Archive | May, 2016

Return to Kathmandu

16 May

We arrived back in town late last night after an eleven hour drive back from Nawal Parasi. The high winding road with mountains leaving us dwarfed on the road had been very busy with some very slow patches and several times when ambulances had to be let through the throng to get to people or get them to hospital. I was pleased to read online later that today has seen the launch of an initiative by Princes William, Harry and Princess Catherine: ‘Heads together’ which is a charity that encourages physical activity for mental wellbeing.–abc-news-wellness.html#

The third round of maternal mental health workshops went very well. We were inspired by the collective midwifery skills of the auxilliary nurse-midwives (ANMs) in the room. They were eager to add to their knowledge and had clearly learned from the first two workshops. The experience was made even better for us by the kind hospitality of the staff of the Lotus Resort who were always there for a chat, sharing a story or a song and of course looking after our needs with tasty food and drinks and when the electricity went off,  needing the generator to be started. I felt humbled by how kind everyone was to us and to each other. They were all motivated and engaged and were generous in sharing knowledge we ourselves needed to understand their circumstances. As a team, Andrea Lawrie (Aberdeen Maternity Hospital & RGU), David Havelock (Tees, Esk & Wear Valleys NHS Foundation Trust) and I have enjoyed working together and are very grateful to Sampada Ghimirie, a recent graduate (Public Health) of Pokhara University who translated EVERY presentation and activity over the three days. We wish her luck in her first post graduation job interview on Wednesday. Laxmi Basnet from Green Tara Nepal was also a great support to us.

Mental health has not been given priority in the region (much as in the UK), a point made by the District Health Officer and Chief Public Health Nurse who took the opportunity to visit for at least part of the workshops.This was a new DHO and he wanted to get to know the staff and hear their concerns. The nurse-midwives took the opportunity to ask for his help in resolving a pay anomaly. They have not been paid their ‘night allowance’ for the past year. Male nurses (doing equivalent work) have taken a grievance and they have received back pay and restoration of their special duty payments. The ANMs explain that as they are women, their voice is not being heard. They are calm, coherent and assertive – good to see.

We will spend the next few days in sharing both our own recent experience and the findings of a review of the nursing & midwifery curricula regarding maternal mental health completed by : Bibha Simkhada, Edwin van Teijlingen, Padam Simkhada, Jillian Ireland, Bhimsen Devkota, Lokendra Sherchan, Ram Chandra Silwal, Shyam K. Maharjan, Ram K. Maharjan, Geeta Sharma, Samridhi Pradham for THET and from Tribhuvan University, Nepal; Liverpool John Moores University, Bournemouth University and Green Tara Nepal.




Reunited with Green Tara Nepal friends!

9 May

We arrived in Kathmandu after two very comfortable flights totalling almost 12 hours (London – Doha – Kathmandu). It was the first time for both Andrea and I have been met at any airport by someone with my name on a card (thank you Siddarth) We felt like VIPs!

It’s warm. A gentle introduction to the country as we know that further South in the lower Terai region of Nawal Parasi it will be HOT. We spent a day looking around yesterday and today got down to the work of checking our learning/teaching and evaluation workshops. We’ll be facilitating the same workshop to three groups of twenty auxilliary nurse-midwives who will be travelling form all over Nawal Parasi to the town of Parasi for this, third round of workshops working towards a deeper understanding of maternal emotional and mental wellbeing, health and illness.

The subject of Maternal and emotional wellbeing is close to the heart of midwives. It is tragic to see pregnancy and early motherhood marred by anxiety and depression. We are much more aware of early signs to be alert to in pregnancy and can share this knowledge with families we see in the course of our work. I have used the RCM guide document (see link) extensively in the project I am running in Poole, in partnership with Health Visitor Ruth Evans and Children’s Centre staff Hayley Roberts and Jessica Lanham. This is a practise development project funded and supported by the Burdett Fund for Nursing and the Foundation of Nursing Studies. This guide brings together the research and makes sense of the findings and how to implement them.

Over lunch with staff from Green Tara with heard how Green Tara approach women and children’s Health from a social/midwifery model (as opposed to the more usual Medical model approach found in Government institutions). Staff are involved in the rural community settings running health groups using outreach health workers. These (mostly) women share knowledge about health and hygiene, pregnancy care and signs of conditions watch for (eg pre-eclampsia) often using picture boards  where female literacy is low. They are due to evaluate the two birth centres and outreach work in the region but they already know that their facilities are popular which is in itself a marker of success.

RCM Midwives Guide

Less than a week to go!

1 May

THET Maternal Mental Health project, Nawal Parasi, Nepal

#jcmireland #edwinvanteijlingen

We are leaving the UK on Friday to work on a THET funded (Tropical Health Education Trust) project run by a partnership of UK (Bournemouth and Liverpool John Moores) and Nepal (Tribhuvan) universities. THET fund health training in the poorest of countries. This project has been blogged by one the earlier volunteers, retired health visitor Ish Fawcett ( Mental health is a difficult topic to discuss in Nepal (as it often is in the UK). This makes it hard for front-line health workers, especially non-mental health specialists, to start a discussion about mental health issues with patients (Van Teijlingen, E.R.; Simkahda, P.; Devkota, B., Padmadharini.; Ireland, J.; Simkhada, B.; Sherchan, L.; Chandra Sikwak, R.; Pradhan Samridhi.; Maharjan, S.K.; Maharjan, M.K. (2015) Mental Health Issues in pregnant women in Nepal. Editorial. Nepal Journal of Epidemiology.499-501.)

The project has been running since early 2015 with the target group being Auxilliary Nurse-Midwives (18 month year training covering both specialities) who are invited to local training in the Nawal Parasi region of Nepal, in the Terai (low level) ,region close to the Indian border. Each round of workshops reaches three groups of 20-30 staff. The day longblog1THETGeetablog1THET workshops are designed to facilitate learning about perinatal mental health in greater and greater depth as the programme progresses. A curriculum for use in national training programmes will be designed by the end of the project. This will be achieved through co-learning within the project team, learners and training bodies. We are carrying on from previous volunteers’ work at number 4 (to 7) below. Out team is two midwives (myself from St Mary’s Maternity Hospital, Poole, Dorset, Andrea Lawrie from Robert Gordon University/Aberdeen Maternity Hospital, Aberdeen) and a mental health nurse specialising in high intensity therapy (IAP), Dave Havelock (Whitby, N.Yorkshire).

  1. Baseline knowledge and learning needs assessment (publication forthcoming)
  2. Communication skills
  3. Why perinatal mental health is important (for mother and infant)
  4. Prevention of emotional and mental ill health
  5. Techniques for relaxation and reflection
  6. Measuring depression using the Edinburgh perinatal depression scale
  7. An introduction to CBT

A learning technique I have long wanted to participate in is ‘forum theatre’ (always effective at Royal College of Midwives Conferences) and our Nepalese counterparts (and translators) are familiar with the technique (for background see ). We will be labelling depression as the ‘oppressor’ and the exercise will run throughout the day as an active link between presentations giving participants to reflect and demonstrate their learning and feelings.

I have only ever been in Nepal in the month of December and am preparing for heat this time! There has been a lot of work  preparing for this experience and I am sure that Andrea and Dave will fall in love with the country and its people like so many before them.