Saturday, 8 November 2014

Midwifery leadership and a mini-strike long before the RCM's!

This week in Nepal I was privileged to spend some time with a retired midwifery leader.  She prefers not to be named so we'll call her Momo, the Nepali lunch-time snack we were eating whilst she told me this story.

Momo was matron of a busy maternity unit.  Under her leadership, midwives started to perform vacuum deliveries, an essential life-saving skill for midwives who would be going out to work in rural areas with no back-up.  For three years midwives had a faultless track record, performing vacuum births with much better outcomes than their medical colleauges.  Then, one busy day and one difficult delivery with the cord tight around the neck, a baby died during a vacuum birth. The woman's visitors complained.  Doctors and others blamed the midwives for the death.  The hospital director was unsupportive, sending the visitors to Momo's office. Momo had a difficult three days trying to support and protect her staff, not helped by vitriolic TV propaganda against midwives.  Momo drew staff together in her office and they all agreed to a 'mini-strike' or 'work-to-rule' until the issue was resolved.  No midwife (or nurse midwives as they are in Nepal) would do anything other than basic care - no episiotomies or repairs, no IVs or oxytocin etc.  Everyone stuck together.  If a doctor asked them to perform any extra task the midwives apologised but said he would have to discuss this with Matron as they were not allowed to perform extended roles.

After 24 hours of the work to rule, Momo was called to the Hospital Director's office.  The doctors couldn't cope and the maternity ward was in melt-down.  The director accepted that the death could just as easily have happened with a doctor performing the vacuum delivery. Momo scolded the director, asking her why she could not have just taken this stance at the outset, avoiding all the difficulties.  Midwives returned to their usual roles and have never since had anyone questioning their right to perform vacuum deliveries (according to the ICM, one of the additional skills a midwife  may be required to have  to make the difference in maternal and neonatal outcomes in their country).  

Some time later, Momo felt the staffing her maternity unit was dangerously low with only 5 or 6 per shift to cover the whole unit including for 30 labour/delivery beds.  She wanted to double this to 11 staff.  After weeks of unsuccessful campaigning she told the hospital director  she would close the maternity unit unless the staffing increased.  And so it was agreed!

What a great example of leadership.  It just goes to show that the RCM were not the first to host a midwives' strike!

Saturday, 1 November 2014

Here, there and everywhere

My good intentions about blogging every few days whilst overseas have failed to come to fruition in the last few weeks. Apologies!

I was in Cambodia from 18th-28th October, monitoring the progress of the Cambodian Midwives Association and facilitating a 2 day workshop in which they assessed themselves and reported back on various project activities.  It was encouraging to hear about the Kompong Cham local branch that has increased its membership three-fold since the start of the Global Midwifery Twinning Project. Also encouraging was a report from the midwifery training school in Kampot where three cohorts of GMTP volunteer midwives from the UK have been based.  Their efforts have been much appreciated. Thida, a senior Cambodian midwife teacher, gave a great presentation on the impact of her trip to Prague and the UK with our project and her increased confidence since returning.  She has recently been promoted and will be in a key government position to influence midwifery in Cambodia.  I'm sure our project has contributed to her development.  In this picture she is standing to the far right in a black suit.

GMTP Workshop, Cambodia - October 2014
I also conducted many stakeholder meetings, mostly with Mrs, Chea Ath, President of the Cambodian Midwives Association.  In the picture she is directly to the left of me in the pink & yellow blouse. On the last two days I attended a WHO workshop on accelerating the reduction of newborn mortality in Cambodia.  Midwives will play a very significant part in achieving this.  I had formal meetings with:

  • National Maternal and Child Health Centre
  • Partnering to Save Lives Cambodia
  • Gender and Development Cambodia
  • GIZ (German version of DFID)
  • WHO
  • URC

I also met up with various individuals living and working in Cambodia to help understand recent changes in the cultural context.  I attended both the Anglican Church of Phnom Penh, and the International Christian Fellowship. These were good opportunities to catch with friends I used to know when I lived in Cambodia, and sometimes to meet some useful contacts!  Of course, the spiritual encouragement is also important, far away from friends and family.

I then went onto Colombo (Sri Lanka) where I met with Kiran Bajracharya, President of the Midwifery Society of Nepal. Kiran was giving a presentation about midwifery in Nepal at a regional conference for obstetricians and gynaecologists.  My role was to support Kiran and for us both to plan next week's workshop in Nepal together.  We had a good time staying at the local YWCA where the hospitality shown by manageress Dipani and house-boy Suresh was outstanding.
Dipani and Suresh, staff at the YWCA Colombo
With Petra ten-Hoope Bender from the State of the World's Midwifery Team, Kiran and the other presenters of the midwifery symposium at SAFOG conference 2014
So, now I have arrived in Nepal and will be here for one week, facilitating a similar workshop to the one held in Cambodia last week.  Right now I'm heading for bed as I missed out on a night's sleep last night due to unsociable flying hours.  I've just managed to join in a family gathering by Facetime and speak to my parents, my aunt, my sister and her husband, my cousin and my daughter.  My sister is making my cousin's wedding dress so it was great to be there virtually for the fitting.  I am so grateful for the internet which makes keeping in touch, and keeping others up to date if they are interested, so much easier.  After years of living overseas with only airmail letters I never take it for granted.


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