These last days....

27th June 2013, Thursday.

I somehow managed to lose my last blog...it disappeared into the ether without trace and cannot be found! What to do! I'll start again....
Life is never straight forward or easy, especially in Nepal.
Bimala, MIDSONS Programme Officer was recounting the difficulties they face on a daily basis when doing 'official business', trying to negotiate an unwieldy and complex bureaucracy, so many forms to fill, petty officials to charm. It would drive me to distraction, but she remains unperturbed and goes about her business with patience and good humour.
I've really enjoyed her  company these past weeks. We've had some interesting chats about all manner of things. She is a qualified nurse and hopes to train as a midwife too and one day return to her home in north eastern Nepal to set up a clinic providing quality health care for her people. However her attempts to secure a scholarship abroad have proved unsuccessful so far and the midwifery training in Nepal is still some way off to being actualised. She would make an excellent midwife with her kindness, sensitivity and discerning intelligence. I hope she can realise her dream!

Bimala

Another remarkable young woman I've got to know here is Samjhana Phuyal from the Safe Motherhood Network Foundation, (SMNF), Nepal's branch of the White Ribbon Alliance, (WRA.org).
She invited me to a meeting last week regarding the draft bill for Safe Motherhood and Newborn Health Care (already 3 years in discussion), with inputs re Respectful Maternity Care.
Various VIP's were there including Dr Arzu Rana Deuba ,the global president of the WRA and a government minister from the Ministry of Health and Population.
I was able to meet with Ishvari Devi Shreshtha, the Chief Hospital Nursing Administrator who was keen to hear about my observations while working at the Paropakar Maternity Hospital (PMWH).
She asked me to write an interim report to be discussed with her and the hospital director at the next morning meeting.

I arrived on the designated day to find that I was the guest speaker at a meeting of some 40 or so doctors and senior nurses, where I had to deliver the key points of my report! It was a little intimidating but I managed to rise to the occasion !
My main points were around Respectful Maternity Care ( a recurring message from all the previous volunteers) i.e the importance of maintaining a woman's privacy, informed consent and continuity of carer, (as far as this is possible in a low resource setting), creating the 'right'  environment for the normal physiology of labour to unfold, ( midwifery model).
MIDSON had asked me to write basic guidelines for infection prevention and a hand hygiene audit tool to be used at ward level, which I presented to the Sister of the birth centre.
Needless to say, I was careful to highlight the positive points first!

They do have their own comprehensive infection prevention guidelines,( a huge volume), and are expected to attend mandatory updates, but the levels of hygiene are , shall we say, less than optimal!
One doctor came up to me afterwards to talk about the lack of vocational doctors.  Many study medicine to fulfil the their parents wishes, for the prestige that being a doctor affords and for the financial rewards.

After the meeting

Nepal has a strongly patriarchal society and the status of women is low. This coupled with the complexities of the caste system means that woman are often not respected and woman's issues are low on the political agenda when it comes to developing a midwifery profession for instance.
I met with Kerstin Erlandsson, UNFPA's midwifery adviser and Kiran ( MIDSON's president) today, They were discussing the upcoming conference in September and all the difficulties they face in dealing with the government and the underlying political agenda that hampers any real change and development from happening efficiently and easily. And we think politicians our politicians are bad!
It seems a constant uphill struggle that would test the patience of a saint.
Kiran is passionate and committed in her mission to bring about midwifery education and its recognition as a profession in Nepal. Her energy and drive are truly impressive!
She has a good cohort of colleagues behind her too, Rashmi, Sanjena, Rita, Bimala to name a few, but not all the executive members are so engaged it seems.