PESON

Yesterday was again a day to remember, we were up early to meet Kiran in Kathmandu and visit the health camp that was happening in a local area, offering gynae, paed, and general health clinics. It was great to see the local community working together, and all the doctors and nurses there were volunteers...imagine not being paid to work a Saturday...I dont think I know a GP who would do that??!! We then spent the day at Kirans, relaxing, having lunch and preparing for our talk on Antenatal Education in the UK. Before coming to Nepal, we knew about presenting to some nurse-midwives, but we were asked by the president of the PESON (Perinatal Association of Nepal)2 weeks before the event to also share this with them and maybe add a bit more research.....so we added qualitative, RCT's and even a few notes we had made from being in Nepal ourselves....you should be very proud Jane Boulton!!

We made our way to the venue, which was very posh!! Even had an infinity pool...but Sam and I behaved and didnt jump in!! After hearing lead consulatant Obstetricians and Paediatricians speak about the importance of AN care it was our turn....vomit!! Our EBL skills were put to the test, and as we imagined everyone in their knickers we presented our powerpoint. Everyone really enjoyed it, especioally the TENs demonstartion on Kiran and Sams superb birthing ball positions! To make our heads swell even more we were given an award for speaking....so mayeb Surrey Lecturers could dip in to their pockets and invest in some ribbons or atleast some tea for our presentation skills!!??

I lost Sam to the ex-president and professor so I ordered the wine and waited for the two intellects to remember I was there too before heading off to dinner. We both felt like stars that night and even now smile at eachother like school kids.

today we got a tuktuk to meet Kiran on route to the university hospital. We thought the impressive 8 in the tuk tuk was good, but the 22 that rode with us to the hosiptal in an 9 seater mini-van blew that out of the water (see photo which does not give justice to fear we felt...especially going up hill lol). Did we mention no seatblets in Nepal lol?? The univeristy is amazing, beautiful hill backdrop, huge hospital and so many happy students...the uniforms were even cute! We attended a lecture on body, mind and medicine....which was in Hindi, but we managed to grasp some of it and even got blessed with a bindi...which has proved very useful. There was a landslide on Friday closing the main road to Chitwan...so we need all the luck we can get so that we arrive there tomorrow to wash elephants and see the sunset!!

we have had an amzing time in placements all around Kathmandu Valley but we must admit we are looking forward to a week of fun in the hopeful sun! If we dont update for a while or are not on fb dont worry, we are probably having too much fun and if we are stuck on a road to Chitwan..... we are on route to get junk food now!!

Love and miss you all loads,

Sam and Laura xx

So many babies so little time................

Hello England,
So after eventually falling asleep after the cockroach adventure, we walk to work for the last time and worked on the labour ward. Which consisted of three rooms of three patients in each, we quickly observed a delivery, the woman amazingly in her pain squatted on the bed to gain the help of gravity to deliver her baby which helped straight away. But sadly the baby had the cord around its neck and was whisked away to the resuscitaire for resus, the team straight away gave the baby oxygen and started compressions. The paed was quickly on the scene and inhubated the baby and the baby was taken to SCBU.
Another lady was admitted and everyone was very excited to hear she had twins on board, she was progressing well but nearing to the end of our shift it was decided to go to theatre to deliver her twins.
Meanwhile another patient was admitted from A & E in the second stage, on examination the nurse-midwife found thick meconium stained liquor, so they encouraged the mother to push well. Quickly after she delivered after bonny little pre-term boy, again straight to the resus and after suctioning the meconium he gave the alomost biggest cry from this tiny baby.
In one of the delivery rooms the sweetest image of the three mothers asleep and all the babies lined up in their cots asleep, so so cute!
So that sums up our last shift at the hospital which we have throughly enjoyed and leanrt lots and mostly importanlty gained an invaluable experience.
Tomorrow were goign with Kiran to the teaching hospital..................
take care england love Laura and Sam x

SPLAT!

Today we had a great day. We observed on the IUI (intra-uterine insemination) which has a 18% success rate. Which is similar to worldwide rate of 20%. The nurse-midwife, who had been trained in India, explained the whole process to us, showing how the spin and seperate the sperm from RBC and WBC. I even made them giggle when I said those poor sperm, get spun around a 2000 rotations per minute and then got to get to the egg first....I guess kind of like pin the tail on the donkey lol!?!? We got to see the sperm under the microscope and then with permission from the ladies, observed the insemination. They use a catheter and allow for ten minutes before the woman can go home, and return again in one week to try again. The hospital charges 5000 rupees (about 50 UK pounds) per session. We then got to attend the Atenatal Clinic (ANC) where we, along with 5 other nursing-midwifery students got to assist with the examinations. The government of Nepal encourages a minimum of 4 visits in pregnancy and this was this ladies 2nd visit. She was 27/40 and was given a very thorough head to toe assessment. Very similar to the UK. The one major difference was the waiting room.....they have 250+ women per day!!!

Kiran then took us into Kathmandu where we enjoyed some more window shopping and had some very yummy snacks, We had a huge pancake and nan bread like food with very yummy chickpea dips and spicy soups. We had a very unique desert, that was sweet and sour, I made Sam eat more of it than she wanted to!! hehehe

We then headed off to Patan Hospital to see Rashmi, sadly again we missed the babies being born, but got to see their pharamcy, record keeping and A&E department. I must say I was very tempted to sneak back in when I heard about the police cases locked in the back....guess I will always be nosey! We were going to have tea when the pressure I had earlier put on Sam to be polite and finish her sweet and sour desert came back to bite me....and sadly more her in the ass!!

After a what seemed like a long taxi ride home for Sam, we arrived back at home to settle down and discuss our day. Just as we started to relax watching Sex and the City we were under attack!! a COCKROACH the size of my head....ok not my head, but hand..was in our room, we both did what any good girl would do and jump to the couch and scream at the top of our lungs. Sam who was frozen in fear left me no choice but to act responsibly, so I threw a book at it.....luckily we were saved by our neighbour downstairs, who spoke no english, who came in took the cockroach and threw it outside...what happened next was even more worrying, as she gestured that we should have eaten it!!?? What was in that sweet and sour desert....maybe a cockroach??!!

Antenatal Education...............in Nepal.............

Hello England,

Tuesday we were suppose to meet the Matron but quickly found out she was holiday so there was nobody to introduce us to our next clinical placement, so we practised more for our presentation on the roof top and made the most of the warm weather for a change! Whilst bathing in the sun on the roof top, Laura heard a click like a mobile phone, we then turned around and discovered a builder from across the next building took a picture of us!ha ha, good job we weren't in our bikinis!We then went to our local for some lunch and tried there pizzas which were very nice and some cheesy balls which were interesting. The time had come to do our presentation, ahhhhhhh, after one last practise in the sun the sister came and found us to take us to the room.

The MIDSON group gathered and Kiran started off the presentation by discussing what the MIDSON had done recently, their goals and how to achieve them. Then totally embarrassed me and laura by thanking us for choosing Nepal as our elective and accepting their invitation to do a presentation for them. The presentation went very well, we made it as interactive as possible which included me demonstrating the TENS machine with Laura, Laura explaining about water birth which they found very interesting and me on the birthing ball showing different labour positions and exercises postnatally. We also got the group to conduct the labour line which I feel they enjoyed and discussing how they would conduct antenatal education in Nepal and what they feel would be the main issues. We had done it and received a warm congrads and well done from the group, Laxmi went on to say thanks again to us which was very lovely, everyone is so kind at times it is very overwhelming.

At the end of the presentation, Laura handed Kiran and Laxmi a thankyou card from both of us with the donation from the SANDS organisation from Chicester and from us too. Which was very appreciated and Laxmi straight away said this will help her patients pay for cervical screening and the midwifery society of Nepal will be using it on training on perinatal death. So a big THANKYOU to SANDS, in Chicester.

We then went back to our local restaurant where we had lunch and had some nepalise milkshakes and snacks with the Matron and Laxmi. We tried bbq/fried chicken, fried vegetables, more moomoos and Laura tried a peanut dish. All very nice, so THANKYOU to the Matron who treated us.

Sadly thought the food was short lived and on he way home I had to leave Laura and run home as I had a tummy upset, sorry again Laura, I don't think Ive ever ran so fast!! and then Laura had a tummy upset too................. so we had a chilled out evening after a very busy but successful day.

Take care England x

Another day for them, but a lasting memory for us

This post should have been before Sam's last post, but we both wanted to write it together so we do it right. We spent our first day on SCBU yesterday. There were babies needing blood transfusions due to rhesus status, those with infections such as meningitis, those who had been born premature due to their mothers PIH or Pre-Eclampsia, twins, low birth weight, and even sadly those who had been abandoned. The abandoned babies are very loved though, Sam and I fight over who gets to cuddle them first everyday and dont worry James and Ashley, we aren't allowed to bring them home :(.

We spent our first day observing the staff bath, feed and care for the babies, only 2nurses and 2 HCA's for over 25 babies!! The nurse had explained that two babies had sadly passed away in the night, one due to hypothermia from a homebirth and second from a hospital birth that choked on its milk. Although their equipment here is old and not as up to date as ours in the UK, it is better than we expected.

Two babies were on CPAP (continuous positive airway pressure) and one was not doing very well, although the doctors and nurses attempted to resuscitate this baby, he sadly passed away in front of our eyes. I was not as strong as Sam and had to leave the room, neither of us have ever witnessed a Neonatal Death and were not quite sure how to react or what to say. When we asked the nurse if she was ok, she replied, "When I first started here I used to cry all the time, I even asked to be switched to a different ward, but the longer I have been here, the more I know I need to be strong for these babies and their mothers." The young doctor had also told us that she too used to cry, cry and cry, but now she was just "emotionless." Sam and I felt completely lost at the end of that shift. We both reflected on how lucky we are in the UK, and although we knew neonatal mortality rate is high in Nepal, we both weren't really ready to witness it.

There were two in the bed and the little one said move over move over..................

Hello England, Me and Laura did not sleep very well last night went to bed early like good girls ready for the week ahead and got waken up and stupid o'clock by some dogs next door barking. Then barking to the whole dog population in Nepal it sounded like, so apogilises if this is short and gumpy!ha ha........ So we had our second shift on SCBU today and this time we got stuck in straight away, cuddling the crying babies and even cup fed them which was an experience, using these small metal cups with spouts and slowly letting them suck on the milk flowing. So cute, we also helped a little bit more today and changed a few dirty nappies! Meet one of the sisters in charge of SCBU who is coming to our presentation tomorrow which makes us even more nervous. We found it very hot in the intensive care part with all the equipment which I suppose gets some getting used too. But loved our last shift on SCBU watching the nurses hard at work, bathing the each baby, then cup feeding, placing cannulas in their tiny hands so carefully, it has been a wonderful experience with again some lovely,helpful and kind staff and some very very cute beautiful Nepalise babies and mothers.
This afternoon were off to visit Bhaktapur the third major town of the valley, traffic free , the traditionally intact town is also in many ways the most timeless! Will let you know soon how it was and if we get lost!ha ha, goodbye for now England, Take care, can you believe only two more weeks left of our trip and then no more blogs:(
love Laura and Sam x

Lady in Red is dancing with me

So Teej was amazing. Rashmi, a member from MIDSON, met us at Patan Hospital and took us to Durbar Square to take in all the excitement. Teej is a festival celebrated by Nepali Hindu women, they fast for 24 hours and dance and give offerings to their god in the hopes of getting a healthy husband or protecting their current one. Everyone wears red, as this is the wedding colour. Sam and I wore red, and I even wore a bindi, with bling of course. We watched tarditional dancing and really enjoyed the girl power! Next thing we know we are both being dragged into the middle of the circle and are dancing with Nepali women, who put Shakira to shame with the way they can shake their hips! We must have been good...or more likely funny, as we are asked to do an encore!! We then visited Rashmi sisters house, where we met her niece and enjoyed talking to her so very much. Her english was excellent and gave us great tips for our trip to Pokhara next week. After some now much loved Nepali tea, we headed back home to enjoy some drinks under the stars.

A bbq with a difference...................

Hello England, So yesterday me and Laura had an extra day observing the theatres as the previous day we were only there a couple of hours due to my tummy upset. Again very interesting, four more c/sections for various different reasons including a breech, PPH (post partum haemorrhage) and APH (antepartum haemorrhage). After work we bought some bannanas from a fruit stall and some lovely milk, ice-cream (butterscotch - yummy) and paneer (which were yet to cook) from a dairy shop! Freshed up and had a quick power nap ready for an evening out, we went into Thamel to a bar that had happy hour, we quickly found out we didnt like the Margaritas so stuck with mabilbu and coke on BOGOF! After tucking into a tradional nepalise bbq, which was very deliclious the live band started to play, Layra was very happy as they played classics hits by Jimi Hendrix. Some tradional nepalise music and some english classics too, what a way to end nearly two weeks in Nepal chilling out wuth the Nepalise at quite a popular open air bar.

I' ll be watching you.............

Hello England, So it was my turn today to experience the upset belly but unfortunately it was in the middle of observing a hysterectomy in theatres, was very hard using the toilets and squatting with poorly belly. So we left work early and made it home OK and I slept if off plus some good old Imodium!And I now feel much better, this afternoon we jumped in a taxi to The Boudha Stupa which is an amazing site and was built some time after AD 600! The weather was beautifully from a roof toop terrace with amazing views of the mountains, the pray flags hanging and the sun shining. We are now in settle as it is pouring down with rain. I have enclosed an internet link for photos as the cable for my camera doesn't work on this computer, enjoy, we did, very peaceful and religious. Tomorrow we are observing on the antenatal clinic, wish us luck, take care England. Love Sam and Laura xxx

A day in theatres...................

Hello England, another beautiful warm day in Nepal, the sun was sunning when we left for work!We observed the operating theatres today and tomorrow, today we saw four caesrean sections, very impressed with their equipment, very similiar to home. The staff were very friendly and we had lovely Nepal tea made for us in the staff room. At lunch we went to our local moo moo restuarant near the hospital and had a tradional nepal dish which consisted of rice, spinach, i had chicken for laura vegtables, curried pots and sauces with poppadoms, yummy, i chose to use fork but iam proud to say Laura got stuck in with her hands just like the Nepalise. This afternoon we went to visit Patan hospital not sure about the transport we used a tuk tuk a small type van that on the way home fitted 13 people will saw you pictures when home. The hospital is a semi-goverment run hospital, which was very lovely, big, clean and some of the lay outs of the wards are like england. We were kindly shown around by the supervisor who we had a really nice chat we over some more nepalise tea which i love now!very sweet and cinamon. On the way home me and Laura got distracted by a spa and might of booked a few pampering treats for the end of our trip and got lost, but hey we found out way but to the cyber cafe obviously and gained more exercise ready for a takeaway pizza if they understand english, wish us luck, good night england all our love from Nepal Laura and Sam xxx

I can see clearly now the rain is gone!

Monday was a bit of a set back. I sadly lost my battle with some momos and didnt make it in to work, lovely Sam stayed with me and by 12ish we were off out in the rain! We went to into Thamel and got lost in the lanes and lanes of shops and bars. We managed to find a postoffice and sent our postcards to a select few! Had a drink and left our mark at Sam's bar....yes Sam's bar!! And then had a race home to beat the rain. Had a huge thunder storm and had an early night. Luckily Tuesday I felt better and Sam and I were back to work! We had our last day on the birth centre and also had some time to update our antenatal education powerpoint that we are doing for MIDSON next week. Kiran, our hostess with the mostess, then took us to into Kathmandu to do some shopping. She took us to her HUGE 8 storey house, with panaromic views of Kathmandu Valley. She gave us a feast of fruit, rice, and other Nepali treats and made us feel like family. We can not get over the amazing warmth and kindness we have been shown while in Nepal.....do we really have to leave?? She then took us to see Kathmandu Durbar Square where we saw temples being dressed for an upcoming festival and visited the house of the living goddess. She was sleeping so we could not meet her this visit! Kiran then took us through the winding streets to see the most beautiful fabric, pashminas, food, and music. We decided we best hop in a cab ride home as it started to rain again, and we had our first day on the Operating Theatre, dont want to seem like cheeky British girls!! shhhh dont tell anyone!!

woah an emotional day.................................

hello england, so our second shift on the birthing unit at the hospital started off the q word yes it was quiet, no patients, then after an hour or so labouring women arrived. Laura was famous again we her nose piercing, they love it as traditional over here to get the left side of your nose pierced. We observed some distressed women today who we just wanted to speak to, reassure and encourage very hard tho when nepalise isnt out first language, we can just about say hello and my name is.......anyway we encourage in our own sign lanuage and ram roo = very good. One very tired patient finally delivered and had a lovely bonny boy who needed suction and a little oxygen but then he was fine. Kiran meet us after our shift and introduced us to the director of the Perinatal Society of Nepal, discussing the study day we may be guest speakers in. After lunch we bumped into our man that we booked our excursions for the last week with, a big thankyou and mention to him, Sam Pun at Above and Beyond Trekking who helped us greatly and give us lots of good advice for hopefully an excellent last week of our trip. Me and Laura are now very exhausted and its 5.15pm here so will do a spot of shopping and head home for an early night ready for work 2mor, all our love to you England, take care love Laura and Sam x

Monkey business!

Well what started off as a lazy Saturday turned out to be our busiest day yet! We had Lazmi and Kiran over to give the donations, which were very well received....so thank you everyone! We then went to visit the first and only stand alone birth centre in Nepal. What an amazing place! As stated before this birth centre is what inspired us to come to Nepal, and it continues to give inspiration now. Laxmi and her members have funded the birth centre themselves and purhased items that have increased the services avaialble to those who access it, including a $600 scanner! Laxmi's passion for safemotherhood is amazing! It is free for all who access it and it offers pregancy care through the antenatal and postnatal visits including home visits, to immunizations and sexual health. Laxmi hopes to expand the centre in the future to allow for more beds and a training centre. Kiran and Laxmi, and the other members of MIDSON (Midwfery Society of Nepal) are in the process of trying to introduce a 3 year degree training in midwifery as there are nurse-midwives here and SBA's who have minimal training. After visiting the birth centre we jumped in a minibus carrying over 15 of us to the monkey temple. We reached the top (365 steps later) in the pouring rain, and embraced like we had conquered Everst! The view was breath taking and the excitement of monkeys was a bit obvious, with Nepali people mimicking our squeels and laughing!
After walking down and seeing Buddhas Eye we ventured into Thamel and only just made it home alive after one crazy taxi driver blarring Ne-yo dropped us home! Don't worry tho Lisa/Mum, no fun without a little drama!!

how cute are the babies here......................

Hello England (sorry for the delay did start this blog yesterday and after 30 minutes we had a power cut). So we survived our first shift on the birthing unit at the hospital, started a bit slow and we stuck out like two sore thumbs, but then observed a few deliveries. Spoke to some very friendly staff including an SHO type doctor who conducted the first delivery we observed, very interesting the different practises and how strong Nepalise women are! Kiran treated us to lunch and we had some more delicious moomoos and tea. After mouching around and having drinks in the rain we had the best curry ever which i feel we will re-visit again, so yummy. Tomorrow is are day off and were planning on going into Kathmandu................ keep you posted take care Laura and Sam xxx

On Nepali time

So after a day of walking around Patan and having a few drinks at the Roadhouse Cafe we crawled into bed to be well rested for our first official day at the hospital. Well until our partners missed us so much they called and woke us up....well who wouldnt miss us?!?!?

This morning we walked in the rain to the hospital where we were so thrilled to have survived crossing the chaotic traffic on the Bagmati River Bridge! We were greated and formally introduced to the matron who informed us that Kiran was running late due to traffic....which you just cannot imagine, but closest comparison would be like oxford street on Christmas Eve!

When Kiran arrived after about 3 minutes we were ready to roll! But we were told we had to meet the director and get formally approved first. This was at 1030am, we met and were approved by 1300! We are offically on Nepali time now! In between this we ate Nepali Guava, tasted like pear with crunchy seeds, drank milky tea, ate doughnut like bread, met more members of the Midwifery Society of Nepal and learned about the removal of TBA's and introduction of Specialised Birth Attendants (SBA's) who are trained nurses.

When waiting to meet the director we felt like we were meeting royalty. Made to wait and being ushered out quite quickly so she could have her lunch. But not once did we feel unwelcome. The staff here are so warm.

We had a formal tour of the hospital, after giving our greatly appreciated $200 US, with the Matron where we saw admission room, Sexual Health clinic, abortion clinic, damily plannning clinic, birth centre, SCBU and NNU and recovery rooms.

We startour official first day tomorrow.....wish us luck!!! Miss you all

Lots of love

Sam and Laura xx

Namaste!

So we are here! What an amazing trip. The plane ride was great and the transfers went off without a hitch. The drive to our apartment, well that was crazy! We have never seen so many cars, buses, bikes, cows, bulls and dogs all trying to get past one another! Walking through our neighbouhood is ok, a bit like Amsterdamn with motorbikes lol! We were greated by Ram who is absolutely fabulous, and the only reason we found this internet cafe was becuase of him. He took us to the hospital today, where it was the 51st anniversary! They had the prime minister of Nepal there and were giving awards to staff and even one for the best child. The baby was wrapped in gold, and we got a picture, will post later. We met Kiran there, and she is brilliant. She took us into the Matrons room where we practised our first new Nepali skills. Drinking out of a water bottle without it touching our lips or spilling on our shirt, so far Laura pass and Sam FAIL lol!! She is arranging our placements and a possible visit to a study day held by the perinatal association of Nepal and some birth centres in Kathmandu and Chitwan.
We then carried onto Patan, as it was Lord Krishna's birthday today. There were thousands of Nepalis there offering gifts to Krishna. We both ot given tikkas for good luck from Holy Men, but at a cost of course.
We start our first shift tomorrow on the hospital. We are working 8-2 for 6 days a week, but we may try and work some long days to allow for trips to Chitwan and Pokhara.
We want to thank everyone for their support and hope you enjoy reading our blog. Special thanks to mum/Lisa for your heart felt card which made us both cry on the plane! We are both wearing our guardian angels!