The rule of thirds

I've been here for four months now and it's probably a sign of how much more at home I'm feeling that I haven't written a blog post for a while.  I have been out of the country twice since my last post: once for a week's holiday with my lovely husband Stephen in Istanbul and again, last week, to Nepal for a work-related trip for some south-to-south regional collaboration to strengthen midwifery in Nepal and Bangladesh.  Though I thoroughly enjoyed both trips, it was nice to come 'home' to Bangladesh, to catch up with friends and colleagues and to catch up with myself.

Thus to the topic of today's blog post: the rule of thirds. I've been working internationally since 1988 and have had my share of busy jobs, both at home and abroad.  I learned the hard way about the effects of stress on one's physical and mental health; a spell in hospital with nasty eczema, back in 2010, brought a crisis of confidence in my academic career and a change in professional direction which, as it turned out, was the very best thing that could have happened. It led me back, via a circuitous route, to working globally and combining my two worlds of work: midwifery and international development.  I'm now much more careful to protect my wellbeing and do this with the rule of thirds; this works in two different ways.

Firstly, I divide each day into thirds - morning, afternoon and evening.  I know that I need to keep one of these 'thirds' free in order to function and not to burn out.  Of course, some days are more packed than others but if I'm working all day then I try not to fill the evening with more work or people-focused activities. Likewise, if I know that I will be working in the evening then I try to start work later in the morning or finish earlier in the afternoon to create the space I need to process and reflect on the day, to write my journal, to do the mundane stuff like housework and grocery shopping, to exercise and to ensure that I eat well.  I also need to prepare for the day and week ahead.  

The other 'two thirds rule' (and I honestly can't remember where this came from) is that people working cross-culturally need to ensure that they spend at least a third of their time working alongside national staff and colleagues.  In my case that means ensuring that I spend enough time with my team in Bangladesh, working in our national office, having lunch with national colleagues, learning the language and enjoying time with my Bangladeshi friends. It's too easy for expats to exist in a diplomatic or international bubble, never really connecting with the local population; the 'thirds rule' can give a useful guide. The next 'third' is spending time with people from one's own or a similar culture, especially people who have been in-country for longer than oneself and can give helpful perspective on experiences and behaviours that may be perplexing or different.  I am lucky to travel to work in a car-share with other international staff; we reflect on the challenges of the day, help each other out with practical issues and sometimes socialise together. I have also joined an international club (mainly for the pool), a choir and a faith community - these are all places where I meet other people from my own or a similar culture and help me laugh at myself and the frustrations we sometimes face being a long way from home. It was a particular joy today, to meet my friend Susan who is visiting Bangladesh.  We've known each other for almost thirty years and have both lived in Cambodia and Bangladesh; deep friendships such as these are very precious.  The final third is, of course, spending time alone to do all the things already highlighted above, to attend to one's emotional and spiritual wellbeing, and to keep friends and family up to date through video calls, social media and blog posts!

I haven't included photos in this blog but those who follow me on social media see plenty of pictures every day.  I'm travelling back to the UK for Christmas and am looking forward to seeing loved ones - especially my dog Cracker!  Bangladesh is preparing for a general election, probably in January, so life is a little unpredictable at present; the office and the roads are frequently closed and we mostly stay close to home.  Our choir has a concert on Saturday - I'm making my debut on the flute and opening the event as part of a choral sextet.  

Thank you for travelling with me on this journey and for all the love and support extended to me and my family by so many people; it means so much.

Ten weeks in...

It's now 10 weeks since I left the UK for Bangladesh.

Drinking some coconut juice this morning after water aerobics

Highlights include finding friends and a faith community, feeling more comfortable when I'm out and about, lovely colleagues and - of course - meeting midwives. I've joined an international choir and an aquarobics class so my weekends and evenings have become much less lonely. 

Church

'My' keyboard!

Coffee with midwife Sangita last week

With my friend Sharmin from Bangladesh Midwifery Society

I've discovered the library at the BAGHA club - plenty of books to keep me happy :)

It's also been a joy to have visits from some of our international partners from Swedish Universities and the International Confederation of Midwives and to know that we are journeying together. I recently took a work-related trip to Barisal in Southern Bangladesh - known as the Venice of Bengal as there is water all-around. We took a boat trip exploring some of the canals and fruit gardens (where they grow guavas and other wonderful tropical fruit) and it was so beautiful and peaceful on the water - a welcome break from the traffic, pollution and concrete jungle in Dhaka. 

On our boat trip near Barisal

Guavas we bought from a passing boat at the floating market

My colleagues preparing the fruit with the boatman's knife

 Tomorrow I leave for a week in Cox's Bazar, a popular tourist destination in the south east of Bangladesh, boasting the longest uninterrupted beach in the world. I'm not going for the tourism but for orientation to our humanitarian programmes and the midwifery team based there, for which I have oversight. Some things have been challenging too. Time is needed to settle into a new job, especially in a different culture and in a multi-cultural team. Dengue fever (a mosquito-borne virus that can have serious complications) is all around, with many colleagues and their family members being infected and hospitalised. The prevalent strain here is the dangerous one that causes bleeding and haemorrhagic shock, so I'm being extremely careful not to get mosquito bites - having already had dengue three times in the past (whilst living in Thailand and Cambodia) I certainly don't want to get it again. 

Visiting my Korean colleague Hayoung who was hospitalised with Dengue Fever

 There is also the on-going stress of being far away from my home and family, though video calls every few days help enormously. My Mum seems to be thriving and is getting fabulous support from my sisters and wider family and friends. I'm having regular language lessons though am, as yet, far from fluent! Grammar is different from that of English, with words placed in a different order in a sentence; for example 'yesterday Tuesday was', 'yes, my one person girl have' (I have one daughter) and 'all things good were'. Did you know that cuturally, Bengalis don't eat female goats, only male ones? Apparently some people can sniff goat meat and tell instantly whether it comes from a male or female :) 

 I had a wonderful time in India earlier this month, visiting my family (Uncle, Aunt, Cousins) who live in Dehradun. My Uncle is recovering well after his bilateral knee replacement and I hope to return in the new year for another mini-break. I'm trying to persuade my Mum to join me! It's only three weeks now until I meet Stephen in Istanbul and I can't wait.

With my Aunt Catherine in India 

With my cousin Jonny in India

With my cousin Sarena in India - foothills of the Himalayas behind

With my cousins and their families

Settling in

It's been five weeks since I left the UK to take up my new role as International Midwifery Specialist with the UN in Bangladesh. I am feeling more at home now, living in an apartment with two other UN staff, one Italian and one Russian. My rent (£235 per month) includes all bills and the services of a lovely maid six mornings per week. We have a washing machine, a microwave oven, kettle and toaster, two fridge-freezers and air-conditioning - positively luxurious compared to many places where I've lived before. On next week's shopping list are a small electric oven and a laundry basket! Our flat is on a quiet dead-end street by a lake and its proximity to two hotels with cafés, restaurants, spas and other facilities give us options on the doorstep when Ubers are not available (frequently!)

I made fresh pasta with my new rolling pin - it was delicious

I made pancakes for the ladies' breakfast

I've joined a church and signed up to the music group and the ladies' breakfast; joined the British social club (mainly to use the pool but my membership gives me access to various other expat clubs in Dhaka); joined a gym, bought a new phone and worked out how to use various Apps that make life here easier - Uber for getting around in taxis and CNGs (tuk tuks), FoodPanda (for groceries and fast food) and an App for the all important internet data top ups! I have also started taking Bangla language lessons. 

With Thomas, my Bangla Teacher.  We have lessons in the hotel café next to my house

 I already have many national friends from the Bangladesh Midwifery Society and it is a joy to reconnect when they are passing through Dhaka. Sharmin and her husband Jewel have given practical help in so many ways, especially sourcing things that I can't find a supermarket. I am now the proud owner of some new bedding, a rolling pin and board, waste-paper bin, wooden spoon and a reusable mug! 

With midwife Mim

Just some of the food on offer at the ladies' breakfast last Saturday

In the hotel gym

Having a manicure and hand massage at the hotel spa.  I fell asleep :)

I'm beginning to feel more confident at work too, with ideas emerging in my role leading the midwifery team. We have several partner organisations, some national and some international; each is supporting a different area of midwifery in Bangladesh. I have been familiarising myself with all of their programmes as well as that of other teams within our own organisation whose work intersects with midwives. Midwifery is our flagship programme here so the work of my amazing team has huge significance nationally and internationally. 

At a recent workshop

With Sharmin and Tuhid in my office - we've been working together for 6 years, now with me in a different role

Off to a meeting last week

I look forward to taking my first field-trips out of Dhaka soon (just as soon as my security training is complete) and my first international travel; I have booked a mini-break to Dehradun (India) in September to stay with family there (Aunt, Uncle, cousins) then an October rendezvous in Turkey with Stephen.  There may be work-related trips to Kathmandu and Athens so the next few months will fly past. I am grateful for such an amazing network of family, friends and colleagues, here and afar, travelling this journey with me. I hold you all in my heart, none more than my beloved Stephen and Hannah, who, along with all of you, make my world a better place.

My photo wall at work

Three weeks in...

It’s three weeks today since I left the UK for Bangladesh. I’ve come out of the house for the first time in 2 days after a nasty bout of D&V that took me by surprise; I have a pretty cast-iron constitution having lived and worked away for so many years. As a friend said this week, one should never underestimate Bangladesh!

I have now moved out of the hotel and am living in an apartment in Banani, part of the diplomatic area of the city and considered safe for foreigners. I’m sharing with two other UN staff, though they are both away on leave so we are yet to meet. It’s fairly basic but the landlord has promised some more furniture (I’m not holding my breath!) and I’m slowly discovering how things work around the house. A maid comes in to clean 6 mornings a week and there are a couple of hotels next door which are good places to meet people for a coffee.

As this is my first job with the UN I have a lot to learn about the rules, processes and all the acronyms. Most of the forms have now been filled, I am officially on the payroll and in the pension scheme and I’m working my way through all the mandatory training and orientation papers. I’m slowly getting a handle on my role, which includes being acting Chief of Health when my boss is away. Thankfully there is a great national team around me. Next week we’ll have a team meeting to help me understand the priorities and work on our shared vision. This week it has been good to work with a visiting team from Sweden and India, focusing on high quality midwifery education. They are introducing a new quality assurance process with the midwife teachers to help them prepare for accreditation. I know the two Swedish midwives and count them among my friends and mentors, so it’s been great to reconnect.

Last weekend I attended an international church and enjoyed lunch out together. Sadly I had to miss the meeting today as I’m still feeling a bit fragile. I have also booked my first Bangla lesson. It’s early days, but so far so good. Stephen and I are planning a rendezvous in Istanbul in October.

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