Monday, 30 September 2013

Homeward bound

Well I've just said goodbye to Cambodia for another 6 months and landed in Bangkok.  The last time I was here was 2000; Stephen and I were on our way to China to adopt our (then) 9 month old baby daughter. On the wise advice of friends, we stopped over in Bangkok for a few days to recover from jet-lag and a last few moments of being 'just us' before our lives were changed (and wonderfully blessed) for ever.  I remember staying at the YMCA (nicer than it sounds!) and enjoying a wonderful meal at the Oriental Hotel on the riverfront. We also met up with Steve and Marie Goode, veterans of the Thai/Cambodia border camps who live in Bangkok and whose lives have intersected with mine on many occasions.  I am currently sitting in an internet cafe about to meet Steve again for the first time since then - we have lots of catching up to do!  Looking forward to getting his perspective on all things related to development work across the world and exchanging news of family and our shared friends.

I've been away from home for three weeks and I'm ready for some family time and walks with my dog in the coolness of autumn.  However, it's been a great trip and I'm really encouraged by the progress our Global Midwifery Twinning Project is making, both in Nepal and Cambodia.  I have been reminded, once again, of the importance of relationships in overseas development work (and in other spheres!) and that seeds cannot be sown before the ground is prepared.  I do believe that we are now beginning to sow seeds and even nurture green shoots with the Midwifery Society of Nepal and the Cambodian Midwives Association - though relationships must continue to be built and strengthened in the same way as weeding a garden is necessary to avoid choking fragile seedlings.  Much of my work when travelling is networking - I try to meet as many people as possible who have a stake in midwifery in the host country... and some who don't but whose knowledge provides invaluable cultural or strategic context.  Thus today I found myself meeting with a professor from a UK university, based here in Thailand and working all over South East Asia, who shares some of our interests and networks in Cambodia.  We were able to offer one another useful information and contacts and who knows, maybe together we can be stronger!  Three years is such a short time-frame in which to achieve sustainable results and right now it's good to explore ways that our efforts may be continued - either by us or by others.

Never under-estimate the power of drinking tea and 'wasting time' with others in development work - such time is never truly wasted and will doubtless bear much fruit in the years to come
I'm feeling really positive about the placements we've arranged for the next few groups of volunteers in Cambodia and Nepal.  MIDSON and the CMA are more clear now about who and what they need, and how to support volunteers in country.  We are developing our knowledge too about what information they need before they go, how we can ensure their placements are as effective and fulfilling as possible, and how we can best debrief and disseminate their learning on return.  I've been developing a 'tour guide' for volunteers as I've travelled around so thanks to all those in both countries who gave me recommendations for restaurants, hotels, shops, tuk tuk drivers, hospitals, favourite outings and lots of other information besides.  Our volunteers should have plenty of options in their down-time now!

In addition to leading workshops and drinking countless cups of tea, I have also conducted a mid-term evaluation for both our project in both countries whilst on this trip.  I have met with many people, both inside and outside of the midwifery associations, and asked them questions on the successes, challenges and lessons learned from our project so far.  I have two notebooks packed with information - my challenge is now to filter and synthesise this so we can use it to capture an accurate picture of where we are now and where we want to be in April 2015.  In addition to this we have a major donor report to submit on 15 October, then I leave for 2 weeks in Uganda on 20th to undertake the same thing again.  I am feeling rather tired and overwhelmed so appreciate all the love, prayers and support that my colleagues, friends and family continue to offer via Facebook, Skype, Phone, E mail and face-to-face.  Stephen and Hannah are enormously gracious in the face of my continued absences from home, so when I get home tomorrow work will be on hold for a little while whilst I nurture those most important relationships of my own.

Meanwhile, I feel something  little stronger than tea may be required to celebrate our family reunion tomorrow so, in anticipation, cheers!
Gin Fizz, Cambodian-style!









Thursday, 26 September 2013

Prey Veng Revisited

I have just returned from 5 days in rural Cambodia.  Prey Veng province, where the Cambodian Midwives Association had organised a workshop, is a large and densely populated area with more than its fair share of poverty and over 300 midwives.  Wikipedia describes the provincial town:

 "This quaint town is off the usual tourist trail and is uncrowded. It houses several old dilapidated colonial homes. There is a large lake west of the city which is dry from March to August."

Co-incidentally, I used to live in Prey Veng from 1994-1996 and was very happy there.  Life was very simple; one of only 2 foreigners in the district town of Svay Antor we had no running water or electricity, just solar panels on the roof for lighting.  We ate Khmer food every day and wrote letters home for entertainment.  I worked with a community development programme, training traditional midwives and supporting community health services, as well as planting rice, delivering sacks of cement and drinking a lot of tea on walkabouts in the villages. 

I was overjoyed when the CMA wanted to conduct their workshop there, giving me the opportunity to return.  Their provincial branch had died and they had few members.  They planned to invite midwives from across the province, recruiting them to the CMA, providing some continuous professional education and vote for a new branch leader.

I travelled on the public bus ($2.50 per ticket compared to a minimum of $35 for a taxi).  It was a hot and squashed affair but got me back into the reality of Cambodia nicely after the luxury of my Phnom Penh hotel.
Getting off the Public Bus in Prey Veng with Nisay, my Khmer assistant
I stayed with Barb, a British Midwife who I have known for more than half my life and is a veteran of Cambodia.  It was wonderful to be in her traditional wooden Khmer home, sharing life with her family and having her company and invaluable input during our workshop.  Nisay, my Khmer assistant this week, is Barb's daughter so she enjoyed being back with her sister.  It was great to hear them giggling together!
Barb's House in Prey Veng

The shower at Barb's House

Kanika (Student Midwife) and Nisay (my assistant this week), Barb's daughters


Barb with her cat, Ginger
The workshop was a real milestone for the CMA and for our twinning project.  It was wonderful to see the executive team pulling together to organise an event.  Our short-term support for a part-time office administrator has meant there is someone in the office to get jobs done.  They had planned the timetable and executed it with little input from me except my speeches at the opening and closing events and my presence at the meeting with the provincial health chief.  This left me free to interview several people for our mid-term evaluation and to observe the event with a critical eye.  We visited a Health Centre in Prey Veng Town and the CMA members did some mentoring (in the very loosest sense!) with midwives there as well as meeting some mothers-to-be and engaging in some health promotion activities.  There's a whole other story in this tale but that's for another time!
 
Around 150 midwives (half of all the midwives in the province) attended one of the workshops and signed up for membership of the CMA and it now has a newly elected, enthusiastic branch leader.  We have negotiated with the Provincial Health Chief for two of our British midwife volunteers to come to Prey Veng sometime early next year to engage in some mentorship for the new branch leader, supporting her to support midwives across the province and training her as a trainer. 
Me with the newly elected branch leader of the CMA in Prey Veng
I have a sense of a job well-done, though there was much room for improvement.  It is real progress from the state of our project 6 months ago and I feel positive for the future.

Three of us travelled back to Phnom Penh today and decided to take a taxi so that we could stop on the way and visit some other health facilities.  It was also much more comfortable than the journey down and far quicker!  We went through Svay Antor past my old house which was unrecognisable, and though some of the villages where I used to work, all now accessible on tarmac-ed roads and much more developed.  Some people still recognised us though, and we also met some of the midwives who had been at our workshops and were delighted to show us round their workplaces.

Midwives in the newly re-furbished delivery room at Svay Antor Health Centre

My old house in Svay Antor.  When I lived there it had wooden steps, no brick-built room downstairs and an outside bathroom under the house, with no running water or electricity.  Unrecognisable now!

Barb and I meeting three midwives in Chrey Health Centre who had all been to our workshops this week and have signed up for CMA membership

The Delivery Room at Pear Reing District Hospital - 3 beds, no curtains

Operating theatre where caesarean sections are performed at Pear Reing District Referral Hospital

Barb helping a lady to breastfeed (note the heavy bag of ice on her abdomen.  They seem to use that here to prevent or treat post-partum haemorrhage!)



Sunday, 22 September 2013

Culture shock

Since I returned to Cambodia with GMTP I've been quite culture shocked. This feeling keeps revisiting me as I realise Cambodia has changed in so many ways yet, in others, it is much the same.

It first hit me flying into Phnom Penh in May. Looking down over the city I wondered if the plane had flown mistakenly to Kuala Lumpur. All those brick houses with tiled roofs, tall multi-storey buildings and just such a big place. Surely this was not Cambodia? Last time I visited in 1999 the airport was little more than a shack and was some way out of the small city of Phnom Penh, separated by acres of rice paddies. Now it's one continuous sprawl of new houses and factories.  Before, we rode pillion on 'motodups' (motorbike taxis) or pedalled cyclos. Now there are tuk-tuks and the streets are full of air conditioned top-of-the-range 4 wheel drives, many with government plates...

A new wave of culture shock hit me this time as I came directly from Nepal. Kathmandu is the most polluted city in the world; it's full of dirt and dust, clapped out taxis with zero suspension, bumpy roads, dirt and smells, mangy dogs and people everywhere. It's also vibrant, colourful, genteel and exciting.

Driving from Phnom Penh airport to the hotel late at night, the roads were smooth as a baby's bottom as I sat comfortably in a new, air conditioned taxi. The road were quiet. We passed streets of brand new flood lit buildings and complexes, tree-lined boulevards and ornate, shiny gates. There are air-conditioned coffee shops on every corner. The hotel, with pool, is a tranquil oasis next to an elegant temple. There is bacon for breakfast.

Yet I know this is not the real Cambodia and that the gap between rich and poor is getting wider as the relatively few elite profit from land-grabbing and other practices the poor have no power to redress.  I am looking forward to my trip to Prey Veng to reconnect with a Cambodia that is more familiar. To staying in a traditional Khmer house without a western bathroom; eating traditional Khmer food (though I hear Barb is planning chicken and chips this evening!) and resting my eyes on green rice fields scattered with sugar-palm trees.

Saturday, 21 September 2013

Hooray - my expenses balance!

It's always a relief when one's expenses balance - this trip involves 5 different currencies and I'm so grateful to my lovely husband for designing me a spread sheet to manage my financial nightmares.  I'm pleased to say that I have exactly the right number of reil, pounds, dollars, rupees and baht left and I'm rather proud of myself.

It's always a treat to be back in Cambodia - I worked with Cambodian refugees in Thailand in the 1980s and learned to speak, read and write the language fairly fluently.  I lived in Cambodia itself in the early 1990s with CORD (http://www.cord.org.uk/) and visited frequently when I was Tearfund's southeast Asia Desk officer, until we adopted  Hannah in the Year 2000.  It had been 14 years since I spoke any Khmer but I'm pleased to say it's all coming back to me now that I have undertaken 3 trips here with the Global Midwifery Twinning Project.  I have a network of friends and contacts here that has been invaluable.  The programme here had a slow start and we have managed to pull it round thanks to some sound in-country advice and support. 

I am here to undertake some mid-term evaluation activities and join the Cambodian Midwives Association in a regional workshop in Prey Veng Province.  They chose the location as it's a very poor province and has a low density of CMA members. Co-incidentally it is where I worked in the 1990s so I am able to stay with my friend Barb, a midwife from the UK who has lived here for over 20 years.  I will travel down to Prey Veng tomorrow (Sunday) on the Public Bus which will doubtless be a warm, dusty and bumpy ride but will enable me to see the countryside close up and observe the changes since the 1990s.  I have my traditional Khmer outfit to wear for the conference (Jacque and I had them made when we were here in July) and have packed my mini suitcase with Duchy Originals biscuits and home-made jam, treats for those who live far away from Western Supermarkets!

I had a restful day today - I needed it having worked flat out for 10 days in Nepal with no break.  I did have three meetings but they were all quite relaxed and took place over pots of tea or lovely meals.  In between times I found time to have a pedicure ($5 for a full-hour!) so I now have coral toes in time for the workshop!

The art of report-writing whilst having a pedicure
I met up with Kath Hinchcliff for tea this afternoon. She is a retired Senior NHS Commissioner who has been working as a VSO volunteer here for the past 3 years, assisting the Cambodian Midwives Association and the Cambodian Midwives Council.  Her input to our project and our own volunteers has been invaluable and I know that the impact of her work here will be felt for years to come.  Kath provided some very useful insights for my programme evaluation and feels that GMTP is beginning to yield some results here
With Kath Hinchcliff
  I dinner with Steve and Ruth Penfold and three of their four children.  Steve is a locally based healthcare consultant with fantastic expertise in reproductive and sexual health and has been enormously helpful to GMTP in Cambodia.  It was good to catch up personally and professionally and to view the new family car!

Who needs a car when you can buy a tuk tuk? Much more fun!
So, I will attend the International Church tomorrow morning then head off on my next adventure.  I have hired some help whilst I am here - Nisay is a very smart graduate who will help me with translation and other duties, leaving me free to do what I need to do.  I'm not travelling with anyone else on this leg of the trip so needed some help with the donkey work.  Let's hope we survive the bus journey tomorrow!

Friday, 20 September 2013

Leaving Nepal and on to Cambodia

What a great ten days it has been.  As usual, the pace of the days increased as we crept closer to our flights home/onwards - sometimes however much planning I try to do in advance, things all seem to come together once I'm in country.

We spent the morning of our last day in Nepal at the Midwifery Society Office, where we undertook a mid-way evaluation of the project using a tool developed by the International Confederation of Midwives. This enabled MIDSON to assess their development to date and make plans for how they want to develop in the future.  We all agreed that after such an enormous effort organising the conference, they need some time to re-group and focus internally for a while.

After a lovely lunch of Nepal Thali at a local canteen, we headed to the Tribhuvan University Hospital on the other side of town, where Kiran (President of MIDSON) is an associate midwifery professor.  We were shown around the labour ward and met some wonderful, passionate midwives who are so frustrated at their powerlessness to make changes.  Staffing levels are a real challenge - 2 midwives for a busy labour ward with 8 beds, so no chance for one to one care.  The on-call doctors are medical students who have more authority in the system than senior midwives with over 20 years' experience.  The day we were there the midwives were so sad - earlier in the day a woman had died after complications from a caesarean section, leaving 2 motherless children.  Turns out the elective caesarean was performed by a medical student.  They also showed us an adjoining building that they wish to turn into a birth centre.  It has all been nicely renovated and equipped, but they are at stalemate because the obstetricians don't think a midwife-led unit in a different building would be safe.  Our volunteer midwives have been working there trying to influen
ce practice and have clearly made a difference - the Nepali midwives all spoke warmly about what they have learned and are trying to put into practice.  However, I wonder whether a more multi-disciplinary approach is needed with some obstetric 'converts' from the UK working alongside the midwives to effect change.  Think that is probably outside the scope of this project though!
At the birth centre, currently being used as a postnatal ward

We had a lovely dinner with some of the UK volunteers and others, then breakfast with MIDSON members this morning before heading out the airport.  Now in the departure lounge at Bangkok airport waiting for my onward flight to Phnom Penh.

Next instalment will be from Cambodia!

With midwives on the labour ward at Tribhuvan Teaching Hospital, Kathmandu

Tuesday, 17 September 2013

What a week!

Time is flying so fast.  Haven't posted since Friday and so much has happened since then. We've been here a week and the days are getting busier and busier as we had towards our flights out on Friday.  I'm going onto Cambodia and there has been civil unrest there this week after July's elections, so I'm keeping a careful eye on the FCO website and keeping in close touch with friends in Phnom Penh - won't be taking any risks so don't worry about me!  Gillian will be flying home and I know Nepal will now hold a very special place in her heart - this trip has been full of wonderful, memorable moments making us very proud to be playing a part in developing the midwifery profession here.

The first ever midwifery conference in Nepal was a resounding success.  We both gave opening and closing speeches, and other presentations besides.  There were approximately 300 delegates and MIDSON did an amazing job of organising the conference - from registration packs, badges, freebie bags, certificates, trophies, souvenir publications... incredible to think that they have only been in existence as an organisation

 for 3 years.  It was one of the best organised conferences I have even been to!  The message was given loud and clear - Nepal needs midwives.  Midwives save lives.   Work together to change the law to allow midwives to be registered with a protected title. Finish developing educational standards that meet international standards and the country context in Nepal.  Be brave, make it happen without delay, and support the midwifery society.


Tracy, one of the GMTP Volunteer Midwives, arriving at the conference
Our fabulous Delicia giving an inspiring closing speech at the midwifery conference



















Now the conference is over, our Project Adminstrator Delicia has been helping MIDSON finish up,writing letters of thanks and settling finances, plus gathering information for our next report.   
Gillian and I have been meeting stakeholders, visiting hospitals where our volunteers have been working, gathering data to evaluate project progress to date, and making plans for the future of the project.  Today we toured Thaphatali Womens' and Children's Hospital (20,000 deliveries per year) where Gillian was able to donate lots of knitted baby clothes, handmade by Grannies in Scotland!
Gillian donating knitted baby clothes in the Kangaroo care ward
Dad in the Kangaroo-care ward having some lovely skin to skin time with his lovely baby - and modelling the Scottish Grannies' hand-knits!
We met with the Matrons, took tea with the Assistant Hospital Director, visited the medical library and then spent some time in the birth centre where Gillian saw her first birth for 18 years and wept buckets at the joy of it :)  We rejoiced in seeing the small but significant changes that our programme is making through the influence of midwife volunteers from the UK: screens around the beds for privacy, encouraging women to mobilise in labour, a relatively clean environment, delivering in a (sort-of!) upright position, no episiotomy performed even though the woman was a primigravida, and - most important of all - some kindness and compassionate care.
Birthing woman in an upright position, supported by her mother, with screens around the bed
This woman had triplets by normal delivery - no caesarean section!  Two head down, one breech.  The babies are still in SCBU but Gillian was able to give her 3 hats and 3 cardigans for when they're finally reunited with Mum

Cuties on the post natal ward
 
We also visited the very impressive one-stop crisis management centre in the hospital where women are referred (or self refer) with domestic abuse, rape, crisis pregnancy or other difficult situations.  Staff at the women's hospital work with police, social services, housing and others to find refuge and solutions for such women. 
 
We then had a very fruitful meeting at the Ministry of Health and Population with the Public Health Chief and Chief Nurse, advocating for midwives and the midwives association and encouraging the ministry to act without delay.  Also asked them if they will sponsor a midwife to attend the ICM Congress in Prague in June 2014.
 
After lunch at the Nepal Nursing Assocation, Gillian attended a UNFPA workshop and I went to interview Ishwori, Nepal's Chief Nurse and Registrar at the Nursing Council.  Had a slightly embarrassing moment when I fell asleep on the sofa!  The evening finished with a meeting of the Perinatal Society of Nepal, hearing about UNICEF's new programme to reduce neonatal mortality and the Nepal country plan.  Responded to one of the presentations with a recommendation that Midwives will meet many of the needs in the country plan and got a standing ovation!  They laid on a lovely supper then I returned to the hotel around 9.30 to have a cuppa with Gillian and Delicia before retiring to my room to deal with e mails and write the blog.
Meeting the Public Health Chief (second from right) and Chief Nurse (rar right) at the Ministry of Health and Population

 

Friday, 13 September 2013

Friday 13th - definitely a lucky day!

It's been an amazing, full-on, exhausting and exhilarating day - at the end of which I am sitting in a luxury hotel room after a hot shower, fluffy towels and even a pair of those hotel slippers!  We have moved into the hotel where the midwifery conference is to be held - a beautiful, grand hotel, full of olde worlde Nepali charm but very competitively priced and with facilities big enough to host 300 conference delegates tomorrow.

After a quick breakfast, Gillian and I crossed town to the Tribhuvan University Teaching Hospital to observe a Training of Trainers session being run by UNFPA.  The University is one of the five government hospitals training midwives and our project volunteers have previously been placed in the Hospital's maternity department to role model women-centred midwifery care.  They have also partnered with the midwifery teachers in the University, helping to develop them to be able to teach the new midwifery curriculum currently under development. 

The training was excellent, using a relatively new birthing simulator 'Mama Natalie'.  I unexpectedly ended up doing some role play, showing how encouraging upright positions in labour can encourage normal birth and prevent complications.  It brought a few laughs - I was glad I had worn a Salwar Chemise so I could maintain my modesty throughout some interesting manoeuvres with a chair and a birthing ball!

We enjoyed a tour of the University Library, and saw what books and resources they had (or did not have) for their teaching.  In a previous job I was responsible for ordering midwifery books and resources for the University Library - what a difference between the UK and Nepal. However, we were so impressed with the chief librarian, who is also the editor of the Nepal Nursing Education Journal.  It was great to see some midwifery contributions to the journal and a strong emphasis on women's health. 

We had lunch with the ICM's regional advisor for Asia, an amazing Afghan midwife who founded the Afghan midwifery association and is now helping to strengthen midwifery throughout the region. She has flown in for the midwifery conference and is closely linked with our project.  It was emotional seeing each other again - big hugs all round - and a privilege to introduce her to Gillian.  Lunches here are great - a takeaway box with a selection of different veggie curries, rice and pickles. Yum.

We moved hotels this afternoon and then all the visiting midwives and some of MIDSON staff were invited to the home of Kirsten, UNFPA Midwifery Advisor.  We had a beautiful Nepali meal, sat on the roof terrace with a view of the mountains, and spent some time gathering around Kiran (MIDSON's president) assuring her of our support over the next few days and trying to quell her nerves about the first day of the conference tomorrow.

Taxis home, and then met with Lesley Milne, a British Midwife Teacher/Researcher from Portsmouth who is here for 4 weeks on an RCM/WOW grant to research health worker's views about why women don't access midwifery care.  Lesley will be presenting at our conference and is also staying here in the hotel.  She's been working in quite rural/remote communities, often on her own, over the past few weeks so is glad of some company and English conversation.

I'm giving a speech at the opening ceremony tomorrow then have been asked to present someone else's research who is unable to attend the conference.  I hope I do it justice!  On Sunday, Gillian and I are doing a half-hour presentation on midwifery education in the UK so I'm hoping to get some time tomorrow to refresh my knowledge of the NMC standards for midwifery education!

I'm as ready as I can be.  I've had (my first ever) Facetime conversation with my daughter and my dog, and now I'm going to fall into that luxury bed and hope to sleep until the alarm rouses me tomorrow.  Thanks for following the blog everyone - hope you're enjoying it.

Thursday, 12 September 2013

Thursday in Nepal: a day of strikes and signatures

Ruth and Tracy, UK Midwife Volunteers, helping to prepare 300 delegate bags for Nepal's first midwifery conference, being held this weekend and supported by our project.

Me signing three hundred conference certificates of attendance!

Today there was a national strike to protest about the increase in fuel prices.  It was eerily quiet on the roads; no vehicles except emergency services, and very few motorbikes.  Our hotel is on a main road so breakfast seemed so peaceful compared to the usual cacophony of horns, whistles and trucks. No taxis or buses were running so we had a lovely walk to the Midwifery Society Office, about 30 minutes away from the hotel.  It was all hands on deck to prepare for the conference - finishing the programme, signing all the certificates, packing all the delegate bags, and writing speeches.  The MIDSON staff also had a small welcome ceremony for Gillian and I, presenting us with beautiful scarves, a folder of information, and an apple for good luck!  They bought us Momos (savoury dumplings with a spicy sauce) then shortly afterwards also gave us each a takeaway lunch box which was enormous - rice, curries, dahl, spinach, poppadums, chutney, yogurt...   Couldn't possibly eat it all but thankfully the Ruth and Tracy (UK midwife volunteers) arrived back from the maternity hospital in time to help us out!

I had time for a short chat with the Kiran Bajracharya, president of MIDSON, planning the rest of our 10 day visit here and making sure that we set enough sufficient time for everything that needs to be done. 

Tomorrow morning we will go to Tribhuvan University to observe a 'Saving Mother's Lives' workshop on Post Partum Haemorrhage being run by UNFPA before the 2 day midwifery conference starts on Saturday.  The conference is at The Shanker Hotel so we are moving there tomorrow to stay for the rest of our time in Nepal.  I have just looked at the website and realised that we're definitely going up in the world http://www.shankerhotel.com.np/.  This is certainly not the project's usual style but I will enjoy it whilst it lasts!

Still writing speeches and planning evaluation tools so time to sign off for today.  Thanks for following the Blog and lending your support.

Wednesday, 11 September 2013

Second GMTP Nepal Trip September 2013 - Day One

We arrived in Nepal at 3pm this afternoon and have our first meeting at 6pm.  Little rest for the wicked!  I'm here for the second time in my role as Global Midwifery Advisor to the Royal College of Midwives' Global Midwifery Twinning Project.  I'm travelling with Gillian Smith, Director for the RCM in Scotland.  For this project, Scotland is twinned with Nepal.  Senior Scottish (and some English) midwives volunteer here for periods of 2-4 weeks, helping to grow the midwifery profession and midwives association in Nepal, in addition to the workshops that occur every six months developing different aspects of midwifery regulation, education and association.  Gillian has a crucial role in the project, helping to orientate volunteers and others, supporting the project's activities and relationships, and promoting Nepal and the Twinning Project in Scotland.  I'm delighted she's here with me to see the project for herself and to develop a deeper understanding of the context of midwifery in Nepal.  She is also blogging during this trip so you can follow her at http://midwife4scotland.wordpress.com/

This coming weekend Nepal will be holding its first ever midwifery conference with almost 300 delegates. Gillian and I will be giving a couple of speeches and chairing some sessions, plus doing lots of networking with officials, agencies and key people involved in trying to get midwifery education and regulation off the ground in Nepal.  At present there is no separate midwifery registration or direct entry course and we have been contributing to the effort to establish these as quickly as possible, and to get midwives on the ground, saving lives.  Nepal has been working hard to reduce its maternal mortality rate through training skilled birth attendants (a short crash course in emergency obstetric care) but there is good evidence that midwives are the long term solution http://www.unfpa.org/sowmy/resources/docs/main_report/en_SOWMR_ExecSum.pdf

We also hope to undertake some evaluation of the project at this, the midway point, so we have a busy schedule lined up. My colleague Delicia, our project administrator, is also here with us helping MIDSON (The Midwifery Society of Nepal) to organise the conference  and two UK midwife volunteers are here supporting local midwives alongside us. The Asia Advisor for the International Confederation of Midwives will also be here for a few days - she's an amazing, inspirational midwife from Afghanistan who I met on my first trip here.  We're hoping to have a good time all together but, more importantly, to make a difference.   I will then fly on to Cambodia to do the whole process again, and will be away for a total of 3 weeks. 

Organising a trip like this takes a huge effort.  Aside from the hotel and flight bookings, currency, phone, packing and other resources required, family life in the UK continues as normal.  Dogs need walking, daughter transporting to various activities, meals cooking, church and other commitments covering... and the family needs loving and nurturing.  I am immensely grateful to my wonderful husband Stephen for being such a great Dad to Hannah and for supporting me in my role, but also to our parents, dog walkers, family and friends who help out in various ways, to those who follow and encourage me via Facebook and Blog, colleagues who hold the fort and answer emergencies queries from afar, and those who love, pray and send good wishes.  It wouldn't be possible without you.

Dhaka Diary

I'm back in Dhaka (Bangladesh), five weeks after my last visit in July, to help facilitate the first ever online election of executiv...