Gangtok, Sikkim – Day 10

Dear MaTI friends,

 

Our last day in Sikkim saw another busy schedule. We visited the studios of the Nauyma TV network for some filming; we met with local women’s groups representatives; and we had a final farewell evening with our lovely hosts.

The morning started with Ippokratis gazing at the cloud formations after his breakfast with a cup of delicious Sikkim tea, wearing his jeans (in a welcomed rare instance in the last few days of formal functions), when Haider approached him and spluttered out with barely concealed panic: “Do you have my phone?”. “Of course not”, replied Ippokratis showing him his own phone. “Why would I?”. Ippokratis tried to call it but to no avail as there was no cellular reception available. The calm of the moment had been lost. The clouds mattered no more. The phone had to be located. Upon our return to the room Haider’s anxiety at potentially having lost his phone was evident by the state that it was in. It appeared as if a grizzly bear had ransacked it, after having just woken up from a winter’s sleep, hungrily rummaging for food in an unsuspecting camper’s tent. Ippokratis quickly went for his pocket to take out his phone and capture the moment, when he realized that he was already holding one in his other hand. Whose was that in his pocket then? “Whoops”, uttered a red-faced Ippokratis. That is what happens when both have identical phones.

Midmorning the entire CALMED team along with their hosts assembled at the hotel and headed for the studios of the local TV network – Nauyma TV. There we were carefully positioned in seats and mic-ed up, as the talk show host joined us. This was going to be more than an interview as part of a short feature as we initially thought. In fact, we filmed for a solid hour and a half and the plan is to edit it down to an hour-long broadcast that will fill up the entire episode of one of the shows of this popular local weekly programme. Despite the fact that the filming was conducted half in Nepali and half in English, Ippokratis was very happy that he still found the opportunity to convey the message that MaTI and GLOWM are a wonderfully rich, and free, resource of on-line educational material for all to use!

We are reminded that CALMED is more than just training health professionals. In order to ensure sustainability, it must also include the involvement of local women’s group. To that end, in the afternoon we met with women’s group representatives. These included 16 representatives from the; State women commission; Inner wheel; NHRM; and State ASHA trainers. We discussed women’s involvement as the third arm of the CALMED programme and developing of an advocacy role to concentrate at the bottoms up approach, linking women from the villages. The local lead of the inner wheel group, Dr Renu (who is a remarkable lady) has made it her personal mission to organize these women’s groups in to providing the necessary framework to keep the link between healthcare providers and women open. In addition, one of the newly trained faculty members which was also present at the meeting informed us that she is already planning a training session with peripheral health workers next week. The skills transfer model is clearly already underway.

The meeting was also attended by a representative of the Chief Minister of Sikkim. It appears that news of our work reached his ears. Apparently, he was planning to have an audience with us. However, as one would expect, he was hard pressed for time today so he couldn’t make it. Nevertheless, via his representative he sent us gifts as a token of his appreciation for our work along with a personal message of support. In return, his representative recorded a video greeting from us and requested if we could arrange for a report from our work to be sent personally to the Chief Minister himself. The gesture was very touching and we are more confident now that with such heavyweight political support our CALMED work in Sikkim will be more sustainable.

We have now come to the end of our training trip and we are all very tired. Although every single of the five MaTI members that attended as part of the CALMED programme did so by using their annual leave allowance, this was definitely not a holiday but hard work indeed. Our bodies might be tired and our brains buzzing but our spirits are high. We return back home with a life experience gained and a sizeable collection of Khadas to prove it as well!

After twelve days in India, Ippokratis and Haider found the only store up to now that sells diet coke. It was like manna from heaven! We bought two and consumed them in one go. Disappointingly it didn’t make us happy. Maybe these twelve days without one cured us of our addiction. Fresh air and non-stop work does marvels for ones cravings!

The evening saw a farewell dinner organized by our local hosts and more wonderful presents offered to us. To them we are eternally grateful, as our work in Sikkim would have never been possible without them. Too many to mention, and fearful of inadvertently and inexcusably missing someone out, they are now are friends. We would also like to thank the Rotary International and the rotary districts in Kent and Sikkim for their funding and hospitality.

Tomorrow we will be leaving the majestic scenery of the Himalayas and the city of Gangtok draped on the sides of the mountains like the hanging gardens of Babylon. Then our laborious two-day trip back to the UK starts in reverse order, starting with another bone crunching six-hour drive with an overnight stay in Siliguri, and then on to New Delhi for two nights. We are all looking forward to seeing our friends and loved ones, as communication with them and the outside world in general has been problematic whilst here to say the least.

We have a final confession to make; some of us were initially skeptical as to the way that we would have been greeted upon our arrival and if those that we were meant to help would have found what we were offering of use. At the end of an exhausting few days we are true converts. It is obvious to us now that all involved here in Sikkim have really appreciated having us, as the feedback was just phenomenal. Not a single negative comment. And what is more important, they can now do it all themselves. We can put our hands on our hearts and say with true honesty that it has been worth it.

The next two areas where the CALMED model will be implemented are in Patna, in Bihar (with the initial visit by a professional vocational team planned for end of 2013/beginning of 2014) and Gujarat, both in India. The funding application is on its way and we are hopeful that it will be granted. In fact, a representative from Bihar came to see us whilst we were training in Sikkim and he is very eager for a CALMED team to visit him next. The disappointment in his face was obvious when he asked us if we could visit next month as they really could do with our help and we had to explain that unfortunately that would not be possible for various logistical reasons.

Although our training trip is over, our work at Sikkim is not. All five MaTI members that took part have formed mentorship relationships with the newly trained faculty. We will be keeping contact electronically and support them in their work commenced with CALMED. We eagerly await the data that they are going to collect and we already have a lot with us that we are analyzing. In addition, Haider and Ippokratis are preparing a 10-15 minute film documenting this trip. It will be used as a mean to raise awareness and promote the CALMED programme. The footage has been shot and now comes the long and tiring process of editing the scenes. The storyboard looks amazing and we hope that you will enjoy it. When it is ready we will post it for your viewing pleasure!

Thank you all for following the MaTI blog during our trip to Sikkim as part of our collaboration with the CALMED programme.

Bidha pau Gangtok, and dharai dhanyabad for your hospitality.

Next stop; round 2: Bihar

Ippokratis, Haider, Vinita, Radhika and Sangeetha

 

In the studio of Nauyma TV

Round table discussion with the local women’s groups

The representative of the Chief Minister of Sikkim handing over his gifts

A token of thanks from the Chief Minister

The MaTI team

Gangtok, Sikkim – Day 9

Dear MaTI friends.

 

Today saw the launch of the second component of the Calmed programme; we dinned with government officials; and marveled at the clouds.

To save cost (it is a charity after all!) Haider and Ippokratis (as well as Sangeetha and Vinita for that matter) have been sharing a room. It has been an experience akin to a slumber party, but instead of talking about teenage fantasies we are talking about stats, papers and future MaTI projects. Nevertheless, it still took us back to our childhood. From the nightly nonstop post lights-off chatter to the daily morning rush to the shower (or rather the fight of who should go first so that the other can snooze in for another 15mins!), it has been a fun experience!

In the morning we were greeted by a mix of 38 ANMs (Auxilary Nurse Midwives), LHVs (Lady Health Visitors) and ASHA trainers (Activist Social Health Assistant) who had travelled from around the region. For the first session we chose a selection of MaTI and GLOWM videos to present and talk about on topics that we deemed appropriate and relevant to the level of our audience. We proved our adaptability when after the coffee break, and whilst mingling with the group, we realized that our delegates were eager for an even higher level of complexity of topics. With some fast passed thinking and with the entire MaTI and GLOWM library at our fingertips, we re-arranged our presentations and accommodated their wish within minutes.

For the second session we run some basic skills brake-out stations and discussions using pictorial, non-language based, flip charts. The attendees pleasantly surprised us again by asking for further hands-on simulation training and we were happy to oblige! Pity their transport arrived and they had to go, for they were clearly hungry for more. This is definitely a part of the programme we could do with more time during the next visits. We hope that the knowledge and skills we showed them will percolate in to the community. Some of our previously trained faculty from the first few days of our CALMED visit are keen to also take forward this phase and continue the ASHA, ANM and LHV training.

The afternoon was filled with administrative tasks, looking at the inventory of equipment left behind and tiding up some loose ends. Haider and Ippokratis signed the books left behind in hard copy (which are also available electronically for free on the Global Library Of Women’s Medicine website) in their capacity as Executive Editors of GLOWM – “Textbook of postpartum haemorrhage” & ”Gynaecology for less-resourced locations”.

The training part of our trip is now over, but the programme is not finished just yet. Tomorrow we will be meeting with local women’s groups to enlist their help and discuss their involvement and development of an advocacy role.

In the evening we dinned with representatives from the government and the NHRM (National Rural Health Mission). The venue had imposing views of mount Kanchenjunga. Or at least so we were told, as in typical fashion it was being uncooperative and shrouded in clouds and darkness. At least the food and the excellent hospitality of our hosts kept our spirits high and we soon forgot our moody mountain friend. During the customary formalities and exchange of presents, the Health Secretary invited one of the newly trained faculty to stand up and tell us of her experience of her training with us and if it was of any use. She narrated the following story:

“About four weeks ago I was called by one of the doctors from a PMC (peripheral medical centre) where they had a shoulder dystocia and they didn’t know what to do. Although I knew what I would do I couldn’t explain it to them properly. I saw the same doctor at the course when I was training them after we had been trained ourselves on how to train. She came up to me and said; I wish I had been to this four weeks ago because that baby would have lived.”

Stunned silence followed. We now appreciate unequivocally that our efforts and sleepless nights working on this programme were well worth it.

In between some of the day’s work we managed to steal a few minutes and settle at one of the big bay windows of our hotel overlooking the valley, where we were treated to a performance only mother earth could put on for us. The valley unfolding beyond us was engulfed by ever shifting cloud formations, some settling between the rolling peaks for a nap, others charging through in a rush. We could just spend the entire day looking at them as they played hide and seek with the mountains. This is what the gods of ancient Greece must have felt like when in residence on the top of mount Olympus.

Voli Vetaula! (See you tomorrow)

Ippokratis, Haider, Sangeetha, Vinita and Radhika

Ippokratis teaching using simple-to-understand pictorial charts

Break-out sessions with the ANMs, LHVs and ASHA trainers

Haider doing some impromptu breech delivery training after popular request from our trainees

Today’s ANM, ASHA and LHV delegates

Ippokratis and Haider signing the books left behind in hard copy, in their capacity as Executive Editors of GLOWM

MaTI solidarity

The comments book filled with lovely notes by our trainees from the entire week

Gangtok, Sikkim – Day 8

Dear MaTI friends,

 

Today saw the end of our second course, this time run by the faculty previously trained by us; we started preparations for the next stage of the CALMED programme starting tomorrow; and we said good buy to our newly found friends.

Haider and Ippokratis struggled once more to sleep. But this time it was not just the tea. Howling dogs kept us up most of the night, and Ippokratis was convinced that they were heralding the end of the world. Luckily, that did not happen. We kept the daily routine though of being woken up by the beat of drums and the humming of Buddhist monks as they performed their morning prayers. We decided to make do with alarm clocks from now on as we guessed that this could be the only right way to wake up in a city steeped in religion. A stone through from Tibet, frequented by visitors in search of spiritual cleansing; it just adds to the aura of mystique already abundant in Sikkim.

Our newly trained faculty again beat us to the morning roll call. Watching them today running the final day of their course was akin to watching a well choreographed and impeccably performed ballet. They were effortless, efficient in their work and buzzing with excitement. It looked like they have been doing this forever. Haider and Ippokratis plugged quickly in to SPSS the pre- and post- test scores for their trainees and showed once more a statistically significant improvement.

The day closed with the kind of official and staged ceremony that we have come to expect, with the NRHM (National Rural Health Minister) director, Dr Pradhan, attending as the guest of honor. He pledged that the NRHM will continue with the training instituted by the CALMED visit and take upon itself to help the new faculty and provide them with the resources needed to continue the work started over the last few days. Sangeetha got a special mention from him for the development of “appropriate technology”!

Despite constantly asking for feedback by our trainees as to how we were performing and what they thought of our programme, we appreciate that when one has a negative comment to make it is better done anonymously. We therefore invited our trainees to anonymously write comments in a book. At the end of the day we all looked at it. To our amazement, there were no negative comments. In fact, because everybody had written so many nice things they all printed their name next to what they wrote because they wanted us to know whom it was from. A brief selection includes:

“It was a lifetime opportunity to have attended this course as nothing like this has been done before, and we are very grateful for you coming all the way from England” – Midwife trainer

 “I feel very confident that I can now handle the emergencies taught. Good food and ambience which is very important as well!” – Medical Officer  

 “The thing we enjoyed the most was the videos” – Midwife

“When we first started, we were skeptical as to the need for another programme. But after the first day we all fell in love with it. The visual material, the simulators, the systematic approach; we loved it all and can see how useful this training has been” – Hospital Doctor

“We enjoyed being trained, and we enjoyed training” – Hospital Doctor

“The only negative comment I have is that you will have to come back and do it all again as we enjoyed it so much!” – Hospital Doctor

In fact, CALMED is planning to come back to Sikkim to follow-up on the progress of the programme in 12 and 24 months.

Our newly trained faculty had a final surprise for us, as they presented us all with presents as a token of their appreciation. What made us particularly proud at MaTI, was how so many trainees came up to us individually and told us how much they liked our videos. In fact, a number of them have already registered with the MaTI website and our Facebook page so that they can keep in contact with us and use new material as it is being produced.

Having the material is one thing. But showing them how to use it is another. At MaTI we feel that what we have donated is more than just our knowledge. It is also the skill set to disseminate it. The USB keys with the GLOWM and MaTI material pre-loaded, along with the simulators, has given them some of the tools. The training they received these last few days in how to use these tools will hopefully act as a pebble tossed in the water, and our trainees like the ripples will propagate this knowledge through this lake which is Sikkim. We just wish that we could give them even more.

With a sadness in our hearts we had to bid farewell as we are leaving our new found friends. Nevertheless, our work does not end here and with these two courses. The three prong approach of CALMED continues tomorrow with part 2 of the programme; teaching ASHA trainers (Activist Social Health Assistant), ANMs (Auxilary Nurse Midwives) and LHVs (Lady Health Visitors).

On a separate note, as part of the effort to ensure the sustainability of CALMED’s work, we found out that we have been invited tomorrow to dine with the government. We are not really sure what that actually means, but it is a “I wish I had brought another suit” moment, as the number of official functions we have been invited to attend as the guests of honour over the last 2 weeks was beyond what we excepted when we departed from the UK (which now also includes an invite to a wedding on Monday!).

All the MaTI members undertaking this trip to Sikkim (Haider, Ippokratis, Vinita, Radhika, Sangeetha) would like to use this post as an opportunity to thank all those back at home that have been sending us messages of support. We have read them all, but unfortunately we are unable to respond to them individually and we will be doing so upon our return to the UK. The WiFi where we are staying (as no doubt you know by now as we have been complaining about it like a spoilt child, but bear with us please once more) is so temperamental, that we keep on losing the signal every time we even breath close to the computer. We have transformed into this newly found class of criminal, called a “bandwidth thief”, as we compete for what must be the only 3Kbytes available to the hotel’s residents. We eagerly stalk for the right window of opportunity to fire-up our email browser, and when everything invariably freezes and the “twirling rainbow-coloured wheel of death” appears on screen the crushing disappointment is soon to follow. How did we ever manage a few years back we ponder?

Bidha Pau! (See you tomorrow)

Ippokratis, Haider, Vinita, Sangeetha and Radhika

The new faculty with their trainees

Haider talking about MaTI and GLOWM at the closing ceremony

Radhika addressing the trained delegates

Ippokratis receiving the gifts given by the trained faculty by Dr Deokota, Assistant Professor of the O&G department at Sikkim General Hospital

Gangtok, Sikkim – Day 7

Namaskar MaTI friends and happy Hanuman Jayanthi

 

 

Today saw another exciting day. The course run by the newly trained faculty entered its second day; Vinita made an appearance on All India Radio; we were given newspapers and footage from the news broadcast on the local TV station featuring the CALMED inaugural day; and Sangeetha unveiled her new low-cost substitute for episiotomy training.

Our trained faculty is now, for all intense and purpose, independent. By mentoring them closely but supervising them at arms length they have nurtured their own teamwork, developed their own leadership qualities, and are able to adapt to the shifting needs of their own trainees. Although we taught them in English, when they are teaching their own trainees they are doing so in a combination of both English and their own local language. This is sensible, efficient and culturally relevant. Mrs Tilt has become Mrs Tedhi, and they have already tweaked our – now their – lectures.

At lunchtime, our new MaTI member Vinita, along with one of the newly trained faculty, went to the local studios of All India Radio (the equivalent of the BBC) to pre-record a feature in Hindi after we had been invited to talk about the CALMED programme and our work in Sikkim. At 19.05 we all sat cramped up in the car of one of our hosts and listened intently to the mesmerizing words delivered by an unfazed Vinita poring out of the speakers. Although Haider and Ippokratis couldn’t understand a word beyond CALMED, VTT, Doctors, ASHA, England, Sikkim and a few names, we were assured by our Hindi speaking contingent that it sounded great. We just had to take their word for it!

The publicity of CALMED however does not end there. We found out that in addition to the features run by the two local newspapers the day before we arrived, they had also printed articles about our inaugural day and the message of support bestowed upon the programme by the Health Minister Mr DN Takarpa. In one of them (Sikkim Express) we even made the front page! This is very important for if we want our work to be sustainable it needs the support of the local stakeholders, such as the government. That is why the CALMED model has three prongs: training the trainers; training traditional birth attenders and community health workers; developing women’s group advocacy. The first part of the programme has already been achieved. On day 9 of our programme we will be teaching ASHA trainers (Activist Social Health Assistant), ANMs (Auxilary Nurse Midwives) and LHV (Lady Health Visitors). On the final day, day 10, we will be meeting with local women’s groups to enlist their help and then discuss their involvement and development of an advocacy role by them.  The aim of this is for these groups to promote issues such as women’s education; further professional maternity training; advocate for resource allocation; and give a voice to women so programmes such as the CALMED one do not get neglected.

As a final surprise, we were given footage of the local news. Our inaugural day had been filmed, but unbeknown to us, segments of it were broadcast by the local TV network – Nauyma TV – both in the Nepali and in the English language version. The original clip was aired on the 8pm main news, and it was then repeated the next day at 8am and 1.30pm.

Here at MaTI, we always try to innovate and think about ways to improve what and how we do things in our effort to bring high quality material to low resource settings. Alongside state of the art audiovisual material, we are acutely aware that nothing can substitute hands on practice. With this ethos in mind, Sangeetha developed a novel model for episiotomy training using low cost material sourced locally. Cost of episiotomy repair kit bought in the UK: £200; cost of episiotomy repair kit that Sangeetha created: 200 rupees (£2.5); simple yet effective ideas: priceless. The “blue-prints” of the design are with the faculty and they have already put it to the test.

Disappointingly, yesterday’s pledge to stay off the gulab jamun failed when at lunchtime the very friendly staff at the hotel had it freshly prepared just for us. The fight that our guilt put up against our stomachs went as far as consuming only one portion each. Round one of this battle goes to food.

Haider and Ippokratis decided to go back to the teashop previously visited for more. We again consumed in the late evening tea that amounted to the equivalent of an industrial dose of diuretics and stimulants. Despite being dedicated trainers, one thing we could agree on; some people just don’t learn!

Voli vetaula! (See you tomorrow)

Ippokratis, Haider, Vinita, Radhika and Sangeetha

Haider prepping a faculty member on their upcoming lecture

Vinita recording at the studios of All India Radio

The prototype model for episiotomy training using low cost material

Demonstrating the skill of dealing with a shoulder dystocia with nothing more than a doll and a pair of hands – who said that simulation training had to be high tech or expensive

Sikkim Express’ front page – note the bottom right part of the picture

Some people just don’t learn…

Gangtok, Sikkim – Day 6

Pyaaro MaTI saathi,

Hajur Kasto Hunu Huncha? (How are you?)

 

Unsurprisingly, neither Haider nor Ippokratis managed to sleep much yesterday night. That is what 8 cups of the finest Darjeeling and Sikkim tea does to you if drunk after 9pm. Lesson learnt. Wish we knew that when we were revising for our finals!

We had a packed day today. The second course, run now by the new local faculty, started; Ippokratis and Haider visited the Sikkim-Manipal University Medical School; and to top it all, we woke at 5.30am to see Mount Kanchenjunga draped in the morning sunlight.

We departed from our hotel bleary-eyed but full of expectation to marvel at one of the most famous mountain range in the world. Unfortunately, after a short drive, we found the peak of Kanchenjunga to be obscured by thick clouds. In a cruel play of luck, the opposite side of the horizon had beautifully clear skies. Nevertheless, the “lower” peaks that were visible are equally impressive. We started to make our way back when suddenly, the clouds parted momentarily and the snow-tipped giant itself appeared. The 3^rd tallest mountain in the world dwarfed the surrounding ones by a factor of 2. It was worth the morning rise after all.

The new trainers commenced the first day of their course full of vigor. For the first time, they arrived at the hall before us (and that is not because we were late coming back from our morning trek). They are training a group of 19 community midwives and medical health officers. To our delight, and unbeknown to us, after yesterday’s course and despite the late finish due to pre-course preparatory work, they had a further meeting and refined the details further. The morning started with a few hick-ups with the power supply flickering on and off (mental note – don’t use the lift!) and some of the videos not being supported by the computers of the new faculty. However, these were swiftly overcome. This demonstrated the advantage of staying back and offering support to the new trainers with their first course. Otherwise, they run everything on their own with only the occasional need to ask us for what amounted to mainly reassurance and little real need for more.

It was wonderful to see them come out of their shell. From shy and retiring trainees they have morphed into competent and extrovert trainers. They all have been enjoying their newfound confidence and they are busing with the excitement of teaching. We know the feeling, as this is exactly the same one that has turned us in to junkies looking for the next fix of teaching.

Following an invitation by the Dean of the Institute of Medical Sciences, Dr Joneja, after lunch Ippokratis, Haider and Dr Basu visited the campus of the Sikkim-Manipal University Medical School. The Dean greeted us warmly and a brief meeting with the Vice-Chancellor, Dr Somnath Mishra followed. We were then invited to lecture and demonstrate the use of simulation training to a mix of medical and nursing faculty waiting in one of the lecture halls. Despite the last minute brief, we hooked up our computer to the audiovisual system and ad-libbed. Ippokratis and Haider put on a performance involving role-play with one of the simulators we brought from the course and presented a mixture of videos and other relevant visual MaTI material. The reaction was positive and they eagerly jotted down the webpage addresses for both MaTI and GLOWM. A brief tour of the campus and the adjoining university hospital followed. We enjoyed this part of the day a lot. We hope that they found our visit useful, and we have agreed with the Dean to keep in contact and support him in developing a simulation and surgical skills lab if possible.

Upon our return to our hotel, Haider announced that he has started to feel like a battery hen; we are cooped up in a hotel for most of the day and we are constantly being fed. This was never meant to be a holiday I guess, a life experience nonetheless. We therefore decided that tonight we would detoxify with fruit and plain water. This is one of the spiritual homes of Buddhism and meditation after all, so indulging in the sin of gluttony as we have been doing seems a tad inappropriate. No more delicious gulab jamun then… Yeh right, as if!

Finally, we are also very happy to be adding to our MaTI team three further dynamic members. These are Drs Vinita Nair, Radhika Vishwanatha and Sangeetha Devarajan. Although we have been already working closely with them over the last few months whilst preparing the CALMED training material and they are part of the team travelling to Sikkim with us, all three have now confirmed their wish and eagerness to continue this collaboration and their work with us. Together we are hoping to improve and continue on what has been achieved thus far. They are all hard working, knowledgeable, likable, enthusiastic towards our cause and believers of the principles underpinning MaTI. We are very happy to be adding them to our ranks.

Ippokratis and Haider

The new trainers demonstrating the simulator

Mrs pregnant Sharma took over the role of Mrs pregnant Ippokratis

A captivated audience enjoying the audiovisual material

Visiting the University

The delivery suite

The sign speaks for itself