My name is Maddi and I am a second year student midwife studying in the UK. As part of our training we are encouraged to spend time in different maternity settings. I chose to travel to Nepal to see how healthcare is structured here and to find out where I could fit into this system as a qualified midwife. Therefore, my role with PHASE was mainly observational, but I also gave some teaching and revision of basic midwifery to supplement my presence!
My trip to the remote village of Rayale began with an early start, giving me time to navigate the bustling morning streets of Patan. My aim was to find a local bus or ‘micro’ to take me to a main junction where I would meet my guide and friend (PHASE ANM Durga) for the journey and next few days. 85 Rupees and 3 hours later we arrived at the end of the bus route and began the uphill walk to the government clinic, which is in a stunning position on a raised outcrop, with views of the valley and lush, green, terraced rice paddies. We were still in time to put in a good day’s work and so after introductions, I settled down to observe the comings and goings of this government provided health outpost.
When we first arrived there were no patients, but then all of a sudden everyone turned up at once. This is clearly a phenomenon that occurs all around the globe! There were a variety of ailments from chest infections and conjunctivitis to routine care for a contraceptive injection and an antenatal appointment. The encouragement (and uptake of advice) of family planning and regular antenatal care was surprising but an incredibly positive action to see. I was very impressed to see these practices being successfully implemented by the wonderful Auxiliary Nurse Midwives.
The mother-to-be was 22 weeks pregnant and this was her second visit to the clinic. I also got to see their use of sterile equipment when suturing an open arm wound. Again, I was impressed at the use of a small, electric autoclave to sterilise their bandages and equipment. Working together, like a well oiled machine, the girls soon had the farm labourer stitched up and on her way with antibiotics to prevent infection.
I spent 3 days with the PHASE team where we were stationed at the different outposts across the valley. They were dedicated to answering out of hours calls, attending a patient with a strong fever and patching up a sliced finger. All this was done with the most important of the nursing skills – a smile. The women would chat away with their patients and it appeared everyone left happy with the care they received. After working hours, I was welcomed into their home and their life routine. They taught me to eat ‘properly’ with my hands. I fear I was a very poor student in their attempts teach me Nepali! In return, we had evening teaching sessions of basic midwifery care. With the aid of models, pictures, diagrams and some acting(!), we explored a variety of topics as a revision, more than anything else, as these efficient nurses demonstrated that they have a very broad knowledge base which allows them to care for the whole community so effectively.
On day 4 I left feeling full and satisfied after being fed plenty of tea, rice and dal baat. During my solitary return to Kathmandu (if you don’t include the bus crammed full of people!), I had time to reflect on my observations of the work carried out by the team in Rayale. I was impressed by their confidence in their skills and knowledge, as well as their strict adherence to sterile techniques and hygiene maintenance. But most of all I was struck by how well these women get on together. Despite working and living together, spending most of their waking hours as a threesome, there was never a quiet moment with constant laughter or chatter. Surely this is one of the greatest successes of the PHASE project in Rayale – a team which enjoys their life and work and passes this happiness onto the community through their compassionate and proficient health care. It was a real pleasure to spend a few days with them in Rayale and I just hope they enjoyed my company as much as I did theirs!