Catching babies the Canadian way

Like the mountain that we could not see and then appears as if my magic, we feel like things have drastically shifted since our arrival at the hospital. With the language and cultural barrier in our first 2 days we felt a bit imposing and awkward and were unsure what the nurses and nursing students had been told (or not told) about our partnership. It was hard for us to even think about how to share our experiences here, because we weren't even sure about them ourselves.

Since the first few challenging days however, we have managed to work more effectively as a team with our Nepali colleagues. We discuss everything from culture, to marriage, to children, to fashion and of course clinical management with them and by doing this we all have learned so much.

We have now attended quite a few women in labour, and I have had the privilege of catching 2 babies (both multips) and Kristi caught a preeclamptic primip! Krista was about to have her first catch tonight when a weird case presented itself. All of the nurses who checked the woman had said she was fully dilated. When Krista finally checked her she thought there was a thick cervical lip but they were seeing head during contractions. Finally Cathy checked and determined her to only be 6cm even though the head was visible! Cathy said in all her career she had never seen this before and this woman likely has and will have a uterine prolapse. There's always something new in our work, even for the very experienced!

There are some differences in management here that we are learning about and working with. One is oxytocin augmentation and induction. Like in Canada, the doctor and nurses are concerned about postdates. Most of the nurses here say the protocol for induction is 41 weeks but we have seen variation in cases. One woman was augmented at 40+1 and another at 41+5. As far as I can gather when the women present and how far they travel from is impacting this decision. This is the case in Canada too. The difference here is that management decisions are generally decided for women rather than them being able to chose or reject an induction. The interesting thing about all the oxytocin/IVs in general is that we have been able to observed some skilled IV insertions and also had to monitor our own flow rates carefully, as there are no pumps to do that for us. Another reason for the daytime augments/inductions is a resource one. The doctor capable of C/S is around during the day so they would like more women to deliver (or not) during the day so if they need a C/S he is readily available. There are also less staff on at night. Yesterday there were two C/S. One had a previous C/S with a vertical scar. The other was a footling breech. It ended up being a bit exciting as they did the C/S for footling later in the day and by that point she was 8cm dilated! For those of you who are not clinicians, footling breech is a dangerous presentation because the feet are small parts and the cord could easily slip by if the mother's membranes ruptured leading to a cord prolapse and possible baby death.

The delivery tables also present their own challenges. They are narrow and high and short. Designed for semi-recumbent/lithotomy position they are difficult for the women and also for us to encourage more woman friendly positions. Today however, we managed to show how left lateral position could be done. It is Cathy's favorite position for preventing/reducing tearing and it worked! The multip I delivered had an intact perineum afterwards and Kristi's primip only had a small first degree tear. We were both super happy and on a birth high this afternoon/evening! It was also exciting because our Nepali colleagues were excited about it too and were quick to share with us and each other that this position was better than lithotomy because it reduced tears. Left lateral has now been dubbed the Canadian way. :)

We also noticed at the first two births we observed/attended that there was a desire to suction breathing babies. This is not a good idea and is not a part of Helping Babies Breathe, the neonatal program that is taught here. So we have decided this is one thing worth discussing and working to change here. It will make a big difference for all the babies who do not need to be suctioned after birth as it can cause harm to their little mouths and problems with feeding as well.

The other things we have modeled are waiting for restitution, two somersaults for nuchal cord (around the neck) instead of trying to loop or cut a tight cord, delayed cord clamping, immediate skin to skin with mom and no episiotomies, which are still common here for primips.

Today is International Nursing Day so Happy Day to all the amazing nurses here and far who do so much to improve the lives of people in maternity and beyond!

Unfortunately, you will have to wait for more photos as the internet here is slow and patchy.

Baglung Hospital

(I can't upload the photos right now as our internet connection is poor, but you could visit Kristi Rose Mintz on Instagram if you are interested, I will try and get them on this post soon!)

May 11/2016
I'm sitting down to write a new post as a mid-afternoon thunder and rain storm is blowing over.  In Nepal we are just about to enter the monsoon season. In the morning we see the sun and then the intense building of humidity and pressure begins culminating finally in the relief of rain and thunder around 3pm.  It is a welcome reprieve from the heat as it is over 30 degrees every day.  The countryside has been experiencing a drought, rivers are extremely low and the farmland yellow and waiting to spring into the life that only water will bring.

The last few days we have been in Baglung and have finally started our clinical placement.  We have witnessed and participated in the births of three babies in the last two days. We have also spent a lot of time trying to overcome the language barrier so that we can get to know the nurses here who are primarily in charge of managing birth in the public facility in which we are working.  The public facilities here in Nepal are free for women.  In fact women receive a monetary incentive to give birth here.  If they also attend 4 prenatal appointments the government will give them another small additional amount.  All in an effort to have women deliver their babies with a Skilled Birth Attendant. (SBA)

The hospital we are working in has some of the best conditions for a public facility in the country and as you can see by the pictures it is still very different than a facility in Canada.  The infant resuscitation table is 30 years old, and there are no cozy beds or bathtubs.  As a healthcare worker, there isn't even water readily available to wash our hands and if there is soap that is a bonus.  We bring our own gloves, sanitizer, soap and toilet paper so that we don't use up what little of these items that the hospital may have.

We have done some teaching already with some of the nurses and student nurses.  We have brought them birthing dolls and newborn dolls so that we can teach using them.  We will also leave these tools with them so that they can continue to practice emergency skills and use them for further teaching once we go.  We have several workshops to do with these dolls in the next few weeks with Skilled Birth Attendants who live in the more remote district of Baglung.

We have been challenged, we have been brought to tears and we have found our inner momma bears roar at numerous things that we see and experience and this is only just the beginning.

Was it an adventure?

May 7 Pokhara

Today was a 'rest' day to help K + K deal with jet lag before we start our clinical placement in Baglung on Monday.

In the morning we had a lovely breakfast on our rooftop patio and then we got organized for our day. Krista and Cathy decided to go for a walk and explore this side of Fewa lake we are on, Mickey went about taking many gorgeous photos of birds, boats, people and more birds, and Kristi and I decided to rent bikes.

We read a short blurb in a magazine that said there were many mountain bike trails around Pohkara. full stop. At the bike shop I tried out the bikes, all of them crappy. One of them felt like the pedals were screwing themselves of the bike. I chose the least bad one I could fine. Then I asked for a map. No map. I asked for directions and was told to head out of town towards Devil's falls. So I went and saw the path and headed for it and was stopped by an army official. He informed me I could not go that way, army base. I explained I was looking for devil's falls. He said to take the main road. I told him the main road was too dangerous, I wanted to take the path. Meanwhile, there were people walking and cycling on the path I could clearly see. Finally another man came and told him to let me go in. So I did. Only to discover the path ended in less than 1km and I was in an enclosed field. After wrangling my bike through the turn style I headed back to get Kristi, a bit defeated. Then Cathy said there was a road out of town around the lake. After lunch we headed that way.

Soon we were on a stone and dirt road with a few other bikes, cars and the occasional bus but traffic was sparse and slow. The sun beat down strongly as we made our way winding around the lake through two villages. At one point we came to a fork and asked a young boy on a mountain bike how to get around Fewa lake to Pokhara. He pointed the way and we followed. Soon we crossed a footbridge. On the other side there was a driveway up and some steps down. I asked again which way and the young boy pointed down. At which point there was much laughing and an olderboy cuffed him across the head. he informed us there was no way around the lake but that there was a road and we could go for awhile and then come back.

So we did. First at the wetlands at the end where we watched cattle grazing and people farming and then we continued up and down as the track winded around the lake. It was incredible. No other vehicles, or cyclists and very few people. The people we met were mostly going about their daily life on the lake. We ran into one adorable woman who came out and hugged Kristi and patted her on the head. She then told her she was so beautiful because she was so white and tall. Kristi said "No, you are so beautiful." I told her ramro, ramro. She hugged us both and laughed and we went on our way.

We ran into a few buffalo who were startled by us and a few times we outran them on our bikes. After ascending and descending along the track a few more times we decided the road must continue around the lake and we were determined to go all the way. At this point turning around would have made for a very long trip indeed and we wanted to make it back before dark. Then we began climbing very very steeply. The rocks on the road made it especially difficult and our tires started slipping a lot. We finally had to walk the steepest parts, riding the less steep parts up and up and up. At the top of one hill there was a house and some more boys came to great us and ask for chocolate. (Aside: all the children in Pokhara are very used to tourists and demand chocolate and money - we do not oblige them. We just smile and say No, we don't have any.) They asked us if we were heading to the Stupa. I said no, Pohkara. They told me, no road to Pokhara, you need to go by boat, we can take you. I said no - the road was still going. I figured they wanted us to take a boat and so wasn't ready to believe them. So we continued down for awhile and then again climbing (and walking). Then the road descended steeply and we inched and bumped our way down. In places the road was washed out in deep groves. I should mention at this point that the entire day we were concerned our crappy bikes would split in two. They were definitely not mountain bikes although appeared deceptively to be them. Fortunately we made it. At the point we came to another fork where a young man was tending his cows. I asked for the way to Pohkara due to another fork. He said, this is the end of the road. We needed to take a boat. He said he could take us for $1000 rupees ($10US) I said, too much and tried to bargain with him. Kristi said she would pay $1000 rupees though and then the bargaining was over. We headed down the steep hill pushing our bikes after the cows. Then down some steps, then along a narrow footpath, through the barnyard and some gates, around a cornfield, up some steps and then down more steps to the beach.

At the beach his young daughter helped him bail out our boat and then his kayak and our bikes were loaded in the front. Kristi and I volunteered to help paddle and so we took turns all the way across to the dock near where we are staying.

We made it most of the way around the lake - had there been a road we think it would have been maximum another 30min of riding. But the surprise ending and experience of paddling on Fewa lake was great fun and we are glad it turned out that way!

The whole day was very enjoyable. We had a very fun adventure and got to see some beautiful countryside. After having hot showers and a good meal including our new staple, frozen lassis, we fell into a deep sleep.

This morning when we woke up the mountains were visible! So amazing! Also Jaquie, our first night here the lassis were on you, so thank you! We LOVE them! We are getting our fill because we know it'll be noodles or dahl baht and takari for the next 3.5 weeks!

More photos!

Cathy with MIDSON colleagues after her oratory speech with her "gift of love" scarf :) 

Happy International Day of the Midwife!

Lunch on our bus trip - takari, dahl and bhat yum!

Arrival in Pokhara

May 4-6 Midwifery conference and trip to Pokhara

A clear day in Kathmandu!

Greetings from Pokhara!

 May 6, five of us (Krista, Kristi, Cathy, Mickey, and I) traveled by tourist bus from Kathmandu to Pokhara. It was a beautiful drive. The landscape in this part of Nepal was much more fertile and lush than the Karnali region that we took our jeep ride through last week. Kristi kept commenting on how dry it was and I kept saying it looked great. A matter of perspective for sure!

We checked into Sacred Valley Hotel. Luckily they sent our driver in a large passenger van. We need it for our luggage. We are bringing teaching materials, donations and all our supplies for our 3 week clinical placement in Baglung so we have A LOT of luggage. It filled the back of the van and a good portion of the roof too!

Now to go back a few days. Cathy, Mickey and I were at the Midwifery conference on May 4. Cathy was the figure or oratory, which was a great honour. For us, just getting back from Mugu region, Kathmandu has been a stark contrast and even our drive up to Pokhara was a bit of a culture shock. At the conference there were hundreds of people, mostly women, many of them with lots of education and expertise in the field of maternity care. I had been feeling quite heavy about the state of women in the Mugu area and meeting leaders in the field in Nepal was good for me. So much needs to be done to improve the lives of those women, however at the conference I met many energetic passionate people who are currently working in programs and on projects that are trying to help address this. Additionally, all the midwifery leaders we already knew from MIDSON were in attendance as well and it was so nice to see them again. Especially Nani and she was the one person there who had been to Mugu with us and truly understood. In the afternoon I attended the sessions relating to uterine prolapse and violence against women. One presentation by Aruna Uprety was on acceptance and success of using pessaries for women who have uterine prolapse. They found that a majority of women still had the pessary at follow up and that it improved their quality of life - this is a great alternative to surgery and hopefully will be used in more places in Nepal as uterine prolapse here is quite common. Poverty, pregnancies early in life, lack of skilled attendant at birth, and returning to hard work too soon are some of the factors that lead to more uterine prolapse. Another presentation was on the relationship between having prolapse and spousal violence. Women were more likely to experience emotional, physical and sexual violence from their partner if they suffered from uterine prolapse. There was also a fascinating presentation by an anthropology fellow on the maternal-child health situation post-earthquake. He mentioned that in Nepal, often good results are found to please donors and alluded to the fact that some information that has been presented in the past may be focusing on all the accomplishments,perhaps even exaggerating them, whereas his work was focused on noticing what still needed to be done. Unfortunately due to the delayed schedule of the conference his presentation was cut short, but I have requested the paper when it is published and look forward to reading it! Since arriving here I have read 5-6 books, non-fiction and fiction about Nepal and many research papers - anything to learn more about the context is helping me to better understand what I am a witness to.

Nani and I

The night of the 4th we spent up on our hotel rooftop patio in Kathmandu, singing with some new friends we made here. Funny enough, many of them are Canadian! It was a good end to the night when I came down off the patio and jumped into a taxi to go the airport to get Kristi and Krista! I arrived at the airport and walked in just in time to see them walking out! It is very exciting to be with them and have comrades for the next part of our journey!

We all went to the conference on May 5th, International Day of the Midwife and got sashes that say International Day of the Midwife May 5 in Nepali! It was so nice to be able to celebrate this special day with our friends and colleagues in Nepal. It was also great to be at a midwifery conference and to learn about what is happening in Nepal in relation to maternal and child health and the development of midwifery. We were assured again at the conference that the Bachelor level Midwifery will be available in Nepal soon. We all hope this is the case and that strong, brave women take up the call to serve the women of Nepal with compassionate skilled midwifery care.

Likely (hopefully) you will be hearing less from me and more from Kristi and Krista to get a new and fresh perspective on our journey. I will continue to write occasionally though. Thank you for continuing to follow our experience. More pictures from Mickey to come!

No fly days

April 29-30...May 1

We were supposed to fly back to Kathmandu yesterday. The thick dust that has made itself semi-permanent in the valley foiled our plan. We were up early and hauled all our luggage through town only to discover through some mix up our vehicle had left. But there was another vehicle for us. Unfortunately it had a very flat tire, but no problem, some men set about to fix it! We were optimistic about the flight because we really need to get back to Kathmandu. Nani has to work and we are meant to help MIDSON get ready for the conference. Finally we found another vehicle and headed off. We were left with all of bags of gear and training supplies on a gravel pile. We decided to read to pass the time. As the heat increased and the dust resisted clearing our hope of leaving dissipated. Now we needed to make another plan. By this point our driver had already filled the vehicle with 6 others who decided they would go by land to Nepalgunj. 7 hrs for one day along the roads I have been describing and then another day where they would be 2 hrs of pavement. I thought that idea sounded wretched. I feel like a milkshake when we travel by vehicle around 1 hr. I cannot imagine what 7-14 would feel like! Anyways, they headed off in the vehicle, which by then we had all noticed had a weak tire – so dangerous. And then we were there on the gravel pile just waiting.

Soon we were surrounded by the Mugu version of street children. They kept inching their way closer to us and our bags and Cathy was getting me to sit on or near the most valuable bags. Then they began to throw rocks at each other, some of which were getting close to me. At that point I began to develop sensory overload – the heat, the dust, and the noisy children. Finally, the airport security came and asked the children to leave and we were left in peace to wait. Nani had been coordinating this entire time and she gave word that Jill was able to arrange a vehicle to come and pick us up from the airport. After we waited there for many hours in the direct sun on the side of the gravel pit, a vehicle came and we headed back down to Gamghadi. I guess I celebrated too soon that I would never have to do that drive again!

It gets worse. Once we arrived back to Gamghadi we made preparations to drive to Nepalgunj in the morning if the sky was still filled with dust and smoke. I’ll save the suspense. We drove. Words cannot describe what it is like to crawl along averaging 8kpm for 10.5hrs but that is what we did on our first day to the soundtrack of a squeaking vehicle or looped Nepali music. I think Nepali music has been designed for Nepali roads...this one song we heard dozens of times probably lasts 15min! The road is sometimes pillowing dust, sometimes hard stones and every variety of rut in between. Do you remember the game popcorn on the trampoline as children? That is what it felt like bouncing along trying not to be too stiff or too loose for fear of bouncing off the sides or the roof. Cathy made herself a neck brace out of a towel and it may have saved her. She was even able to sleep for a bit, I have no idea how! We had been told it would take 7 hours to get to Karikot centre, Manmo. Not so, we only stopped for a total of 45min. and it took 10.5hrs. In Manmo we were lucky to find accommodation and fell to sleep after some dal bhat. Nani and I did not sleep so well but Cathy took the right concoction of anti-inflammatory medication and slept well.

At some point near the end of Day 1 we started to encounter patches of rough pavement  and some road markers, both a welcome relief. At first the road markers were depressing. We would drive for a half hour and only go 4-5km. But then it was also an indication that those kms would never need to be driven by us again! I started talking to myself the way I would talk to a laboring woman – that one is done, you will never see it again. :) And we had a destination, not a new baby but a flight to Kathmandu! I am not sure why seeing the numbers helped – it meant nothing as far as timing but knowing there was an end, a destination helped.We had been told that Nepalgunj was 100km for Surkhet and now we had an indication of where Surkhet was. By the time we arrived in Manmo at dusk we had 154km left to get to Surkhet.

I would say the end of Day 1 was my lowest point of the trip. The stress of bouncing up and down the mountainside and the accompanying body and headache. At one point I laughed to myself because we were down in the valley and it would only be a 500ft. roll off the cliff and I thought “If we went off the road here it might not be so bad.” Better than the thousands of feet we had been in the hour before! The scenery on Day 1 was very beautiful. We left dusty dry Mugu and worked our way up into the forest. The air was cooler, a bit cleaner and there were lots of nice vistas. We also had the comfort of following the beautiful Karnali river. Occasionally I wanted a swim but mostly I just wanted to keep going, to endure the drive as long as I could so that it could be over.

Day 2 we left around 5:30am. Our driver Ganesh said if we left at 7am we would get there by 3pm. Cathy and I voted to leave earlier since we and especially Nani wanted to make the plane, as Ganesh’s estimate of 2 more hours to Manmo the night before had turned into 5. Thank goodness we did! Although Day 2 was easier driving, bits of pavement with regular rock or mudslide wash outs, it was still very windy, and bumpy and slow going. When we finally reached pavement that was wide enough for 2 vehicles to pass our driver still insisted on driving in the middle of the road, honking frequently around corners (as was done the entire ride) and swerving at the last minute around the oncoming jeep, bus or truck. I have to say his driving expertise is in the very rough rock and dirt roads and not so much the pavement – mind you everyone coming at us was doing the same thing so it seems the custom in that part of Nepal. And although I imagined a smooth, straight 2 lane road from Surkhet to Nepalgunj, it was not the case. The road still was washed out in places. Most of the pavement was one strip down the centre, and it was windy most of the way. 10.5hrs later we were in Nepalgunj. So it took us around 10 hours to drive 254km on day 2. When we reached the flat tarai I counted over 200 people riding bicycles on the road in less than 30min. Bicycle transport is very common here which made me happy.

Probably the 15th police check stop...

Back in Kathmandu having showered, eaten and slept on a good bed I can say it was type 2 fun but the journey definitely pushed my physical and mental limits. I think walking would have been easier because then I would've felt I had accomplished something!

Another point is that some mix up resulted in all of our flights being cancelled, even the one from Nepalgunj to Kathmandu! If this had happened to me in Canada I would have been outraged. And Nani was, but in true Nepali last minute spirit I knew something would work out. And it did. Nani spent a good portion of Day 2 on the phone when we had service trying to get in contact with Tara air and our travel agent. Thanks to Nani and her Tara air contact we found out about mid-day that we would indeed have a flight out of Nepalgunj that evening. Another delay averted! As we moved into the tarai I started to notice the forest had been burnt. I would say between Surkhet and Nepalgunj over 70% of the forest was charred. It was so sad. We had seen a few fires on our trip (including one on the hill just across from our hotel one night!) and had remarked many a time how devastating it would be if someone's cigarette were carelessly discarded. And here was acres and acres of evidence of how devastating it actually is. We found out later when we returned to Kathmandu that the haze that had descended on Mugu was not only dust, but also smoke from many nearby fires.

I would like to take a step back now and reflect on some details of our trip that I have not mentioned yet. First of all let me introduce you to Ratna and her family. Ratna was our host at Unique Guest House in Mugu. She was so sweet and kind to us. In the morning one of her family members would make their way up 3 ladders with dudh chia (Nepali milk tea) that I would drink in bed, still curled up in my sleeping bag liner. Although I spent each night trying to find the right balance of blankets underneath for softness to ease my bruised hip bones, and on top to prevent chills from the wind slipping through the cracks in our walls, and although we had to climb up and down to the squat toilet and dank shower stall for a cold bath, our hosts were so gracious that I really enjoyed our time there. It felt like camping in a tree house on the wooden top story of our stone house. Whenever we needed water for washing they would carry it to the house by hand. We did our best to use little water because we saw how difficult it was to carry the water to the house and up the 3 stories to the sink on our floor. For breakfast Ratna would make us boiled eggs and takari (potato curry) and fresh roti. For lunch and/or dinner we would have dal bhat and takari or boiled potatoes with chutneys of chilis (spicy) or sesame or pickled herbs. They were all tasty and we know she made them by hand on a large mortar and pestle. I do not mind eating dal bhat and takari and boiled potatoes every day. The food is good and Ratna is good to make clean food because none of us got sick which is a huge relief given the immense difficulty in getting to the bathroom in a quick way. Seeing her in the morning and the evening when we returned from our long hot, dry, dusty days was so nice. I will think of her and her kindness when I think of Mugu.

Pema and my bedroom from the inside and outside!

Yesterday we had a vacation day to Rara Lake. In the 2 days prior the fine dust had become suspended throughout the entire valley. It coated the view - almost like a thick smoke from a fire. We were hoping to get above the dust by going to Rara. We first drove up the road past the aiport and then turned off to continue up towards the lake. Have any of you ever been on the Indiana Jones ride at Disneyland? Driving here is like that, except the thrill is greater because you are not on a track and their is always a cliff to role of if the driver makes a wrong move. ;) At a certain point we got out of the jeep and then we continued on foot. The dust in the air was much less and we could breathe in the air of the forest. The lake is very large and beautiful. When we arrived the horses were grazing on an open space by the beach. Across from us there appeared to be a village - a few people were there grazing their animals. We got our feet wet in the cold lake - it was refreshing. Then Pema and I went for a hike along the lake. On our walk we were able to see some rhododendrons even though the season is almost over. It was nice to get out in nature - away from people and the dust.

Today the sky has cleared a bit and the plane came in which we are happy about, hopefully it holds and our plane will come in to take us back tomorrow. Cathy, Nani and I will go and Jill and Pema will stay to go to another community that is at least a 6hr walk away. Today we went to Karkiwada, a small village near Gamghadi where we are staying. It is a very poor community, however they have a birth centre. It was built after there were 2 maternal deaths in the community and the community then rallied together and asked for a birth centre. It is funded by a German - local NGO partnership. 2 ANMs work there. Both were in our training the other day. When we arrived no one was there, but within 10 min the place was full of women. We decided to interview them in focus groups so they would not have to wait as long. At first they thought we were there to hand out medicine...apparently white people, trekkers etc. just give out medicine. I think that is so irresponsible...to give out medicine without really understanding what the health problem is or being able to provide follow up. One of the mothers wanted us to help her baby with scabies. We told her she should take the baby to the health post or hospital as we were not providing medical care, only asking questions of the community because we believe that solutions to problems in the community will come from the community itself.

Some very engaging female leaders.

The focus groups went very well. The women seemed eager to share their stories. I have been given permission to share some general information from our research over the past week which I think you will find interesting. In the past here there has been a cultural belief that women who are menstruating or who are giving birth will pollute the household. Therefore they were not allowed to be in the house and had to go to an outside place, usually where the animals were during the time of their period or for birth. This place called the Goath, and whether it is still used is of interest to us when talking about birth planning preparedness. Because of the pollution women often delivered alone. The government of Nepal does not condone this practice and we are curious if it is still happening. Some women say, no, it is not happening anymore and others say it is. From what we gather, although some people still do use it, is is less common now, especially for birth as women are going to facilities more often to birth (where facilities exist). Women who live far from the birthing centre and those who deliver at night often still deliver at home. For menstruation, being in the Goath still happens, but for most families the women are not in the Goath with the animals, they are in a separated room on the house. We are informed that this is better because the women are in the home or very near it and there is less concern for their safety. Having seen the old Goath where the animals are and the new one attached to the house I would say so too.

Room below house is old Goath, tin room above is the new one.

                                                                                                              Gamghadi traffic jam!

One of our questions is about decision making. Who makes the decision about where a woman will give birth? Who needs to be educated about safe birth? (In my own words, who has the power?)  A few people say they make decision collaboratively. Mostly however it is Sasura, Shriman and Sasu. Father in-law, husband and mother-in-law. Women seem to have very little say in what happens in their lives. So there is change, but as always, change is slow. I keep thinking that the men must be part of the change. There has to be some men who look and say, it is not right that we control everything the women do,  that women deserve a say in what happens to them. In everything women should have a say, but especially in menstruation and birth. When we talk to women and ask questions it is very obvious that the key to a better life for women truly is education. The women who are educated, they can articulate problems and solutions - they have critical thinking skills and they are keen to make change in their communities. The ones with low education when probed for solutions to problems have a hard time understanding what we are even asking them about and find it difficult to articulate solutions. This post is dedicated to the many incredible women we have met over this past week in Mugu. It is their strength in the face of great adversity, it is their push for education for themselves and their children that will continue to improve life for women, and all people in this region.