be in the pictures (and yes! My daily half bucket of washing water got a whole lot bigger; swimming pool size to be exact. My relationship with conscience = It’s complicated.) It was pretty central, and I could walk to the Birth Centre in 15minutes.

     One morning, as I wandered towards the centre, taking in the smells and now familiar dogs, waste, shops, and families spewing into the roads, I was joined by three young school girls. Their English was impeccable. They were walking to school and wanted to know why I was there, and what my life at home was like. By the time we arrived at the school entrance, I’d collected six more children, all wanting to talk with me. They invited me into school with them, to talk with their teacher and friends. I wish I’d accepted the offer. To have gone in, with such a young, captive audience, I could have shared female health promotion.

Why?

    My personal project for the trip was to spend time in two slightly more rural birth centres around the valley, along with being at the APS centre. However, much effort and time was needed by the MIDSON nurse-midwives for the GMTP workshop held during the second week of our stay, and this quite rightly became the emphasis for our first week. 

I was initially disappointed I’d not spent time sharing meaningfully with the hard working, and very isolated health workers of these centres. But as the days passed, I came to understand there was a greater picture panning out.

 It’s good to do hands-on work with teaching because it feels like you’re making a difference, and of course you are, but making leaders see that Midwifery is the way forward if they are to decrease the maternal and neonatal mortality rate, is REALLY what it’s all about, and it needs tackling from all levels.

 (Quite a thick download, but well worth a read, is 'The State of the World’s Midwifery', 2011; Delivering Health, Saving Lives.).

During our stay we had meetings and working lunches in the office. We had orientation visits around hospitals and birth centres.

 

One very memorable moment was entering the 'fistula ward'. These poor women are left doubly incontinent after days of labour, and delivering a dead baby, to face sometimes years of isolation and shame. A team seeks these women out from communities to offer corrective surgery.

We met inspired and hard working faculty leaders and chiefs, health ministerial staff, research midwives and doctors. These guys had commitment and dedication that UK staff would find hard to better. 

Pressure is required at a high level to ensure this long awaited midwifery course will get the financial backing and protection it needs to become a reality.

     The sessions I attended within the workshop allowed me some insight into the many areas that need to come together. I’d never before thought about how you put teaching modules into place, where the funds come from and how they are sustained, or how to acknowledge and work with the different skills mix already present. Some nurse midwives would need little to bring them up to International Confederation of Midwives standards, whereas basic skilled birth attendants might require several years. (See ICM Essential Competencies for Basic Midwifery Practice, 2010, and Global Standards for Midwifery Education, 2010).

What now?

For the rest of this year I will concentrate my thoughts on just where this journey is taking me. I would like to start up an International Midwives group within my hospital trust. I have gained so much confidence and inspiration, and it would be lovely to share it. There are midwives who have experience of working in other countries, some rich in expertise, some very much lacking. Tips on fundraising, working time off, global issues, maybe talks by NGOs ( Medecins Sans Frontieres/ Merlin/ VSO) etc can all be shared during quarterly meetings. I’d hope the group could provide support for other midwives considering voluntary work. 

    Experiencing midwifery beyond my immediate work place has opened my eyes to global issues and women’s rights that I’d previously had no burning desire to see. I know now, that I have skills I can share, and I can make a difference. I see how midwifery is at the centre of women’s health worldwide, and I can be part of that movement to make things better. That’s put fire in my belly like nothing I’ve felt so far within my NHS profession.

     In addition to plans for a new group, and keeping in mind there is no such thing as a free meal....I am eager to keep communications with my Nepali friends strong. This is part of THET’s grand scheme. I also need to feed back to my managers, trust and colleagues, the benefits all round of volunteering. I want to find out just how much my trust can support me with payment of my pension, and giving me a job to come back to should I decide on a longer trip.

       I DO plan to return to Nepal, maybe not until September next year. But I need to focus my intention so that I use whatever I can offer to best effect.  I’d like to make a grand trip early in 2014 to coincide with my 50^th birthday. I want a mission (Ewan McGregor, where are you? Remembering the ‘Vaccine Run’ TV series filmed in Nepal last year. It was fantastic. Could I do something like that? With Ewan?...Mmmm.) This mission will need lots of homework and preparation, lots of fundraising, completed alone? With a ‘health camp’? Within the Kathmandu valley? Up in the hills? I don’t know at the moment, but it will become clear.

I’m really happy to work through any ideas you might have for this ‘mission’.