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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