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!

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.

Blurb from Bohemia

Leaving home at 6am yesterday on a Bank Holiday Monday, I flew to Prague for the 30th International Confederation of Midwives Congress http://www.midwives2014.org/ - a momentous occasion when over 3000 midwives from across the world will gather together.  I am here early as our twinned midwives from Cambodia and Uganda will attending the pre-congress ICM council so I will be supporting and spending time with them as well as preparing for my presentations, workshops and our exhibition stand.  Our Nepalese twins will arrive in a few days' time.

I nearly missed my connecting flight in Vienna - we had almost touched down when we took off again at alarming speed. The captain later told us there had been a car on the runway!  The time it took to ascend, circle and land again gave me just 20 minutes between flights and I had to run from one end of the airport to the other.  Amazingly my suitcase and me both made it!

As I arrived in daylight and had no immediate deadlines I braved the public transport system with my suitcase - one bus and two metro trains later I arrived at our hotel, right by the conference centre.

Hotel Corinthia, Prague

I had intercepted an e mail from the Cambodians who were holed up, too scared to venture out, so I went straight over to meet them at their hotel and we took advantage of our free afternoon for some sightseeing. Together we negotiated the metro once more and found the centre of town, wandering around beautiful buildings and stopping for drinks in streetside cafes.

Lida and Thida hit the streets of Prague!

Tea at the Tramway Cafe

Beautiful roses in Prague - national museum at the top of the picture

They were very jetlagged after flying Phnom Penh - Bangkok - London - Prague and flagged after a couple of hours but we squeezed in a visit to the most amazing Cheese shop to introduce them to this European delight, not a feature of the Cambodian Diet.  They were amazed by the whole parma hams hanging in the store - I love seeing the world through others' eyes.

Wonderful Cheese Shop in Prague's main street

Finally we met up for dinner with Professor Lesley Page, the RCM's President, and managed to negotiate some rice for Lida even though it was not on the menu - Cambodians need to eat rice every day!  Lesley was moved to hear about their experiences of losing family in Khmer Rouge times and the long-lasting impact this has had on Cambodian society and midwifery.

Slowly the world of midwifery is gathering here in Bohemia.  I was overjoyed to see Pashtoon Azfar, founder of the Afghan Midwives Assocation and now working with the International Confederation of Midwives.  We have worked together twice in Nepal and she's an amazing midwife with a powerful message.

Unfortunately our Ugandan twins are not yet here - UK visa delays mean they could not catch their flight as planned. All of our project team and contacts are working hard in UK, Uganda and Prague to make a miracle happen.  Meanwhile, prayers and positive vibes appreciated!

At the end of a long day this was the best sight in the world.  More blurb from Bohemia soon!

My cosy bed in Bohemia