It's a Lilongwe to Malawi...

We’ve now been in Malawi for 10 days and have travelled the length and breadth of the country with our driver Penjani and his pick-up, feeding him coke and cake so he stays awake on the long drives. Singing 'It's Lilongwe to Malawi' to the tune of 'It's a long way to Tipperary...' has kept us laughing along the road.

The car over-heated yesterday but thankfully some water in the radiator and a quick prayer did the trick!  We have hired the car and driver from the Aids Project at Ekwendeni Mission Station.  It's good to know that the money is helping a good cause

We’ve stayed with families on mission stations in the north and the south, visiting hospitals, clinics and midwifery training schools/universities and meeting anyone who can tell us something about midwifery and professional associations in Malawi.  We’ve met donors and NGOs, doctors, midwives, nurse and students.  We’ve seen some really impressive buildings and heard of great achievements but we’ve also been trying to dig deeper and see the reality behind the facades and hear the stories of people on the ground. 

Kamuzu College of Nursing, Lilongwe.  We also visited the Blantyre Campus in the South 

Student midwives learning normal delivery skills on the 'Mama Natalie' mannekins

Now we’re back in the capital, Lilongwe, to join the Association of Malawian Midwives (AMAMI) at their AGM today.  We’re looking forward to hearing the achievements and challenges of the past year and their plans for the future.  We hope to meet the Ministry of Health, the Nurses Trades' Union, the Nurses and Midwives Council and to make a return visit to the British Department for International Development before heading home on Friday.

Meeting Alice Kandango, Midwifery Teacher at Kamuzu College of Nursing's Blantyre Campus

Labour Ward in a Township Health Centre in Blantyre

Midwife Ruby, Matron Modesta and Clinical Officer Frank at Ndirande Township Health Centre where they have 10 deliveries per day, no  operating theatre and no doctor.  They have 4 midwives though they should have 9. They are currently building a theatre and hope it will be staffed.  I hope so too.

One of the personal highlights of this trip was meeting with Dr Patrice White from the American College of Nurse Midwives who happened to be in the same town in the same country at the same time as me.  We used to share a house in Cambodia many moons ago and now have similar roles in our respective professional associations.  Such a treat.

a very jet-lagged Patrice

With Patrice in Blantyre, after delicious curries at the Malawi Sun Hotel

Once our trip is complete we’ll be writing our report for the trip’s funders and hopefully putting bids together to continue supporting midwifery in Malawi in some way.

Thanks for reading 

A taste of a long day

A taste of today. Early morning meeting with VSO Malawi office, packing up then driving 400kms north to Ekwendeni, a Mission Hospital and Training School where we are staying for 2 days whilst we meet midwives all over the north.

Musings from Malawi Part 1

Written on 23rd but posted today as had no internet before!

My feet have hardly touched the ground returning from my summer holiday in August.  Following successful trips to Uganda in September and Nepal in October, the global team has been fully occupied selecting, interviewing and preparing our member volunteer consultants for their placement in Uganda in January 2016, submitting our Action Research Proposal to the Ugandan Ministry of Health and recruiting more member consultants for positions with DFID in Bangladesh.  We’ve also been supporting the RCOG with their ‘Leading Safe Choices’ project and attending the launch at the House of Lords.  We contributed to a needs assessment led by UNFPA in Cambodia by Skype, visited Scotland for a three-day fact-finding mission about Malawi and attended the  annual THET (our project funder's) conference in Birmingham and the RCM conference in Telford.  I also presented a symposium at the NET healthcare education conference with my colleagues Louise Silverton and Aine Alam. 

My House of Lords souvenirs (just in case I never get invited again!)

With RCM Global Volunteers Tracy Miller, Jilly Ireland and Sue Petersen at the RCM Conference

Now we are in Malawi, undertaking a scoping visit/needs assessment to explore the possibility of a twinning relationship with the Midwives Association here.  We have a team of four: Eleanor and me from the RCM’s global team, Shirley Stronge, one of our members from Northern Ireland who has local knowledge from her six-year placement teaching midwifery in Malawi and also Mary Gorret Musoke, President of the Ugandan Private Midwives’ Association, our existing twinning partner.  Malawi is the world’s poorest country and has a very high maternal mortality rate of 574 per 100,000, one of the highest in the world.  It had hoped to reduce this to 155 by 2015 but is sadly far off this target.  Child marriage and adolescent pregnancies are a big problem here: half of all women are pregnant by the age of 18.  So there is much to do and there are many needs.  However, there are many agencies already working here so we are talking to a wide selection of stakeholders and travelling the length and breadth of the country in the next two weeks to identify strengths and gaps and ascertain whether there is a role for the support that we can provide.

Meeting AMAMI, the Association of Midwives in Malawi

Dinner on our first night - Shirley, Mary and Eleanor.  Mary tasting apple crumble for the first time!

At the Central Hospital in Lilongwe, with the Chief Midwife in Charge and the Labour Ward Matron.  Mary enjoying talking midwifery with her Malawian sisters

Exchanging gifts with Professor Address Malata, previous President of AMAMI and Principal of  Kamuzu College of Nursing

In our first day we met with AMAMI (the Midwives’ Association of Malawi), the World Health Organisation and the United Nations Family Planning Agency (UNFPA).  Yesterday we met the largest health training University in Africa (Kamuzu College of Nursing) and the Principal Address Malata who was previously the President of AMAMI and is currently the Vice President of the International Confederation of Midwives.    We've seen the Central Hospital in Lilongwe and a mission hospital and training school and met with midwives from GIZ, the German Government Aid Agency.We also met with the UK Department for International Development and had a chance encounter with the British High Commissioner in a corridor!  Having Shirley on our team is such a bonus, with all her local contacts.  We’re staying at a lovely guesthouse and are being taken to local restaurants serving great food at reasonable prices.  We’ve hired a car and a driver through a friend of a friend and will be staying in midwives’ houses in the north and south – this is sure to give us a fascinating insight into local customs and culture whilst also being economical. 

We’ll be sharing more posts and pictures as our time here progresses.  

For Sarah

A tribute to my friend Sarah Cullen, nee Chavasse, at whose memorial service I was privileged to say a few words this afternoon.

'Sarah was my best friend at junior school from the ages of four and five when we both started in Kindergarten at Walthamstow Hall until the summer of 1976 when I left to join my two older sisters at Tonbridge Grammar School for Girls.  I found school very difficult.  I am dyslexic, though no one knew that back then.  I was one of the last in my class to learn my times-tables; there may even be some others here today who remember the dreaded felt mice with knotted string tails and the shame of being slow to achieve the required 12 knots, one for each times table! I was also slow to achieve the required standard for neat hand-writing and to progress from a pencil to a fountain pen.  Sarah, on the other hand, was exceptionally bright despite being the youngest in the class with a September birthday.  She never judged, was kind and constant and quietly encouraged me in my efforts to achieve.  She was also my yearly partner in the three-legged race which we won triumphantly in our final year.  It was the only occasion upon which I won anything at junior school!  Our career ambitions were clear from an early age. I would be a nurse, following in the footsteps of my maternal grandmother and aunt. Sarah would be the Astronomer Royal.  I marvelled at her knowledge of the constellations and her superior intellect.

Sarah had the best birthday parties in which her father, Michael, was a key figure.  Such parties invariably involved the Kim's game, a test of short-term memory at which I always failed miserably.  However, I shone at the eating part of such gatherings and I remember being showered with praise by Sarah's father as I bravely ate his burned barbequed sausages and proclaimed them to be delicious.  Sometimes Sarah held fancy-dress parties.  One year I won the fancy-dress competition when I came dressed as 'Queen of the Bathroom' in a quilted dressing-gown of my mother's, curlers in my hair, fluffy slippers and a sponge-bag draped nonchalantly over my arm.  Praised by Sarah's mother Rose for my wit and creativity, it was all a sham.  My sister had attended a different party wearing the same outfit the week before and I had simply stolen her idea!

My memories of Sarah and the Chavasse's lovely family home in Chevening Park were not just of parties.  I was privileged to be invited back to play after school.  Though our own house in Otford was very comfortable, I suffered from inexcusable envy over the beautiful portraits of the Chavasse daughters that hung in the drawing room, the feeling of importance as we drove past the sentry box and through the estate in Mrs. Chavasse's sky-blue 2CV, tooting as we went around the corners.  And the soda-stream machine which seemed to me to be the very height of luxury and modernity. Visiting the dairy farm at Chevening to see the calves being fed; playing in the garden with Jason the standard poodle; spending hours on girlish pursuits in Sarah's bedroom and walking through the park up to the Keyhole, a distinctive arboreal feature in the Chevening grounds; these are very happy memories for me.

Recently, in celebration of my 50th birthday, a milestone that Sarah sadly did not achieve, I walked the length of the North Downs Way National Trail that passes the top of the Keyhole and affords views down to Chevening House. Once again I felt the pain of my separation from Sarah keenly. We kept in touch until our early twenties when I visited her in her rooms at Oxford.  However, my nursing and midwifery career took me overseas and we lost touch.  In the past few years I, with several other school friends, tried to reconnect with Sarah, all remembering her warm friendship and wanting to rekindle it.  However, Sarah was not to be found through the internet or social media, the family had moved on from Chevening and we learned that Sarah had been ill and known trouble in her adult years.  It is a great sadness to me that I did not make a greater effort to stay in touch with Sarah; that I never managed to renew our friendship; to tell Sarah how much she meant to me and to let her know how she made my experience of school and childhood so much richer and happier.

My faith has always been a comfort to me in times of sadness.  I don't know whether Sarah, or indeed her family and friends here today, had or have a faith.  However, I feel strongly that I saw in Sarah a reflection of the love and gentle nature of God in whose image I believe she was created.  In the Bible, we find a verse in Paul's letter to the Philippians, Chapter 1 verse 6, which says: 'I am certain that God who began a good work in you will bring it to completion...'. I love singing and indeed have memories of performing with Sarah in our school's production of 'Joseph and his technicolour dream-coat'. I'd like to finish this reflection with a verse from a hymn by the modern hymn-writer Stuart Townend, called 'There is a Hope'.  It is my hope that these words will comfort you as they also comfort me.

There is a hope that lifts my weary head

A consolation strong against despair

That when the world has plunged me in its deepest pit I find the Saviour there!

Through present sufferings, future's fear,

He whispers 'courage' in my ear.

For I am safe in Everlasting Arms

And they will lead me home.

Thank you.'

To listen to this hymn follow this link 

Bye bye Kathmandu... until next time

By Joy Kemp, Global Professional Advisor for the Royal College of Midwives.

I'm on my way home from an amazing 10 days in Kathmandu.  Following a successful fundraising campaign by UK midwives, coordinated by the RCM, it was time to travel back to Nepal to meet our twinning partner, the Midwifery Society of Nepal (MIDSON) for the first time since the earthquakes in April and May and to see how things had changed and developed, as well as ensuring that our funds are being spent wisely.

I was wonderfully hosted by MIDSON at their office in Kupondole, and by Ashok and Katrin (with toddler son Aryan and dog Butterscotch) at the At Home Guesthouse in Jamshikhel.  Nepal has certainly had a difficult year - first the earthquakes and now political stalemate with its neighbour Inda with the border road blocked and no fuel getting through.  Kathmandu was much quieter (and less polluted) with fewer cars on the road, so I walked everywhere locally and had fun exploring the city on local tuk tuks, mini-buses and green buses rather than getting taxis which were almost impossible to find.  My large European frame is quite challenging for the small spaces available in such vehicles!

long queues for petrol all over the city - many drivers waiting for days just to get 5 litres of fuel

Squeezing into a local minibus.  I got a seat but many were standing and others on the roof and handing out of the doors!

There was also little cooking gas available so many restaurants were closed and others had a limited menu.  The tandoor ovens were fine so we had a lot of bread, naan and roti; delicious but something I try to avoid at home!  Thankfully the guest house was well-stocked and the Sun Indian Jazz Cafe (yes, really) just opposite made great lassis and chicken tikka masala. I also really enjoyed sampling Nepali home cooking at Kirans' house (MIDSON's president) where I learned how to make momos (Nepalese Dumplings) and also tried fried goats lung for the first time, an acquired taste!

Fried goat's lung, fresh coriander chutney, home made chicken momos

I was so encouraged by MIDSON's response to the earthquake, mobilising themselves within days, first in the Kathmandu valley reaching out to the local maternity hospital and to women and families in temporary camps and shelters, but later with funds from UNICEF, UNFPA and Direct Relief, providing midwifery skills, professional and personal care kits and reproductive health outreach to communities in some of most remote earthquake-affected areas.  The 's RCM's funds helped to provide the staff and capacity needed to make this response happen and we've just signed an agreement enabling MIDSON to reach 5 more districts with care and supplies, vital as winter will soon be here. I had a busy schedule of meetings, visits and field trips and am happy to report that at the end of the trip we have a firm plan for using the remainder of the funds raised and ideas for 2 new projects for submission to donors for external funding.

 I brought with me a suitcase full of knitted baby clothes from the Crafty Coffee group in my village and these will be distributed to families living at altitude in temporary shelters.  

A happy little girl modelling her new woolly hat and tank top!

I was especially glad to visit Nepal's chief nurse, Ishwori, who played a big role in the success of our Global Midwifery Twinning Project and has herself recently given birth to a beautiful baby boy.
Let's join in hoping that this baby grows up in a country moving forward after such a huge challenge, with trained and competent midwives available to every woman and her family.  Meanwhile' the RCM will continue to work with MIDSON to fulfill this dream.

Ishwori and her baby

In Nepal again after the earthquakes

The RCM has been twinned with the Midwifery Society of Nepal (MIDSON) since 2012.   Between April 2012 and March 2015 we sent 23 of our midwife members as volunteers on 25 placements to Nepal through the Global MidwiferyTwinning Project. In addition, many of our members have visited Nepal and some have a long standing relationship with the country.  Therefore, when a 7.8 magnitude earthquake and more than 100 associated aftershocks struck Nepal in April 2015, killing more than 9000 people, our members were deeply concerned about the safety and wellbeing of their friends and colleagues in Nepal and asked the RCM to respond.

Having run a fundraising campaign from May - August 2015 we have been hugely encouraged by the response.   Your efforts have raised around £25,000 to help provide access to midwifery care for women and babies in Nepal  during the emergency, now and for the future.  We have been working with MIDSON to ensure that the monies raised are put to good use.

MIDSON rapidly responded to the earthquake, helping to relieve pressure on Kathmandu’s maternity hospitals and coordinating outreach to the worst affected urban and rural areas.  Partnering with other agencies such as UNFPA, UNCIEF and Direct Relief, they got supplies and midwifery expertise to where they were needed.  Our funds helped to make this happen and will go on supporting MIDSON’s capacity and activities in the months to come.  This is especially important as geologists predict a further earthquake in the future.

I am currently in Nepal (funded by the RCM, not by any monies you raised) conducting monitoring and evaluation of our inputs and helping in MIDSON’s forward planning.  Getting around is difficult as there is a tense political situation and associated fuel shortage.  However, I hope to see some of the fruits of MIDSON’s recent endeavours with my own eyes and also to meet with many of their local partners and funding agencies to scope out future work.  We will have a small workshop next week and I hope to blog again before I leave to give you a flavour of how your money is helping to make a difference here and to share some photos. 

Meanwhile, my suitcase has finally arrived, 24 hours after me.  It was a casualty of the fuel crisis as they didn't have sufficient fuel to take all the bags on the plane.  I’ve enjoyed a warm welcome from MIDSON and am so grateful that none of these wonderful, dedicated women lost their lives in the earthquakes. Work starts in earnest tomorrow afternoon.

A lovely welcome from the MIDSON executive yesterday who came to see me in the guesthouse

Nepal Update

It's now more than 3 months since the earthquakes in Nepal that caused such devastation and loss of life and livelihood.  The Royal College of Midwives had just finished a three-year twinning project with the Midwifery Society of Nepal during which time we had formed a close working relationship. We immediately started a fund-raising campaign amongst our members and have raised a staggering £21,000.  Reading the messages on our justgiving page, and the letters and cheques that arrived at HQ, was truly humbling.  Some gave large amounts; musician Gary from Kent whose wife Annette is a midwife, put on a fundraising concert and recorded a special CD for Nepal raising £660; seventeen year old Emily, an aspiring midwife, held a tea party with her Mum and raised £121; midwives in Coventry did the Wolf run and raised over £500. Others could only give a small amount but the messages with their donations were poignant: 'A donation to help colleagues in Nepal help women safely birth their babies who will bring a little happiness in this sad time'  and 'this is Nepal's future'. Kathy from Australia, a flower-farmer, gave money because 'I would like all other women to have the same midwifery care as I was able to'.  Message after message, donation after donation, midwives and their friends and families baked cakes, walked, forfeited their retirement presents and dug deep to make a difference.  The campaign has now officially ended but you are still able to donate by sending a cheque, made payable to The Royal College of Midwives Trust, to Eleanor Shaw, RCM, 15 Mansfield Street, London W1G 9NH.  Please clearly mark your donation for the Nepal appeal. Personally, aside from holding a garden party in May I have been walking the North Downs Way, a 156 mile-long national trail near my home, to celebrate my 50th birthday and show gratitude for living in a place of safety.  I recently completed the first 88 miles and hope to manage the remaining distance over weekends before Christmas.  You can sponsor me here

At the start of the walk in Farnham, Surrey, on the famous North Downs Way seat with my dog Cracker

I am pleased to be able to announce that I plan to visit Nepal from 8-18 October (the funds for my travel will not come out of any money raised in the campaign).  Although I have made six trips in the past three years, and have been in regular Skype, e mail and social media contact with our partner MIDSON since the earthquakes, this is the first opportunity I've had personally to see how they have responded and to report back to the RCM on how the funds raised are making a difference.  I'll be helping MIDSON to review their situation and undertake some contingency planning.  I'll be sure to blog whilst I'm there.  

Meanwhile, thanks to everyone for all your generous donations. The RCM has now launched a new fundraising campaign for Women's Aid. Women’s Aid is the national charity for women and children working to end domestic abuse; domestic abuse is a significant factor in the ill health and mortality of mothers and pregnant women.  You can read more about the campaign and how to donate here.  I have signed up for the RCM's charity bike ride so it seems to be my season for fitness challenges!