Day 7: Mental Health Training (Day 2) Nawalparasi – 14 May 2016

 

(From Top: Class arrive for workshop day 2, evaluations from previous training, Sampada interprets for us, Dave’s balloon session).

 

After our debrief * last night, Jilly, Dave and I agree that yesterday’s session appeared to ‘go well’ (NB yet to be fully evaluated) and little needed changed – just a few tweaks here and there. The students seemed to enjoy our session. Evaluations were gathered and will be looked at after all 3 days of training are complete.

And so today starts again as it did yesterday. The auxiliary nurse midwives and skilled birth attendants arrive (when they can) and they’re welcomed wholeheartedly. Today the students seem quieter.  We think perhaps there’s one of their managers present and Sampada, our interpreter, tells us most students don’t know each other. I sense a different mood from yesterday’s ‘party-like’, almost celebratory atmosphere.

Dave begins with the welcome and ‘safe space’ talk; Jilly gives her presentation on the Edinburgh Postnatal Depression Scale and confidence building around asking women about their mental health. I start my presentation … and the electricity cuts out. The air conditioning shuts down. And I think to myself as beads of sweat urgently form on my brow … this environment is definitely not conducive to a group relaxation session!  As the temperature soars in the room we call the Lotus Staff. Cold drinks please … and a comfort break for everyone. The students head outside, but I can’t decide whether it’s cooler inside or out. At least we have the generator to fall back on. Right?

My session begins sometime after lunch (once a man comes to fix the broken generator). My talk and relaxation session go okay, and we take a comfort break. Just like yesterday, Jilly plays her Nepalese flute and there’s some smiles. No dancing or spontaneous singing today. Education and human interaction I find eternally fascinating. A lecturer/teacher/facilitator may think they can read reactions from students through verbal and non verbal communication or from how well we feel a session is going, but can we? Just because we’re not receiving instant, obvious gratification (as we perceive it), is teaching necessarily effective or ineffective? We need a more solid measurement.

But then a student, within the quiet, offers that she’d like to sing for us, with a You Tube video in the background to play the music for her. Her singing is beautiful and the moment rather moving. I’m experiencing a lot. I’m not fully sure what yet, but I’m fascinated by the mix of interactions, behaviours and human relationships that we’re all part of.

After lunch, Dave’s session begins. His talk is an introduction to cognitive behaviour therapy and it begins with balloons. First checking for any balloon phobias. No. Safe to go ahead. The women take great care choosing a balloon. White is generally avoided and coloured balloons most welcome. Dave asks everyone to blow up their balloon (What a great ice breaker – each day, there’s lots of laughter).  Our inner children leak out, play together and run free. Dave asks everyone to blow up the balloons and there’s loud squeals as balloons burst. More balloons please. Now tie the balloon and place it in your mouth. Mmm, not so fun. Dave now walks about with a pin held high and asks us all to close our eyes. I keep my eyes wide open, closing them puts me in touch with feelings of vulnerability. I imagine how women must feel blindly placing trust in health professionals. Afterwards, when all eyes are open, Dave asks everyone open questions about the exercise based on The Five Aspects Model, ie what were your thoughts, how did you feel, how did that make you behave, any physical sensations in your body and he showed the group that by asking open questions he derived a lot of information about their inner feelings.  The women shared they felt happy to start with, excited even; they thought it was a competition to see who could blow up the biggest balloon. Yesterday it was someone’s birthday and she thought we’d brought balloons to celebrate (perhaps a reason for the different atmosphere?)  they shared how those feelings quickly turned to suspicion, anxiety, fear and how their hearts raced when they thought he might burst their balloons.

Dave explained “the best way of getting a detailed analysis of a woman’s problem is to ask them to recall a recent incident of the problem and get them to take you through it step-by-step in the sequence in which things occurred, remembering to summarise what they have said at regular intervals and to ask relevant open questions about all the different symptom areas. The aim should be to build up a picture of triggers and consequences that may be maintaining the problem, and to generalise from this one incident to a wider picture”.

After this, Dave puts learning into action with a role play scenario and then Jilly ends with her ‘Button’ session. I’ll explain these tomorrow though as tonight Jilly and I have to leave early. We’re heading off on a 5 hour round trip to the southern border where Nepal meets India. We’re going to visit rural Karunamati Birth Centre (owned by Green Tara Nepal). The auxiliary nurse midwives are waiting for us there and Suman, our driver, awaits!  Off on our next road trip adventure then.

 

*There may be professional disagreement about the occurrence of this event.

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Day 6: Mental Health Workshops (Day 1) – Nawalparasi – 13 May 2016

Our workshops start at 9am, but the auxiliary nurse midwives (ANMs) and skilled birth attendants (SBAs) are relying on unreliable public transport to get them here. Some are even travelling miles by foot to attend. Sampada, our interpreter, tells us the women also have many responsibilities to attend to at home, so they arrive when they’re able to. I’m struck by how patient everyone is as they wait for all the group to arrive, with no request to be informed of a start time. I’ve noticed that all Nepalese people I’ve met so far are patience personified. They live in a society full of uncertainty and appear to be masters in the art of acceptance.

We welcome them all and Jilly offers everyone a Cadbury’s chocolate. Sweet treats are very welcome here. The women are dressed beautifully in colourful saris and their smiles illuminate the room. Around 38 women attend as Gopal and his staff at the Lotus squeeze in more and more chairs. A gentleman arrives too, and a child, and some other men and women.  Sampada, our interpreter, tells us the gentleman is the new public health officer for Nawalparasi and he’s keen to meet all his staff. We’re not sure who the others are. Our ice breaker isn’t needed as the public health officer asks the women to stand up one by one and introduce themselves. The women seem confident and they all appear to know each other. I sense a good atmosphere brewing.

You may already know that we are participating in a project (a collaboration between Bournemouth University, Nepal’s Tribhuvan University and Liverpool John Moore’s University) aiming to raise awareness of mental health issues and build skills among Community Maternity Care Providers so that they can recognise and assist women with mental health issues. The project aims to reduce Nepal’s increasing suicide rate among women of reproductive age and, once evaluated and designed, will deliver a curriculum to the Government of Nepal.

Two waves of volunteers have already visited Nepal in the last few months. We are the third, building on the training sessions that have already gone before.  The next volunteers (in July and September) will build on our sessions further (I believe the topics will be bereavement and suicide).

We have a laptop and projector but no white board so we tape flip chart paper to the wall. The electricity comes and goes so we don’t know if we’ll have access to any of our equipment at any given time (nor air conditioning and its 35 degrees!)  Due to ‘load shedding’ in Nepal, the electricity goes off daily in different regions, spreading a fair share throughout the country. Good hotel establishments, like the Lotus Resort, have a generator – so we should be okay *fingers crossed*

Dave starts by welcoming everyone and introduces the subject of mental health. He mentions this subject can be difficult to discuss and reassures the women that this is a safe place to share, and if need be, they can leave the building at any time or come and speak to us privately if they wish. We start by asking what they have learned from previous sessions and it seems ‘awareness of mental health issues’ (where they had none before) and ‘providing counselling’ to women (where they would not have spoken to them about mental health before) and ‘recognising signs of mental illness’. One had recognised psychosis and referred the woman to a psychiatrist and others say they have now referred women for medication. They say they didn’t know before that babies can be in danger when mothers are psychotic and would consider removing a baby to a safe place until the mother was better. Some go on to share desperately sad stories of how women they have known have committed suicide. Sampada, our interpreter is incredible – the group are keen to share and it’s become apparent she needs to be a mental gymnast to keep up with the variety of local dialects as well as our English.

Once the discussion is rounded up, Jilly then begins her presentation on how to detect depression and what the difference is between baby blues, depression and psychosis. She discusses the Edinburgh Perinatal Depression Scale and how they can use this to detect, measure risk and respond to women’s needs. She empowers them to be able to confidently ask difficult questions of women and the students are keen to interact with her and know more.

I then give my presentation in a story telling format from a personal point of view as a mother and midwife. I discuss that I had both positive and less positive experiences with midwives during my pregnancies and that I noticed this made me more or less likely to share my feelings and also determined pain levels in labour depending who entered the room and what they said. I discussed how health care workers and women both benefit from building positive relationships making it more likely for women to trust their health care workers and divulge their true feelings, which can dissolve maternal anxieties, fears and stress all common in pregnancy, childbirth and postnatally. I discussed the physical effects oxytocin and adrenalin have on our body and mind and how the midwife can affect this balance and how by encouraging ‘active birth’ (where women are free to move around in labour) health care workers can help women feel more in control which can lead to higher rates of normal birth and reduced morbidity, ie perineal damage, increased blood loss, reduced birth trauma.  This can and also increase satisfaction rates for both mothers and health care workers.

The subject of active birth provokes a lot of interesting debate, as does water birth. They can’t seem to understand why or how. From what I’m told, here in Nepal, women are told to lie on their backs in both hospital and birth centres (a common side effect when birth moves from the home to the hospital setting, and one which persists in many instances in the UK to this day). I believe from our colleagues in MIDSON that many women are treated terribly – mostly in bigger hospitals. They say health care workers in some cases, have even been known to be physically and emotionally abusive to women in labour.

We tease out some of the issues in response to their questions. Their difficulty is especially with women carrying a ‘big baby’. They feel women must lie on their backs if a baby is big. We take time to discuss the logic behind this belief and Jilly and I demonstrate positions for what they call ‘freestyle birth’ and how health care providers can facilitate this. I feel this would be a class all of its own though and try to keep the matter on the subject in hand when the debate moves swiftly on to shoulder dystocia. (When completing evaluations, however, I will feed the interest in this back).

I then encourage the women to consider how they care for their own mental health and that of their colleagues, and how our own mental health can affect others positively or negatively. I discuss the stresses of the job and why it’s important to look after ourself in order to be able to look after others. The subject seems to strike a cord and there’s lots of nodding in agreement. I suggest they can use relaxation, meditation or simply take time for themselves to do something they enjoy each day to ensure a healthy work life balance for positive mental health. Happy midwives equals happy mothers and babies.

I wondered if culturally women in Nepal already meditated or practiced yoga, but it seems not – they say they are too busy and I don’t doubt it (a familiar story the world over). So I begin a 10 minute guided relaxation with the whole group and I’m glad (relieved?) to see how receptive they are to this (I wasn’t sure it would work and the translation into Nepali was difficult). Sitting in their chairs most allow themselves to relax, some fall asleep and some don’t close their eyes at first but do later. A couple don’t close their eyes at all – but that’s okay.

We break for lunch afterwards and then Jilly treats everyone to a tune – ‘Resham Firiri’ a local folk tune, on her Nepalese flute and the women are delighted. They clap and sing. One woman gets up to dance and takes my hands to join in. I try to copy the moves and they all laugh. We all feel very relaxed in each other’s company. We feel honoured and touched how easily they have welcomed us and how open they are with us.

After lunch the fun will begin again when Dave starts his cognitive behaviour therapy session …. I’ll tell you all about it tomorrow. We’re here for 3 days after all!

 

Clockwise:  Relxation session, our whiteboard, Jilly and Sampada, Sampada translates for me.

Day 5: Lumbini – 12 May 2016

image Lotus Resort, Sunwal, Nawalpari

We’re so lucky to have Suman as our own personal driver. Although the driving here is treacherous, Suman’s reflexes are superhuman and we’re lucky (and relieved) to find he’s an extremely skilled driver. He got us to Sunwal, Nawalparasi without a hitch and we’re happy to be here in our new home at the Lotus Resort. Professor Van Teijlingen of Bournemouth University (BU) has visited here before and recommended the place to us. The staff are keen to ask if we know ‘Prof Edwin Sir’ – his public health work here in Nepal is known to many and they appreciate his hard work and keen interest to improve the health of their people. They show us photos of him on their mobile phones and take some of us too to add to their collection. People in Nepal have a real interest in public health, not something we hear many people speak about here in the UK – a sign that this is, for the most part, under control here. How lucky we are. The staff couldn’t have welcomed us more and are already keen to know us. The manager Gopal makes sure we have everything we need. Mosquito nets are a must. The rooms are laid out in small chalet’s around a leafy green campus and there’s even a swimming pool! Very welcome in the 35 degree humidity. There’s already a chorus of insects and birds and their volume has been turned up to max. Our neighbours, from India, have already come out to say hello. Namaste one and all 🙏🏻

Today is a day off, firstly as a recovery day after the long drive yesterday and secondly so we can get our bearings in the venue and practice for the 3 teaching days which start tomorrow. It’s agreed we’ll all head to Lumbini, birthplace of Lord Buddha in the Rupandehi district of Nepal – a UNESCO World Heritage Site. I’m trying to imagine how you’d ever find your way to the site as a tourist on your own. There’s so many twists and turns on the roads (some Tarmac, some dirt track) and Suman has to stop a lot to ask people for directions. Sampada tells us there are maps but there’s so many roads they’re too difficult to read so it’s easier just to ask locals along the way. I try to imagine the millions of people living rurally around Nepal and how cut off they are from services in Kathmandhu. As we head further south the temperature and humidity increases; yet only a 7 hour drive north and we’d be in the Arctic Himalaya gazing at snow capped peaks which boast 8 out of 10 of the world’s top ten highest mountains – what a country!

This holy place of pilgrimage is a far reaching maze of huge temples, some still under construction and strictly no shops, hotels or restaurants allowed. Many countries have built their own ornate monasteries here in honour of Buddha and the religion that came to be, based largely on his teachings. This place has many entrances but no signposts – but we are patience and mindfulness personified. Nothing else for it.

Buddha’s actual birthplace (rediscovered in 1896) comprises ruined palace foundations and a flat, glass covered slab which apparently marks the exact spot of Buddha’s birth (the ruins are now within a modern temple building which serves as a protective cover). People throw offerings of rupees, marigolds and coloured powder. According to Buddhist tradition, Queen Mayadevi gave birth to Siddhartha Gautama here in 563 BCE when she came from India to Nepal to revisit her family home here. The midwife in me wonders what her experience was like and who were the midwives who attended her? We leave this sacred place and soak in the beauty of the manicured lawns and hedges and the shimmering trees seem to attract and emit a much needed breeze. I turn round and see a huge, sacred Bodhi tree adorned with colourful Tibetan prayer flags with an altar built into the trunk. We light incense and take photos in the hope we’ll capture this moment forever, already knowing it won’t.

We flit from temple to temple and marvel at the huge icons and statues in Chinese, Nepalese, Tibetan, Japanese and European styles. There’s opulence everywhere but it’s getting hotter and hotter and our bare feet start to scorch on the stone. Indian and Nepalese people stop us for selfies, and more and more join the crowd – even grandparents and children huddle in and Jilly even has a baby thrown into her arms. Apparently we’re pretty unusual round these parts and they consider it an honour to be photographed with us. We consider it an honour too and a monk returns the favour by posing for a photo for me in front of the World Peace Candle site.

imageBirthplace of Buddha, Tibetan monk at world peace candle, Sampada at Mayandevi Temple, Lotus blossom

image

Me, Laxmi, Jilly, Sampada and Dave at bodhi tree

When heat seems to shut our bodies and minds down, we head for home. A swim, a traditional meal and a quick practice before tomorrow … oh and 3 Gurkha beers Arjun please!

Andrea

Day 4: Kathmandu to Nawalparasi – 11 May 2016

We leave at 7am for Nawalparasi. GTN have arranged for one of their employees, Laxmi Basnet, to accompany Jilly, Dave and I and she will attend to all logistical arrangements. A driver has been hired to take us there and, of course, our interpreter, Sampada, will be by our sides. We’re all excited to begin our 3 day workshops and there’s also talk of squeezing in trips to Lumbini (Buddha’s birthplace) and Chitwan National Park (for an elephant safari).

Nawalparasi is in the Terai region of southern Nepal, near to the Indian border. A stark contrast to the arctic northern himalaya which boasts the highest mountain in the world. The Terai climate is lush and tropical and we’ve been warned to expect a hot, humid climate +10 degrees centigrade hotter than Kathmandu. We’re told the journey may take 5 or 6 hours, but no one can be sure. We may find the road will be closed due to road works, or maybe not … no one can tell. Everything is unpredictable here in Nepal and nothing is organised in the same way we’re used to in the UK. I find it an ideal place to practice mindfulness. Uncertainty, patience and acceptance is part of the culture here and everyone seems relaxed about that. It sits well with me, as does their attitude towards time keeping. If something starts at 3pm it may start at 4pm or … maybe later (I can already picture my family’s faces when I tell them – they’d agree I’d fit in well here!)

I try to absorb every view and moment of the exhilarating, high speed, break jamming journey, but there’s just too much to take in. Lush green towering mountains, muddy rivers, cultivated hillsides and coloured houses that lead impossibly up the mountainsides. The road is dusty, fast paced, nose to tail with weird and wonderful modes of transportation, like an adult sized kids ride at a fun fair! Brightly decorated lorries as if from the 60s hippy days, non-stop carrying loads from India to Kathmandu send out painted messages of Krishna, Buddha and peace and blessings to all. Our driver overtakes everyone he encounters, even though vehicles are coming in the opposite direction. Everyone moves out of each other’s way following an imaginary Highway Code all of their own, based on nothing but a mutual understanding and a shed load of luck!

I’m surprised how many people live along this highway. There’s unending brick houses, tin houses, tall brightly painted buildings, altars, temples, smartly dressed school children laughing along the roadside in western uniforms, people showering publicly in front of their houses, others sell their wares in an endless choice of roadside shops, old men and women carry impossible loads on their backs, young men stand around smoking (the only 3 smokers I’ve seen). Chickens run around, pigs forage near rivers, goats graze, toddlers hold hands, playing in the street, beaming with joy. Nepalese people really do have the most beautiful smiles!

It’s warm but not too hot …. yet. I see ravines hundreds of feet below and then a mountain that looks like Aberdeenshire’s ‘Clachnaben’. I tell our companions Laxmi and Sampada what I’m pointing at and tell them how high Clachnaben is – they find it funny as they look up at the Himalayan foothills.

Jilly, Dave and I reminisce about our fun evening the night before which we spent with a Nepalese couple, Prakash and Ambika. Prakash had completed his
MSc in public health in Aberdeen a few years ago and very kindly sent me a message inviting us all over to his home. I realise that it’s normal and in the nature of Nepalese people to extend a friendly welcome to strangers who visit their country. Professor Edwin Van Teijlingen, Jilly’s husband, had once been Prakash’s tutor and he’d heard we were in town. We felt like we were in a movie making our way to his home …

Prakash assigned us our mission: ‘I have no address so, give the taxi driver my mobile number, ask him to phone me and I’ll give him directions. See you around 6:30pm’. The journey was fun … and mysterious and involved lots of stops to phone Prakash and ask countless locals ‘where is Prakash’s house?’ The taxi drivers are honest and keen to help and have endless patience. This is just how things are done in Kathmandhu. We arrived safe and sound and were welcomed into Prakash and Ambika’s home as if we’d known them forever. We had a beautiful meal of chicken pieces, Dal-bhat and ice cream and enjoyed swapping stories of life in Nepal with our lives in the UK.

The journey to Nawal Parasi took around 7 exciting hours. We arrive at the paradise-like Lotus Resort in Sunwal and eye up the swimming pool. We are greeted by the happiest face I think I’ve ever seen. Gopal Gautam, the manger shows Jilly and I to our new home … Room 101 … plus lizards!

Photos above:

Suman loads our luggage, Laxmi and Sampada, Prakash and Ambika, Room 101

Nawalparasi:
https://en.m.wikipedia.org/wiki/Nawalparasi_District

Day 2: Kathmandu – 9 May 2016

Yesterday afternoon, Jilly and I had a few hours free so we explored Kathmandu.

We walked into town, trying to memorise the streets for the way back. There’s mostly no street names in Nepal (so not much of a postal service I’m told); local people just seem to know where they’re going … if not, they stop and ask locals what the next turn should be until they get there.

This is Jilly’s fourth visit to Nepal so she knows her way around well and is educating me about the politics and culture of women’s health here and about some of the research and interventions that’s been ongoing here over the years by The Green Tara Trust and their affiliates (including academics from the UK (Bournemouth University and Liverpool John Moore)).  It’s interesting to hear her reflect on the ways in which international volunteering can benefit practice back home too – something that will be evaluated in due course and somethings I will experience first hand once we complete our workshops in Nawal Parasi this week.

We visit Bhatbhatini shopping centre; a department store where you can buy everything from alcohol and food to clothes and crockery. There’s no legal age limited for drinking alcohol, so Jilly and I don’t get asked for proof of our age 😉 At lunch time I tried Momos for the first time – listed as one of Lonely Planet’s top 10 things to do in Nepal (not far behind Everest!) it’s a Nepalese traditional dish; dumplings stuffed with veg, chicken, buffalo or mutton – steamed or fried and served with a small dish of spicy sauce. They’re delicious!

We then took a long walk to Thamel which is known as the tourist or ‘hippy’ quarter. Lots of beautiful crystals, jewellery, fabrics, fruit stalls, and everything in between – even a ‘Diabetic and Thyroid shop’ (I wonder what they offer there?). Colourful rickshaws line the streets. Everything is colourful here and teeming with life but it’s heartbreaking to see children and adults begging on the streets. There’s so many people in need here, much more so since the earthquake last April. Many still live under tarpaulin in the city and on the fringes. Rebuilding will take time …. but the monsoon is coming and many are still without a roof over their head. Despite the stresses they face, people here remain polite, friendly, honest and trustworthy. A most humbling experience.

We go on to visit the Royal Palaces at Durbar Square (a UNESCO World Heritage Site). Our guide Bishwo is fantastically knowledgeable and funny. He took us to temples, and to see a local artist who paints Buddhist mandalas, wheels of life and more. The intricate and minutely detailed paintings are so impressive. We see many historic buildings, central to Nepalese culture, including the Royal Palace (sadly damaged in the earthquake), the erotic temple, hanuman temple and the home of Kumari the living goddess. A child who is considered to be the reincarnation of the Kumari is chosen when just a baby and kept indoors until she reaches puberty. The current Kumari is 10 years old and it’s strictly forbidden to take photos of her if you see her through one of her windows.

The oldest temple in the square dates back to the 11th century. It’s sadly reduced to rubble after the earthquake. Ten people were killed here when it fell. I can’t imagine the horrors the people here have seen and what they are still living through. Bishwo reassures us the temple is being rebuilt … but into a new temple across the square, using the old bricks from the original sacred Hindhu temple!

Jilly and I end our day walking home in the dusk, miraculously finding our way back home through the winding alleyways – the Nepalese way. A day I will never forget.

Today we worked on our presentations and workshop plan. We were introduced to Sampada Ghimire who will accompany us to Nawal Parasi as our interpreter for the workshop. Sampada is a recent university graduate and after achieving her BSc in public health is extremely keen to be involved with the project and ultimately wants to use her education and experience to be an activist she says, to help the people of Nepal. Many Nepalese people we’ve met take education very seriously and want to use their education to improve their country and the lives of its people. I find them extremely inspirational.

Jilly has organised some more meetings for us and after a morning’s work we head to Boudnath Stupa. I’m in my element among the Tibetan monks walking with the people around the giant stupa. I light incense on the Buddhist alter and revel in the sights and sounds.  A wedding party suddenly descent to the sound of drumming and the bride and groom emerge from a small temple after 10 mins or so.  The whole scene before me is colourful, but the bride even more so in her reddish orange glittering veil.

image

Soon our sightseeing in Kathmandu will come to an end – we travel south to the Terai region, the outer foothills of the himalaya, on 11 May and I’m told to expect high temperatures and humidity.

 

 

Nepal Earthquakes http://www.bbc.com/news/world-asia-32479909

Volunteering in developing countries
http://m.bma.org.uk/developing-your-career/career-progression/volunteering-abroad

Durbar Square, Nepal, UNESCO World Heritage Site https://en.m.wikipedia.org/wiki/Kathmandu_Durbar_Square

Kumari Goddess https://en.m.wikipedia.org/wiki/Kumari_(goddess)

Day 1: Kathmandu – 8 May 2016

Day 1 in Kathmandu – 8 May 2016 Today is 26-1-2073 in the Nepalese Calendar.  It is Baishak, their new year.

We’re meeting at the offices of Green Tara Nepal (GTN) here in Kathmandu.  The staff here give us a warm, friendly welcome and we’re given sweet milky, Nepalese tea, which kick starts the day beautifully.

Ram Chandra Silwal, the Country lead for GTN explains a little about the non-profit making organisation which has been working in the field of maternal and child health in Nepal since 2007.  GTN work in research, publications, advocacy, training and social mobilisation using an holistic community development approach.   In 2012 the organisation had 5 members of staff.  Today it has 25 with 13 more due to be recruited.  They have 47 volunteers across Nepal.

GTNs Nepalese public health and community development professionals are committed to improving the health, livelihood and socio economic status of Nepalese people using an evidence based approach and aim to bridge the gap between rural, urban, rich and poor families by removing barriers to them accessing maternity services.  In rural areas, Green Tara health workers have improved and changed traditional practice.  One such change is birth attendants visiting women in their homes, rather than women travelling to see them, which has improved uptake of services and improved women and family health.

Several research papers can be accessed at this link if you wish to read more http://www.greentaratrust.com/?page_id=15

At the meeting everyone explains what their role is within GTN and Jilly brings a smile when she plays a traditional folk tune on a Nepalese flute!  Tulsi has a go too!

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From left to right.  Jilly, Sujita, Sushila, Siddhant, Tulasi, Bill, Baby, Smriti, Namuna, Ram, Salita, Rajib.

Jilly and I leave the meeting and continue to make arrangements to travel to Nawal Parasi in the southern Terai region of Nepal on Thursday.  This is where the training will take place.  We have prepared power points which will be translated into Nepalese and we will think of creative ways how to present our ideas to GTN staff in Nawal Parasi.    Dave, our UK colleague, will be arriving on Tuesday.

Andrea 🙂