Sajana, Kiran, Jilly, me & Nina Jilly, Laxmi and I
We’re up early and head off to Tribuvhan Airport to pick up our colleague, Dave. He is joining us as a volunteer on the project and will give our participants an insight into mental health disorders, such as obsessive compulsive disorder (OCD) and cognitive behaviour therapy (CBT), an area which Dave specialises in. We flag a taxi down outside the door of GTN and agree a price for the round trip. No fixed prices here.
On our return, we introduce Dave to GTN staff and continue to plan our workshops. GTN have found us an interpreter to accompany us to Nawal Parasi. Our power points have already been translated into Nepalese (beautiful writing!) and we decide the best way to present during the workshops is to first say a sentence in English and Sampada will then translate each sentence into Nepalese. We met Sampada Gamire for the first time yesterday. She’s highly capable and her understanding of English is impressive – she can even understand our differing Scottish and English accents!
We consider the format the teaching days will take, but are unsure if our ideas will work well with a Nepalese audience. We are keen to choose the best way to appeal to the students to maximise their learning and we feel our approaches will provide a good variety of teaching methods that will appeal to differing learning styles. We’ll only know for sure once we actually teach, but we plan to evaluate each day and change the format as we go along if need be.
Later that day, Jilly and I visit the Midwifery Society of Nepal (MIDSON) and meet with some of the staff: founding member of MIDSON Dr Laxmi Tamang, President of MIDSON Professor Kiran Bajracharya, Secretary Nani May Kaway and Treasurer Sajana Ranjit. They tell us of their recent Second National Midwifery Conference (the timing of which coincided with International Day of the Midwife) entitled ‘Reaching to unreached women: Strengthening midwifery services after the earthquake’ and they kindly give us souvenir programmes and bags. It’s heartening to hear them speak out as advocates for women in Nepal and they clearly have passion and drive to promote woman-centred care. There is a desire here to change the behaviours and attitudes of birth attendants towards women and we discuss some of the issues that may lie at the heart of these negative traits. We share the fact that these behaviours are often present with UK midwives too and the staff at MIDSON know about the UKs desire to tackle undermining and bullying behaviours from working with the UK’s Royal College of Midwives (RCM). Prof Kiran says the RCMs global twinning project between Scotland and Nepal has been extremely beneficial in assisting them to develop models of midwifery led care here in Nepal and they are also keen to learn about the mental health training programme which we’re here to deliver. There’s no formal midwifery education nor qualification as yet here in Nepal, but MIDSON’s hope is that this will change in the not too distant future but they say they have some way to go.
Laxmi shares with us her insight into some possible reasons at the root of negative behaviours by birth attendants towards women here in Nepal and has written academically on the subject of obstetric violence. She enlightens us about historical, social, cultural and religious reasons which impact on this. She feels women are discriminated against here depending on the caste they are born into and gives a fascinating explanation about this and why if it’s not addressed , barriers to progress will remain.
Further reading about these challenges can be found here:-
Pregnancy and childbirth in Nepal:
Maternal and child health in Nepal: The effects of caste, ethnicity and regional identity
We then hear first hand how the nurse-midwives and skilled birth attendants (SBAs) managed the care of women in the immediate aftermath following the earthquake on 25 April 2015 and how they evacuated women from the maternity hospital nearby, which was completely reduced to rubble. Amazingly no mothers or babies were injured and it was sobering to hear of the care they provided with little to no resources.
We leave MIDSON in the pouring rain – rain drops the size of golf balls in the hot air, sheltering under an umbrella kindly given to us by Kiran Ma’am. I reflect on how impressive these women are and try to imagine myself in their shoes … I wonder how I would have coped in their situation? Would I have adapted and been as ingenious as them, or would I have felt the task impossible without the comfort of a multidisciplinary team and resource-rich environment around me? We head home to Green Tara with thunder rumbling enormously in the air. The first thunder storm of many.