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.

Rachelle and I arrived last night at midnight from our 13 hour layover in Hong Kong. While we were in Hong Kong, we did get out to do some sight-seeing, which included some pretty intense walking up stairs (and down stairs, and up more stairs) with our “carry-on” packs on, mine which was far too heavy for this sort of layover (I will learn one day what it means to “pack light”). Rachelle was much smarter. On arrival in Kathmandu, we were ushered off the plane and into the airport, where there was some waiting, and some more waiting. As we learned on our ride back to the guest house, there had been 5 planes that had arrived at the same time. INCREDIBLY FORTUNATELY for us, our fearless leader, Cathy was at the airport to meet us! While we didn’t see her right away, as we were accosted by 5 men trying to “help us” with our luggage and a ride, we did eventually spot her and we were reunited with hugs and smiles.

We were ushered to our vehicle (a Diesel Corolla!!! – to clarify, I have a Corolla, slightly newer, but felt right at home in the North American driver’s side while being driven busy streets at night) were assisted with our luggage, and eventually pulled away to go to our guest house. The ride was uneventful, though I’d be lying to say I wasn’t on the edge of my seat from time to time. Let’s just say there were a lot of people in cars very close together in tight streets, and driving that would rival that of most professional stunt drivers. We were duly impressed, and relieved to safely arrive at our guest house. We were warmly welcomed, offered drinking water and shown to our room.

After some unpacking, cold showers and the requisite chatting, we headed off to sleep, reflecting on just how lucky we are to have received such luxurious treatment here in Nepal. Traveling with Cathy gives me confidence that would be replaced with distress if I were doing this alone. Having friendly faces and logistical arrangements already made for us with known individuals, is such a gift. I feel so grateful to be here, and to be doing it this way. I feel so taken care of.

Yesterday was our final official day of packing at UBC. As the “lead packer” I’ve had an incredible amount of help from the other students who are travelling as well as our wonderful faculty members in sorting and packing bag after bag of beautiful donated items and much-needed medical supplies. We are so fortunate to have so much, and to have so many caring, dedicated individuals who support us in our travels abroad.

That being said, as much as yesterday was about packing, it was also about farewells. Interestingly, I found myself saying “See you in Nepal!” and “See you in Uganda!” (accompanied by big smiles and tight hugs) to many of my colleagues both yesterday and today. Reality is starting to sink in. In just over a week, some of us will be stepping on a plane, not to return home for 3 months.

The packing stages have been overwhelming at times, but I’m sure they bear no resemblance to the degree of overwhelm we’ll experience abroad. And yet, I find myself thinking more and more about my midwifery “family”; my colleagues, who I’ve come to know and love over the last three years. I feel so fortunate to find myself in a program that has brought us so close to each other, that in the absence of my own family, I know I’ll feel better being in the presence of my colleagues and teachers.

On a drive back from Vancouver tonight I heard the song “Closing Time”, which I recently discovered is actually a song about birth. What struck me were some of the final words in the tune…”Every new beginning comes from some other beginning’s end”. We are very much at the beginning, but it also feels as though something is shifting, that something is also coming to an end.

So for now, I’ll keep saying “See you in Nepal! See you in Uganda” to those fortunate few who we get to travel with, and many “I love you’s and see you soon” to those we love and will see again, come summer.