Talking about mental health

Earlier in this blog I spoke about my experience of PTSD after a year of war-zone living.  I recovered thanks to a strong constitution, provision of the right friends and family at the right time and a community of faith.

Yesterday I found myself at the bedside of a young man, my friends' son, hospitalised following a heroin overdose after years of poor mental health and devastating alcohol dependency.  Despite his loving family, such complex needs and the power of addiction engender a sense of hopelessness and make recovery seem very far off.. Troubled after my visit and hurting for all involved, I was drawn to the Sunday evening worship at our local church.  This service provides a quiet space to reflect on the week just past and find strength for what lies ahead.

The chosen Bible passage,  Ezekiel chapter 34, seemed to speak directly into this difficult situation:

"I myself will look for my sheep... I will bring them back from that dark and disastrous day.  I will lead them back... I will let them graze in safety.. and I will find them a place to rest.  I will look for those that are lost, bring back those who wander off, bandage those that are hurt and heal those who are sick".

Returning home to meet our youth group, I felt compelled to talk about mental health with these young people, currently facing exams and the stresses and strains of teenage life, to let them know they can talk about depression and anxiety and ask for help.  It was one of the best sessions we have ever had, sharing ideas about 'What is health?' and challenging the constructs of normality and abnormality that seem to reinforce taboos and stereotypes.  It was encouraging to hear of passionate individuals in local schools providing safe spaces to talk about mental health; to note these wonderful young adults explain how they support their friends who have anxiety or depression by listening and signposting them to sources of help. We talked through how to recognise when you or others might be struggling and how to access support. Finally, we reflected on our shared faith and how this can provide comfort and meaning.

For further stimulating reading on mental health I can recommend this excellent blog Salomons' Blog to which my sister Anne Cooke, a clinical psychologist, is a regular contributor.

Home but not yet over!

The ICM Congress in Prague finished on Thursday and I have returned home for a brief weekend with my family whilst our twinned midwives from Nepal, Cambodia and Uganda visit Scotland, the north of England and Wales/Northern Ireland respectively, each to their own twinned countries.  I am enormously grateful to my RCM colleagues and some of our returned volunteer midwives for arranging both accommodation and clinical/academic visits for their twins, giving me a little window to share a sunny Sunday lunch with my extended family, walk my dog in the nearby nature reserve and catch up on some sleep.

Catching up with former colleagues from St Thomas Hospital /Kings College London at the RCM Stand

It's hard to put into words what an amazing experience it was to be with over 3,000 midwives from across the world in Prague, to reunite with friends and colleagues from the past 30 years and to share this adventure with amazing midwives from the RCM and from our twinned countries.  At times I felt like a frazzled tour guide, making sure that everyone was where they needed to be at the right time but it was just fantastic when it all came together.  One of the loveliest moments was when one of MY midwifery tutors, who has just edited the new Myles Textbook for Midwives, presented a signed copy (paid for by our project) to each of our twins.  These midwives are all teachers in their own countries and will be able to make such good use of this important resource.  I have been to the libraries in their teaching schools and many are still using 1970s and 1980s editions as it's all they have. Jacque Gerrard, RCM England's Director, gave each twin a beautiful RCM badge and the Cambodians presented Louise Silverton, Jacque and Jayne with traditional hand-woven Khmer Kramas (cotton scarves).

Author and editor Dr. Jayne Marshall presenting signed copies of the 16th edition (just published) of Myles Textbook for Midwives to our twins from Cambodia, Uganda and Nepal

Louise Silverton, RCM's Director of Midwifery, receiving her Krama

Sadly, despite all of our best efforts (Jacque sat in the visa office all day on Wednesday) we were unable to get a visa for Mary from Uganda to visit the UK so when everyone flew out of Prague on Thursday and Friday, Mary stayed behind to board a plane back to Entebbe on Saturday.  She touched us all with her gracious and godly response to such a disappointment.  I accompanied her to Catholic Mass on Thursday morning in Prague and she took great comfort from the rituals of her faith.  Thankfully we have three UK midwives currently in Uganda so I have asked them to help Mary reflect on her experience in Prague and to surround her with support.

I will be staying at a hotel in London with our twins this week as we travel to Oxford on Wednesday for the RCM's annual event and Zepherina Veitch Lecture by Professor Debra Bick, hold the final day of our GMTP workshop on Thursday and then the formal board meeting on Friday before everyone flies home at the weekend.  It will be the first time in the history of the programme that everyone is together for the board meeting and Mary hopes to join us by Skype.  I will be glad when this very busy period is over but it has been an incredible, enriching and exciting experience and feel so privileged to do the job I do with such fantastic people.

With Mary and Sarah in Prague

Does your friend bite?

Those of a certain age may remember Peter Sellers in the famous Pink Panther sketch 'Does your dog bite?' Does your dog bite? .  There are plenty of dogs here in Prague but thankfully none have bitten me.  However, I can't say the same about my midwifery friends!  A Ugandan midwife that I have come to know during my travels was so pleased to see me that she bit me after first giving me a bear hug and a very painful pinch.  A true sign of love apparently. I'm grateful to have been wearing a robust shirt so she didn't break my skin and realise that, however well-travelled, I still have much to learn about cross-cultural communication!

With Florence (left), Prof. Ann Thomson and RCM Wales Director Helen Rogers in Uganda, April 2014

The story of my growing friendship with Florence (the biting midwife) provides a snapshot of what our twinning project is achieving in Uganda.  Florence is the Chair of the Midwifery Chapter of the Uganda Nurses and Midwives Union. Until recently the Union focused mostly on nurses and did not provide a voice for midwives.  Florence had little power within the organisation.  As its twinning partner the RCM chose the Uganda Private Midwives Association (a rival to the Union) which had more potential for development and more capacity to manage UK volunteers.  However, our clear purpose was  to strengthen midwifery through working with all stakeholders in country.  Concurrently, the UNFPA's midwifery advisor and the Ministry of Health in Uganda had been encouraging all the midwives associations (there are at least four!) to join together and speak with one voice.  However, such discussions were politically and emotionally charged and had to be protected with armed guards, such was the strength of feeling.

In September 2012 our first project workshop brought the Association and the Union together with others invested in midwifery to assess their capacity and identify areas for development over the 3 years of the Global Midwifery Twinning Project.  This was a landmark moment for both organisations and Florence joined the meeting to make an action plan for her midwifery chapter. However, there was still tension and rivalry.  On my first visit in April 2013, together with our country directors for Wales and Northern Ireland we visited the Union but were not given access to Florence to discuss midwifery.  Meanwhile, the president of UPMA was doing her best to build bridges, inviting Florence to join in midwifery events and advocating on her behalf with the Union.  The breakthrough came in October 2013 when, as requested by UPMA, the Royal College of Midwives brought all of Uganda's midwifery stakeholders together for an advocacy workshop - you can read, see and hear about that in my earlier blog: The Sound of Singing in Kampala. Florence was a key player in that workshop and since then both Union and Assocation have been working hard to move and cooperate together. Mary and Florence have become great friends. They have attended many events together and joined up in celebrations such as International Day of the Midwife.

With Mary and Florence at the GMTP Advocacy Workshop, October 2013 in Kampala

At a landmark symposium on 4 May 2014, just before International Day of the Midwife, all midwifery associations agreed to come together in a midwifery task force to have one voice for midwifery in Uganda. Florence and Mary are both here in Prague for the International Confederation of Midwives Congress and there is plenty of love being shared.  And biting.

Last night, at my invitation, Florence and Mary attended the RCM's evening reception in the conference centre and met with midwives from Northern Ireland and Wales, their twinned countries.  Only afterwards did Florence confess she was not confident to travel alone to her hotel on the other side of Prague.  So, I found myself alone with my gnashing friend, braving the metro system and trying to keep my distance (unsuccessfully... I got plenty more pinches but thankfully no more bites).

Czech travel buddies: Midwives on the Metro

As we said goodnight she gave me several huge hugs, looked me in the eye and said 'Love, pure love, that is all I can say' then prayed several prayers of blessing over me, my husband (who she met a few weeks ago in Uganda), my extended family and all of the midwives in our project.  Florence is now fully on-board with the midwifery agenda in Uganda and the Union is realising the power of partnership.  Let's hope that as the new midwifery task force finds it feet the voice of midwives will grow stronger to influence midwifery education and regulation, developing and nurturing the midwifery associations within it.  Global Midwifery Twinning - we love it.  Gnash Gnash.

ICM's techincal midwifery advisor Pashtoon explaining the role of Midwifery Assocations as one of the three pillars in yesterdays Prague workshop

Together in Prague: Moments in History

Our Global Midwifery Twinning Project is linking midwifery associations in Uganda, Cambodia, Nepal and the UK. Yesterday was the first time all four associations had come together since the beginning of the project two years ago.

The moment all the twins arrived in Prague - two year's work and relationships coming together.  

Gathering a day before the ICM Congress began, at a workshop facilitated by an external facilitator, we began the process of telling our stories, coming to a shared understanding of where we have come from, where we are now and where we would like to go together.

Back: Jacque Gerrard, Director for RCM England; Delicia Egboh, Project Administrator, RCM UK; Cathy Warwick, Chief Exectuive, RCM UK; Louise Silverton, Director of Midwifery, RCM UK.
Middle: Ishwori Dewi Shrestra, Chief Nurse/Midwife, Ministry of Health and Population, Nepal;Sarah Namyalo, Ugandan Nurses and Midwives Council and UPMA; Yeath Thida, Midwife Educator and Cambodian Midwives Council Executive; Oung Lida, Vice President, Cambodian Midwives Assocation; Mary Garrot Musoke, President, Uganda Private Midwives Assocation; Kiran Bajrachriya, President, Midwifery Society of Nepal
Front: Joy Kemp, Global Professional Advisor, RCM UK (Me!); Lesley Page, President, RCM UK

It was a beautiful and inspiring time, getting to know one another, listening to our partner associations talking about the successes and challenges of furthering the work of midwives where they are, crying and laughing together and sharing a meal.  I was especially grateful to the three RCM directors and our president who set aside the day, in the midst of this enormously busy time, to understand the project better and to deepen the relationships with our partners.  We will have a follow up workshop in London on 12 June, after our twins have completed their UK tours!

Kiran and Mary reconnecting (Nepal and Uganda)

Jacque (England) and Mary (Uganda)

Viewing the overview of the project I have put together for the exhibition stand

Kiran presented all partners with a special Midwifery Society Calendar from Nepal

Sarah and Delicia chatting over lunch (RCM UK and Uganda)

Our meal together

We had to miss dessert in our rush to attend the 'Voices of Midwives' Event in Kampa Park - an attempt to break the World Record for the number of midwives singing together at any one time!  3000 midwives in the sunshine joined in once voice - a spine tingling moment.  Here's a little video showing Jacque Gerrard and Cathy Warwick dancing and singing, and two of our friends from Cambodia getting into the groove!Voices of Midwives singing in Prague

At the Voices of Midwives Sing-a-long: Jacque Gerrard (RCM Director for England) and me with the Cambodia Contingent: Pros, Lida, Thida and Mme. Ing Rada

Another theme of our time here has been people borrowing my glasses to read the conference programme, menus and the map of Prague, which has the most ridiculous small print.  Here's Mary and Gail sporting my £3.99 specials!

Today the congress proper started with over 3000+ midwives from all the world joining for an inspiring opening ceremony.

Amazing flag ceremony - the moment when Mary brought in the Ugandan flag.  I cried when Lida paraded with the Cambodian flag - it's so wonderful that they are here

RCM President Frances Day-Stirk giving the opening address

Those midwifery associations involved in twinning have clubbed together for a Twinning Stand in the exhibition.  It will be a focal point for anyone involved in or interested in twinning.  It proved to be a great meeting point after the opening ceremony, with midwives from Laos delighted to see our twins from Cambodia, swapping business cards and planning to meet up again in due course.

With Thida and Lida, our Cambodian twins, at the twinning stand

Our display at the twinning stand

Tomorrow the scientific sessions start in earnest.  Linked to Prague's beautiful bridges, tomorrow's first session is 'Bridging midwifery and women's health rights'.There are presentations from all of our three twinned countries so I'll be dashing around the congress centre in an atttempt to get to every one!  Hopefully this has given a flavour of this exciting and inspiring event.  More blurb from Bohemia in the next installment.