Small and beautiful

Interesting day on Thursday meeting Kirsten, a midwife who works for UNFPA. Sat on the roof of her office block eating dahl bhat, admiring the views and chatted about maternity care and the status of midwifery in Nepal. She said that facilitating change was extremely difficult and despite attempts over the years to start a proper midwifery course it had never really had much sustained success. It seems that there is a lot of money washing around but not enough of it is going to the right places. Some article in the Himalayan Times estimated there are over 38, 000 NGO's working in Nepal. She surprised me by saying that if she came back again she would be tempted to "come in a window rather than going through the door", suggesting the value of working "small and beautiful" on smaller scale projects.

It was interesting because on the face of it I would have thought that working at a policy level with the most influential people in Nepal would be the best way to ensure the most far reaching and large scale impact. It seems that this is unfortunately not always the case within the context of current levels of government corruption and dysfunction. How best then to contribute as a midwife in Nepal? According to Kirsten, to just be a midwife in Nepal. In her view this was important in helping promote the value of good maternity care, increase the status of the profession and where possible model good practice. 

This was admittedly nice to hear as my thoughts about my own activities have varied, sometimes pondering whether it was at all pointful doing something on such a small scale. I have also thought a lot about charity and how best you can really contribute. It often seems hard to know, with much written about NGO's and how they can sometimes do more harm than good.   However, I have realised more as I have gone along that my primary role, on this trip a least, besides the odd bit of training here and there, seems to be to act as a walking mascot for midwifery.When at times I feel a need to Achieve Things,  it has helped to return to my aims for being here which was primarily to learn and experience and only secondly to try and be of some use while doing so.