Things coming together…. progress?

The sun rose to another clear day and a clear view of the mountains the day after the elections. What would happen next? After breakfast, I got organized to head out to the birth center. Everything was…. normal. How interesting. No violence, no excitement, just life, busy streets and newspaper headlines that the elections were peaceful. Results were coming in. Record voter turnout. The maoists who led the stirkes had lost badly. But rather than responding violently to defeat, it seems they were licking their wounds and moving on. The marxist-leninists and the Nepali Congress are the 2 big winners with the vast  majority of votes. The maoists, with a smaller number, hold the balance of power. Other parties have mostly 5% or less. All of this seems such a mature democratic outcome and brings a dose of optimism and confidence in the future that I think is in the air.

With the birth room redecorated, the childbirth education in place and the brochure at the printers, my work here is coming to a close.The anti-shock garment project sent me in and out of offices, NGO and Government, and I did two hospital presentations on its use.The new graduate level program in midwifery will hopefully start next year, It will be the first in the country and a prerequisite for the Midwifery Society of Nepal to have membership in the International Confederation of Midwives which regulates the profession worldwide. An initial research project would raise the prestige of the program and of the profession. It may really happen that it will be an anti-shock garment project. Kiran is for it. Dr Regmi, a big cheese at the Ministry of Health is for it and will fund impementation if initial funding is found. Doesn’t that sound like concrete progress? It feels good.

Meanwhile there was a funny day last week when the world seemed to be converging on APS birth center.Volunteers and staff were hauling around dusty piles of medical equipment, sorting, chucking, organizing. That frenzied, excitable mood that happens with a big clean was all around. Some of the senior staff who come in occasionally, Rashmi, Asha, Amala, were all there. And so were the Duggars! What? Yes father Duggar and Jill Duggar from the reality TV show about the family with the 19 biological children along with TV crew, invaded the festive cleaning up atmosphere of the center. For my non-US readers, know that even if, like me, you are barely aware of television and popular culture, you cannot help hearing about the Duggars and their TV tribe in the US. Jill D is on her way to becoming a midwife and while visiting Nepal, she wanted to visit a birth center, Nepali midwives and make an episode about her aspirations. Rashmi was interviewed. Mothers, babies and midwives were filmed. A festive mood prevailed.

While this was going on, the normal day at the center was happening too. A couple came in, for what they thought was an intial prenatal appointment at 29 weeks pregnant. But no heart-beat, and measuring many weeks smaller than 29 weeks. Sadly her baby was not alive. The couple were hugged and supported. Follow-up care was arranged. They had a a quiet corner of the center as the camera crew charged around. Sometimes events coincide in strange ways. Meanings are unclear but the strangeness implies meaning of some kind. That is midwifery in Nepal and everywhere.

Here are some birth center pics and then some older tourist pictures

APS motherbaby, APS staff, and a Dugger!

APS motherbaby, APS staff, and a Duggar!

Dinah and Jill (Dugger #4 outof 19)

Dinah and Jill (Duggar #4 outof 19)

APS board dinner

APS board dinner

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Annapurna just after dawn

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Annapurna dawn

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temple guard

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god eats other god alive

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Ganesh Himal

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New directions

Birth center chugging along. Feeling that my work there is finishing off projects: making sure the brochure is printed, getting new towel rails by the sinks (goal to encourage handwashing), discussing with Rashmi the placement of the new Ganesh statue. But my focus the last couple of weeks has been more outward and a bit outside my comfort zone: the anti-shock garment, hospitals, doctors, NGOs and Government administrators. Very different.

My first foray into the hospital world was a low key effort: Did a class for nursing students and faculty at at Tribhuvan University. It was a lot of fun. They were warm and enthusiastic. Here are some of the students having fun with practising labor support.

practicing labor support

practising labor support

Tea with faculty afterwards

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You may remember, that thanks to last minute donors I was able to bring a supercool neoprene and velcro device for stabilizing women who are in shock secondary to postpartum hemorrhage. Very enthusiastic about this simple thing that has been endorsed by the World Health Organization, has great outcomes in clinical trials but is virtually not used here in Nepal, where postpartum hemorrhage remains the number one cause of maternal mortality. So I put together a presentation on the device together with a bit of hands on training, and have been talking, telephoning, emailing, knocking on doors to spread the word. I have met some interesting people this way, and experienced lunch on the roof of the United Nations Fund for Population and a chauffered drive in a Government vehicle in which we drove through the middle of a preelection demonstration in Durbar Square. I did manage a presentation on the anti-shock garment at one of the hospitals, but whether I can really get a structure in place that will lead to training in use of the device, and incorporation into clinical practice is another matter.

Meanwhile, the elections took place yesterday and seem to have been largely peaceful with higher turnout than expected. The day was yet another holiday. This time the shut-down was total; a festive atmosphere of families wandering in the streets. Kiran, president of Midwifery Society of Nepal, invited me to lunch at her house where we talked for four hours…. all midwifery. went on the roof of her house to stare at the mountains through Russian communist era binoculars decorated with hammer and sickle. Ate dal bhat of course. Lots of tea of course.

A few pics.

election rally near the birth center

election rally near the birth center

from my window
from my window

baby massage on the street

baby massage on the street

The dentist's window

The dentist’s window

Below, false teeth. Above..... real ones!!!

Below, false teeth. Above….. real ones!!!

pahupathi. smokie rises from ghatts

pashupathi. smoke rises from ghatts

stoking the fire

stoking the fire

where the ghatts are for burning bodies

where the ghatts are for burning bodies

In every mini temple is....

In every mini temple is….

a "lingam" (phallic symbol)

a “lingam” (phallic symbol)

Eating and drinking Nepali

Amos, this one is for you.

Love the food here. Great for vegetarians. Again, the influence of both India and Tibet but independently Nepali. Nepalis have a very light breakfast: a cup of tea perhaps and maybe a piece of fruit or something very small to go with it. Loads of types of tea. The classic is Masala milk tea. I don’t like it much. Also lots of plain back tea (usually sweetened) (Drinking some now as I write, of course). Also, jasmine tea, mint tea and lots more. I love hot lemon with honey… basic and good. Around 10:30 or 11, the Nepalis break for brunch, which is Dal Bhat, litereally a plate of lentil soup and rice, but can be so much more, with added curries and vegetables and chutneys and maybe meat and even yogurt. Then, early afternoon, time for a snack. This “roti” could be a bit of anything but that’s when I have my small cup of bean soup with a piping hot chapti or two. A unique Nepali snack is momos: vegetable or meat dumpings, steamed or fried with a spicey dipping sauce. Dinner is…. Dal Bhat again…. and while this sounds boringly repetetive, dal bhat does have a lot of variation to it. Pretty healthy way to live. And for me, tasty too. Indian options are lots of curries and tandoori, while Tibet has its own cuisine with heavy breads and soups such as Thukpa. Then to add a bit of interest, many ethnic groups in Nepal have their own cuisines. Newaris have some widely eaten dishes. The only one I have taseted is the “pizza” called chatamari.

Dal Bhatt, fancy version as brought to the table

Dal Bhatt, fancy version: lentila soup, veggie curry, garlic spinach

Dal Bhat fancy version mixxing it up
Dal Bhat fancy version mixxing it up with yogurt

"Roti" bean soup with chapati from the dive next to the birth center

“Roti” bean soup with chapati from the dive next to the birth center. Note puffy chapti hot off the fire.

Tibetan vegetable thupka
Tibetan vegetable thupka. Note chilis!

Newari chatamari ("pizza") made of rice flower
Newari chatamari (“pizza”) made of rice flower

Indian vegetable Biryani

Indian Vegetable Biryani

vegetable momos, also bought next to the birth center

vegetable momos, also bought next to the birth center

Indian sweets (half eaten) served on a takeaway plate made of leaves

Indian sweets (half eaten) served on a takeaway plate made of leaves

Mint tea... just mint leaves and water

Mint tea… just mint leaves and water

rakshi: millet vodka!

rakshi: millet vodka!

Toomba, millet beer

Toomba, millet beer

Politics, caste and the way it is.

A change of focus has brought some new perspectives. I had a week in the mountains. (To donors, please know that this was personal time and therefore personal money. Your donations are kept for midwifery work only) Awe-inspiring panoramas, infinite steps and some ambivalence. Trekking in Nepal is nothing like long distance walking in Europe or hiking in the wilderness in the United Stated. The endless steps connect the mountain villages to which there is no vehicular access at all. Everything is brought in on the backs of ponies or people (wearing flip-flops, which is an improvement over when my sister Sara went trekking 30 years ago and they were barefoot). Tourists are herded into “teahouses” which are village guestshouses of a basic sort. Despite the beauty of the mountain views, a certain sadness pervaded the trek. The early morning is the time of clear air and great views. Within a few hours the cloud/mist enshrouds everything and the mountains disappear. The moisture makes the melancholy mood, the damp is pervasive, and the poverty and tourists make a disturbing mix. The largest national group seen on the treks is the Chinese. They seem to surpass the Americans in loudness and enormous cameras.

I met several Tibetan Nepalis and received a bit of an education on thier lack of rights. They are denied refugee status due to pressure from China and even those who have been here 60 years or were born here have no rights in Nepal: no official right to work or vote, no passport or travel documents. They exist by working around the system which in this country is kind of what everybody is doing anyway, but…. no way to live. Poor Nepal squeezed between India and China seems totally stuck.  And talking politics, there is an election for the Constitutional Assembly here on the 19th. Some of the Maoists, who fought and won a civil war are against the election (they might lose) and are planning strikes. It seems that the strikes are not a popular idea so they may not come off. I hope they don’t… Had it a bit with holidays! However there is concern that if they lose the election they may not relinquish power and,  well,  it could get complicated. The recent political history here is dramatic in the extreme. For the bizarre story of the massacre of  almost the entire royal family in 2001 by one of the princes, follow this link.

http://blogs.hindustantimes.com/kurakani-in-kathmandu/2011/06/01/ten-years-on-mystery-behind-nepal-royal-massacre-still-lingers/

And this is about the election from the New York times….yes a fascinating mess: 120 parties, ballots to be collected from high up in the Himalayas, fun will be had

http://www.nytimes.com/2013/11/07/world/asia/in-fractured-nepal-plans-for-national-elections-provide-a-series-of-subplots.html?pagewanted=1

Today I met with Kersten at United Nations Population Fund(UNFPA). She is a Swedish midwife, whose mission is to strengthen the midwifery profession in order to improve maternal child health outcomes. I was looking for her help in promoting the use of the anti-shock garment. About that she was encouraging and gave me more contacts, but about midwifery in Nepal she is a bit pessimistic. The bureaucratic and political barriers are great. Karma and caste maintain the status quo.

Here are a few pics. Yes, beautiful.

Pokhara lake sunset

Pokhara lake sunset

Traditional house and terrace

Traditional house and terrace

A few of the endless steps

A few of the endless steps

looking cold!

looking cold!

hooray

hooray

flowers through the waterfall

flowers through the waterfall

more traditional village buildings

more traditional village buildings

marijuana widely grown. Legal on Shiva's birthday only!

marijuana widely grown. Legal on Shiva’s birthday only!

stunning, huh?

stunning, huh?

i love terraces

i love terraces

pack pony

pack pony

gentians for mum

gentians for mum

witchy haystack thing

witchy haystack thing