That’s the way it is in Nepal

I drew back the curtains one morning last week, and the air was clear. The mountains rose behind the houses. And there behind them… were the real mountains, the snow-capped Himalayas right outside my window. They had been hidden every other day by smoggy haze. Hooray, a clear sharp view of snowy peaks puts the smile on any morning face.

So through the city to the birth center. All is well. Things are happening despite glacial slowness. Why use one person to do something when 3 will do? Decide to go to buy the flooring for the birth room at last but wait there is a phone call then someone comes round with an important piece of paper to sign which involves much thinking and rereading and then of course there is another cup of tea and finally off on the errand we go. That’s the way it is. The task of getting the brochure printed is mammoth. Misunderstandiings about who is doing what and how it should be done… days pass. Leisurely dysfunction.

The story of Ratna sadly exemplifies the way it is in Nepal. She is a nurse with a few months’ midwifery training like most of the staff at the center. She wants to study more and finish her Bachelors in Nursing. Last week she told me that her grades weren’t good enough and she was on the waiting list. I commiserated. Today Rashmi told me the full story. Most applicants are wait-listed she said. Those that are accepted from the list are those who pay. Ratna can’t pay. Rashmi tried to use her influence, without paying, a little string-pulling but to no avail. No pay no place.

On a more hopeful note, I think I have found someone who will “champion” the non-pneumatic anti-shock garment in Nepal. It will need a champion to push its use, spread the word, inform, instruct, and cajole. Asa works part time at APS as well as full time at the big public hospital. She told me that she became a midwife because of her mother. Her mother died at the age of 33 of a postpartum hemorrhage. We weren’t talking about the anti-shock garment when she told me about her mother. We have not talked much. I am not sure why she told me about her mother. It was emotional and hard to talk about. Strange that she told me. Then I told her about the anti-shock garment. The anti-shock garment impressed her. She knows it will saves mothers’ lives.

And I want to tell all you deviners out there, Nepal is a place where it is apparently impossible to lose things because someone will find it for you. From my little flashlight which I left in a crowded restaurant and was returned to me 3 days later, to my camera which I lost at the Boudenath stupa and was returned to me by a delightful Nepali child. And a bag of precious goodies I had bought were carefully rescued for me by a guard at the Golden Temple in Patan.

And some pictures:

Beautiful Boudenath where I lost my camera

Beautiful Boudenath where I lost my camera

more Boudenath

more Boudenath

prayer wheels at Boudenath

prayer wheels at Boudenath

she found my camera!

she found my camera!

Happy at the Golden Temple. Have'nt lost my bag yet

Happy at the Golden Temple. Have’nt lost my bag yet

the fabulous Golden Temple

the fabulous Golden Temple

on a wall at the Golden Temple

on a wall at the Golden Temple

Sumitra learnt to apply the anti-shock garment

Sumitra learnt to apply the anti-shock garment

Ratna and Amala measure the floor of the birth room for the new lino

Ratna and Amala measure the floor of the birth room for the new lino

delightfully round faced baby

delightfully round faced baby

The birth center makes angelic babies

The birth center makes angelic babies

Three hours old

Three hours old

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Dashain fatigue…. and reenergizing

The festival of Dashain lasts 15 days! The build-up was fun. There was the buzz of shoppers, travellers, preparation. Then there was the height of the festival: ritual, puja, tika, food. And then… it went on. Many shops still closed. Not much getting done. Personally, I had a case of Dashain fatigue. I wondered if the Nepalis felt the same. I had the feeling that some of them did.

I continued working at the birth center through the holiday. It was quiet but a bit of action here and there. Babies get born whatever is happening and the clinic is always open. But today the festival is over and despite being saturday which is the Nepali weekend, I had a much-anticipated meeting with Kiran at the Midwifery Society of Nepal and feel energized in new directions. We had a wonderful two hours together. She described her struggles for acceptance for the profession of midwifery and the resistance of both physicians and nurses (a sad and old story). She is working towards an in-hospital birth center (more like a midwifery led unit in the UK) which can serve as a model midwifery care site and as a clinical setting for midwifery students. We planned my continuing education topics. I will do a series of weekly hour-long sessions to the society through November. The first will be (surprise surprise) childbirth education and adapting teaching models to Nepal. The second will be on the topic of the anti-shock garment. Hooray! The third will be on birth centers and there may be a fourth on finding and using evidence for midwifery care practices. So lots of prep for me for those workshops lies ahead. Of course I continue to work with Rashmi and the midwives at APS Birth Center.

So now a few pitures. First shoving the sacrificial goats into a variety of vehicles!

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You can put a goat on a motorbike

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Or in the back of a car

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Or in the front of a car

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car puja

I was invited to Devi the tailor-carpenter for family celebrations

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Puja for devi’s carpentry tools

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Puja for Devi’s tailor tools

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tika for Devi’s wife

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tika for Devi’s mother

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tika for Devi’s guest

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HAPPY DASHAIN!

Outside “helpers”. Thoughts from a wandering Jew.

Tiptoeing through a minefield

Tiptoeing through a minefield

We are a wandering species. Wandering and shared culture is mutually strengthening. One of my personal goals on this trip is to be tipped off-balance by new experiences, different people and places, and to gain personally from this. As I wrote in one of my earliest posts (“Intercultural Understanding July 29th” https://wiwok.wordpress.com/2013/07/  ) “I believe that help is a minefiled”. My whiteness and my American experience give my words and my ideas power that I do not intend. I am treated with a deference that is both natural hospitality and a discomfitting honor that belies a very mixed intercultural history.

Bringing ideas and teaching imply a negative assessment of midwives and APS Birth Center. A negative assessment does not mean criticism. There is no blame given. But I know it is felt. And that feeling weakens the confidence of those struggling here under very difficult circumstances. It disempowers them and makes them more dependent. So, what if I didn’t try to do what I am doing? What if all the do-gooders walked out of Nepal and left them to their own devices? Maybe they would be better off and midwifery, mothers and babies would figure out quite happily how to care for themselves. Such abstract questions are meaningless and absurd, however, in a globalised and interdependent world. The strength of technological systems deriving from corporate power are such that the marginalised, the midwives and normal birth would lose. So I continue to tiptoe around the minefield.

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What do you call a Nepali midwife?

As part of the promotional materials we are creating for the birth center, I asked a couple of the midwives to translate a piece called “What a midwife does”. This proved extremely difficult. Despite an online dictionary, translations were elusive. Most difficult of all…. the word “midwife”. In Nepal, English words are often used for things of a technical or maybe prestigious nature. (This sometimes leads to both the sense that an individual Nepali’s English is bettter than it is, and also sometimes to the feeling that you understand things that are being said when you actually do not). Thus, Nepali midwives like the term “midwife” to describe themselves even though it is in English and ordinary Nepalis do not really know what it is. They do know the word “daiamma” which means literally “with mother” and also the word “sudani” which means community health worker (I think). But neither of the words satisfy the midwives at APS. The “daiamma” is an untrained village traditional birth attendant and the sudani is not right either. So they choose midwife. I understand but I am sad. I am sad that the word “daiamma” which is clearly related to so many words for midwife in so many languages (partera, sagefemme, meyaledet, hebamme) has been tarnished with the reputation of the untrained. How can midwifery in Nepal be professionalised if it cannot claim it’s name?

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Prena struggling with the translation

Rashmi has decided that with my help (our help, thank you donors), she would like to make a few physical changes at the center. I am relieved. She is so modest with her ideas. We walked down the hill from the center to the carpenter’s shack. He will put up a movable partition to help the flow of the center. Currently most people walk through the pharmacy to get into the main building. It doesn’t really make sense. The carpenter and Rashmi seem to be old buddies and after planning the changes we wandered a few steps behind the shack to his house for cups of tea with his wife and sister. They have a sewing business in their home and quickly whippped out the tape measure, spread out the cloth and had me measured for a “kurta” before I knew what was going on.

Rashmi and Dev the carpenter shooting the breeze

Rashmi and Dev the carpenter shooting the breezeIMG_0610

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So that was a slice of today.

Hanging out in Kathmandu

I’m hanging out here in Kathmandu. I’m a routines kind of person.  And I’m develping my routines. My quiet breakfasts. Organizing to go over to the birth center. What will I be bringing with me? What will we be working on? Wandering through the town to the bus. Last week or so I learnt that buses make sense. A cab is a bargain at $3 but it was my biggest daily expense! At 15 cents, it’s hard not to get a bus. And it feels a lot safer than a taxi. It’s bigger and it sticks to the bigger roads (much less picturesque and less bumpy). So it takes longer to get to the birth center. But I’m in no hurry. I love my wander/walk through Tahity (called Tahity??) and via a mini-monkey temple called Kathesimbhu Stupa

Kathesimbhu Stupa

Kathesimbhu Stupa

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IMG_0573 and via the square with a temple that honors the tooth protecting deity

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I think this is the tooth guy but not sure. Fierce anyway

and the veggie sellers of Asan Tole, and the crazy pre-festival shoppers, to Ratna Park where the foot traffic squeezes through a toothpaste tube and up onto the footbridge where people sit and sell flip-flops and watches, and a beggar plays listlessly on a drum and someone else is begging for a kidney transplant, to my bus. They squeeze us in cozily and off we go. Kalanki is dusty, dirty and busy. I walk a few minutes towards the birth center, and today before going in, I took a few pictures of the goat market opposite. Goats to be sacrificed for the Dashain festival

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Today at the birth center, I was planning to prepare three topics for a meeting with Kiran, the president of the Midwifery Society of Nepal: 1) A presentation on Childbirth Education  (I seem, bizarrely, to be becoming an “expert” on this topic)  2) A presentation on the anti-shock garment, it’s benefits, research to support it’s use in shock secondary to postpartum hemorrhage. I really believe in this thing and hope that Kiran will be inspired to push it to the Nepali Government and 3) Some topics in evidence based maternity care. I was supposed to meet with her at 3 and worked away at my prep but then she cancelled on me till next week. That’s kind of the way things go here, so I worked with the birth center midwives on posterior babies and other topics. We’ve had a good few days at the center. A Nestle man (boo, hiss) came to present on nutrition in pregnancy, and while we were all somewhat stimulated by some of it, I was also inspired to prepare my own nutrition power point! (of course). Here are some midwives listening to the Nestle (boo, hiss) man:

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Here is more childbirth ed stuff: preparing material:

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Prena and Laxmi

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And here is a gorgeous Nepali lady smiling as she gets a depo shot!!!

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And here are two delightful midwives bravely preparing to head home on their motor bikes

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Progya and Ratna

So that’s it for today’s update folks. Happy Dashain festival.

Tourism on a rainy festival Saturday

Ferst day of the Dashain holiday which is 15 days long! It seems day 1 days 7,8,9, and 10 are the highlights. Rituals and stories seem very complicated. Durga…. one of the many mothers, is the heroine and sacrifices play a part. Lots of people travel to be with family (It’s kind of like Christmas/Seder night I think) Lots of people were out shopping. Being both Saturday and a festival, I didn’t go to the birth center but instead, dedicated myself to Kathmandu tourism. Been here 3 weeks and decided it was high time to see the monkey temple. I did a lot of walking in the rain: Up to Swayambhunath (monkeys and staring eye stupa) and then back down over the river and through the alleyways to Durbar Square which I had visited on my first day in a jet-lagged fog. Great food and alleyways clogged with festival shoppers and back wet, muddy, satisfied.

Pics:

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impossible task of cleaning

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Flowing with Nepal

Nepalis are warm, welcoming, kind, relaxed, open. They are amazing. It is not easy to live here and things don’t work well. Clean water, trash pick-up, sewage system, electricity on demand, none are functional. But Nepalis flow with Nepal. Not only are they used to it, they smile.

Most women wear saris or kurtas with loose pants, long and flowing, bright and gorgeous. On their feet, flip-flops. When it rains, the streets turn to streams of slimy mud and the women flow through the streets and emerge clean, fabulous and unscathed, while I am covered in mud and splattered up to my knees.

Through the piles and piles of urban filth you can glimpse, amazingly, nature! I saw an eagle swooping low over the black trash-strewn river, as well as egrets and butterflies. Glimpses of mountains rise behind the slums. Hurtling through the backstreets I saw empty lots in the middle of the city where people are growing rice. In addition to cows, there are also plenty of goats and chickens. The festival of Dasain is coming up and goats will be bought and slaughtered. The birth center is situated right by the goat bazaar and yesterday goats were massing among the motorbikes!

Yesterday, to my surprise the childbirth education program sprung into action. Lesson plans were going to be revised and rewritten in Nepali, staff was going to get together and review, but Rashmi decided…. no time for niceties like planning, we go for it. And they did. They did great. …. tore through 3 lesson plans in 45 minutes…. but the group was engaged and happy. Rashmi said she thinks this is the first childbirth education ever in Nepal. Maybe she is right. It deserves a press release I think.

Here are some pics of the class.

Prena and Rashmi having fun preparing

Prena and Rashmi having fun preparing

The class has begun!

The class has begun!

Dipshika organizing the visual aids

Dipshika organizing the visual aids

focused......

focused……

rapt attention!

rapt attention!

class is fun

class is fun

getting into it

getting into it

also in class

also in class

Some pictures around town

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mushrooms

mushrooms

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