The pace increases tenfold. Day 2.

Breakfast, a short distance up the happy narrow red brick road, was a confusing affair this morning. Much is lost in translation and we ended up with another full breakfast. Not intended, but not altogether a bad thing that we were inadvertently fed for a busy day. Emails started pinging during our coffee, and suggestions for meetings were starting. We gave our apologies for not being able to fulfil the request of getting out to the student midwives in Jumla this time. Funds depending, we will keep the trip in our aims for next year.

A fifteen minute walk past the little front room shops, dogs, playing children, and fruit sellers, found us at Patan Dhoka for pick up to the midwifery society office (MIDSON). Around the large wooden table, we talked of a journey to Melamchi first thing in the morning, to chat about the changes midwifery students may have brought to women’s care in the area during their short placement, and to assess how a new pregnancy and birth app was being received by the women in that rural area. We’ll travel with two female doctors we met last year, and two others. Someone, maybe two of us, will be enjoying a sideways and possibly nauseating trip in the boot of the people carrier, up the windy hairpin bends out of the valley. Breakfast will be found along the way, and this will be Stevie’s first experience of the joys and scenery awaiting us. It’s likely to be a late, and dark, trip home again.

Thursday looks to be spent preparing for a three day workshop at the Paropakar Women’s Hospital, central Kathmandu. There are upwards of 80 births a day, here, and 16-18 in the newly (earthquake) replaced birth centre. Laxmi did her magic and arranged a meeting for 1.30pm with Dr Gautham, the hospital director, who was again pleased for us to provide our encouragement for physiological birth in their birth centre. Dr Shree Prasad also attended and is keen to rally the obstetric staff for the workshops. We will hope that the brand new qualified midwives will be invited, too. They’re not yet on the payroll, but will all be working within the hospital very soon.

Hmmm....three days to include obstetric emergencies (or, how to avoid them!), physiological birth, and tools for the midwife (balls, TENS, essential oils), but quite probably to an ever rotating set of participants so that they may all attend their shifts, too. I’m keen to ensure this workshop is not a repetition of the skills we have been sharing unfailingly for the last several years. It really is time for these skills to be an accepted part of practice. So, we will be looking at the barriers to putting all of these skills to practice. I hope many of the obstetric team will attend.

Lots to sort by midday on Thursday, when we meet up with the directors of the hospital, and agree the programme. We need to search for a local printer, to get relevant papers printed, possibly certificates, reading lists, etc. We may need to set ourselves a bit of homework in prep for the teaching, too.

Saturday is the rest day in Nepal. We may need to get some prep done, but we might also take a little rest from brain ache and get some fresh hill air. We’ll have to stay flexible, though.

We managed to visit the up and running new birth centre, where they have ten relatively spacey ‘bays’ with curtains for privacy. Partners were supporting their women to birth squatting on the bed. It was airy and light. It’s hard for us to keep in our minds that any positive changes made have been the results of much challenge and debate. We will revisit provisions and actions in the birth centre over the three day workshops.

We were then invited back to the MIDSON office to join a meeting of individuals working on an information leaflet to be given to all women receiving maternity care. The leaflet will be written in Nepali, obviously, but it was fascinating to hear how many words used daily in maternity care nowadays, that are English with no simple translation. For instance, the term ‘women’s defender’ was already chosen for the leaflet, but no direct translation could be agreed. Our input was small, very small, but it was in the form of women centred care and informed choice, which is still a new concept in the country.

We were fed, and it was very tasty, too. Then we enjoyed a leisurely 30 minute wander back to our guest house. One foot in front of the other always offers a welcome time to mentally digest events. Language barriers are less in recent years, but it still takes real focus to follow conversation and sometimes we can ‘fill in the gaps’ quite wrongly. Meeting are always tiring. We reached ‘home’ about 5.30pm, sandals off, blisters treated, ice cubes retrieved from the ancient fridge upstairs (for the Gin, not the blisters), the Archers listened to by those not writing this blog (Linda died, apparently).

(Or did she? And who on earth is Tracy?)

Tonight we’ll eat nibbles in our room. We have an early start in the morning. The journey will be a brain scrambling one, and the corners will induce a few prayers, but we’ll have experience rather than ‘work’ tomorrow. The real heavy work will come when we return in the evening. Lets’ hope we’re vaguely functional.