Thursday, 21 January 2016

If you want to go far, go together

There is a Ugandan Proverb that says: 'If you want to go fast, go alone; if you want to go far, go together'.  We've had to constantly remind ourselves of this during the past week at our MOMENTUM project workshop where the Royal College of Midwives' UK consultants came together with their Ugandan counterparts to develop a shared understanding of mentorship, explore some teaching and learning theories, consider the context of Ugandan midwifery (where maternal mortality is 438:100,000 compared to 9 in the UK and 4 in Sweden) and finalise workplans for the next 5 months.  It's all too easy for us to fly in, require our partners to drop everything to escort us around and attend our workshop, and expect our plans to be their top priority.  We can tend to be results and outcomes driven, rather than learning from our twins about the importance of relationship, of respecting cultural traditions and putting family first.  We try to remember that that building capacity and relationships comes first and the project outcomes second.  It's tough to do that though, especially when the days in-country fly past at an alarming rate.

UK midwife consultant Liz Bannon, with her counterpart from the Ugandan Nurses and Midwives Council, Mercy
UK midwife consultant Kade Mondeh, with two of the midwifery students who hope to benefit from better mentorship through their placements in our project pilot sites
Its fabulous being here with such a great team of experienced and knowledgeable RCM midwives. Everyone is getting along famously and in many ways it reminds me of my first overseas posting to Cambodian refugee camps in Thailand where I was part of a big team and made life-long friendships. Here we've eaten together most nights, debriefing from our busy days, identifying opportunities and challenges and sharing many laughs.   Due to a mix-up with bookings, my colleague Eleanor and I have left the team guest-house and de-camped to the hotel next door where we both have huge rooms but everything is dysfunctional including the water which is liquid mud and the breakfasts which offer plantain stew, goat, liver and lurid pink sausages as well as toast and eggs.  Thankfully we can laugh about it and I do occasionally sample the Ugandan options at breakfast with mixed results.  We have made it though a week's worth of Ugandan workshop lunches which are carb-heavy and rather samey but generous nonetheless.  Looking forward to going home and eating salads!
This is why I usually decline the fish

Eleanor and I will depart for the UK on Saturday evening, leaving our UK consultants to work with their twins for a further 2 weeks.  During the workshop the changes that we want to see have been identified and some of those barriers to change such as cultural beliefs which we explored using more proverbs.  We shared proverbs from the UK such as 'The leopard can't change its spots' and 'You can't teach an old dog new tricks' and the Ugandans shared one of their own: 'You can take the girl out of the village but you can't take the village out of the girl'.  Achieving change can be challenging when a culture believes that change is not possible.  However, we all agreed that we don't have to accept such sayings and that with support and friendship midwives can change the way they work and adopt new practices.  We've also had lots of singing, dancing, role play and prayers!
Brainstorming around the Lancet Midwifery Series for the Ugandan Context

Teaching how to tie a reef knot using the 4 stage technique, a simple strategy for learning on your feet at work, facilitated by RCM consultants and midwife teachers Aine Alam and Hilary Patrick,
Our first action-reflection cycles have been identified and the activities agreed upon.  Communication strategies have been drawn up for twins to communicate via E mail and Whatsapp and the M&E tools are being developed as we speak.  Bridges have been built, tea has been taken, speeches have been made and much coloured paper stuck on walls.  I'll be back in June for the next workshop and to visit each project pilot site.  Hopefully we'll find that progress is being made.  I shall close with a few more pictures from our workshop and one of the new frock!
Making workplans

Using the Lancet Midwifery Series (2014) Framework to identify what care women need in Uganda

RCM consultant Sue Deakin (left) and Global Projects Officer Eleanor Shaw (right) in disucssion with Ugandan colleagues about the skills that women need their caregivers to have in Uganda

The new frock!

Friday, 15 January 2016

Negotiating Access for Action Research

I’ve now been back in Uganda for over a week and the team is growing.  Eleanor, the RCM’s Global Projects Officer, arrived on Thursday and tomorrow we will welcome Dr. Lucie Byrne-Davis and Dr. Jo Hart from Manchester University’s ‘Change ExchangeProject’ who are working alongside our MOMENTUM mentorship action research project, helping us to maximise the effectiveness of health behaviour change interventions.

Due to double-booking at the lovely Emmaus Guest House, and to enable our UK midwifery consultants to stay together as a team, Eleanor and I have moved out to the ‘Christian Glory Guest House’ down the road.  So far it has been rather un-glorious but it’s only a bed – we are taking meals with the team and out all day.
View of Lake Victoria from Emmaus Guest House this morning
Our consultants headed out to their project sites for the past two days, meeting their ‘twins’ with whom they will work together, face to face and remotely, for the next 18 months and seeing the context, opportunities and challenges of their workplaces.  We’re experiencing the reality of negotiating access to sites, especially where information is not shared and access must be assured at many different levels.  However, due to the tact and diplomacy of our consultants, based on their many years of midwifery experience, everyone has built good relationships and gained engagement with  the project.   Meanwhile, Eleanor and I have been working with our Ugandan Partner Midwifery Association to plan next week’s workshops and meet more important stakeholders at a national level. We now have a workshop  programme and everyone will spend the weekend preparing the sessions they are leading as well as getting some R&R.  Trips to the nail salon and supermarket, swimming and ice cream have been mooted along with a desire to try some different churches including Catholic Mass and the Anglican Cathedral service on Sunday.  I suspect some may also spend Sunday morning catching up on sleep!

With Aine Alam (in white), meeting Agatha (in red) who trained as a midwife at Lewisham and Pembury Hospitals in the 1960s. Now in her 70s she's running a private midwifery home in Uganda, is a member of the Private Midwives Association and was renewing her license at the Nursing and Midwifery Council when we bumped into her.

We had excellent meetings today with a Nursing and Midwifery School Principal who is also Chair of the Nursing and Midwifery Council, a Professor of Nursing and Midwifery who is the Chair of the NMC’s Education Committee and the Assistant Director General at the Ministry of Health who appeared equally interested in Northern Irish Politics as he did our programme!  It’s great to have buy-in from these very important individuals and we hope they will attend the opening day of our workshop to give their blessing.

With Liz Bannon (one of our team who has worked for the Nursing and Midwifery Council in the UK), Mary from the Uganda Private Midwives Association, me and Sister Stella, Chair of the Ugandan Nursing and Midwifery Council and Principal of the Nsambya Catholic School of Nursing and Midwifery.  A formidable nun!

Next instalment in another few days.  Meanwhile, thanks for reading.

Saturday, 9 January 2016

Building MOMENTUM in Uganda

Checking in for my flight at 4am - British Airways no longer fly direct to Kampala so this time I flew with Brussels.  Good leg room and a spacious seat, strange food and lots of turbulence.  Overall impression: OK but please make the skies smooth, I don't like bumps, however seasoned a traveller I may be!
I'm back in Uganda, my 7th stay here since joining the Royal College of Midwives 3 years ago and so in many ways it feels like coming home.  Our new MOMENTUM (Developing a MOdel of MENTorship for Ugandan Midwifery students) project will be officially launched next week and tonight 7 UK volunteer midwife consultants, members of the RCM, will be arriving for four weeks to take up their roles in supporting the development of midwifery mentorship in Uganda.  In the first week they'll be meeting their Ugandan 'twins', seeing the challenges they face and gathering some baseline data.  Some will be in Kampala but others will be based at hospitals, clinics or Universities further afield.  The following week we will all come together for a workshop to launch the programme with various dignitaries, to share ideas, identify challenges and opportunities and set workplans for the next year.  I'll be leading the workshop with our partners, the Uganda Private Midwives Association.  It will be very participatory with contributions from everyone and (if previous experience is anything to go buy) will involve lots of flipchart, coloured paper, blu tack, singing and prayers!  Even meetings in government offices and at the Nursing and Midwifery Council  start and end with a prayer.  I can't see it catching on in the UK....  For their final two weeks our volunteers will be working with their twins in their workplaces.

The calibre of our UK volunteer midwives is exceptional.  To work with the Ugandan Nursing and Midwifery Council on developing a national standard for midwifery mentorship comes Eliz Bannon from Northern Ireland; Eliz is recently retired, giving her an opportunity to do something different. She has worked for the Nursing and Midwifery Council in the UK and has held many other senior health service roles in addition to close links with the RCM and we are so lucky to have her associated with our programme.  Another MOMENTUM workstream is the development of a work-based learning CPD module to train midwives as mentors. Again we have two exceptional UK midwives to lead on this; Hilary Patrick, a Lead Midwife for Education in Scotland with loads of curriculum planning experience and a previous placement in Nepal with our Global Midwifery Twinning Project in 2014; also Aine Alam, a midwife and teacher from Kent who is currently completing her PhD in work-based learning and has recently published a book on midwifery education aimed at low-resource settings.  Aine has undertaken 2 previous placements in Uganda with the RCM, helping to develop a Midwifery Masters Programme, and is also an RCM Union Learning Rep.
Left to right: Patricia Cosgrove, Kade Mondeh, Helen Rogers (RCM Director for Wales), Joy Kemp (RCM Global Professional Advisor), Eliz Bannon, Cathy Warwick (RCM Chief Executive), Eleanor Shaw (RCM Global Projects Officer), Aine Alam, Sue Deakin, George Castle, Breedagh Hughes (RCM Director for Northern Ireland), Hilary Patrick
The MOMENTUM project will also link with four clinical pilot sites to improve the quality of mentorship in practice.  These sites have been chosen in conjunction with the Ministry of Health and include public, private and faith-based services, reflecting the different health sectors in Uganda. Four UK midwives with expertise in clinical mentorship will link with these sites.  George Castle from Berkshire is a Practice Development Midwife and RCM steward who has previously lived and practiced as a midwife for many years in Uganda, bringing much local as well as professional knowledge.  Kade Mondeh, a consultant midwife in London, has years of Practice Development and midwifery leadership experience.  Sue Deakin from Yorkshire has a previous placement with the RCM in Uganda, several other overseas postings and years of experience as a practice learning facilitator in the UK to draw upon.  And last but not least, Patricia Cosgrove from Northern Ireland is an experience Practice Education Facilitator who participated in the Global Midwifery Twinning Project in Uganda in 2014 and assisted with the needs assessment for the MOMENTUM project. I have every confidence that these seven individuals, working with our Ugandan Partners and supported by the RCM, will make a huge difference to the experience of student midwives in Uganda and ultimately improve the quality of care available to women and babies.

Due to lack of flight availability I've had an additional two days in Uganda before everyone else arrives. It's enabled me to rest and prepare my mind for the next two weeks, to stay with my school friend Deborah in her spacious and peaceful home on the outskirts of Kampala, and to catch up with e mails.  I hope to blog again as this trip continues; meanwhile, thanks again to my husband Stephen and daughter Hannah for releasing me so generously, to all who offer lifts, meals and dog-walking whilst I'm away, and for all who support this work in so many other ways.
A game of Banangrams with Deborah last night - thanks to my friend Manda for the Christmas Present!

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...