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

Reflections on Uganda - March 2014

I recently spent a week in Uganda with the RCM's director for Wales, Helen Rogers.  Sadly I couldn't blog whilst I was there as I got sick on day 2 and barely had energy to struggle through the days let alone blog at night.  However, we still had a productive trip and were enormously encouraged by the progress made with our Global Midwifery Twinning Project in the past year.  This time we stayed with friends rather than in a hotel: Michele and Phil Ball for the first few days then Deborah and Phillip Betts for our last weekend.  It was so nice to come back to a home at the end of the day and for me, feeling under the weather, it made all the difference to be able to wander out to the kitchen in the middle of the night!

Helen (right) with Michele Ball, UK midwife and RCM member living and working in Uganda Phillip and Deborah, working with cocoa and vanilla growers in Uganda and DR Congo (Deborah and I went to school together!

The purpose of our visit was to agree a plan for the last year of our twinning project in Uganda and to attend a workshop being run by one of our volunteers Ann Thomson, Emeritus Professor of Midwifery from the University of Manchester.  Ann had been in country for 3 weeks, working with the midwifery associations, universities, NGOs and others to advise on the national midwifery curriculum and help to develop a midwifery research framework for Uganda.  Also in country were Emma Morris, a midwife from Shrewsbury on a placement with the Uganda Nurses and Midwives Council and Zeenath Uddin, a research and clinical midwife from London undertaking training of trainers in life saving skills.  A formidable team!

Emma (GMTP volunteer) conducting training in neonatal resuscitation with Ugandan Midwives

Mary Gorete, President of the Uganda Private Midwives Association, saying goodbye to Professor Ann Thomson

Helen and I had a punishing schedule of visits to agencies and individuals connected with supporting midwifery in Uganda, always taking a member of UPMA with us to help develop their networking and negotiating skills.  Particular highlights were visits to the Mildmay Campus (especially the children's HIV ward, full of love and hope) https://www.mildmay.org/overseas/uganda/  and meeting with Jean Chamberlain and Dr. Eve from Save the Mothers, an inspirational programme (http://www.savethemothers.org)

Mildmay are increasingly realising the value of working with midwives to address issues of sexual and reproductive health  in Uganda.  We had a very fruitful meeting planning how Mildmay can work with the Midwifery Association and how GMTP can support this.

We dropped in on a local branch meeting of the UPMA in Kampala

Plans for this final year include working with many stakeholders to support Uganda's first national midwifery education conference, supporting Ugandan midwifery educators as they develop Masters courses and modules in supervision and mentorship, supporting the development of the midwifery directorate at the Uganda Nurses and Midwives Council and continuing to support midwives in clinical practice through twinning.  Exciting but challenging times!

Me handing over some baby clothes and blankets, loving knitted by my church's new knitting club.  UPMA will distribute these to mothers on International Day of the Midwife (5 May). 

A crazy week in Kathmandu

I'm coming to the end of a crazy week in Kathmandu.  I've loved staying in the 'At Home' guesthouse http://www.at-home-nepal.com - it's a large family house so much more friendly than a hotel and the other guests are really interesting - German, British, Swedish and Nepali.  We all sit around the breakfast table and I enjoy the sharing of experiences and ideas.  The only down side is that our volunteers are staying on the other side of town but we've still managed to share several meals together and meet up during the day. There is a yoga class on the rooftop several mornings a week and some participants stay for breakfast so there are lots of interesting people to meet.

Me with our three midwife volunteers: Asha (Senior Lecturer in Midwifery, England); Fiona (Head of Midwifery, England); Hilary (Lead Midwife for Education, Scotland)

Asha, Fiona and Hilary are on a four week placement helping to 'upskill' Nepal's midwife teachers so that they will be able to deliver the midwifery education curriculum once it starts.  They have prepared and delivered a fantastic programme including leadership.  All participants (including me) did the Myers Briggs Personality Test and I was surprised that my profile had changed considerably since I first took the test in the 1990s.  I'm a lot more T and J than I used to be! I gave a short presentation to the workshop today about the Global Midwifery Twinning Project and enjoyed showing photos from all three countries and talking through some of the challenges midwives are facing.  The Nepalese midwives were so interested in what their sisters are doing across the world.

Planning their ideal birthing rooms. and thinking about small changes they could make right now to improve the environment for birthing women

Role playing birth in upright positions.  They were fascinated (and we had a lot of fun!)

Today I attended a Human Resources for Health workshop in the 5 star 'Yak and Yeti' Hotel http://www.yakandyeti.com/home/index.php - take a look at the website, it's an incredible place  It was a shame we couldn't stay for lunch!  It was a great opportunity to network with health ministers, heads of professional associations, Deans of Universities, NGOs and other agencies and do some advocacy on behalf of the Midwifery Society of Nepal. Hopefully the Universities will soon agree to deliver the midwifery curriculum - but everything here is entrenched in stultifying political red tape.  It's very frustrating.

I had meetings with UNFPA, Ministry of Health and Nursing Council representatives in the afternoon then took the volunteers out for dinner this evening, together with a British Midwife living here in Nepal and her lovely 12 year old daughters.  Tomorrow is meetings and project plans before leaving for the airport at 6am on Sunday morning - and doing all of this again in Uganda next week!

Back in Nepal again

I'm currently on a flying visit to Nepal for just a week.  Next week I go onto Uganda and in April I'll be back in Cambodia.I'm here with the RCM's Global Midwifery Twinning Project (now two thirds complete) to ensure we have a clear direction for the remaining year of the project in Nepal, to meet our RCM volunteers and other RCM members here, to plan for our partner's forthcoming trip to Prague and the UK, to meet all the people involved in the project and the external stakeholders and to plan for the future after GMTP. That's a tall agenda in under a week!

I arrived last night and was delighted to meet a friend ( a Swedish midwife working here with UNFPA) on the flight from Delhi and to be met at the airport by a driver carrying a sign with my name on it.  It's always such a relief not to have to run the gauntlet of gannet-like taxi drivers at the airport.  I have an old Nokia phone with a Nepali SIM card so I topped it up at the airport - it's so important to be able to contact people here.  I changed some money at the airport too - it's so easy there.  I have learned from bitter experience that changing it in a bank here is very complicated and to be avoided at all costs!

I'm staying in a new place, a family-run guesthouse that's very friendly with yummy kiwi jam for breakfast and plenty of tea on tap (essential for me!) There's a new Indian restaurant just across from the guesthouse so handy for dinner. I'm having a vegetarian lent and it's so easy to be veggie in South Asia, with so many delicious veg curries.

It's been a very busy first day in-country. A very important meeting at UNFPA first thing, talking about how we can support each other's work in midwifery capacity building.  Their midwifery advisor leaves her post soon so our continued input will be especially welcome.  Then onto the new National Health Training Centre for a 5 day midwifery education workshop that our UK volunteers are facilitating, helping to bridge the gap between the nurse-midwife training currently on offer and the new midwifery curriculum soon to be introduced in Nepal . From there I went back to the volunteer's hotel for tea and to catch up with them on how their placements have been going to date. They are very senior midwives in the UK - one is a Head of Midwifery and the others are Senior Midwifery Lecturers.  They are doing a brilliant job and working so well together.  They have proved themselves very skilled negotiators!

This evening there was a formal reception and dinner to celebrate the workshop and network with VIPs - Deans and Vice Deans came from various universities who will be responsible for delivering the new midwifery curriculum.  I also met a UK RCM member midwife who has just managed to register as a midwife with the Nepal Nursing Council despite not being a nurse.  This is so exciting as it paves the way for more midwifery registration.  She is a fluent Nepali speaker and we hope to stay in touch and use her as a resource.  I was able to tell her about the RCM's online training tool i-learn, and it's i-portfolio.  Hopefully she will find these very useful for keeping up to date as a midwife.  I also met a Swedish Professor of midwifery also supporting midwifery education here: we shared experiences and made plans to keep in touch.

Back at the guest house there were many e mails to answer, including offering support to a volunteer in Cambodia struggling with her placement.  There's never a dull day in the life of a Global Professional Advisor!

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

What a week!

Time is flying so fast.  Haven't posted since Friday and so much has happened since then. We've been here a week and the days are getting busier and busier as we had towards our flights out on Friday.  I'm going onto Cambodia and there has been civil unrest there this week after July's elections, so I'm keeping a careful eye on the FCO website and keeping in close touch with friends in Phnom Penh - won't be taking any risks so don't worry about me!  Gillian will be flying home and I know Nepal will now hold a very special place in her heart - this trip has been full of wonderful, memorable moments making us very proud to be playing a part in developing the midwifery profession here.

The first ever midwifery conference in Nepal was a resounding success.  We both gave opening and closing speeches, and other presentations besides.  There were approximately 300 delegates and MIDSON did an amazing job of organising the conference - from registration packs, badges, freebie bags, certificates, trophies, souvenir publications... incredible to think that they have only been in existence as an organisation

 for 3 years.  It was one of the best organised conferences I have even been to!  The message was given loud and clear - Nepal needs midwives.  Midwives save lives.   Work together to change the law to allow midwives to be registered with a protected title. Finish developing educational standards that meet international standards and the country context in Nepal.  Be brave, make it happen without delay, and support the midwifery society.



Tracy, one of the GMTP Volunteer Midwives, arriving at the conference

Our fabulous Delicia giving an inspiring closing speech at the midwifery conference

Now the conference is over, our Project Adminstrator Delicia has been helping MIDSON finish up,writing letters of thanks and settling finances, plus gathering information for our next report.   

Gillian and I have been meeting stakeholders, visiting hospitals where our volunteers have been working, gathering data to evaluate project progress to date, and making plans for the future of the project.  Today we toured Thaphatali Womens' and Children's Hospital (20,000 deliveries per year) where Gillian was able to donate lots of knitted baby clothes, handmade by Grannies in Scotland!

Gillian donating knitted baby clothes in the Kangaroo care ward

Dad in the Kangaroo-care ward having some lovely skin to skin time with his lovely baby - and modelling the Scottish Grannies' hand-knits!

We met with the Matrons, took tea with the Assistant Hospital Director, visited the medical library and then spent some time in the birth centre where Gillian saw her first birth for 18 years and wept buckets at the joy of it :)  We rejoiced in seeing the small but significant changes that our programme is making through the influence of midwife volunteers from the UK: screens around the beds for privacy, encouraging women to mobilise in labour, a relatively clean environment, delivering in a (sort-of!) upright position, no episiotomy performed even though the woman was a primigravida, and - most important of all - some kindness and compassionate care.

Birthing woman in an upright position, supported by her mother, with screens around the bed

This woman had triplets by normal delivery - no caesarean section!  Two head down, one breech.  The babies are still in SCBU but Gillian was able to give her 3 hats and 3 cardigans for when they're finally reunited with Mum

Cuties on the post natal ward

 

We also visited the very impressive one-stop crisis management centre in the hospital where women are referred (or self refer) with domestic abuse, rape, crisis pregnancy or other difficult situations.  Staff at the women's hospital work with police, social services, housing and others to find refuge and solutions for such women. 

 

We then had a very fruitful meeting at the Ministry of Health and Population with the Public Health Chief and Chief Nurse, advocating for midwives and the midwives association and encouraging the ministry to act without delay.  Also asked them if they will sponsor a midwife to attend the ICM Congress in Prague in June 2014.

 

After lunch at the Nepal Nursing Assocation, Gillian attended a UNFPA workshop and I went to interview Ishwori, Nepal's Chief Nurse and Registrar at the Nursing Council.  Had a slightly embarrassing moment when I fell asleep on the sofa!  The evening finished with a meeting of the Perinatal Society of Nepal, hearing about UNICEF's new programme to reduce neonatal mortality and the Nepal country plan.  Responded to one of the presentations with a recommendation that Midwives will meet many of the needs in the country plan and got a standing ovation!  They laid on a lovely supper then I returned to the hotel around 9.30 to have a cuppa with Gillian and Delicia before retiring to my room to deal with e mails and write the blog.

Meeting the Public Health Chief (second from right) and Chief Nurse (rar right) at the Ministry of Health and Population