Leaving Nepal and on to Cambodia

What a great ten days it has been.  As usual, the pace of the days increased as we crept closer to our flights home/onwards - sometimes however much planning I try to do in advance, things all seem to come together once I'm in country.

We spent the morning of our last day in Nepal at the Midwifery Society Office, where we undertook a mid-way evaluation of the project using a tool developed by the International Confederation of Midwives. This enabled MIDSON to assess their development to date and make plans for how they want to develop in the future.  We all agreed that after such an enormous effort organising the conference, they need some time to re-group and focus internally for a while.

After a lovely lunch of Nepal Thali at a local canteen, we headed to the Tribhuvan University Hospital on the other side of town, where Kiran (President of MIDSON) is an associate midwifery professor.  We were shown around the labour ward and met some wonderful, passionate midwives who are so frustrated at their powerlessness to make changes.  Staffing levels are a real challenge - 2 midwives for a busy labour ward with 8 beds, so no chance for one to one care.  The on-call doctors are medical students who have more authority in the system than senior midwives with over 20 years' experience.  The day we were there the midwives were so sad - earlier in the day a woman had died after complications from a caesarean section, leaving 2 motherless children.  Turns out the elective caesarean was performed by a medical student.  They also showed us an adjoining building that they wish to turn into a birth centre.  It has all been nicely renovated and equipped, but they are at stalemate because the obstetricians don't think a midwife-led unit in a different building would be safe.  Our volunteer midwives have been working there trying to influen
ce practice and have clearly made a difference - the Nepali midwives all spoke warmly about what they have learned and are trying to put into practice.  However, I wonder whether a more multi-disciplinary approach is needed with some obstetric 'converts' from the UK working alongside the midwives to effect change.  Think that is probably outside the scope of this project though!

At the birth centre, currently being used as a postnatal ward

We had a lovely dinner with some of the UK volunteers and others, then breakfast with MIDSON members this morning before heading out the airport.  Now in the departure lounge at Bangkok airport waiting for my onward flight to Phnom Penh.

Next instalment will be from Cambodia!


With midwives on the labour ward at Tribhuvan Teaching Hospital, Kathmandu