One of my favourite things is waking up to the sounds of a new place. This morning was no exception. To say the birds were ‘deafening’ might be a bit extreme… but the chirping symphony was definitely a loud one, ha ha! (but it also immediately put a smile on my face 🙂
After breakfast in the courtyard Jacquie, Cathy and I taxi’d out to the local teaching hospital to meet Kiran, the president of the midwifery society of Nepal (MIDSON). She filled us in about her vision to provide a specific Midwifery education program to Nepal. Right now midwifery training is offered as part of general nursing training, but the nurses are not able to practice as autonomous care providers. Her hope is that the program will be rolled out by the end of 2015, so there is much to do and she and her team are working round the clock to get the syllabus created, government documents signed, and the never ending work of networking to get all stakeholders on board. The government is on board, but there is still a lot of work to see midwifery become a sustainable part of maternity care in Nepal. Changing a system is challenging, but the MIDSON vision is that midwifery integrates as a respected, sustainable, and accessible option of care for women, that is also supported by the medical system. I’m sure we will learn more about this as we go (and the fact that we were pretty jet lagged yesterday didn’t bode well for asking the most articulate of questions!).
Our afternoon was spent across the dusty road in a birth centre that opened just over a year ago. While we were there a woman gave birth to a 3.75kg baby boy supported by two nurses, her Didi (big sister) & husband. It was eye opening to see what a positive birth scenario can look like in what we’ve been told can be a very interventive medical system. For example, the woman who birthed her baby didn’t have an episiotomy, which is quite standard in hospital births in Nepal. In it’s first year, this birth centre has facilitated just over 70 births. In comparison, the hospital down the road sees over 100 births each day. There is a long way to go to see this kind of facility thrive.
The two women in labour yesterday were from a higher caste and had all their supplies with them – including oxytocin and misoprostil: two drugs important in case of hemorrhage. They also had brought their own syringes, saline, and catheters for the nurses to use. Both husbands were quite involved supporting their wives and both women had also received 7 antenatal visits (which is over the minimum 4 as recommended by the WHO.) Kiran wants to see more births happen like this. Until we observe the larger hospital and also the situation in the more rural parts of Nepal I’m not sure we can fully appreciate what they are trying to facilitate here. From my perspective it was a nice space with colourful curtains and comfortable beds on the floor with the option of privacy screens. The ‘delivery table’ was only used if suturing is required after the birth. But, what do women do who don’t have their own supplies? Also, the criteria to birth at the centre are very strict and offer little leeway for labour to diverge from a very defined pattern, even if that pattern is still considered ‘normal progress’ in our experience. We didn’t get a chance to ask all our questions, so I’m also not totally sure I’ve understood everything correctly.
I’m realizing this experience is going to be hard to capture as we go, but we had a wonderful first day here in Nepal and we’re eager for all we’re going to see in the weeks to come.