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!

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:

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

It's been a great day.  I'm here for my fifth visit to Cambodia with the Global Midwifery Twinning Project.  Our aim is to build the capacity of the Cambodian Midwives Association thereby strengthening the internationally recognised Three Pillars of a strong midwifery profession - Education, Regulation and Professional Midwifery Association.

One of our objectives is to develop the executive members of the association in their roles as midwifery leaders.  A key person in this is the President of the Association.  On my first visit here in May 2013 it was difficult to engage with her, she seemed very disheartened and dis-empowered.  We were supposed to be running a workshop but no plan or programme had been made and I wondered whether we should even continue with the programme or focus in other areas where we were more likely to be able to effect change.  We decided to take the risk.

This time it couldn't be more different.  The President called me on Sunday to see that I had arrived safely and met with me first thing this morning. She has booked time off work to spend with me working on the project.  She was so excited about showing me all the preparation she had done for the workshop: she has prepared a fantastic two day programme.  She's been networking and has invited some interesting speakers to attend and present at the workshop.  The invitations have all been printed and sent out.  The photocopying and materials we need have all been prepared.  The venue and catering (at much more appropriately costed establishments) have been booked.  And she has prepared a presentation, as President, clearly explaining the role of the association, successes and challenges and a great plan for the future.

Mrs Chea Ath showing my her presentation with a beaming smile

I was speechless.  I think I shed a tear or two. We went out for a lovely lunch together, to test the food at the restaurant that is catering for the workshop, and ate all my favourite Khmer dishes: stir fried chicken and ginger, prohok k'thi (minced pork with fermented fish paste, pea aubergines and salad with rice) and cold rice noodles with salad and curry sauce.

There's a long way to go but at least for today I feel a great sense of hope and achievement.  Thanks everyone for your interest in the project and support to me in my role.

Off on my travels - Asia bound

Today is my last day in the office before flying to Cambodia on Friday.  I'll be away from home for nearly 4 weeks.  Here is my schedule:

17- 28 October in Cambodia with Cambodian Midwives Association - hosting workshops and visiting lots of organisations and individuals connected with midwifery in Cambodia.  I'll be staying with my long-time friends Steve and Ruth Penfold.  We all worked together in Cambodia back in the early 1990s and it's great to have reconnected through my recent visits to the country.

28 Oct - 1 Nov in Colombo, Sri Lanka at the regional SAFOG/FIGO conference.  Professor Kiran Bajracharya from the Midwifery Society of Nepal will be presenting a paper. This is a great excitement as raising the profile of our twinned midwifery associations is one of the aims of our Global Midwifery Twinning Project.  Kiran and I will be staying at the YWCA Colombo - first time there and first time in Sri Lanka for me, so that's another pin for the world map!

(Meanwhile, back in Uganda Mary Garote Musoke, President of the Uganda Private Midwives Association, will also be presenting a paper at the Regional Fistula Conference there on 28-29 October.  This will be the first time that midwives have presented to their obstetric colleagues and it's another outcome of our project.  We worked on the abstract together and were delighted to have it accepted.  Wishing you courage and clarity Mary!)

1-9 November in Nepal, working with the Midwifery Society of Nepal evaluating the impact of our project and planning for the future.

10-12 November back in the UK at the RCM's annual conference in Telford, raising the profile of the RCM's global work.

I'll then be taking a few days off to recover from jetlag and catch up with my family before returning to the RCM office on 17th November.

Whilst I'm away I'll still have to keep an eye on correspondence as our project administrator has left and we are waiting for a new person to be appointed.  We are also submitting a bid to our donors for more work to follow on from our twinning project so I'll be working on this remotely too.

Please do continue to follow the blog - I'll try to update it with some photos every few days - and keep sending me messages of encouragement.  They really do keep me going!

Leaving Uganda

Wow, where did those 10 days go?!  Monday and Tuesday have been a whirlwind, visiting DFID and the Commissioner for Nursing and Midwifery at the Ministry of Health then finally facilitating a workshop with the external stakeholders of the midwives' association.  This included representatives from various universities, the Ministry of Health, the Nurses and Midwives Union, the Ugandan Nurses and Midwives Council, The White Ribbon Alliance and various NGOs such as White Ribbon Alliance and AMREF.

The room at UPMA's office where they are going to install their new E-learning centre so Enrolled Midwives can updgrade to Registered Midwives

Workshop was supposed to start at 0930.  This is what it looked like at 1015... African time!

Lovely Andrew, UPMA's Project Administrator, organising all the handouts etc.

Groundrules!

Finally everyone arrived, just in time for coffee!

Disan outlining the background to the workshop

Once we got going it went really well

Group work to assess the capacity of the assocation with the external stakeholders

More group work

Rebecca, Deputy Chair at the Uganda Nurses and Midwives Council, feeding back

Elizabeth, Head of Midwifery at Uganda Christian University, feeding back

I'm flying home tonight and going straight from Heathrow to the office where I'm meeting a delegation of high level health representatives from Malawi, including the President of the Association of Malawian Midwives (AMM).  Jacque Gerrard, the RCM's Director for England will be joining our meeting and we're really excited as we have just submitted a bid for some work in Malawi with the AMM.  After the meeting I'll be travelling to Birmingham by train to attend a two day conference hosted by our donors, THET.  I'm doing a 3 minute presentation at the conference so may have to re-hash our project song! Click here to hear Uganda midwives singing our project song at last year's workshop  I'm looking forward to staying with my friends Helen and Andy Tidy whilst at the conference - Helen and I studied nursing together in 1984 and have stayed in touch ever since.

I'll finally arrive home on Friday evening and am really looking forward to seeing my family and friends and sleeping in my own bed without mosquitoes keeping me awake!  The following 2 weeks are very busy with writing a bid to continue our work in Cambodia, Nepal and Uganda, writing a big report and then flying to Cambodia on 15 October.  I'll go straight onto Nepal and won't be home until 8 November by which time it will be well into winter!

Saturday... pausing for breath

I have moved out of the hotel to stay with my long-time friends Deborah and Philip Betts and their lovely family who live here in Uganda.  Deborah and I went to school together and our parents were friends long before that, so our ties go way back.  Such friendships are so precious.  Their beautiful house and garden in the suburbs of Kampala is providing a much-needed oasis for me to gather my thoughts, reflecting on the achievements and challenges of the past week and planning my last few days so that when I step on the plane in the early hours of Wednesday morning we will be on track to achieve our objectives here in the last six months of our programme.

Deborah, with husband Philip, chopping home-grown lemons for marmalade over coffee and birthday cake

The Betts' beautiful home in Makindye, Kampala

My 'bloggers' view from the Verandah

Last week continued to involve delicate negotiation, ensuring that I can achieve what is necessary during my short time here without compromising the programme for our volunteers. By nature a capacity building project means that the Ugandan Midwives Association has limited capacity... the imposition of four UK midwives on short-term placements plus the programme manager certainly presents challenges!  However it has been good to share accommodation with everyone until this point so that we could talk and plan together.  I'm sure they're now grateful to have some space without me!

We spent Tuesday at Kiwoko Church of Uganda Hospital (approximately 3 hours' drive from Kampala), meeting some inspiring midwives and midwife teachers and leaving Sue, one of our volunteers, there for a few days to work with the Midwife Training School and the Maternity Unit, to help assess their capacity for learning and teaching in clinical practice for student midwives and newly qualified midwives.  Sue and Patricia will return there next week. The highlight was seeing their nice (by Ugandan standards) labour ward and neonatal intensive care unit, providing high quality care to mothers and babies and training for student midwives.  We also met some beautiful Ugandan women who had recently given birth to twins and triplets normally, a rarity in the UK these days.

ALL PICTURES TAKEN WITH PERMISSION

With medical director and staff at Kiwoko, under the banner 'We treat, Jesus Heals'!

Newly born twins

Mum of triplets, born normally, cup feeding one of her babies

With the midwife teachers at Kiwoko School of Nursing and Midwifery

On Wednesday Professor Ann Thomson, one of our volunteers, was visiting speaker at the Midwives' Association's Research Interest Group, something that has developed during our project.  Eight Ugandan Midwives and two of UPMA's staff gathered to learn about midwifery research and Ann helped them to understand the process involved in conducting a randomised controlled trial, and how to read a research paper.  I joined in some of the meeting and also met with the Global Health Foundation who are providing Solar Suitcases for midwives clinics.  These brilliant cases provide light and power to midwives working in rural areas enabling 24 hour care.  More on solar suitcases . They include a hand-held doppler and a mobile phone charger, so midwives can always phone for help and advice. They have already been installed in 17 of UPMA's clinics.  Our twinning project has given the midwives' association the skills and confidence to develop links with organisations such as these and others.

On Thursday we held a workshop with the Midwives Association to assess their current capacity and determine how they have developed over the past 2 1/2 years since our project began.  Though I helped to plan it and did a presentation, it was mostly facilitated by the President and the Executive Director, who have really grown in confidence to take the lead at events such as these.  We broke into groups and 'enjoyed' a beige (all the food was decidedly colourless!) take-away lunch from a local restaurant.  The workshop was very successful and included prayers and singing.  Uganda is such a great example of religious tolerance: one of the workshop energisers was a rousing chorus of 'Give me oil in my lamp, sing hosanna' led by a Muslim Midwife!  It was an exhausting day but also very encouraging and shows that real progress has been made.  See more on assessing the capacity of midwives' associations

Ugandan midwives learning how to read a research paper

Discussing how the association has developed during the lifetime of the twinning project

Lamla, UPMA's secretary, fully engaged with the workshop and presenting at the plenary feedback.  She is a hidden gem, full of institutional knowledge

Friday was also very busy!  We went out to Mukono, approximately 1 hours' drive from Kampala, to meet Jemima, Elizabeth and Faith, midwife teachers at the Uganda Christian University.  One of our volunteers (Aine Alam from Maidstone and Tunbridge Wells NHS Trust, currently undertaking her PhD) has helped to develop UCU's Masters in Midwifery Curriculum which they hope will be approved in January, ready to teach in May 2015. Aine will return there in December to help develop the clinical assessment tools and support the teachers as they prepare to teach at Masters Level for the first time.  There is only one other midwifery masters programme in Uganda and UPMA hope that many of their midwives will be able to graduate from UCU in due course. We then met with Dr. Jean Chamberlain from Save the Mothers to see how UMPA and STM can collaborate with the 'Mother Friendly Hospitals' initiative, bringing safe and dignified care to mothers in Uganda.  After delicious smoothies in the hospital's cafe, we travelled back to Kampala to meet with AMREF who are installing computers at UPMA's office so that enrolled midwives can study online and upgrade themselves to become registered midwives. It's a really impressive programme and through our project UPMA was enabled to meet AMREF and set the ball in motion. Two UPMA midwives are already enrolled on the project and many more will be starting soon.  The E Learning Centre will be open to other midwives for a small fee, generating income for UPMA.  It can also be used to help midwives search for evidence to support their practice.  We had a great discussion about mentorship and engaged AMREF to work with UPMA in helping the Uganda Nurses and Midwives Council to develop standards for learning and teaching in practice.

Next week I will be meeting with DFID and facilitating another workshop with UPMA's external stakeholders to discuss the way forward.  Look out for the next and final blog from Uganda in a few days!

Fried Blobby Fish and other Ugandan Stories

Here I am in Uganda for my fourth visit in 18 months.  I was feeling particularly anxious prior to my trip as we approach the end of our programme and need to show that we have achieved our objectives and provided value for money.  I have travelled previously with other members of RCM staff or external consultants; this time I have a dauntingly long list of objectives to achieve my myself.  However, I am happily overlapping with four of our UK midwife volunteers, two of whom (Tricia and Sue) flew out with me from Heathrow.  It's great to be staying in the Kolping Hotel together and to have arrived in the middle of the night with other people rather than on my own.

Ebola defences were in evidence at the airport; we were met by a wall of nurses in uniform, wellies, masks and gloves who made us sanitise our hands and checked our temperatures before we passed through immigration.  We also had to complete a long checklist to rule out any suspicious symptoms of disease! Thankfully UPMA's staff members Andrew and Bonny were there to meet us and drive us back to Kampala from Entebbe airport (approx 1.5 hours drive) arriving at 1am.  I am staying in the same room as my previous visit which is a mini suite (of sorts) and very comfortable.

After settling in and reconnecting with Ann and Kate, volunteer midwives who have been here for 1 week already, we went to the UPMA's office this afternoon for a meeting to discuss everyone's workplans and my objectives and ensure that everything dovetailed into our project plan.  This required much skillful cross cultural negotiation and I was quite tired at the end!  Back at the hotel we continued our discussions over dinner - it's lovely all being together but sometimes difficult to switch off!

Meeting at UPMA this afternoon

Having experienced the hotel buffet for lunch (starch, starch and starch) we decided A la carte was the best option for dinner.  Here is the fish menu - I was briefly tempted by the 'English Style Blobby Fish Fillet - look big, delicious but fish certainly' but decided to leave that delicacy for another night.

Yum yum, blobby fish

Kate, Tricia, Ann, Sue - lovely RCM midwife volunteers rehydrating at the end of the day

Tomorrow we are heading for Kiwoko to leave Sue there for the rest of the week and start collecting data towards developing a tool for supporting learning and teaching in midwifery practice.  More stories soon!

Half a kilo of peppers and other stories

As the result of a dyslexic moment whilst placing my online Tesco order, I have spent this weekend working my way through a glut of courgettes. Courgette tart, courgette chutney, ratatouille, courgette cake, vegetable curry; we've managed to reduce the courgette mountain to just three. 

Stephen reminded me of a similar incident some years ago involving green peppers. In 1999, relatively newly married, we lived in Albania for a year working with refugees from Kosovo. In many ways it was my most 'civilised' overseas posting to date.  We rented a brick house with a sit-down toilet and a proper shower in the middle of the city. There was a bidet! We had a four-wheel drive car and a maid to clean the house.  However, it was also difficult and challenging in many ways.  Albania was only just beginning to surface from years of isolation and extreme communism under the dictator Enver Hoxha. Though geographically in Europe, parts of the country were locked in tribal warfare, car-jackings were rife and the streets of the city were not safe.  Stephen, together with his side-kicks Edi and Callum, was frequently away from home, rebuilding schools and hospitals in neighbouring Kosovo.  There was a curfew after 9pm so we spent many evenings at home playing Scrabble, knitting and listening to the BBC World Service.  We also held dinner parties but these too posed their challenges: they had to take place early in the evening for guests to arrive home before curfew, we had only 2 small gas burners and a dodgy oven and there was limited food available.  Albanian is a difficult indo-European langauge in a branch by itself, with no relationship to other languages and therefore no familiar words.  I attempted to learn some words in order to shop for food and other essential items and soon learned the phrase 'half a kilo' (gjsime kilogrami) as this seemed about the right amount of most foodstuffs.  Except for peppers.  

Have you ever seen just how many peppers there are in half a kg?  They're very light.  Half a kg fills three large carrier bags.  I could see my mistake as soon as I'd placed my order at the market.  The stallholder raised her eyebrows, then shrugged her shoulders and proceeded to borrow peppers and plastic bags from a neighbouring stall as she soon ran out.  However, I didn't know how to say 'no, stop, I've made a mistake', so I walked home carrying my three bags and we ate peppers six hundred different ways for the next few weeks.  

So, please do ask me if you need any ideas for a glut of peppers.  Or courgettes.  I'm an old pro.


Other stories for other posts include: Stephen's ride in the Albanian Foreign Minister's helicopter; Jean and D's (my in-laws) epic tour of Europe culminating in a four-day visit to see us in Albania; knitted hats (yes, believe me, that's a story); bread and culture shock (yes, that's a story too); Eleanor and Ian in the pyramid and nightclubbing in Elbasan.

With Eli, our fearsome Albanian landlady and cleaner

with a donated ambulance in Albania

Out of a field visit during one of the training sessions

with my lovely project team

A day in the life of a Global Professional Advisor

I've posted many times during my travels but what do I do back in the UK. Here's a snapshot of yesterday.

05.40 am - alarm, shower, dress, feed dog, prepare dinner in the slow cooker, unload and load dishwasher, put a load of washing on, pack breakfast and lunch for work, greet daughter and bark instructions for dinner whilst doing kitchen jobs, wake husband, make cup of tea for the train, pack rucksack for work.

Lamb Tagine - cook on low all day whilst you're at work.  Serves 3 or 4
1 large lamb leg steak
1 tin chick peas
1 tin chopped tomatoes
3 chopped carrots
2 chopped onions
8 medium potatoes peeled and cut into bite sized pieces
2 tsp Ras el hanout spice
1 tsp ground coriander
1/2 tsp ground cinnamon
1/2 tsp dried thyme
1 tbsp honey
1 tbsp tomato puree
1 tsp celery salt
1/2 tsp garlic granules
2 veg stock cubes

06.40 Leave home getting lift to station from husband.  Pay £35.40 travelcard for the day

07.06 Train from West Malling to London Farringdon, Tube to Great Portland Street, walk to RCM office. E mails, Facebook, cup of tea and reading Kindle on the train.

08.30 Arrive at work, make porridge, another cup of tea, have breakfast whilst reading e mails.  Receive an e mail saying 'Greetings from Uganda' but don't know who it's from or why they sent it!  Hope the e mails I sent yesterday arranging Skype calls for today were received and people will be ready to talk to me.

09.00 Skype Mrs. Chea Ath, President of Cambodian Midwives Association about progress with the project and plans for the next workshop and my next trip in October.  Can't get sound on Skype so talk to her on the phone whilst watching her picture on Skype.  She's keen to show me their recently published newsletter with lots of colour photos (some of me!) that they distributed on Intenational Day of the Midwife. Delicia has a quick chat with Chea Ath too.  Everyone loves Delicia, our project administator.

10.00 Louise pops into discuss funding for future overseas projects and we arrange a meeting with our donor for next week.  More e mails and writing up my notes from the Skype call.

11.00 Try to skype Uganda but no reply.  Phone Mary Musoke, President of the Uganda Private Midwives Association. She's up-country, training midwives and obstetricians as mentors.  We have a quick chat about the next workshop and my next visit and arrange a Skype call tomorrow with the team. It's my day off tomorrow so I'll call from home.  Write up notes from a meeting yesterday and answer lots more e mails.  Review the agenda for next week's briefing and debriefing of volunteers.

12.00 Meeting with Delicia to plan next week's briefing and debriefing events. We reveiew the report from the last one and try to address and areas for improvement.  I start preparing my presentations.

12.45 Have lunch and continue writing notes and answering e mails

13.00 Skype Call with Kiran Bajracharya, President of MIDSON in Nepal.  We catch up about the volunteers that have just been in Nepal for a month.  Great excitement to hear that during their placement the midwife led birth centre at the University Hospital in Kathmandu was opened and the first 2 babies have been born there.

First baby born at the birth centre

We make plans for the next workshop and my next visit in September.

14.00 Booked phonecall with Professor Helen Cheyne from Sitrling University.  Helen has recently been out to Malawi to visit a project we are running with VSO, strengthening midwifery.  Helen feeds back from her visit and we talk about the report she will write for me.  We arrange to meet in Scotland on my next visit to the Edinburgh office to talk about how the RCM can continue to support midwifery in Malawi.

15.00 Helping Angela to sort out the programme for two work experience students coming to the RCM (one of them is Hannah!)  Trying to be creative so they get to see lots of different career pathways to help them decide their paths in life.  Another Skype call from Kiran in Nepal who had thought of a few more things to talk about.

16.00 Booked Skype call with Kathy, a consultant working with us on the twinning project.  She's lives in Holland but is currently in the USA.  Talking about the evaluation of our recent workshops in the Prague and UK and our plans for the final project evaluation.  Rupa, sitting next to me, knows Kathy too so they have a quick chat.  Skype is great!

17.00 Finish writing up notes from the day and answering e mails.  Continue working on the work experience programme and Rupa is really keen to help - that's great.

17.50 Leave the office, bus to Victoria Station, get the 18.43 train.  Phone husband to arrange a lift, get home 19.45.  Discover Hannah has baked a delicious lemon drizzle cake for the yough group camping trip.

19.46 Straight out of the door to drop Hannah at swimming club whilst Husband takes a work phone call.

20.00 Defrost some frozen spinach and have it with a bowl of Lamb Tagine.  Very nice.  Watch half an episode of Trauma Doctors (my guilty pleasure) over dinner.

21.00 Back to pick up Hannah from swimming club.  Drop her at home and take dog to the park for a walk.  Love the light summer evenings.  Have a go on the new outdoor gym at the park - it's great!

Outdoor Gym, Ditton Community Centre

22.00 Cup of tea with the husband and long talk about whether or not he should take on more work.

23.00 To bed - started to read but fell asleep in 2 mins!  Need to be up at 6 tomorrow...

Talking about mental health

Earlier in this blog I spoke about my experience of PTSD after a year of war-zone living.  I recovered thanks to a strong constitution, provision of the right friends and family at the right time and a community of faith.

Yesterday I found myself at the bedside of a young man, my friends' son, hospitalised following a heroin overdose after years of poor mental health and devastating alcohol dependency.  Despite his loving family, such complex needs and the power of addiction engender a sense of hopelessness and make recovery seem very far off.. Troubled after my visit and hurting for all involved, I was drawn to the Sunday evening worship at our local church.  This service provides a quiet space to reflect on the week just past and find strength for what lies ahead.

The chosen Bible passage,  Ezekiel chapter 34, seemed to speak directly into this difficult situation:

"I myself will look for my sheep... I will bring them back from that dark and disastrous day.  I will lead them back... I will let them graze in safety.. and I will find them a place to rest.  I will look for those that are lost, bring back those who wander off, bandage those that are hurt and heal those who are sick".

Returning home to meet our youth group, I felt compelled to talk about mental health with these young people, currently facing exams and the stresses and strains of teenage life, to let them know they can talk about depression and anxiety and ask for help.  It was one of the best sessions we have ever had, sharing ideas about 'What is health?' and challenging the constructs of normality and abnormality that seem to reinforce taboos and stereotypes.  It was encouraging to hear of passionate individuals in local schools providing safe spaces to talk about mental health; to note these wonderful young adults explain how they support their friends who have anxiety or depression by listening and signposting them to sources of help. We talked through how to recognise when you or others might be struggling and how to access support. Finally, we reflected on our shared faith and how this can provide comfort and meaning.

For further stimulating reading on mental health I can recommend this excellent blog Salomons' Blog to which my sister Anne Cooke, a clinical psychologist, is a regular contributor.

Home but not yet over!

The ICM Congress in Prague finished on Thursday and I have returned home for a brief weekend with my family whilst our twinned midwives from Nepal, Cambodia and Uganda visit Scotland, the north of England and Wales/Northern Ireland respectively, each to their own twinned countries.  I am enormously grateful to my RCM colleagues and some of our returned volunteer midwives for arranging both accommodation and clinical/academic visits for their twins, giving me a little window to share a sunny Sunday lunch with my extended family, walk my dog in the nearby nature reserve and catch up on some sleep.

Catching up with former colleagues from St Thomas Hospital /Kings College London at the RCM Stand

It's hard to put into words what an amazing experience it was to be with over 3,000 midwives from across the world in Prague, to reunite with friends and colleagues from the past 30 years and to share this adventure with amazing midwives from the RCM and from our twinned countries.  At times I felt like a frazzled tour guide, making sure that everyone was where they needed to be at the right time but it was just fantastic when it all came together.  One of the loveliest moments was when one of MY midwifery tutors, who has just edited the new Myles Textbook for Midwives, presented a signed copy (paid for by our project) to each of our twins.  These midwives are all teachers in their own countries and will be able to make such good use of this important resource.  I have been to the libraries in their teaching schools and many are still using 1970s and 1980s editions as it's all they have. Jacque Gerrard, RCM England's Director, gave each twin a beautiful RCM badge and the Cambodians presented Louise Silverton, Jacque and Jayne with traditional hand-woven Khmer Kramas (cotton scarves).

Author and editor Dr. Jayne Marshall presenting signed copies of the 16th edition (just published) of Myles Textbook for Midwives to our twins from Cambodia, Uganda and Nepal

Louise Silverton, RCM's Director of Midwifery, receiving her Krama

Sadly, despite all of our best efforts (Jacque sat in the visa office all day on Wednesday) we were unable to get a visa for Mary from Uganda to visit the UK so when everyone flew out of Prague on Thursday and Friday, Mary stayed behind to board a plane back to Entebbe on Saturday.  She touched us all with her gracious and godly response to such a disappointment.  I accompanied her to Catholic Mass on Thursday morning in Prague and she took great comfort from the rituals of her faith.  Thankfully we have three UK midwives currently in Uganda so I have asked them to help Mary reflect on her experience in Prague and to surround her with support.

I will be staying at a hotel in London with our twins this week as we travel to Oxford on Wednesday for the RCM's annual event and Zepherina Veitch Lecture by Professor Debra Bick, hold the final day of our GMTP workshop on Thursday and then the formal board meeting on Friday before everyone flies home at the weekend.  It will be the first time in the history of the programme that everyone is together for the board meeting and Mary hopes to join us by Skype.  I will be glad when this very busy period is over but it has been an incredible, enriching and exciting experience and feel so privileged to do the job I do with such fantastic people.

With Mary and Sarah in Prague

Does your friend bite?

Those of a certain age may remember Peter Sellers in the famous Pink Panther sketch 'Does your dog bite?' Does your dog bite? .  There are plenty of dogs here in Prague but thankfully none have bitten me.  However, I can't say the same about my midwifery friends!  A Ugandan midwife that I have come to know during my travels was so pleased to see me that she bit me after first giving me a bear hug and a very painful pinch.  A true sign of love apparently. I'm grateful to have been wearing a robust shirt so she didn't break my skin and realise that, however well-travelled, I still have much to learn about cross-cultural communication!

With Florence (left), Prof. Ann Thomson and RCM Wales Director Helen Rogers in Uganda, April 2014

The story of my growing friendship with Florence (the biting midwife) provides a snapshot of what our twinning project is achieving in Uganda.  Florence is the Chair of the Midwifery Chapter of the Uganda Nurses and Midwives Union. Until recently the Union focused mostly on nurses and did not provide a voice for midwives.  Florence had little power within the organisation.  As its twinning partner the RCM chose the Uganda Private Midwives Association (a rival to the Union) which had more potential for development and more capacity to manage UK volunteers.  However, our clear purpose was  to strengthen midwifery through working with all stakeholders in country.  Concurrently, the UNFPA's midwifery advisor and the Ministry of Health in Uganda had been encouraging all the midwives associations (there are at least four!) to join together and speak with one voice.  However, such discussions were politically and emotionally charged and had to be protected with armed guards, such was the strength of feeling.

In September 2012 our first project workshop brought the Association and the Union together with others invested in midwifery to assess their capacity and identify areas for development over the 3 years of the Global Midwifery Twinning Project.  This was a landmark moment for both organisations and Florence joined the meeting to make an action plan for her midwifery chapter. However, there was still tension and rivalry.  On my first visit in April 2013, together with our country directors for Wales and Northern Ireland we visited the Union but were not given access to Florence to discuss midwifery.  Meanwhile, the president of UPMA was doing her best to build bridges, inviting Florence to join in midwifery events and advocating on her behalf with the Union.  The breakthrough came in October 2013 when, as requested by UPMA, the Royal College of Midwives brought all of Uganda's midwifery stakeholders together for an advocacy workshop - you can read, see and hear about that in my earlier blog: The Sound of Singing in Kampala. Florence was a key player in that workshop and since then both Union and Assocation have been working hard to move and cooperate together. Mary and Florence have become great friends. They have attended many events together and joined up in celebrations such as International Day of the Midwife.

With Mary and Florence at the GMTP Advocacy Workshop, October 2013 in Kampala

At a landmark symposium on 4 May 2014, just before International Day of the Midwife, all midwifery associations agreed to come together in a midwifery task force to have one voice for midwifery in Uganda. Florence and Mary are both here in Prague for the International Confederation of Midwives Congress and there is plenty of love being shared.  And biting.

Last night, at my invitation, Florence and Mary attended the RCM's evening reception in the conference centre and met with midwives from Northern Ireland and Wales, their twinned countries.  Only afterwards did Florence confess she was not confident to travel alone to her hotel on the other side of Prague.  So, I found myself alone with my gnashing friend, braving the metro system and trying to keep my distance (unsuccessfully... I got plenty more pinches but thankfully no more bites).

Czech travel buddies: Midwives on the Metro

As we said goodnight she gave me several huge hugs, looked me in the eye and said 'Love, pure love, that is all I can say' then prayed several prayers of blessing over me, my husband (who she met a few weeks ago in Uganda), my extended family and all of the midwives in our project.  Florence is now fully on-board with the midwifery agenda in Uganda and the Union is realising the power of partnership.  Let's hope that as the new midwifery task force finds it feet the voice of midwives will grow stronger to influence midwifery education and regulation, developing and nurturing the midwifery associations within it.  Global Midwifery Twinning - we love it.  Gnash Gnash.

ICM's techincal midwifery advisor Pashtoon explaining the role of Midwifery Assocations as one of the three pillars in yesterdays Prague workshop

Together in Prague: Moments in History

Our Global Midwifery Twinning Project is linking midwifery associations in Uganda, Cambodia, Nepal and the UK. Yesterday was the first time all four associations had come together since the beginning of the project two years ago.

The moment all the twins arrived in Prague - two year's work and relationships coming together.  

Gathering a day before the ICM Congress began, at a workshop facilitated by an external facilitator, we began the process of telling our stories, coming to a shared understanding of where we have come from, where we are now and where we would like to go together.

Back: Jacque Gerrard, Director for RCM England; Delicia Egboh, Project Administrator, RCM UK; Cathy Warwick, Chief Exectuive, RCM UK; Louise Silverton, Director of Midwifery, RCM UK.
Middle: Ishwori Dewi Shrestra, Chief Nurse/Midwife, Ministry of Health and Population, Nepal;Sarah Namyalo, Ugandan Nurses and Midwives Council and UPMA; Yeath Thida, Midwife Educator and Cambodian Midwives Council Executive; Oung Lida, Vice President, Cambodian Midwives Assocation; Mary Garrot Musoke, President, Uganda Private Midwives Assocation; Kiran Bajrachriya, President, Midwifery Society of Nepal
Front: Joy Kemp, Global Professional Advisor, RCM UK (Me!); Lesley Page, President, RCM UK

It was a beautiful and inspiring time, getting to know one another, listening to our partner associations talking about the successes and challenges of furthering the work of midwives where they are, crying and laughing together and sharing a meal.  I was especially grateful to the three RCM directors and our president who set aside the day, in the midst of this enormously busy time, to understand the project better and to deepen the relationships with our partners.  We will have a follow up workshop in London on 12 June, after our twins have completed their UK tours!

Kiran and Mary reconnecting (Nepal and Uganda)

Jacque (England) and Mary (Uganda)

Viewing the overview of the project I have put together for the exhibition stand

Kiran presented all partners with a special Midwifery Society Calendar from Nepal

Sarah and Delicia chatting over lunch (RCM UK and Uganda)

Our meal together

We had to miss dessert in our rush to attend the 'Voices of Midwives' Event in Kampa Park - an attempt to break the World Record for the number of midwives singing together at any one time!  3000 midwives in the sunshine joined in once voice - a spine tingling moment.  Here's a little video showing Jacque Gerrard and Cathy Warwick dancing and singing, and two of our friends from Cambodia getting into the groove!Voices of Midwives singing in Prague

At the Voices of Midwives Sing-a-long: Jacque Gerrard (RCM Director for England) and me with the Cambodia Contingent: Pros, Lida, Thida and Mme. Ing Rada

Another theme of our time here has been people borrowing my glasses to read the conference programme, menus and the map of Prague, which has the most ridiculous small print.  Here's Mary and Gail sporting my £3.99 specials!

Today the congress proper started with over 3000+ midwives from all the world joining for an inspiring opening ceremony.

Amazing flag ceremony - the moment when Mary brought in the Ugandan flag.  I cried when Lida paraded with the Cambodian flag - it's so wonderful that they are here

RCM President Frances Day-Stirk giving the opening address

Those midwifery associations involved in twinning have clubbed together for a Twinning Stand in the exhibition.  It will be a focal point for anyone involved in or interested in twinning.  It proved to be a great meeting point after the opening ceremony, with midwives from Laos delighted to see our twins from Cambodia, swapping business cards and planning to meet up again in due course.

With Thida and Lida, our Cambodian twins, at the twinning stand

Our display at the twinning stand

Tomorrow the scientific sessions start in earnest.  Linked to Prague's beautiful bridges, tomorrow's first session is 'Bridging midwifery and women's health rights'.There are presentations from all of our three twinned countries so I'll be dashing around the congress centre in an atttempt to get to every one!  Hopefully this has given a flavour of this exciting and inspiring event.  More blurb from Bohemia in the next installment.