Sigiriya, Sri Lanka 

Travel Recommendation; Sri Lanka

Ayubowan Readers! “Ayubowan” is the word used in Sri Lanka to greet someone

Sri Lanka is a small Island off the south east tip of the Indian subcontinent. Measuring a total area of 65 610km, it is home to 20.5 million people (2013). Until 1972 the island was known as Ceylon, however still goes by many other names such as “The pearl of the Indian Ocean” and “The teardrop of India”. Colombo is the nation’s commercial and capital city. 

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Working with Symbiosis in Bangladesh

Lipi’s Story

The noises of the slum continue well into the wee hours of the morning. As Lipi and her husband stepped gingerly yet resolutely across the moonlit dry river bed, the muffled sound came again. Now they were closer to the source. Somehow the stillness of the night brought a clarity that added to the terror of the cry as it hung palpably in the air almost seeming to urge them forward. Reaching the large island of sand now in the centre of the old river, Lipi looked up at the group of huts just visible at the edge of the sand cliff in front of her. In her torch light she could just make out the sandbags set into the sloping cliff of sand, marking the well-worn pathway up. Almost crawling to keep from slipping at the final step, Lipi was grateful again for her husband’s strong hands on the small of her back easing her onto the flat path ahead. Looking down the four metres or so below, she wondered how they would go with the return journey.

Her pulse pounding in her head and her hands sweaty and shaking, Lipi turned back to the task at hand and in her torch light could make out the path between the closely built huts. Stepping in and over the wet concrete tube-well basin, Lipi was taking care to avoid the slippery wet rim when another muffled cry confirmed their sense of direction. To her left as she glanced up she could just make out the glow of the lights on the Mymensingh town side of the river bank, the 20 concrete steps and her own familiar surrounds in the slum that sprawled out along that bank. Somehow, just seeing it gave her courage as she thought of her own son sleeping safely there.

Suddenly a piercing scream brought her back to this less familiar surrounds and what lay ahead of her. Lipi glanced briefly at her husband, as if gaining strength and knocked loudly on the wooden door. Her knock was met by a sudden silence in the muffled voices inside. She knocked again, this time calling out, requesting admission. She was here to help.

The reply was drowned out by another long desperate howl coming from inside the hut but this time fading abruptly as if muffled deliberately. Again Lipi knocked strongly and the door opened a crack and the face of an elderly woman appeared – the expression was not inviting. “We are fine!” she spoke in village Bangla but Lipi stepped resolutely forward and pushed through the crack into the tin hut. The room was dark, lit by a hurricane lantern hanging over the bed where the young girl lay. By her side were 2 other ladies, one wiping her forehead and other sitting wearily at the foot of the wooden bed. The older lady at the door spoke first, “we are fine. She will deliver here.” The scene brought back to Lipi strong memories of the final night with her own struggle – the night her first child had been born – and she knew she would not accept that statement. Lipi strode across to the bedside, taking in the scene before her. The young girl was clearly very weak and exhausted, her hair was matted with sweat and strewn across her face, confirming Lipi’s suspicion that her hair had been thrust down her throat as the helpers often did to trigger the gagging they believed would help her force the  baby out.  There was a strong smell of sweat, urine, vomit… the young girl arched again as another contraction came and her scream galvanised Lipi to action. “How long?” she asked.

“Two days… but she will deliver here.” The lady at the door also swiftly crossed the room and roughly pushed Lipi’s hand away as Lipi instinctively reached out to touch the labouring girl. However Lipi was not to be deterred. “It is too long. There is a problem. The only chance is if you take her to the Mother and Child Hospital”. This time the lady at the foot of the bed joined in to push Lipi away. “She will deliver normally – here”. Lipi’s own sad experience was backed up by the new knowledge she was learning from Bani, the Symbiosis midwife, and Lipi stood her ground undeterred.

Coral Continues

Lipi and her husband that night saved the life of the baby boy and quite possibly his 17yo mother as well. As Lipi so totally unassumingly relayed to me some of the details of that night, her face showed the determination and the heart that she has. She also quietly explained that her own first baby died in very similar circumstances because the birth had been obstructed and when her baby was finally born there was no life and happy ending for her and her husband.

Photo: Lipi (in pink) with the young mother and baby and Shafali (Symbiosis Skilled Birth Attendant).

Bani Banowary is a fully trained nurse-midwife , one of less than 1000 midwives in Bangladesh. Bani commenced working with Symbiosis in 2009.  Bangladesh with its population of 160million has a health system that is concentrated in urban hospitals while 70% of the population live in the rural areas. In these rural areas over 90% women still give birth without the assistance of any trained personnel. Bani and  3 Symbiosis staff like Lipi, are very well respected by both the women in the areas of the central north Bangladesh ,where Symbiosis has been working for 21 years, and also by the Traditional Birth Attendants (TBAs) who are the women who assist in most deliveries still today in Bangladesh.  I have had the privilege of meeting several experienced and new TBAs and they are wonderful women with an amasing community heart  and tremendous courage but are all illiterate and learn from each other.

The Symbiosis 3 women staff who have been assisting and learning from Bani, have each been living in remote village areas, going home to home and making contact with young pregnant mothers, the vast majority aged 16-20, and educating them in basic hygiene and nutrition as well as arranging them to attend for antenatal care when Bani is able to visit. These antenatal group visits include the local TBAs who Bani also gives  instruction via a laptop and visual aids.

In September 2015,  with the funds raised over 2 years by myself and 6 other midwives  from  Brisbane, Hobart and Perth,  we were able to send these 3 Symbiosis women and 1 other to LAMB Hospital in Dinajpur, Bangladesh for 6 months,full-time,live-in course in community Skilled Birth Attendants. We also raised the funds to  send Bani to a 3 month refresher –   Emergencies in Obstetrics.

In March this year, my husband  Graeme (who has worked with Symbiosis for 19 years and in Bangladesh since 1986) and I together with 2 of the nurse/midwives visited Bangladesh to  encourage Bani and the 4 cSBA  trainees as they approached their final exams.  Feducci, Shafali, Beauty and Lovely were absolutely thrilled to demonstrate to us their new skills and were full of stories about how they now understood just what had happened with various relatives  and friends who had suffered tragedies  and serious complications during childbirth.

The photos Feducci is demonstrating a normal delivery, Shafali the management of Post Partum  Haemorrhage.    Neonatal resuscitation was demonstrated by Beauty and Lovely.

The nurse/midwives and I also spent a week observing deliveries and care in a rural 100 bed hospital that is well known to Graeme and I. Breastfeeding assistance was heavily in demand.  Photos.

We spent a day visiting 3 levels of Bangladesh government health complexes and clinics and found the care to be sporadic and the hygiene poor, confirming all reports. With so few normal deliveries presenting to government clinics, and then only when all other avenues have been exhausted in the village and both mother and baby already travelled long distances and in extreme distress , the expertise in the government clinics lies in performing Caesarean Sections.

We also visited Symbiosis work and saw first-hand the groups of women doing their 9 month courses of adult literacy as well as having the absolute joy and privilege  of  seeing  several Symbiosis’ Savings Groups.  The  Savings Groups  are groups of around 20  women who formed together initially  for the purpose of learning to read and write  but have now continued to meet weekly under the care of a Symbiosis staff worker. The women sit in the shade outside a hut, each has a bank book and they contribute 15 Taka ( approx. 20 cents)  per week to the group’s fund.  As the funds grow individual women request and take loans from the group for small business projects repaying the loans with agreed small interest. It was so exciting to hear the ladies’ stories of their personal businesses eg  duck eggs, goats for  milk and meat, small vegetable gardens, tea shop. One group we saw had been meeting for 1 year and they were saving together to buy a bull. Another group had been meeting for much longer and they had many stories of how they previously lived from day to day as their husbands were day labourers and the work very erratic. Now they can send their children to school and also provide for their  family and make small profits. This is true “empowering” as the funds are all their own. What Symbiosis gives them is encouragement and assistance in forming the groups, the literacy books and assistance if they need with their small business ideas – unlike microfinance, Symbiosis neither gives the poor money nor makes any money from the poor.

So where to from here?  Feducci, Shafal, Beauty and Lovely have returned to their areas of work in Symbiosis now fully trained cSBAs (community Birth Attendants) . Whereas their knowledge and skills previously were basic and patchy, now they are confident and can work independently to undertake strong antenatal and postnatal  care in their areas. They are also trained by LAMB to be able to undertake normal deliveries. The 4 cSBAs and Bani expressed a strong desire to us to broaden their work beyond their previous antenatal and postnatal care and for Symbiosis to setup a 2-room Safe Birthing Centre so that they can use all their skills that are so desperately needed. Symbiosis local staff are in agreement with their request and have plans underway.

However such a clinic would require initial outlay in such capital items as delivery bed, steriliser, lights, generators and rental.   Wages and costs in Bangladesh are low.   Our desire is to see these 5 Bangladeshi ladies using their new knowledge, education and skills to their full potential as they so desire and as their tutors at LAMB Hospital have every confidence they can.  The work costs and wages and delivery supplies can be covered for the total cost of $A8000/ year for each of these 5 Symbiosis staff.  We are now hoping to find 5 (or more) sponsors who can commit to making such an impact on the lives of women and babies through such a sponsorship.

The long term goal will be to work towards to assisting the rural poor in making childbirth a priority of their saving and to contribute to these costs also.

 

Written by Dr Coral Johnson 

TMA Brisbane,

Dr Deb’s The Travel Doctor

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My Adventure In Nepal….?

Be prepared for anything!

I recently went on a trip to Nepal, it was not an adventure trip, just four fit and healthy women with a car and a driver. The aim of the trip was to have a good time and learn something new at a Travel Medicine Conference, which was being held in Kathmandu, as well as see the country that we often talk about.

I’ve worked in Travel Medicine for nearly 25 years, so I was pretty well prepared, with my vaccinations up to date and my first aid kit packed.  My travel companions also worked in travel medicine so our combined knowledge and good sense would ensure we had a healthy trip…. well… you’d think it would.

We had a day stop in Kuala Lumpur and by the time we were going back to the airport I was feeling pretty shabby.  Fever, headache and aches and pains.  So, within 24 hours of our trip the first aid kit was cracked and I was into the paracetamol.  I was so disappointed! I did not want to miss a moment of our trip and here I was feeling average.

Day 1, 2 and 3 were a struggle. Paracetamol turned into Ibuprofen because my throat was on fire.  One of my travel companions started to get sick as well, so between the two of us, we depleted our kits. We then raided the kits of our other companions.  Within a couple of days we were at the local pharmacies buying more, hoping they were not counterfeit and stocking up on lozenges that were not much better than out of date lollies. Just I was feeling a bit better the cough began.

I coughed through the day and night.  Visiting the Basmati River- the holly cremation site, I turned myself inside out coughing. The streets of Kathmandu, Bhaktapur, the quiet hillside town of Nagarkot and Chitwan National park all had the delightful background noise of my constant cough.  While hearing the wonders of the local singing or healing bowls I asked our man if they would cure my cough and he said no – I had to take a pill.

I bought a healing bowl in case but again we were forced to the pharmacies.  Cough suppressants don’t seem to be big in Nepal (so maybe take your own) but I tried the local ones with no effect.  I’m not sure if my travel companions were concerned or just sick of me, but I was certainly getting a lot of medical advice. Not to mention a lot of medication varying from antihistamines to ventolin until finally they gave me a face mask and told me to sit in a corner.

We had a very serious guide in Chitwan who was not amused by my cough, and he suggested I go to the pharmacy to get a cure.  At one stage, while on foot in Chitwan, we saw a big bull elephant coming our way, so it was obvious that my cough had not frightened all the wild life, because as our guide said “You must run, you must run fast!!” as the elephant was coming our way, so run we did.

My cough went on for the full three weeks.  It was probably due to the residue of a virus that irritated my airway.  At the time I was in Nepal because of the Indian fuel embargo to Nepal the air was full of smoke because of the open fires, air pollution in Nepal cities if often bad because the crazy traffic and vehicles that spew out pollution.

The moral of my story is to be prepared. 

No matter who you are,  how healthy you are or how healthy you have been, always pack a medical kit. The kits cannot prepare you for everything but certainly can provide you time to seek alternatives.  Additionally, if travelling to areas that are highly polluted or have a very dry atmosphere, consider packing saline nasal spray (I know I will never travel again without a nasal allergy spray).   If your are lucky enough to not use your kit, consider leaving it behind to a good cause before you return home.

After all that – Would I go back to Nepal?

The answer is an emphatic yes.

by Cath Pugh RN

Travel Bug Adelaide

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A travel bucket list from Alice Springs

As a solo GP living literally in the middle of Australia for the last 18 years, it is approx. 1500kms to the North & South, much further to the East or West. I do love a road trip or unfortunately it’s super expensive to fly out of Alice to connect to the rest of the world.

My first overseas trip was to New Zealand for my 40th birthday, now over 5 years ago. It is a postcard view as you drive across the Corona Ranges, down into Wanaka, where the lake, with Mt Aspiring National Park beckons you in the distance with snow capped mountains. For me living in Central Australia, despite loving our ranges, the views were gobsmacking.

From moving out of home aged 18 years, to working numerous part-time jobs to get through Medical School, to years off to make extra money to finish that degree, to the obligatory long hours working as a junior doctor in various roles averaging 80 – 100 hour weeks, time just seemed to have flown by. My peers could afford the overseas elective at the end of 5th year, but my first serious attempt to get overseas was halted, when I realised the 6 week elective to Kathmandu would be the cost of living through my final year of Uni. I was so bitter & twisted, but instead of the snow-capped Annapurna Ranges, I got on the Ghan & trained it up to the red & orange ranges of the Red Centre. My disappointment soon changed to excitement as it was nothing like I expected.

My love affair with Central Australia had begun.

Long story seriously truncated…

Lots of working to pay off university & accumulated life debts, completed various post graduate diplomas, celebrated the 10th anniversary of my own general practice, a 17 year relationship with my partner, the amazement of being a parent to the most awesome 6-year-old boy and somehow it is nearly 2017 & my overseas experiences have been 2 trips to Wanaka NZ & a 5 week road trip around Great Britain & Ireland for my brother’s wedding in Wales.

Working for myself for the last 10 years, I have had to live vicariously through my patients & their preparation ( sometimes inept ones at that!!) for their overseas trips. And this has inspired my own travel bucket list, which I am writing as I sit in a hospital waiting room awaiting my admission for major surgery. So apologies travel bloggers, this has been the only spare time I’ve had recently to compose my thoughts on a relevant topic & despite thinking about this for weeks I have come up blank. As I am engrossed with my impending morbidity & mortality risk, I am writing down my ultimate travel wish list to have something to look forward to after the next few months of recovery.

Nepal & Bhutan
PNG – Kokoda Track
Antartica
Iceland
Norway
Spain – to walk the Camino Trek
South America
Hawaii
Maldives
Motor home around both islands of NZ ( need that road trip fix)
I could go on & on…. But my anaesthetic pre-check is over & I’m about to go into theatre. See you on the other side.

What’s your bucket travel list?

Merry Christmas & I hope 2017 is full of adventures, excitement, love & joy.

Dr Deb Mitchell

TMA Member Alice Springs

 

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The Bucket List

My travel bucket list; Dr Deb Mitchell

As a solo GP living literally in the middle of Australia for the last 18 years, it is approx. 1500kms to the North & South, much further to the East or West. Luckily I do love a road trip because unfortunately it isn’t cheap to fly out of Alice to connect to the rest of the world.

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Silfra Diving in Iceland

In June 2016, I went on a trip to Iceland.  The overwhelming highlight of the trip was having the opportunity to dry-suit dive at Silfra. Before visiting Iceland an intrepid friend of mine had told me of her adventure fresh-water diving between 2 tectonic plates in Iceland.

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Sea Sickness Tips

Who gets sea sickness?

Sea sickness can ruin sea voyages whether on small yachts or larger cruise ships. Although anyone can get sea sickness in severe conditions, some 20-30 % of the population are more prone, especially migraine sufferers, women and children. Situations that increase susceptibility include changes in boat motion, on-board reading, heavy weather, passenger fatigue and even extreme smells. Prevention measures are better than relying on using medications to treat sea sickness.

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The delayed 2016 Influenza Vaccine

Dr Cormac Carey, Medical Director, TMA Toowoomba

With the 100th birthday of CSL coinciding with Anzac Day this month and the first zephyrs of Winter’s winds arriving it is time to look at the turmoil re this year’s rollout of the 2016 influenza vaccine which has been anything but smooth. CSL started producing influenza vaccine in 1944 along with the mass production of penicillin which was widely used by both Australian and Allied troops in the closing stages of World War Two.

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Influenza Vaccine 2016

WHY SHOULD I HAVE A FLU SHOT FOR MY TRIP OVERSEAS??

Dr Michael Long  TMA Narre Warren

Huh?!  I don’t need a flu shot for going to Thailand, Europe or the US do I? Isn’t the flu just a cold or the “man flu” or something the oldies get?

WRONG WRONG WRONG! Keep reading fellow travellers for more info

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The real risk from terrorism

Dr Messieh  Burnie TMA 

After the brutal attack on Brussells on the 22nd March 2016, and Paris in November 15, it is helpful to put the risks of these attacks into perspective. The risk of dying from a terror attack is still very small.

It’s estimated that the risk of dying in a terror attack is in the vicinity of  1 in 20 million. To put that into context:

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Travel Health Information

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