New job, new life, new reflections

I’ve made it through my first week in Bangladesh! 

It was emotional leaving my family just a few days after the death of my wonderful mother-in-law.  A huge thank you to all of my family and friends for supporting my decision to continue as planned and for all the practical help and messages of support received.  

With Stephen and Hannah at the airport

A tearful goodbye

With my mother in law Jean and Hannah back in January

The journey to Bangladesh was uneventful except for the delay of one suitcase which arrived promptly the following day.  I have received a warm welcome from hotel staff (I’ve stayed in this hotel many times before), from previous colleagues at the Bangladesh Midwifery Society and from my new colleagues.   A local friend came to my hotel on arrival, with a jar of her husband’s home-made mango chutney.  On my first day at work, new colleagues in the SRH team presented me with beautiful flowers and we shared singara, savoury pastries similar to samosas. The midwifery team also presented gorgeous flowers and we shared lunch and snacks together, including the delicious mangoes that are now in-season.  At yesterday’s all-staff (120 person) meeting there was a huge birthday cake to celebrate those with birthdays this month (including me!) and today some staff members brought in more singara and a shared lunch of mutton biryani and borhani – a type of lassi dessert.   The desired intention to lose weight whilst I’m here is being severely challenged! 

Flower and snacks from the midwifery team

Informal Thursday biryani party with colleagues

Highlights of the week include getting my new work e mail, ID badge and local mobile phone set up, joining a social club and having my first swim, making some lovely friends from the office car-share and looking at some apartments to rent. I’ve found a flat that looks promising and I’ll make a decision next week once I’ve seen a few more for comparison.  Social media is proving invaluable in finding properties and a national friend is kindly accompanying me for viewings to ask all the right questions.  I’ve also done lots of online training and form-filling and have begun to get a handle on who’s who and what’s what.  My office is on the 15^th floor of a tower block with great views across Dhaka and a canteen in the basement selling cheap but tasty local food. Lovely ladies keep me supplied with tea, coffee, chopped salads and prepared fruits - no problem getting my ‘five-a-day’! I also attended an informatiive event on the prevention of gender-based sex selection (again with a nice lunch!)

Welcome flowers from the SRH team

With Momtaz

With Sharmin

I’ve been reflecting on the first time I lived abroad (1988), when we relied on letters home once a week and occasional (very expensive) landline telephone calls, and the ease with which I can now keep in touch with family and friends through WhatsApp, Facetime, e mail and various other means. It’s been great to have a few video calls and to see the photos and videos of everyone’s exploits.  I’ve also had some encouraging e mails and messages from RCM colleagues which have been much appreciated. 

So, all in all, a good start.  Am I homesick?  Yes, especially knowing it’s a tough time for my family, but I’m feeling well-loved and supported, excited to be here and ready for the challenges and opportunities ahead.

Saying goodbye to Mum

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 executive officers for the Bangladesh Midwifery Society which is twinned with the Royal College of Midwives.  I am the Project Leader for this twinning project which builds on the RCM's previous twinning work with midwives associations in Cambodia, Uganda and Nepal.

Selfie with staff and executive committee members of the Bangladesh Midwifery Society

The government of Bangladesh is to be congratulated on its commitment to midwifery, a new profession here.  The first ever international-standard midwives were deployed into government service on 1st July and midwifery education only started in 2013.  The governments of the UK, Sweden and Canada are funding a national strengthening midwifery programme through the Ministry of Health and Family Welfare and coordinated by UNFPA.  Our twinning project is a part of this, aiming to develop midwife leaders to advance the profession.  The International Confederation of Midwives suggests that midwifery has three 'pillars' - education, regulation and professional association.  So our work is vital to develop a strong midwifery profession.  Other implementing partners in the Strengthening Midwifery programme include Save the Children, the Obstetric and Gynaecological Society of Bangladesh, UCEP and Dalarna University. Through these organisations midwife teachers are being supported and developed, newly qualified midwives are being mentored, and health facilities are being upgraded along with skills and language labs and academic libraries.  The scale and scope of the programme is impressive and this afternoon we were all called to a meeting to update each other and high-ranking ministry officials on progress towards our objectives.

Jesmin and I felt relaxed presenting together, having honed our presentation skills in Dubai last week at the International Confederation of Midwives Regional Conference for Asia.  The conference was a wonderful opportunity, not only to present our twinning work from Bangladesh but also to catch up with twinned partners from Nepal and Cambodia and the wider ICM community.  We were honoured with a visit from Princess Muna al-Hussein, a global ambassador for nursing and midwifery.  I was also delighted to have the company of my daughter Hannah (19) in Dubai.  I've been away from home for almost 3 months with travel to Bangladesh and Uganda, so it was great to catch up, sharing a room and experiencing the sights of Dubai together.  We watched a movie in the cinema and wandered around shopping malls, things we never get a chance to do in the UK. 

With my daughter Hannah at Dubai Mall

Kiran from Nepal and Chea Ath from Cambodia - previous twinning partners of the RCM and both presidents of their respective midwifery associations

Once the elections are over in Bangladesh, we will be focusing on supporting the new executive committee, whilst honouring the contributions of the outgoing executive and ensure a smooth handover.  We will be evaluating the first phase of the project during the next quarter and planning for a further three years of partnership.  We are also interviewing for a new RCM Global Projects Officer, to be other half of my team, on the day after I return from Bangladesh so hopefully I can fight the jet-lag and stay awake for the duration of the interviews!

Tragedy today in Uganda

I'm in Uganda for a month, helping to mentor some midwives who are leading palliative care services in Mbale (Eastern Uganda, near the Kenyan border) and furthering the RCM's twinning partnership with the Uganda Private Midwives Association.  I'm currently up-county in Mbale - 6 hours away from Kampala - seeing where my mentees work and getting a flavour of the challenges they face on a daily basis.

A bit old - of course Zaire is now Congo

Today we went out on a field visit to a remote district reachable only on a bumpy dirt road - to see Esther in action mentoring health professionals she had previously trained in palliative care.   On arrival we were told by the Nurse-in Charge that unfortunately one of their nurses was gravely ill with eclampsia and an ante-partum haemorrhage.

With the Nurse-in-Charge and the Hospital Administrator, District Hospital - at the foot of Mount Elgon

The nurse, 7 months pregnant, was found to have proteinurea last week and had been placed on sick leave.  Today, she arrived at the hospital in the morning with seizures and vaginal bleeding.  They sited an IV with difficulty and gave magnesium sulphate but were unable to perform a Caesarean Section (despite having an operating theatre) because the only doctor was absent.  She was therefore transferred to Mbale, an hour away on that bumpy road.  The hospital has an ambulance but it had no fuel, so they had to find other transport - not easy in the middle of nowhere.

A reasonably good section of the road

On reaching the Regional Referral Hospital she experienced a further delay, joining a queue of women waiting for life-saving surgery.  We heard later that the baby was stillborn and the mother died within half an hour of finally accessing a caesarean section.  She leaves two other small children and a grieving husband and father.

We then visited the labour ward at the district hospital.  Four staff were supposedly on duty but only two were insitu, both very junior.  A woman was in labour with her 5th baby, naked with no privacy, constrained to the bed and lying flat.  She had received no fluid or food for over 6 hours and was not being monitored in any way.  Her contractions had fizzled out, unsurprisingly.  We encouraged the staff to mobilise her, feed her, offer comfort and respectful care.  We phoned throughout the day to see how she was doing - eventually we heard that she too had been referred to the regional referral hospital.  Those staff did not have the skills, support or infrastructure to provide quality maternity care, a problem sadly all to common across Uganda.  Despite the presence of several sinks and taps, there was no access to water - running or otherwise - on the labour ward. This is why the mentorship programme the RCM developed with its partners from 2015-2017 is so vital, allowing midwives to qualify having had good quality learning experiences and effective mentorship as students.  Unfortunately this hospital had no such intervention.

the labour ward

I weep for the woman and baby who lost their lives, for the children left motherless, for the women who missed out on receiving high quality care and for the midwives who experience poor quality training and little support.  We hope, through our long term twinning project, to be able to make a difference.

Another labour ward visited on our way home

Bangladesh Blog July 2018

The RCM has been engaged in midwifery twinning in various countries since 2012 but only started the Bangladesh Twinning Project in July 2017.  Twinning is reciprocal so as we hope to help strengthen the Bangladesh Midwifery Society (BMS), we also hope to bring learning and new ideas back to midwifery in the UK.  It’s a crucial time in the project, nearing the end of our first year – which has seen many successes and challenges – and helping to prepare for an election for their executive board members, voting for which will be fully electronic for the first time. New members are frantically enrolling so that they can be eligible to stand for the board, or to vote for their preferred candidates.  With our help, BMS have hired 6 student midwives to help with data entry and 40-50 new members are joining every day – I’m sure the RCM would love to match that!  I’m here in country for a week to support the preparation, meeting with the Election Commissioners who are overseeing the process and supporting the (one) staff member and outgoing executive officers, plus meeting key stakeholders.  This involves lots of cups of tea and biscuits so not good for my waistline! 

Tea and biscuits with the Director General for Nursing and Midwifery at the Ministry of Health and Family Welfare

Travelling on my own this time, I’m staying in a safe hotel near the Diplomatic section of the city.   I’m using the time to make phone calls and cat-nap to counter the jet-lag.This requires long Uber journeys across the congested and polluted city of Dhaka to get anywhere.  Tomorrow I may take my Kindle!  Yesterday a Bangladeshi colleague asked me how I spend my evenings in the hotel.  She was worried I would be bored or lonely.  In fact, the evenings fly by as I have to keep up with e mails, expenses, writing up notes and preparing presentations in addition to video calls with family, blogs, social media – and often evening meetings over dinner.  I’m lucky to have a couple of long-term friends in Dhaka (though both happen to be away this week) so on other trips I’ve spent time with them too. 

With colleagues from the Bangladesh Midwifery Society

T

We try to practice the ‘rule of thirds’ in our twinning projects, something we learned from the Dutch midwives.  This involves making sure that we spend at least one third of our awake-time with national colleagues, a third with those from our own or a similar culture, and a third alone.  So, I divide the day into morning, afternoon and evening and try to only fill two of those sections to enable sufficient alone time.  I’m not very good at that – but there’s always tomorrow!  It’s also important to get some sleep and this time I’ve brought my own pillow from home which is making such a difference.  What’s on my packing list will have to be the subject of another blog!  Meanwhile, thanks for reading.  If you’re not already a member, join the RCM’s Global Midwifery Facebook Page to follow my travels https://www.facebook.com/groups/499668586833110/?ref=bookmarks 

Comfy with my own pillow

Bangladesh Bulletin

The Royal College of Midwives and the Bangladesh Midwifery Society started a new twinning partnership in June 2017.  Initially for one year, this may extend for a further 3 years if successful.  The project is part of a larger midwifery strengthening project in Bangladesh, funded by UK-Aid and UNFPA.

Action planning

Activities for the first year include setting up the twinning partnership, undertaking an organisational assessment using the MACAT tool, identifying and engaging stakeholders, visiting all 8 branches (divisions) around the country, developing a new membership database, employing a staff member as executive assistant, writing a newsletter, developing capacity in advocacy, making some improvements to the office, holding an AGM and conducting elections for the executive committee.  A busy year!

Having conducted a scoping visit in October 2106, I arrived in Bangladesh on Sunday for my second visit this year.  Additionally, our consultant Tamara Curtis visited in in August.  So far we are making good progress; the partnership is taking shape, the MACAT and Stakeholder Analyses have been achieved, job descriptions have been developed, interviews will take place on Friday and office improvements are underway.  Today we made plans for the AGM and the election, for visiting three divisions later this week, for writing our newsletter and visiting key stakeholders.  We hope to hold a closing event on Saturday to share our achievements with the midwifery community.

MACAT Workshop, July 2017

I'm pleased to be accompanied on this trip by Welsh Midwife Terry Kana, an RCM member who sits on our global advisory group and is a Senior Research Associate at the Liverpool School of Tropical Medicine.  Terry is very familiar with Bangladesh having conducted many training courses here and also collected data for her PhD from all over the country.  It's great to be with someone who is really knows the country and understands the culture.  She's also a phenomenal facilitator and I'm learning so much from her.  I am on the academic programme board for the RCM-accredited Diploma in Sexual and Reproductive Health at Liverpool, so this has been a great opportunity for us to deepen the relationship between our two organisations. (PS it's a great course, why not consider it?!)

Me with Halima, President of the Bangladesh Midwifery Society, and Terry from LSTM

We're here until Sunday 15th and both have a busy few weeks when we return so we're trying to pace ourselves, take time and space to reflect and to explore the city as well as work, work, work.  So far we've been significantly underwhelmed by Asia's largest mall (Jamuna Future Park), eaten some nice food (I can recommend dahl for breakfast) and negotiated Ubers and CNGs (tuk tuks).  Looking forward to dinner with resident friends later this week and spending more time with these lovely Bangladeshi Midwives who are working so hard to bring high quality midwifery to women and newborns in Bangladesh.  Viva La Twinning :)

Today's working lunch in BMS office: Nan bread and veggie curry with fresh coconut juice.  Delicious

Totally unauthentic but very nice veggie noodles

One of my favourite dishes in the whole world is Cambodian Noodles or Nom Banh Chok.  A bowl of these with a friend at the Russian Market in Phnom Penh, with a Cambodian iced coffee made from condensed milk is the stuff of my dreams.  If you want to know how to make authentic Cambodian noodles you can see a video here.

Back in the UK we eat a lot of Asian food in our house: with my years of living in Southeast Asia and Hannah's Chinese heritage I guess it's not surprising, plus I am able to buy Asian ingredients when I travel.  Noodles in some form make it on the household menu most weeks, often on a night before a grocery delivery when we need to use up lots of odd veggies from the fridge.  Tonight I had a vague plan to cook something noodley but when I opened the fridge I saw a bag of left-over cooked spaghetti from Monday's bolognese.  I hate waste so decided to see how Spaghetti worked in place of noodles.  It was delicious!

So, here is my recipe for very un-authentic but quite delicious veggie 'noodles' with left-over spaghetti, another money-saving tip from the Kemps Kitchen!

Saute until soft the following:

• 2 tbsp vegetable oil
• 1 chopped onion
• 2 sticks celery, finely sliced
• 2 cms fresh ginger, grated
• 1 clove garlic, crushed
• 1/2 fresh green chilli

Add 2 tsp medium curry powder and cook for about 5 mins, adding a few tbsp water if it gets too dry.

Add to the pan:

• a bag of prepared veg (in this case carrot, cauliflower and brocolli), chopped a bit smaller (I don't normally used prepared veg but had some left over from Sunday lunch.  Of course, just use any veg that you have in your fridge or freezer)
• 1 tin chick peas, drained and rinsed (or any beans.  Again, totally un-authentic but who cares?  Of course you could use chicken, pork or fish too)
• 1 tin coconut milk (or 1/2 tin coconut and top up with water) 
• 1 tsp fish sauce (or salt if you're being strictly veggie)
• 1/2 tsp tamarind paste (you can substitute the juice of half a lemon or a lime, or even some vinegar.  The purpose of this is to give the sour taste)
• 1 tsp palm sugar (or any sugar)
• 1 veggie stock cube (I know, totally un-Asian but adds an Umami hit when you're not cooking with meat)

Cook until the veg is almost soft but retains some bite.  Add in 1 chopped courgette near the end.

Throw in some leftover spaghetti (of course you can use any noodles, soaked or cooked according to the packet instructions) and heat through.  Add more water if necessary to give a soupy consistency.

Top with chopped peanuts, a chopped fresh red pepper, some chopped coriander and some crispy friend onions (mine come in a jar from an Asian Supermarket).

Serve with extra chopped chillies on the side.

Hannah had thirds.  Our serious German lodger, who doesn't like spicy food, had two helpings and said it had a 'well-balanced flavour'.  Hilarious.  I shall take that as a compliment and judge the meal to have been a success!

Blasting off with the BOOST Project

The Royal College of Midwives has recently signed a contract with UNFPA Bangladesh to help strengthening the Bangladesh Midwifery Society (BMS) through a twinning project, similar to what we have implemented in Uganda, Cambodia and Nepal.  We are calling this new project BOOST: Bangladesh Midwifery Society Opportunity for Organisational Development through Twinning. Initially for one year, the project may extend for a further 3 years and is being funded by DFID through UNFPA. During this first phase we will help BMS to undertake an organisational capacity assessment using tools from the International Confederation of Midwives and walk through a series of other activities together such as situational and stakeholder analyses and an election of office bearers.

With Halima Akter, President of BMS, in October 2016

I visited Bangladesh in October 2016 to meet BMS and to attend the Midwifery Services Framework Workshop that was being hosted by UNFPA and ICM, At that time I visited various clinical sites and educational facilities, met funders and beneficiaries, undertook an intial risk assessment and began to get a feel for what it might be like to have a programme presence here.  Since then, we've been negotiating contracts, developing job descriptions and begun recruiting for the personnel we need to deliver the agreed outcomes (in addition to completing our recent MOMENTUM project in Uganda).  On Friday we appointed a volunteer for a six month placement who will start her new role with BMS in September.  Next week we will be interviewing for a consultant to help with project management and hope to soon fill the Global Projects Officer post at the RCM.

Meanwhile, I have been asked to take some time to pause and reflect on the RCM's programmes, processes, achievements and challenges thus far and to publish and disseminate our work.  This takes time but we've made a start and hope to have some published articles soon to show for it.

Right now, I've just arrived back in Bangladesh for a week of strategising with BMS.  I hope to be joined by the ICM's technical advisor Pashtoon Zyaee, visa permitting, on Wednesday. Pashtoon and I have worked together before in Nepal and it will be a joy to do so again.  If she doesn't make it, I'll be a very busy woman over the next week!

With Pashtoon in Nepal, April 2013

Other things to do whilst I'm here involve setting up arrangements with VSO to house and provide security for any RCM volunteers visiting the country and catching up with Sue Lloyd, a friend from Cambodia days.  I'm still recovering from jetlag after visiting Canada and the USA so will be trying to ensure I get enough sleep.

Meanwhile at home, Hannah has just finished her A levels and is off on her first girlie holiday to Greece, leaving her parents quaking in their boots :)