Gangtok, Sikkim – Day 5

Dear Mati friends,

 

Today was the final day of the first of three parts of the CALMED programme. The energy in the room was palpable and we have now become more than just instructors. We are now friends. The pre-course and post-course test scores have been remarkable. Our trainees have now become 14 trainers. We have selected 8 of them as the faculty for the next stage of the programme and one of them as course director.

Ippokratis handed over to all 14 trainers USB sticks pre-loaded with 6GB of material. This includes almost the entire GLOWM library, relevant MaTI material and the CALMED course material. Haider gave a brief demonstration on how to maximize use out of this precious recourse that contains a tremendous amount of textbooks, videos, master-class lectures, leaflets, wall-charts and many more. Material is present in multiple languages and for 3 levels of expertise: hospital, community, untrained health workers.

As executive editors of GLOWM, Ippokratis and Haider were particularly delighted to find out when we first arrived that some of the gynaecologists that we are training knew of GLOWM already and that they have been using it. When asked how they came to hear about GLOWM they answered that they came across it after they were searching the Internet for good information, that now it has become their main source of information and that they refer to GLOWM whenever they want to find the up-to-date answer to a topic as their printed books are from when they finished medical school years ago and are now out of date. In fact, they were surprised that the entire library is free and than a fee is not required for full access to the books.

All of our new trainers are both eager and anxious at their task lying ahead starting tomorrow – to train a group of community midwives and medical health officers how to deal with obstetric emergencies in their own setting. They are encouraged by the support we will offer them in doing so and we are confident that they will perform well and make us proud.

As a treat to ourselves, Dr Verma (the Medical Superintendant of Gangtok general hospital) and his wife Dr Renu, took us out for a late night walk down the colourful main shopping street, which happens to also be the only level road in the city! It felt strange to be outdoors and not talking about work for a while. Haider and Ippokratis spent two hours in a specialty teashop trying teas from Sikkim and Darjeeling. With Dr Verma explaining to the shopkeeper why we were in the city, a discount was inevitable. After 8 cups sampling the best gardens and flush they had to offer and a detailed explanation of the intricacies of tea, we left with a sizeable purchase and buzzing heads from the quantity consumed. Considering the time of day (or should I say night), it is doubtful that either of us will get any sleep. Not good when we are planning to wake up at 5.30am to catch the sunrise over Mount Kanchenjunga prior to the start of the course tomorrow. Oh dear…. Rookie mistake!

Chalte hai (Ok then, bye)

Ippokratis and Haider

P.S. Apologies for the poor quality of some of the images in the blogs, however, due to the infuriatingly slow Internet we had to compress the images from an original file size of 5MB each to a measly 10-50KB as it has been impossible to upload anything larger. High-resolution images will follow once we return to the UK.

Haider conducting hands-on training

Ippokratis conducting hands-on training

Haider demonstrating how to use the USB with the free educational material

Preping the new trainers for their own course starting tomorrow

The new trainers

Gangtok, Sikkim – Day 4

Dear MaTI friends,

Kya  haal hai?!   (How are you? in Nepali)

 

After yesterday’s break, the second day of our Training the Trainers course has left us with an unebbing feeling of euphoria following a very interactive and dynamic team of delegates, our future local trainers. We started with the resumption of the interactive lectures and hands-on breakout sessions. Haider’s magic abilities with the audiovisual material incorporated in the lectures lighted up our delegates’ eyes with awe and glee knowing that it is all being left behind for them to use as their own. Ippokratis’ rendition of an eclamptic (fitting) pregnant woman provided amusement and a plethora of laughter. The positive reception and feedback on the sessions thus far is further proof (as if any was required), that our modern teaching methods and approach is a fresh brake from the traditional, dry, didactic ways.

After the last hands-on break off session, the 14 delegates chose the specific topics that they will prepare to teach on, as after tomorrow’s final day of training, they will then go on to conduct their own training course under our guidance and support.

The day closed with the Chief Medical Superintendent of Gangtok, Dr Yogesh Verma, and CALMED programme Director, Dr Himansu Basu, giving a short pep talk and words of encouragement to our new trainers. Their tired but inspired smiles said it all.

On a lighter note, the clouds covering the valley have been playing with our visual senses as they have been performing some amazing formations in a constant dance of flowing movement, ranging from clear skies to complete fogging and back to clear skies within a matter of minutes. We have also felt three short but vigorous earthquakes, probably the aftershocks of the big earthquake in China two days ago. Luckily, and despite the fact that Gangtok is essentially built on stilts on what only can be described as a cliff, we have not found ourselves sliding towards the bottom of the valley!

Our evening finished with the customary warm embrace of our hosts’ hospitality. Food continues to flow plentiful and delicious, and we are as always eternally grateful. We were also joined by the Director of NRHM (National Rural Health Mission), Dr Pradhan, and the Dean of the Manipal Medical School of Sikkim, Dr Juneja. The Dean has invited us to his medical school on Wednesday to lecture the students and he is very keen for us to help him set-up some further training courses. More on this to come.

Namaste

Ippokratis and Haider

 

Gangtok, Sikkim – Day 3

Namaste to our MaTI friends,

As mentioned yesterday, Sunday was decided by our lovely local hosts to be a day of rest. After another night of low single digit hours of sleep, we woke up to a marvelous sunny day. Ippokratis was excited to finally have the chance to use his recently purchased walking boots in their natural habitat and Haider had to suffer the indignity of having to wear one of Ippokratis’ jumpers which are two sizes too small as he omitted to bring one of his own and our guides insisted that it might be cold where we were venturing.

After another beyond belief journey on single track roads masquerading as four lane highways, draped in spaghetti like formations over the peaks and gorges, with cars on both directions squeezing inch (im)perfect through narrow passes where even grey bearded goats would have thought twice to pass and with no seatbelts we arrived 3 hours later in Raybong at 2,500m. There we visited a lovely Budhist monastery framed by the imposing backdrop of Mount Kanchenjunga and where the Dalai Lama had just visited, 10kms from the Tibetan borders. Another hard drive followed to Namchi in South Sikkim, but the vistas compensated for this in abundance. There our rotary hosts took us to one of their local projects and explained to us how they are providing safe drinking water for the wider area. We had a brief stop over at the neighboring guesthouse and we were offered tea by the locals. Although most of us were debating the wisdom of drinking the warm chai served to us, we gave in and sampled what must undoubtedly be among the best cups of hot drink we have ever drunk. The rollercoaster journey continued to Solophok, where we visited the magnificent temple of Siddheshwara Dham. This is unique in that all styles of Hindu temples are represented among the sprawling complex of buildings. The return journey was another few hours of brain-against-skull bashing bumps. And if we thought that the morning was terrifying, we were certainly not prepared for the simultaneous addition of rain and fog, and the concurrent removal of any light bar the blinding headlights of the oncoming traffic. To keep us occupied, Haider, Ippokratis and Dr Basu (the CALMED programme director) spent the majority of the journey discussing future strategy for development and funding of our various projects. We have some exciting new ideas and plans and we will be sharing these with you over the months to come as they take shape. Needless to say, we arrived safely back at our hotel in Gangtok.

This has been anything but a day of rest, as we have all returned exhausted and battered from our 12-hour trek round Sikkim. Nonetheless, it was an experience not to be missed and we are very grateful for the hospitality, time, effort and generosity of our lovely local hosts.
The training recommences early tomorrow and we will continue with the updates and pictures.

As a final point, we just realised that our hotel has been looping the same 10min Buddhist-meditation sounding tune throughout all common areas over and over since we arrived. I feel so sorry for the hotel lobby staff…

Subha ratri

Ippokratis and Haider

 

Gangtok, Sikkim – Day 2

Dear MaTI friends,

A big “dhanyabad” (thank you) for all your lovely messages and support. Apologies for the teething glitches with the blog, two of the five pictures and the title were not uploaded with the first one, but these are now on the site. Also, apologies for the occasional typo, but we have been composing this at 2 am local time! Despite the technical mishaps with the internet (it is the Himalayas after all, so a fiber optic high speed link was probably not a realistic expectation) we have managed to upload this second edition of our Sikkim trip blog and below follows what happened today.

We started the day early with a series of talks and presentations by our hosts who welcomed us with unprecedented flattery and praise. We were also honored that the Health Minister of Sikkim (Mr D.N. Takarpa) and the Health Secretary (Dr. K. Bhandari) also attended for the morning proceedings and inaugurated the CALMED programme. Their support is invaluable if the work is to be ongoing and sustainable. Following the talks, Ippokratis had the opportunity to show the Minister around some of the training material and resources brought by the CALMED initiative and its partner organizations for use in Sikkim. This material has been donated and will remain in Gangtok for use by the locally trained future trainers. As a final treat, articles about the programme were published in the two local papers (see picture below).

With the formalities over and the ties off, now the hard work of mentoring and training the new faculty starts. And we couldn’t be more excited as this is what we love doing most… teaching. We have 14 delegates attending for the first part of the training, which is a mixture of local obstetricians and midwife trainers. To our surprise, and delight, we found out that these are not just from Gangtok but also from the wider state of Sikkim and come from both peripheral and secondary health settings. Hopefully this will help with dissemination of knowledge even further than we initially hoped for. As a further incentive to them and motivation to us, our future local trainers have already been invited and requested to teach on local courses in Darjeeling and Kalimpong. This is an encouraging sign that the aim of CALMED in providing sustainable, locally initiated, capacity building is indeed a real possibility.

The enthusiasm of the delegates is boundless and we have rapidly built a warm relationship with them. They are eager to learn and then  teach. They seem to be won over by the novel methods and equipment provided and found both the MaTI and GLOWM resources impressive. We started with a brief pre-course knowledge and skills test to identify areas of need and improvement so we can tailor our training to them. This was then followed a full programme of interactive lectures, videos, small group discussions and hands on skills.

It has been a long day and for the VTT it has continued well into the night as we are preparing for the next few days. Feedback up to now has been positive and encouraging. To our surprise, our delegates seemed not to mind the late finish, despite them having given up their Saturday. In spite of the hard work, the day has been very enjoyable for all involved.

Tomorrow our hosts have insisted (to our delight) that they are going to take us travelling around the area to showcase for us this magical part of the world. Although as a team we are eager to maintain the momentum we built today we have, with little resistance, accepted that perhaps Sunday is indeed a day for rest and enjoyment after all. We are therefore taking them up on this offer. More on that tomorrow though.

Best wishes

Ippokratis and Haider

Ippokratis demonstrating training material to the Health Minister and the Chief Medical Superintendent of Gangtok

Haider discussing with the Chief Medical Superintendent of Gangtok the long term CALMED action plan

Ippokratis lecturing the future trainers

Haider demonstrating hands-on simulation training

The CALMED programme generated much interest in the local papers

Gangtok, Sikkim – Day 1

Dear MaTI friends,

 

We are delighted to announce to you that for the past few months we have been working hard behind the scenes on a very exciting project called CALMED (Collaborative Action in Lowering Maternity Encountered Deaths). This is a project that has a number of collaborators (as implied by the title!). It is being funded by a generous grant from Rotary International and supported, among others, by MaTI, CALMED and FIGO. The main concept is that of a “Training the Trainers” model in order to create a sustainable way of promoting valuable obstetric skills in communities. It follows both a “bottoms up” and a “bottoms down” approach. For more information visit our dedicated CALMED project page on our MaTI site (mati4life.org/calmed).

The pilot project is taking place in the state of Sikkim, in India. Sikkim is the northeastern most state of India and it borders with Nepal, Bhutan and China. The training is being run over a 10 day period in the city of Gangtok, which is draped on the steep sides of the imposing mountains of the eastern Himalayan range, on an altitude of 1,800 metres. Mount Kanchenjunga (8,598 m or 28,208 ft), the world’s third-highest peak, is visible to the west of the city and Tibet is approximately 50kms away.

The training is divided into three parts. It will start with a three-day course during which the visiting team (Vocational Training Team – VTT) will be training local obstetricians in modern methods of high quality simulation training for obstetric emergencies. They are being mentored with the specific intention that these doctors will subsequently go on to become themselves trainers. The second part of the trip involves these new trainers training medical health officers under the supervision and observation of the VTT. A final day is dedicated to the training of health workers (such as midwives and ASHAs) in the periphery.  The purpose of the programme is to create a group of local doctors who will be a resource for further training in the future. This will ensure sustainability and grass-root level expansion of expertise in how to treat some of the leading causes of maternal and neonatal mortality and morbidity. The VTT and the CALMED programme is being supported by the National Rural Health Mission and the local rotary groups. Continuous monitoring of outcomes is planned with follow-up visits as required. If successful, the CALMED model will be expanded to other areas.

MaTI has been heavily involved in preparing the training material for CALMED in general and for this trip to Sikkim in particular. In addition, two MaTI members, Ippokratis and Haider, are participating in the 5 member strong VTT which left London on the 16^th of April. They are being accompanied by two rotary members who are acting as team and programme leaders, Mrs Denise Collins and Dr Himansu Basu.

Both Haider and myself will endeavor to keep you regularly up to date with the developments of this trip (internet permitting)!

Up to now most of the time has been spent travelling and preparing the local arrangements for the training. We arrived in Delhi two day ago. After an internal flight, an overnight stay in Siliguri and a 6 hour trip through the twisting and precarious roads of the Himalayas, we crossed the boarders in to Sikkim and arrived at Gangtok yesterday. The scenery has been breathtaking and the views from the rooms where we will be conducting the training compensates for the fact that we will unfortunately be spending most of the next few days indoors! The local rotary groups have hosted us on each night up to now and their hospitality has been unsurpassed. Both Haider and myself are worried that we will not fit in to our clothes by the end of this 16 day trip. Despite what might seem as just fun, we have been hard at work. We had to check and arrange the local facilities and we where very relieved to see that the equipment that we had arranged for actually did arrive!

The local health minister is inaugurating the programme tomorrow morning and after some more speeches by local dignitaries the training work begins midmorning. Long days are expected and likely poor timekeeping! More on that tomorrow though. We hope that you enjoy some of the attached pictures.

Subha ratri (good night in Nepali)

Ippokratis and Haider