It's a Lilongwe to Malawi...

We’ve now been in Malawi for 10 days and have travelled the length and breadth of the country with our driver Penjani and his pick-up, feeding him coke and cake so he stays awake on the long drives. Singing 'It's Lilongwe to Malawi' to the tune of 'It's a long way to Tipperary...' has kept us laughing along the road.

The car over-heated yesterday but thankfully some water in the radiator and a quick prayer did the trick!  We have hired the car and driver from the Aids Project at Ekwendeni Mission Station.  It's good to know that the money is helping a good cause

We’ve stayed with families on mission stations in the north and the south, visiting hospitals, clinics and midwifery training schools/universities and meeting anyone who can tell us something about midwifery and professional associations in Malawi.  We’ve met donors and NGOs, doctors, midwives, nurse and students.  We’ve seen some really impressive buildings and heard of great achievements but we’ve also been trying to dig deeper and see the reality behind the facades and hear the stories of people on the ground. 

Kamuzu College of Nursing, Lilongwe.  We also visited the Blantyre Campus in the South 

Student midwives learning normal delivery skills on the 'Mama Natalie' mannekins

Now we’re back in the capital, Lilongwe, to join the Association of Malawian Midwives (AMAMI) at their AGM today.  We’re looking forward to hearing the achievements and challenges of the past year and their plans for the future.  We hope to meet the Ministry of Health, the Nurses Trades' Union, the Nurses and Midwives Council and to make a return visit to the British Department for International Development before heading home on Friday.

Meeting Alice Kandango, Midwifery Teacher at Kamuzu College of Nursing's Blantyre Campus

Labour Ward in a Township Health Centre in Blantyre

Midwife Ruby, Matron Modesta and Clinical Officer Frank at Ndirande Township Health Centre where they have 10 deliveries per day, no  operating theatre and no doctor.  They have 4 midwives though they should have 9. They are currently building a theatre and hope it will be staffed.  I hope so too.

One of the personal highlights of this trip was meeting with Dr Patrice White from the American College of Nurse Midwives who happened to be in the same town in the same country at the same time as me.  We used to share a house in Cambodia many moons ago and now have similar roles in our respective professional associations.  Such a treat.

a very jet-lagged Patrice

With Patrice in Blantyre, after delicious curries at the Malawi Sun Hotel

Once our trip is complete we’ll be writing our report for the trip’s funders and hopefully putting bids together to continue supporting midwifery in Malawi in some way.

Thanks for reading 

A taste of a long day

A taste of today. Early morning meeting with VSO Malawi office, packing up then driving 400kms north to Ekwendeni, a Mission Hospital and Training School where we are staying for 2 days whilst we meet midwives all over the north.

Musings from Malawi Part 1

Written on 23rd but posted today as had no internet before!

My feet have hardly touched the ground returning from my summer holiday in August.  Following successful trips to Uganda in September and Nepal in October, the global team has been fully occupied selecting, interviewing and preparing our member volunteer consultants for their placement in Uganda in January 2016, submitting our Action Research Proposal to the Ugandan Ministry of Health and recruiting more member consultants for positions with DFID in Bangladesh.  We’ve also been supporting the RCOG with their ‘Leading Safe Choices’ project and attending the launch at the House of Lords.  We contributed to a needs assessment led by UNFPA in Cambodia by Skype, visited Scotland for a three-day fact-finding mission about Malawi and attended the  annual THET (our project funder's) conference in Birmingham and the RCM conference in Telford.  I also presented a symposium at the NET healthcare education conference with my colleagues Louise Silverton and Aine Alam. 

My House of Lords souvenirs (just in case I never get invited again!)

With RCM Global Volunteers Tracy Miller, Jilly Ireland and Sue Petersen at the RCM Conference

Now we are in Malawi, undertaking a scoping visit/needs assessment to explore the possibility of a twinning relationship with the Midwives Association here.  We have a team of four: Eleanor and me from the RCM’s global team, Shirley Stronge, one of our members from Northern Ireland who has local knowledge from her six-year placement teaching midwifery in Malawi and also Mary Gorret Musoke, President of the Ugandan Private Midwives’ Association, our existing twinning partner.  Malawi is the world’s poorest country and has a very high maternal mortality rate of 574 per 100,000, one of the highest in the world.  It had hoped to reduce this to 155 by 2015 but is sadly far off this target.  Child marriage and adolescent pregnancies are a big problem here: half of all women are pregnant by the age of 18.  So there is much to do and there are many needs.  However, there are many agencies already working here so we are talking to a wide selection of stakeholders and travelling the length and breadth of the country in the next two weeks to identify strengths and gaps and ascertain whether there is a role for the support that we can provide.

Meeting AMAMI, the Association of Midwives in Malawi

Dinner on our first night - Shirley, Mary and Eleanor.  Mary tasting apple crumble for the first time!

At the Central Hospital in Lilongwe, with the Chief Midwife in Charge and the Labour Ward Matron.  Mary enjoying talking midwifery with her Malawian sisters

Exchanging gifts with Professor Address Malata, previous President of AMAMI and Principal of  Kamuzu College of Nursing

In our first day we met with AMAMI (the Midwives’ Association of Malawi), the World Health Organisation and the United Nations Family Planning Agency (UNFPA).  Yesterday we met the largest health training University in Africa (Kamuzu College of Nursing) and the Principal Address Malata who was previously the President of AMAMI and is currently the Vice President of the International Confederation of Midwives.    We've seen the Central Hospital in Lilongwe and a mission hospital and training school and met with midwives from GIZ, the German Government Aid Agency.We also met with the UK Department for International Development and had a chance encounter with the British High Commissioner in a corridor!  Having Shirley on our team is such a bonus, with all her local contacts.  We’re staying at a lovely guesthouse and are being taken to local restaurants serving great food at reasonable prices.  We’ve hired a car and a driver through a friend of a friend and will be staying in midwives’ houses in the north and south – this is sure to give us a fascinating insight into local customs and culture whilst also being economical. 

We’ll be sharing more posts and pictures as our time here progresses.  

For Sarah

A tribute to my friend Sarah Cullen, nee Chavasse, at whose memorial service I was privileged to say a few words this afternoon.

'Sarah was my best friend at junior school from the ages of four and five when we both started in Kindergarten at Walthamstow Hall until the summer of 1976 when I left to join my two older sisters at Tonbridge Grammar School for Girls.  I found school very difficult.  I am dyslexic, though no one knew that back then.  I was one of the last in my class to learn my times-tables; there may even be some others here today who remember the dreaded felt mice with knotted string tails and the shame of being slow to achieve the required 12 knots, one for each times table! I was also slow to achieve the required standard for neat hand-writing and to progress from a pencil to a fountain pen.  Sarah, on the other hand, was exceptionally bright despite being the youngest in the class with a September birthday.  She never judged, was kind and constant and quietly encouraged me in my efforts to achieve.  She was also my yearly partner in the three-legged race which we won triumphantly in our final year.  It was the only occasion upon which I won anything at junior school!  Our career ambitions were clear from an early age. I would be a nurse, following in the footsteps of my maternal grandmother and aunt. Sarah would be the Astronomer Royal.  I marvelled at her knowledge of the constellations and her superior intellect.

Sarah had the best birthday parties in which her father, Michael, was a key figure.  Such parties invariably involved the Kim's game, a test of short-term memory at which I always failed miserably.  However, I shone at the eating part of such gatherings and I remember being showered with praise by Sarah's father as I bravely ate his burned barbequed sausages and proclaimed them to be delicious.  Sometimes Sarah held fancy-dress parties.  One year I won the fancy-dress competition when I came dressed as 'Queen of the Bathroom' in a quilted dressing-gown of my mother's, curlers in my hair, fluffy slippers and a sponge-bag draped nonchalantly over my arm.  Praised by Sarah's mother Rose for my wit and creativity, it was all a sham.  My sister had attended a different party wearing the same outfit the week before and I had simply stolen her idea!

My memories of Sarah and the Chavasse's lovely family home in Chevening Park were not just of parties.  I was privileged to be invited back to play after school.  Though our own house in Otford was very comfortable, I suffered from inexcusable envy over the beautiful portraits of the Chavasse daughters that hung in the drawing room, the feeling of importance as we drove past the sentry box and through the estate in Mrs. Chavasse's sky-blue 2CV, tooting as we went around the corners.  And the soda-stream machine which seemed to me to be the very height of luxury and modernity. Visiting the dairy farm at Chevening to see the calves being fed; playing in the garden with Jason the standard poodle; spending hours on girlish pursuits in Sarah's bedroom and walking through the park up to the Keyhole, a distinctive arboreal feature in the Chevening grounds; these are very happy memories for me.

Recently, in celebration of my 50th birthday, a milestone that Sarah sadly did not achieve, I walked the length of the North Downs Way National Trail that passes the top of the Keyhole and affords views down to Chevening House. Once again I felt the pain of my separation from Sarah keenly. We kept in touch until our early twenties when I visited her in her rooms at Oxford.  However, my nursing and midwifery career took me overseas and we lost touch.  In the past few years I, with several other school friends, tried to reconnect with Sarah, all remembering her warm friendship and wanting to rekindle it.  However, Sarah was not to be found through the internet or social media, the family had moved on from Chevening and we learned that Sarah had been ill and known trouble in her adult years.  It is a great sadness to me that I did not make a greater effort to stay in touch with Sarah; that I never managed to renew our friendship; to tell Sarah how much she meant to me and to let her know how she made my experience of school and childhood so much richer and happier.

My faith has always been a comfort to me in times of sadness.  I don't know whether Sarah, or indeed her family and friends here today, had or have a faith.  However, I feel strongly that I saw in Sarah a reflection of the love and gentle nature of God in whose image I believe she was created.  In the Bible, we find a verse in Paul's letter to the Philippians, Chapter 1 verse 6, which says: 'I am certain that God who began a good work in you will bring it to completion...'. I love singing and indeed have memories of performing with Sarah in our school's production of 'Joseph and his technicolour dream-coat'. I'd like to finish this reflection with a verse from a hymn by the modern hymn-writer Stuart Townend, called 'There is a Hope'.  It is my hope that these words will comfort you as they also comfort me.

There is a hope that lifts my weary head

A consolation strong against despair

That when the world has plunged me in its deepest pit I find the Saviour there!

Through present sufferings, future's fear,

He whispers 'courage' in my ear.

For I am safe in Everlasting Arms

And they will lead me home.

Thank you.'

To listen to this hymn follow this link 

Bye bye Kathmandu... until next time

By Joy Kemp, Global Professional Advisor for the Royal College of Midwives.

I'm on my way home from an amazing 10 days in Kathmandu.  Following a successful fundraising campaign by UK midwives, coordinated by the RCM, it was time to travel back to Nepal to meet our twinning partner, the Midwifery Society of Nepal (MIDSON) for the first time since the earthquakes in April and May and to see how things had changed and developed, as well as ensuring that our funds are being spent wisely.

I was wonderfully hosted by MIDSON at their office in Kupondole, and by Ashok and Katrin (with toddler son Aryan and dog Butterscotch) at the At Home Guesthouse in Jamshikhel.  Nepal has certainly had a difficult year - first the earthquakes and now political stalemate with its neighbour Inda with the border road blocked and no fuel getting through.  Kathmandu was much quieter (and less polluted) with fewer cars on the road, so I walked everywhere locally and had fun exploring the city on local tuk tuks, mini-buses and green buses rather than getting taxis which were almost impossible to find.  My large European frame is quite challenging for the small spaces available in such vehicles!

long queues for petrol all over the city - many drivers waiting for days just to get 5 litres of fuel

Squeezing into a local minibus.  I got a seat but many were standing and others on the roof and handing out of the doors!

There was also little cooking gas available so many restaurants were closed and others had a limited menu.  The tandoor ovens were fine so we had a lot of bread, naan and roti; delicious but something I try to avoid at home!  Thankfully the guest house was well-stocked and the Sun Indian Jazz Cafe (yes, really) just opposite made great lassis and chicken tikka masala. I also really enjoyed sampling Nepali home cooking at Kirans' house (MIDSON's president) where I learned how to make momos (Nepalese Dumplings) and also tried fried goats lung for the first time, an acquired taste!

Fried goat's lung, fresh coriander chutney, home made chicken momos

I was so encouraged by MIDSON's response to the earthquake, mobilising themselves within days, first in the Kathmandu valley reaching out to the local maternity hospital and to women and families in temporary camps and shelters, but later with funds from UNICEF, UNFPA and Direct Relief, providing midwifery skills, professional and personal care kits and reproductive health outreach to communities in some of most remote earthquake-affected areas.  The 's RCM's funds helped to provide the staff and capacity needed to make this response happen and we've just signed an agreement enabling MIDSON to reach 5 more districts with care and supplies, vital as winter will soon be here. I had a busy schedule of meetings, visits and field trips and am happy to report that at the end of the trip we have a firm plan for using the remainder of the funds raised and ideas for 2 new projects for submission to donors for external funding.

 I brought with me a suitcase full of knitted baby clothes from the Crafty Coffee group in my village and these will be distributed to families living at altitude in temporary shelters.  

A happy little girl modelling her new woolly hat and tank top!

I was especially glad to visit Nepal's chief nurse, Ishwori, who played a big role in the success of our Global Midwifery Twinning Project and has herself recently given birth to a beautiful baby boy.
Let's join in hoping that this baby grows up in a country moving forward after such a huge challenge, with trained and competent midwives available to every woman and her family.  Meanwhile' the RCM will continue to work with MIDSON to fulfill this dream.

Ishwori and her baby

In Nepal again after the earthquakes

The RCM has been twinned with the Midwifery Society of Nepal (MIDSON) since 2012.   Between April 2012 and March 2015 we sent 23 of our midwife members as volunteers on 25 placements to Nepal through the Global MidwiferyTwinning Project. In addition, many of our members have visited Nepal and some have a long standing relationship with the country.  Therefore, when a 7.8 magnitude earthquake and more than 100 associated aftershocks struck Nepal in April 2015, killing more than 9000 people, our members were deeply concerned about the safety and wellbeing of their friends and colleagues in Nepal and asked the RCM to respond.

Having run a fundraising campaign from May - August 2015 we have been hugely encouraged by the response.   Your efforts have raised around £25,000 to help provide access to midwifery care for women and babies in Nepal  during the emergency, now and for the future.  We have been working with MIDSON to ensure that the monies raised are put to good use.

MIDSON rapidly responded to the earthquake, helping to relieve pressure on Kathmandu’s maternity hospitals and coordinating outreach to the worst affected urban and rural areas.  Partnering with other agencies such as UNFPA, UNCIEF and Direct Relief, they got supplies and midwifery expertise to where they were needed.  Our funds helped to make this happen and will go on supporting MIDSON’s capacity and activities in the months to come.  This is especially important as geologists predict a further earthquake in the future.

I am currently in Nepal (funded by the RCM, not by any monies you raised) conducting monitoring and evaluation of our inputs and helping in MIDSON’s forward planning.  Getting around is difficult as there is a tense political situation and associated fuel shortage.  However, I hope to see some of the fruits of MIDSON’s recent endeavours with my own eyes and also to meet with many of their local partners and funding agencies to scope out future work.  We will have a small workshop next week and I hope to blog again before I leave to give you a flavour of how your money is helping to make a difference here and to share some photos. 

Meanwhile, my suitcase has finally arrived, 24 hours after me.  It was a casualty of the fuel crisis as they didn't have sufficient fuel to take all the bags on the plane.  I’ve enjoyed a warm welcome from MIDSON and am so grateful that none of these wonderful, dedicated women lost their lives in the earthquakes. Work starts in earnest tomorrow afternoon.

A lovely welcome from the MIDSON executive yesterday who came to see me in the guesthouse

Nepal Update

It's now more than 3 months since the earthquakes in Nepal that caused such devastation and loss of life and livelihood.  The Royal College of Midwives had just finished a three-year twinning project with the Midwifery Society of Nepal during which time we had formed a close working relationship. We immediately started a fund-raising campaign amongst our members and have raised a staggering £21,000.  Reading the messages on our justgiving page, and the letters and cheques that arrived at HQ, was truly humbling.  Some gave large amounts; musician Gary from Kent whose wife Annette is a midwife, put on a fundraising concert and recorded a special CD for Nepal raising £660; seventeen year old Emily, an aspiring midwife, held a tea party with her Mum and raised £121; midwives in Coventry did the Wolf run and raised over £500. Others could only give a small amount but the messages with their donations were poignant: 'A donation to help colleagues in Nepal help women safely birth their babies who will bring a little happiness in this sad time'  and 'this is Nepal's future'. Kathy from Australia, a flower-farmer, gave money because 'I would like all other women to have the same midwifery care as I was able to'.  Message after message, donation after donation, midwives and their friends and families baked cakes, walked, forfeited their retirement presents and dug deep to make a difference.  The campaign has now officially ended but you are still able to donate by sending a cheque, made payable to The Royal College of Midwives Trust, to Eleanor Shaw, RCM, 15 Mansfield Street, London W1G 9NH.  Please clearly mark your donation for the Nepal appeal. Personally, aside from holding a garden party in May I have been walking the North Downs Way, a 156 mile-long national trail near my home, to celebrate my 50th birthday and show gratitude for living in a place of safety.  I recently completed the first 88 miles and hope to manage the remaining distance over weekends before Christmas.  You can sponsor me here

At the start of the walk in Farnham, Surrey, on the famous North Downs Way seat with my dog Cracker

I am pleased to be able to announce that I plan to visit Nepal from 8-18 October (the funds for my travel will not come out of any money raised in the campaign).  Although I have made six trips in the past three years, and have been in regular Skype, e mail and social media contact with our partner MIDSON since the earthquakes, this is the first opportunity I've had personally to see how they have responded and to report back to the RCM on how the funds raised are making a difference.  I'll be helping MIDSON to review their situation and undertake some contingency planning.  I'll be sure to blog whilst I'm there.  

Meanwhile, thanks to everyone for all your generous donations. The RCM has now launched a new fundraising campaign for Women's Aid. Women’s Aid is the national charity for women and children working to end domestic abuse; domestic abuse is a significant factor in the ill health and mortality of mothers and pregnant women.  You can read more about the campaign and how to donate here.  I have signed up for the RCM's charity bike ride so it seems to be my season for fitness challenges!  

Oh Oh Den Haag!

Last week I had the privilege of participating in two short training courses at The International Confederation of Midwives in The Hague.  Excellently facilitated by Tracey Phillips from Southern Hemisphere the courses were 'Theory of Change' and 'Results Based Monitoring and Evaluation'.

Tracey Phillips from Southern Hemisphere (left) with Franka Cadee (KNOV) and Synne (ICM) out on the town!

It's impossible to sum up the wealth of helpful information and practical strategies communicated, but everything I have learned will be immediately useful in my work as Global Professional Advisor for the Royal College of Midwives.  Theory of Change will allow us to ensure that we have carefully considered all the assumptions underpinning our global programmes and partnerships and that our project planning is robust.  Results-based M&E will ensure that we can measure the outcomes of what we do, collect the right information at the right time and report on it appropriately.  There is much work to do in setting up our systems but I feel confident that we can do it and am so grateful for this opportunity to take a step back and reflect, discuss with like-minded others and learn new knowledge and skills for the future.

Working out a Theory of Change!

 It also gave me a chance to work closely with colleagues from the International Confederation of Midwives, the Dutch and German Midwives' Associations and members of civil society organisations and think tanks.  We enjoyed wonderful lunches (pomegranate and pineapple salad with feta was a revelation!) and had some fun evenings exploring the beach and culture of The Hague.

Theory of Change workshop - participants from France, Zimbabwe, Norway, The Netherlands, Ghana, America, Germany, Afghanistan, Malawi and the UK!

I stayed in an excellent B&B called 'Oh Oh Den Haag!' which is also the name of a famous Dutch Song about the city which, according to my friend Anita Willemse, needs to be sung in a cheesey Den Haag accent!  The B&B was cheaper than a hotel, much more friendly and came with my own bike to explore the city and a delicious breakfast in the garden every morning.  Highly recommended for any other ICM visitors or holiday makers.

Jolande, landlady of the B&B with her bicycle

It's time for a week's holiday but I shall be returning to work next week with a sense of enrichment and solidarity, feeling very blessed.

Participants for the Results-Based M&E Course

Nepal Update

It’s just over one month since the earthquake in Nepal on 25 April that killed over 8,800 people and injured more than 23,000.  With subsidiary quakes and aftershocks there have been a total of over 25 earthquakes in the past 7 days; 93 earthquakes in the past month and 104 earthquakes in the past year.  Additionally the monsoon season has now started, further complicating life for those living in tents and temporary shelters and those involved in the relief effort. 

Running for shelter from the monsoon

The global team at the Royal College of Midwives has been in regular communication with the Midwifery Society of Nepal (MIDSON) since immediately after the first earthquake, Skyping every few days to offer psychological and technical support and also giving financial support through our fundraising campaign. http://campaign.justgiving.com/charity/midwives-trust/nepal . We've also been liaising with other agencies, both in Nepal and in the UK, to ensure that there is no duplication and that aid gets to where it's most needed.

Regular Skype Calls

So far we’ve raised just over £10,000 through our online campaign and approximately £3,000 through other donations.  What a fantastic response!  The first tranche of money transferred to MIDSON has been put to good use supporting an outreach programme to the worst affected districts.  In association with UNICEF and the Ministry of Health and Population’s Family Health Division, nine nurse-midwives have been recruited and deployed to work alongside government health services in primary health clinics in remote areas, supporting the development of midwifery skills and taking much needed aid and medical supplies.  The RCM’s contribution has enabled MIDSON to hire trainers and supervisors to prepare and support these nurse midwives and a programme manager to ensure the successful delivery of the project. The nurse midwives have been issued with tents and sleeping mats, raincoats and dried food to ensure their comfort and safety.  Kiran Bajracharya, President of MIDSON, said ‘I am so impressed with the dedication of these young nurse midwives to travel far away from home to help those communities affected by the earthquake.  They are so enthusiastic and happy to help’.

Training the outreach nurse-midwives

Training at the MIDSON office before deployment

MIDSON also want to develop a programme of support for women and staff in Kathmandu’s maternity hospitals.  Kiran explains: ‘with the trauma that both women and staff have experienced and the pressure on services, there is a lack of basic midwifery care.  Women need someone to show them love and compassion, a therapeutic touch.  We need to support hospital staff in providing respectful maternity care.  Women are not getting the support they need to breastfeed their babies. We want to employ some ‘midwifery ambassadors’ to reach out to women and staff in the maternity hospitals with love and compassion and we want to use the RCM money to help us with that’.

 

loading the trucks with supplies and with midwives before their long journey up-country

Finally, the RCM has been very touched by many of the comments from those who have donated through our just giving page and the creativity in raising funds.  Here’s a selection of some of those comments:

  

‘I would like all other women to have the same midwifery care as I was able to’.

‘On International Day of the Midwife the Supervisors of Midwives at Newham Hospital hosted a cake sale; with the help of some budding Mary Berrys and the generosity of all who supported us we raised this money for the mothers and babies of Nepal’.

‘A donation to help colleagues in Nepal help women safely birth their babies who will bring a little happiness in this sad time’.

‘This is Nepal's future’.

‘Good luck to all my fellow midwives working in such a tough environment. Your dedication is inspirational and the lives you save will never forget that’.

Thanks to everyone who has donated so far. The RCM has been doing its bit too. We have taken collections at various events around the country and staff have been donating their own money, baking cakes and selling them at work.  I held a garden party for 30 friends and neighbours on bank holiday Monday and we raised over £300.  What could you do? 

Eating Nettles - fabulous free food!

With the lovely May weather and a slightly less frenetic pace at work of late (well, for the last 4 days anyway), I've been enjoying some longer dog walks with sights, sounds and smells of approaching summer: lawn mowers and cut grass, hawthorn blossom and the lovely bright green hedgerows.

Nettles grow everywhere on our walks so one day earlier this week I took gloves and a carrier bag and returned with some young, tender nettle leaves. I'd read that you should just pick the tips i.e. the top 4 leaves.  Apparently they're best eaten before June as they are 'supercharged with all things good' in spring and get a bit tough after that. The nettle is far superior in nutritional value to many other veg and a good source of vitamin C, iron and protein. 

First, I made nettle pesto, loosely following River Cottage's Recipe.  I didn't use nearly as much oil as Mr. F-W and used a couple of tablespoons of plain veg oil instead of rapeseed.  Instead of bread I toasted some frozen scones that were lurking in the freezer then crumbled them in.  Mine was a bit stiff but I just loosened it with some of the drained pasta-water.  I sprinkled the top of my Spaghetti with Cheddar Cheese and more toasted scone and grated a carrot for extra colour and texture.  And (of course) some hot chilli sauce!  It was delicious - and probably cost around 20p to make. It goes without saying that almost all the ingredients were Tesco Value.

Spaghetti with Nettle Pesto

Today I used the remaining 1/4 bag nettle leaves to make soup. Here's how:

Nettle Soup

Melt 2tbsp butter or olive oil in a large heavy saucepan.  Add the following and sauté until soft:

• 2 chopped onions
• 2 sticks celery, chopped
• 1/2 wilted, sad looking romaine lettuce heart from the back of the salad drawer (optional!)

Meanwhile, plunge the nettle leaves into another saucepan of boiling water for 1 minute then drain (keep the water for the soup) and plunge into iced water.  Drain again and squeeze out the liquid.

Stir in and sauté for another 5 minutes:

• 3 medium potatoes, peeled and diced
• The blanched nettle leaves (to be honest, you could probably just put them in raw but I was a bit nervous!)
• 1 tsp garam masala
• 1/2 tsp ground coriander
• 1/2 tsp ground cumin
• pinch of mace
• pinch of freshly grated nutmeg
• salt and pepper

Add 1 litre water from the kettle, the drained nettle water and 2 veg or chicken stock cubes then simmer everything until the veg is soft, about 20 mins.  Blitz, drizzle a little olive oil on the top and  and serve with home-made bread.

Nettle Soup and Home-made Bread

I think I'll leave growing vegetables to the green fingered and just pick mine for free in the hedgerows!

Cheap as chips Vegetable Tagine with Wild Garlic Coucous

Today I found some wild garlic in the woods whilst out walking the dog and wanted to make something cheap and healthy for dinner, brain food for my daughter who started GSCEs and my husband who started a new job - a big day in our family today!

So here's my cheap as chips vegetable tagine with wild garlic couscous:

Place a medium casserole dish on medium heat (I use my Le Crueset, a wedding present from 19 years ago, still going strong!).  Add:

·          1tbsp olive oil

Prepare the following and sauté in the oil for around 10 mins till beginning to soften.  Add a little water if it starts to stick.

• ·          2 onions (Tesco Value) – each onion peeled and divided into 8 wedges
• ·          1 large carrot (Tesco Value) – peeled and cut into small bite sized chunks
• ·          10 little potatoes (Texco Value) peeled and cut into small bite sized chunks (waxy potatoes are good but any will do)
• ·          ½ butternut squash, peeled and cut into small bite-size chunks (by all means just use carrots which are cheaper, I just happened to have a squash in the drawer that needed using)
• ·          1 chopped fresh chilli (or dried/powdered)
• ·          2 large cloves garlic, peeled and chopped

You can use any combination of root veg including swede, carrot, parsnip or sweet potato too.

Add the following spices and stir round to coat all the vegetables for a couple of minutes (if you don’t have some of these ingredients then add what you like on an Eastern Theme!):

• 1 tsp harissa paste
• ½ tsp ground cinnamon
•  1 tsp ground coriander
• ½ tsp ground cumin
•  1 tsp ras el hanout spice mix

Add in the following and simmer for about ½ hour or until the veg is soft and the sauce has reduced to a thickish stew consistency.

• 2 peppers (Tesco Value, any colour), chopped into small bite-size chunks
•  ½ 400g drained can chick peas  - use the other ½ in the couscous (I buy ‘East End’ which are 3 tins for £1 at Tesco)
• 400g tin of chopped tomatoes (Tesco value)
• One tin full of water (rinse out the tomato tin and add this to the stew)
• 1 tbsp tomato purée
•   2 crumbled vegetable stock cubes (Tesco value)
• 2 tsp honey or sugar
•  salt
• freshly ground black pepper

Meanwhile, to a small casserole dish/saucepan, add:

•  1 mug couscous (I used gluten-free)
• The remaining ½ can chickpeas
•  1 mug boiling  water
• 1 small handful raisins (Tesco Value)
•  5 chopped ready to eat dried apricots (Tesco Value)
•  1 crumbled vegetable stock cube

I often turn the heat on, bring to boil then turn the heat off and let it swell up in the residual heat.

You could use value rice if you don’t have couscous – in which case cook the rice with the sultanas and apricots then add the other ingredients

Leave for about 15 mins then stir through 1 handful of chopped wild garlic (or parsley, coriander or chives, whatever you have.  You could also use spinach or rocket) and  a few flaked almonds.  Season to taste. 

Spicy Meatballs, 60 p per portion

I watch very little TV as I'm too tired at the end of the day, but sometimes on Saturday mornings I catch up with my guilty pleasures like OBEM (I know, I shouldn't), 24 hours in A&E, The Hotel Inspector, NCIS or an Island Parish. And anything cookery.  (I leave University Challenge to watch with the husband as it's one of the few things we like watching together).

So this morning found me watching Rick Stein in Morocco making spicy  meatballs and it got me thinking.  I had some mince in the freezer (bought from the reduced shelf for £1.28) and plenty of veg in the fridge. Rick's version had loads of oil and eggs on top so I changed it a bit and this is what we had, served with spaghetti and a simple side salad.  It was lush.  Even if you buy full-price mince it only works out at 60p a portion (everything is made with value range products where possible).

How to make my spicy meatballs,  serves 6 hungry people

Pre-heat the oven to 140c.

Into the food processor, sling the following and chop up finely but not to a mush:

• 3 sticks celery
• 3 value range carrots (don't bother peeling)
• 2 value range medium sized onions
• 1 value range red pepper
• 2 cloves garlic

Heat 2 tbsp olive oil in an ovenproof casserole dish (though you could use plain veg oil if you're on a budget) and add the chopped veg, leaving to saute on a medium heat for about 10 mins.  

Add, stir and simmer:

• 1 tin value range chopped tomatoes
• 1 pack value range passata
• 1 tbsp sugar (you need this to counter the sharpness of the tinned tomatoes)
• salt and pepper
• 1 tsp worcestershire sauce
• 1 tsp ground cumin
• 1 tsp ground coriander
• 2 tsp ground paprika

Take a packet of mince (I used Morrison's Savers Beef and Pork mince from the reduced shelf for £1.28 but it's only £1.82 at full price.  You could use lean or extra lean if you want to reduce the fat but it will push the price up considerably). Place the mince in a bowl, add the following and mix well:

•  tsp ground cumin
• 1 tsp ground coriander
• 2 tsp ground paprika
• 2 tbsp chopped parsley
• salt and pepper

Form into small balls and drop into the tomato sauce.  Stir round gently then cover with a lid and cook in the oven on a low heat for 1-2 hours until really tender and delicious.  If the sauce gets too thick, just before you serve with spaghetti, loosen the sauce with some of the drained pasta water.

Serve with spaghetti, rice or bread, and sprinkle with chopped coriander or parsely and fresh chillies if you like them.

Even with the spaghetti and salad it's well under £1 a head.

The best loaf of bread ever - 30p

Let me tell you how to make the best loaf of bread ever for around 30p.  Two top tips:

1. (From A Girl Called Jack) You don't need to use special strong bread flour.  Tesco Value plain flour makes amazing bread and you can make three loaves out of a 45p bag of flour, thus 15p for each 
2. (From Nigella) Using potato water (ie the water that you've par-boiled your potatoes in before the Sunday roast) makes brilliant bread.  Apparently the potato make the gluten more stretchy, makes a softer, lighter loaf, and acts as an anti-staling agent so the bread stays fresher for longer.  But you can just use ordinary tap water too.

Ingredients:

500g value plain flour - 15p
7g sachet dried fast action yeast - 10p
1 tbsp caster sugar or honey - 0.001p
1/2 tsp salt - 0.00001p
1 tbsp baking margarine(or olive oil or butter) - 3p
300 mls cooled potato water or cool tap water - negligible cost
Plain vegetable oil for oiling - 2p

Method:

Weigh the flour into a mixing bowl.  Add the yeast on one side of the bowl and the salt on the other.  The salt will kill the yeast if it touches at this stage.  Add the rest of the ingredients and mix in a food mixer with a dough hook for around 5 mins.  Alternatively, mix by hand then turn out onto an oiled work-surface and knead for 10 minutes.  Even though I use the electric mixer, I like to finish off the dough by kneading for a couple of minutes by hand.  That way I get to feel whether the dough is ready.  It should be silky and stretchy when it's done.

Oil a large bowl with a piece of cling film.  Place the dough in the bowl and cover with the oiled cling flim.  Leave to rise at room temperature for around 2 hours until it's at least doubled in size.  Go away and do something else - or you can put the dough in the fridge at this stage to rise slowly overnight then bake it in the morning.

When the dough has risen, punch it with your fist to get all the air out then knead again for a couple of minutes and shape into an oval.  Line a baking tray/sheet with baking parchment (or just oil the tray well) and place the bread on it to prove.  Cover loosely with the oiled cling film and leave for a further 30-45 mins until doubled in size again.

Heat the oven to 220c (200 fan).  Remove the cling film, scatter the top of the loaf with plain flour and make 3 or 4 slashes on the top with a very sharp knife, being careful not to knock all the air out of the loaf.  Bake in the oven for 25-35 mins until golden brown and it sounds hollowed when tapped.

Leave to cool on a wire rack and eat with lovely butter and home-made jam.  Or make a cheese and tomato sandwich :)

Nepal Earthquake

News is flooding in of the devastating earthquake in Nepal; the epicentre was in the Kathmandu Valley, the most densely populated part of Nepal, and the death toll is rising into the thousands, with thousands more affected by a shortage of shelter, water and food.  The Royal College of Midwives has been working in Nepal since 2012 through our partner, the Midwifery Society of Nepal (MIDSON).

Our immediate concern is for the safety of our friends and colleagues. Telephone services in Nepal are mostly unavailable and many will have no way to access the Internet. We have contact with some MIDSON members who are safe, but are unaware of the welfare of others. Once we have established better contact we will assess whether the Royal College of Midwives can assist MIDSON in anyway and what the appropriate response might be. Please continue to hold our sisters in your thoughts and prayers and keep alert for further updates about any ways in which you may be able to help.

Meanwhile the International Committee of the Red Cross has a website on which you can trace family members and friends or report that you are safe.
http://familylinks.icrc.org/nepal-earthquake/en/pages/home.aspx

Thank you.

Last journey from Nepal

I started writing this post in the air (again!) to regain composure in the middle of a nightmare journey.  I can hardly read what I wrote as my handwriting was severely compromised due to turbulence.  I think this is the last time I will fly with Turkish Airlines; it hasn’t been the best of days.  Having left the guesthouse in Kathmandu before 6am I joined a long queue even to enter the airport terminal.  Eventually reaching the check in desk I learned that the flight was 2 hours late so I would miss my connecting flight from Istanbul to Gatwick.  With my trusty 20 year old suitcase I hovered near the desk for another hour whilst they made enquiries before telling me that the next available flight would be tomorrow.  As I have only 72 hours before flying to Uganda I was a bit fed up. 

Having finally boarded the delayed flight, we had an aborted take-off attempt with little explanation. There was an alarming squeal of brakes and a juddery slew to the right and we sat on the tarmac for a further 10 minutes before taking off.  I later found out that another plane was coming into land and we were about to collide head-on. At this stage I wasn’t sure what had happened and worried that there was a technical problem with the plane, so spent much of the flight hoping all was well.  Together with the persistent turbulence and the unpleasantly fragrant and unnecessarily loud French speaker next to me, I was enormously grateful to touch down in Istanbul unscathed.  Sitting at the back of the plane I was one of the last to alight so also had to join the back of a very long queue at the transfer desk.  Thankfully the RCM travel agent’s 24 hour  helpline was fantastic and assured me that there were seats available on a flight to Heathrow later that evening, so not to be fobbed off by the airline!  I am mightily relieved to be in possession of a boarding pass for that flight and to now be sitting in a comfy, if busy, lounge enjoying European-speed wifi, a nice cup of tea and a bowl of tomato soup.  Many Facebook friends advised me to enjoy a night exploring Istanbul but as a female travelling alone I didn’t feel that confident and a nasty assault in the Turkish mountains in the 1990s has somewhat put me off the country.  I’m sure it’s lovely and all that, but I’m happy to be going home.  Today’s experience has confirmed that indeed Kathmandu has one of the worst airports in the world!

It has been an emotional trip to Nepal, though with similar missions to Uganda next week and Cambodia in March I have had to keep myself focused.  I feel so blessed to have such special friends across the world; passionate women (and men) dedicated to making their country safer for women and babies as they ‘cross the river’ (a Cambodian expression for childbirth as it’s so dangerous; like crossing the River Mekong in full flow).  Regardless of whether or not we are successful in getting continued funding for our project, I know these friendships will be sustained long-term, helped by social networking, e mail and Skype that were not available ‘back in the day’ when I had a similar job in the 1990s. 

Professor Kiran Bajracharya, President of MIDSON

Joining in MIDSON's 5th birthday celebrations with younger and older members of the society

There are many successes to celebrate in Nepal at the close of The RCM’s Global Midwifery Twinning Project.  We have truly established a solid twinning relationship with the midwifery society of Nepal and this gives a firm base for any future endeavours.  We also know, and have a working relationship with, many of the key players in Maternal and Newborn Health in Nepal and are well-placed to develop further collaborative partnerships.  A special thank you goes to UNFPA Nepal for their welcome and support at every stage of our project.  Any success we have had owes much to their partnership.

Lovely family who had their second baby in the Mangala Devi Birth Centre, one of the outputs of our project. The woman said: 'During my previous birth my husband was not allowed to stay with me.  I was fearful and anxious on the labour ward and there was no one to support me.  This time, at the Birth Centre, my husband could stay with me and could understand and share my labour pain.  The staff at the birth centre gave me comfort; they encouraged me to use different positions in labour and I was comfortable on the floor mattress.  I used the birthing ball.  After the birth I felt so well, and my baby is healthy.  This is because of the way the staff loved me.  Now I am telling all my friends and neighbours about the birth centre and my husband is sharing the message with his work colleagues; 

There is now wide consensus that Nepal needs midwives and needs them now.  I remain hopeful that midwifery education and regulation will be established in Nepal in the next couple of years.  Agencies are signing agreements to work together to expedite this and partnership can only strengthen everyone’s efforts.  Curricula and standards are being developed, albeit frustratingly slowly.  Various agencies, including ours, are helping to develop practice sites where midwifery students can the learn the skills and ways of being as midwives rather than as nurses.  Centres of excellence are opening, such as the Mangala Devi Birthing Centre, where our own UK member midwife volunteers have played a key role in its naissance.  Thanks to our volunteers many groups of educators, students and nurse midwives have seen midwifery care in action and benefitted from continued professional education in maternal and newborn emergencies and many other topics.  Pregnancy yoga was very popular!  MIDSON, and its newly formed young midwives group, have developed a higher profile in Nepal with MIDSON leading events such as celebrations for International Day of the Midwife, a valentine’s day ‘love parade’ for women’s reproductive and sexual health rights, midwifery outreach camps and coaching more than 3000 nurse midwives, a community midwives’ clinic and national and international presentations and conferences and a raised media profile.  The association has more members than 3 years ago and stronger links are being formed with womens’ and civil society groups as well as other health professional societies.  MIDSON now has a stratetic plan for the next three years and has leaned many organisational development skills in addition to the organisation of workshops and conferences.

First ever Nepal National Midwifery Conference, Sept 2013, organised by MIDSON

Though the Global Midwifery Twinning Project cannot take the credit alone for these achievements, I believe we have played an important role in many of them and am proud to have played a small part in facilitating this.  Over the past week I have taken many video clips of the project’s beneficiaries explaining how GMTP has helped them organisationally and personally and it’s been really encouraging to hear.

Interview with Kiran Bajracharya, President of MIDSON

Interview with Nani Kaway, joint secretary of MIDSON

However, there are also many frustrations.  As in many countries, progress towards establishing this life-saving profession in its own right has been hampered by politics and power-struggles, coupled with a natural fear of change and the unknown.  Women and babies will continue to die until society believes their lives are worth saving.  In addition to the ‘three pillars’ of midwifery (education, regulation and association) I was reminded this week by Della Sherrat, an influential international midwife, that midwifery workforce and retention policies are also crucial in establishing the profession.  Perhaps there are five pillars after all!

We have learned lessons during this project too.  We're frustrated at the slow pace of change in getting midwifery education and regulation established.  Communication can be difficult when a project is managed remotely and internet access is limited in our partner countries.  Our volunteers have been the backbone of the project but the short-term nature of placement does bring disadvantages.  However, volunteering seems to have encouraged our members to become activists – it was apparent that in many of pictures from the picket line during the recent UK midwives’ strike, those holding placards were very often our GMTP volunteers!  We've also found that many of our volunteers have gone on to do more placements overseas and have developed a keen interest

in global health.  Here's an extract from an e mail I received from a volunteer today:

'Since I had this fabulous opportunity of going to Nepal with GMTP in 2013 I also went to Bangladesh with the Liverpool School of Tropical Medicine in May 2014 and November 2014.  I was then one of the facilitators on the LSTM Making it Happen project in Liverpool in Feb 2015 and am now considering taking an MSc in International Public health (despite being retired!!)  While I have the energy and inspiration that this has instilled in me again, I would like to remain very involved in the area of Global Midwifery matters.  I so hope that the work of GMTP and all the volunteers will be well evaluated.  It has been a tremendous honour to be a part of it; I often reflect on it and promote and encourage friends and colleagues to get involved at an International level.  It really does put our own NHS experiences and frustrations into perspective.'

I'm finishing this having finally reached home and hoping that my luggage will follow me soon.  I hope to blog again from Uganda and Cambodia in the next couple of weeks.  Thank you for your interest.