How and Why I became passionate about Midwifery and Sexual, Reproductive and Maternal Health?

We need to write her and his story so that later it would be become mystery what she or he has done in her/his life. Therefore, I thought about writing my own journey on how and why I became passionate about midwifery. There are number of reasons why I became so passionate about midwifery that propel me with perseverance, patience and perspiration to do despite any professional politics draw back. In fact, I love women and the nature because they are the one who give lives on this earth and nature provides everything to sustain life on this earth. Without nature no one can nature on this planet. Similarly, without women there would not be culture to cultivate human society. Both nature and mother are breadth to let us breath on this earth freely and lovingly without putting any terms and conditions on their creation and cultivation.

My passion to work for the improvement of sexual, reproductive and maternal health started immediately after I started by professional career in the public health sector joining a national NGO, "Women's Rehabilitation Centre" (WOREC) in 1996 in which recently this year in January I had been requested by its lead co-founding member, Dr Renu Rajbhandari to be a Board Member. I did not know even had heard about WOREC before but while I was working for Koshi Zonal Hospital in Biratnagar (eastern part of Nepal an hour drive by public bus from my home town, Dharan) after graduated as a Staff Nurse from where I did my clinical nursing practice during my Proficiency Certificate Level Nursing Program as a student from April 1992 to June 1995 (3 years) my by then Campus Chief, Aitu Maya Chhetri requested me to join WOREC because she had been requested by her near and dear friend, Dr Renu Rajbhandari, an Executive Director of WOREC to send a graduate nurse from her campus.

My by then campus chief convinced me saying that if I do not like to work at WOREC I can leave as per my own will anytime. In 1996 this is how I came in contact with the innocent and ignorant Nepali girls and women who were sold and psycho-sexually as well as physically abused, assaulted and exploited in Indian brothels to whom got an opportunity to rehabilitate them for three months as a Rehabilitation Incharge. According to these Nepali young girls and women they were imprisoned for 6 months in India's prison because Mumbai police forces raided the brothels where they were working. of the total 120 girls brought in Nepal by 5 different NGOs challenging government of Nepal 18 girls/women assigned to WOREC for rehabilitation purpose and some of them were pregnant and some were infected with HIV and some had kids as well. I learnt a lot of lessons hearing those innocent and ignorant girls and women stories how they were sold by their own relatives, uncles, brothers, fathers and else luring their young mind and aspiration to see in their bright future that has been darken because of ill minded men and women who were always after MONEY. I also got to learn from them that almost all girls and women in the brothels were forced to practice sex trade NOT by their choice but by chance and challenge to break the silence.

After 3 months rehabilitating those innocent and ignorant Nepalese girls I was transferred to Udhyapur to work for Women's Health Training Centre where I involved in providing sexual and reproductive health training to community women group members and NGO workers across Nepal from east to west. After working almost 2 years in the community setting I left WOREC then joined Paroparkar Maternity and Women's Hospital to gain experience in clinical setting in providing care to childbearing women and their newborns. This provided me an opportunity to learn how childbearing women have been treating by healthcare professionals without any dignity, respect and love. In some instance I was moved to see and hear healthcare professionals attitude and behaviours towards childbearing women and their family members who were mostly socio-economically deprived and marginalised.

While working at the hospital I also got an opportunity to involve in providing Comprehensive Family Planning training to the government healthcare professionals through National Health Training Centre since my passion always remain on sexual and reproductive health soon after I joined WOREC. I also gradually started to learn and understand power politics on sexual and reproductive issues surrounding girls and women.

After gaining three years experience (the minimum requirement to enrol for Bachelor Nursing program) in both clinical and public health setting I decided to pursue my further study in nursing then I enrolled for Bachelor of Nursing program where I did my specialisation in hospital nursing although I was not that much interested to work in clinical setting.

Immediately after completion of my bachelor degree I joined CARE Nepal to work in public health setting again. I was deployed in Mahottari district, a central tarai district with deeply rooted maithili culture domination that always remained backward in health and socio-economic indicators despite having political power at the state level because most of the powerful politicians from tarai district by then belong to that district and became Health Minister several times. For the project I was the only staff and responsible for Polio Eradication Initiative Project where I had to closely work through District Pubic Health system with mothers/women having under 5 children in order to ensure polio complete vaccination to their children. This job provided me an opportunity to learn and understand women's status in the district that has empowered me to do and work for women.

After three years working in Mahottari I decided to pursue my further study in public health then I applied for Australian government scholarship to do Master of Public Health. In my Master of Public Health program I did project on Maternal Health. In order to collect data for my project I came all the way from Australia in my own cost to Mahottari in January 2005 and within 21 days I did survey among 671 women and men to determine maternal health status primarily focusing on prenatal, natal and postnatal period that helped me to understand the status of women's health during childbirth in the district as well as knowledge, attitude and practices relating to it. The finding of my study has provided me further insight that has created deeper interest in me to do something significant in improving women's health in Nepal.

After completion of my study I returned to Nepal in April 2006 then decided not to join NGOs /INGOs to work for development sector in grass-root levels because I realised that my effort to change and challenge status relating to women's status is required at the central level. In that background understanding I joined one private health education institutions and taught Bachelor of Nursing and Bachelor of Public Health where I was not satisfied in what I was doing. Therefore, I was searching for a window of opportunity to do something significant. As I was teaching Reproductive Health to the public health students one day I came across with the government of Nepal policy relating to Safe Motherhood titled "National Policy for Skilled Birth Attendant: Supplementary to Safe Motherhood Policy 1998" that has provided me an insight for what I suppose to do. Then I wrote a concept note to establish the first and only nurse-midwife led private independent birthing centre with the notion of social enterprise for its sustainability in what I am going to do and start for women's health to improve in the country from my level best because working in development sectors with different NGOs and INGOs directly I got an opportunity to see and experience that none of the NGOs/INGOs project activities are sustain despite we talk a lot about sustainaiblity. It is because of the donor driven project approach activities it has to be discontinued after certain period of time which is not an effective approach to change and challenge attitude and behaviour of people within 4-5 years projects which usually we find in a development work. I heard and read about social enterprise and thoughts of putting into real work scenario, therefore, I developed the Birthing Centre's Concept note in that way and shared with my colleagues where I was working as an educator. Some of my nursing educator colleagues were quite interested and three had decided to be on board. Besides, I approached other nurses working at Patan Hospital's Maternity Unit and Paropakar Women's and Maternity Hospital from where I got five senior nurses to be on board. In this way, we were 11 female healthcare professionals who wholeheartedly decided to put my concept of birthing centre into real world practice.Then formally we registered our birth centre in April 2007 and started to provide service from July the same year. The, motivational factors behind establishment of our birthing centre can be explored in detail from my article titled "Factors That Persuaded Nurses to Establish a Maternity Care Centre in Nepal"  published in the Midwifery Today in 2009 [1].

After gaining three years of experiential learning at the birthing centre in 2009 I realised the importance of having one voice of women passionate about midwifery then formed a group of another 11 women involving in providing midwifery service and teaching midwifery .to nursing students that pushed me to take lead role for the establishment Midwifery Society of Nepal that was formally registered in 2010 under the presidentship of by then Associate Professor, Kiran Bajracharya at Institute of Medicine, Tribhuvan University [2] who has been teaching midwifery subject for nurses. 
After the tireless advocacy to bring midwifery workforce in the country last year in September at the Kathmandu University (enrolled 6 students) and from this year January Nepal Academy of Medical Sciences (enrolled 10 students) have started Bachelor of Midwifery Education program. Last year I hired by the Ministry of Health to help to draft Midwifery Education and Workforce Management which I handed over after a month long exercise on it. Similarly, this year honourable Health Minister, Mr. Gagan Thapa has nominated me to be the part of the committee formed the under chairmanship of Prof. Goma Devi Niraula for the reformation of nursing and midwifery profession in the country. Because of my proven contribution for the upliftment of the status of nursing and midwifery profession in the country recently on 28 March the Government of Nepal has nominated me a board member of Nepal Nursing Council amongst the nurses renowned in nursing profession in which I am a Coordinator of Midwifery Committee. However, the challenge remains now on me to implement what we have been recommended for the Ministry of Health to do submitting the committee report. It is my great pleasure to share with my networks that I won the ICM Research Award 2017 for the proposal titled "Experience of mistreatment of women during childbirth in the peri-urban areas of the Kathmandu valley: A mixed methods study."

I became passionate about midwifery because learning and exploring about women's issues particularly, sexual and reproductive health and gender politics I got to understand that all the women's and men's power lies on reproduction and production. I came to realise that a midwife is the only cadre among healthcare professionals who are competent, compassionate, courageous and caring who challenge to break the silence in healthcare delivery system and whole societal system educating and empowering women for their crucial role in life to produce and reproduce human beings Midwife means with woman who challenge gender stereotype indoctrinated outdated thoughts ideas societal norms and values imposed on women's body and their bodily physiological functions becoming self economically and educationally viable and help to make other women and men to work for the betterment of whole society to live happily and healthily I feel great in what I am doing to bring midwifery workforce in the country to help our mothers and family so that our nation can be prosperous like most developed countries where they have midwives as a respected profession such as in Scandinavian countries where gender gap is very narrow in the world and the United Kingdom, the empire where sun never set.
I feel good in what I am doing and always love to take challenge for change because I am not doing only for my own sake of benefit but I am doing for human society to provide dignified and empowered mothers who can provide healthy and strong new human to our human society. 

Reference

1. Tamang, L. 2009. "Factors That Persuaded Nurses to Establish a Maternity Care Centre in Nepal", Midwifery Today accessed from https://www.midwiferytoday.com/articles/intnepal.asp

2. Tamang, L. 2011. Birth and the Establishment of a Professional Organization in Nepal accessed from https://www.midwiferytoday.com/articles/birthnepal.asp