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 5
th, 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.
