Initial thoughts...

So have had an interesting week so far with lots of tea and chat. Have spent part of each day at the birth centre, talking to the girls, practising my nepali (to their obvious amusement) and observing the comings and goings. The situation at the birth centre is a little more complex than first thought. The main issue is that it is not currently being used effectively as a birth centre though does do a lot of work as a local health centre. People attend regularly for immunizations, contraception, child health and minor ailments. Women attend to see the doctor, have scans and will occasionally have some antenatal check ups but not enough maternity care is done by the nurses and the majority of the women seem to go to one of the bigger hospitals elsewhere in the city for the delivery. In talks with the girls they seem unsure as to why this is though they suggested that they lack the status to encourage women to use their services rather than a doctor.

It seems like there needs to be some major promotion of the centre as a maternity service within the locality but none of the junior staff appear very active in promoting the services/facilities of the birth centre, even in giving out the leaflet. I am not entirely sure why this is -  it may be that they just lack the confidence in assuming a more autonomous role as their training does not equip them to be. They are also young and getting paid very little. The difficulty is that the lack of women attending for maternity care means a corresponding lack of experience which I think in turn may reduce enthusiasm for the role. I can't help feeling that what is needed is at least one senior member of staff who is able to be there full time who could then drive things forward and inspire enthusiasm for the centre and what it could achieve. Rashmi of course is fantastic but she works full time at Patan Hospital and can only go to the centre afterwards as do the other 2 senior staff members. Anyway, the up shot as is stands is that I give out leaflets to every woman who steps through the door hoping to lead by example.