Himalayan Heartbeats: To Live life is so startling....

PMWH staff quarters where MIDSON have their office

First day being shown around by Bimala programme officer
for MIDSON with Johan, fellow volunteer.

Two wee boys who live nearby MIDSON office

Hotel Clarion, Jawalakhel, Kathmandu
Friday, 7th june 2013

How much can happen in a week, a day, an hour, a minute, in a momentary pause between two breaths. First gasps are taken and last breaths exhaled and those who witness these beginnings and departures will weep for joy and relief or in sorrow and loss.
The poet Emily Dickinson said " to live life is so startling, it leaves little time for anything else"!Such has been my experience since my arrival!
I hardly know where to begin.
I arrived in Kathmandu last Sunday after a long, and fairly uneventful journey involving quite a lot of hanging around, in the strange limbo world of airports waiting for flight connections.
Caught a taxi through the crazy crowded streets, to our hotel in Patan, "once a fiercely independant city state, now a suburb of Kathmandu, separated only by the murky Bagmati River" , ( so states the Lonely Planet Guide).

Bagmati River

Said murky river is one that I have come to know in my morning walk to the Paropakar Maternity and Woman's Hospital where I have spent the last few days working in the Birth Centre.

PMWH , Kupondole , Lalitpur, Kathmandu

This is where the 'low risk' women go to have their babies, cared for by the nurse/midwives who have had additional training as ' skilled birth attendants' ( SBA's). The nurses have good theoretical knowledge but don't have true autonomy as the the Dr's assess and admit the woman in labour and prescribe their care.
The PWMH was built by the late King Mahendra in 1959, in memory of his wife Indra Rajya Laxmi Devi Shah, who died due to pregnancy related causes. It is a government funded hospital and there are over 20,000 deliveries there a year! Women are given a monetary incentive by the government to encourage them to birth in a health care facility rather than with no SBA at home.

The first morning, we were introduced to the Matron and Nurse Supervisor, and given a tour of the hospital, including the ' Kangaroo' ward where the tiny premature babies are nursed by their mothers before discharge home. There was one baby who weighed only 1.07 kg , all skin and bone , like a frail little bird who was apparently breast feeding well and about to go home!

The Birth Centre has 8 cubicles with metal beds separated by partitions and no curtains, providing little privacy and minimal creature comforts. However the woman are allowed their husbands and family members to be there, to care for them in labour which is not allowed in the high risk ward.
The nurses are quite 'task orientated' , carrying out the Dr's instructions and don't seem to spend much time being 'with woman'. Many woman have their labours inappropriately augmented with IV syntocinon, (albeit a much more dilute dose than we give in the UK), to stimulate their contractions and speed up their labour ,with only intermittent monitoring of the fetal heart. They don't have the equipment to continuously monitor the baby and this means that the Dr's will often intervene to perform a c section if their is any delay in progress.
Our role as volunteer midwives in Nepal, has been to advocate respectful maternity care, (see the White Ribbon Alliance Campaign), and the midwifery model of care, to encourage the nurses to empower and be 'with', rather than 'doing to' woman , supporting and encouraging her to have confidence in her ability to birth naturally, adopting upright active birth positions and thereby avoiding unnecessary and potentially harmful medical interventions.
My first day I was able to assist with a woman in 2nd stage of labour who, was lying supine, becoming increasingly distressed and unable to push effectively. The nurses shook their heads and said 'poor maternal effort'. I suggested we help her to turn onto all fours and massage her back, which had the instant effect of calming her and easing her pain. She could now bear down ,with gravity assisting and deliver her child in full control. It was beautiful to behold and it never ceases to move me,, this miracle of birth! We were all crying, the mother, the sister and I . The women looked up and smiled at me and said " dhanyabad', thank you, and I thought this is surely the best job in the world!!
From then on, the SBA trainees and nurses warmed to me, (initially they had been a bit wary )and by the end of my shift we were exchanging email addressees.
Each day I am summoned at 1pm sharp, to have lunch with the sisters and matrons , sitting in their office where we are served delicious freshly cooked food by their personal cook, a lovely smiley woman.
My first lunch with the matrons, we were served a delicious mild curry, for my benefit .
Maiya Ma'm, the nursing supervisor asked if the food was too spicey to which I replied , " oh no, I love spicey food". The following lunch time, I was served a very spicy curry and was duly scrutinised by a row of matrons, in white saris sitting opposite me, while I ate it all up with only a mildly perceptible watering of the eyes. It felt a bit like an initiation test!
There is an old fashioned hierarchy here, based on age and credentials. The Dr's (of course) are in the highest echelons, but the matrons come not too far behind.

Mother and baby with one of the wooly hats kindly donated

The day after our arrival we were invited to meet Ms.Kiran Bajracharya , president of MIDSON, Nepal's Midwifery Association ,( pictured above, far left with Johan and myself) and Ms.Sajana Ranjit, MIDSON's treasurer.We were presented with fruit and flowers and and a white scarf, in the traditional Nepali way. (Jaki , my other volunteer companion is missing from this group as she arrived a day later).