Delena-Mae PhD

The second year slump: keeping motivated mid PhD

The first 14 months of my PhD were like a crazy rollercoaster that amazingly left me standing solidly at the end of the ride. There were so many ups and down with moments of pure joy and immense concern. Within this first year I was able to see two ethics applications approved, conducted four research projects, spend 7 weeks in Nepal, apply for funding and scholarships and write my first journal article. Not all of these achievements were met with success but looking back at what was accomplished is deeply satisfying.

Now that all my data is collected and (almost) analysed I’m looking ahead to the next 18 months. Without any dooming deadlines I’m feeling a little bit flustered and overwhelmed. There’s so much to do but where do I start? The end goal seems ginormous and almost unachievable and how do I make my way there? As it is, I can’t believe it’s already March (2017) and I feel like this year is just going to zoom by.

So, this blog is a personal pep-talk, a kind-of ‘you can do this, girl’. What do I need to do in order to meet my goals this year? (As a notorious list maker, here’s my list)

First up, make a list of everything I need to do this year 🙂 (check)
Set some timeframes and self-determined ‘deadlines’
Create a GANTT chart for the next 6 months
Breakdown my tasks into tiny achievable steps (make some more lists, girlfriend 🙂 )
Set some rewards when a big task has been achieved e.g a massage, movie or dinner date
Schedule some ‘fun’, have something to look forward to in the near future
Find a PhD buddy to share frustrations, concerns, stress and to encourage each other

Ahhhh I already feel better looking at this awesome list…. now I know for sure ‘I’ve got this’ hahaha (nervous laughter…)

Photograph taken by the talented: Felicity Thomson

Women in the spotlight

My heart is so heavy. My twitter feed is full of stories showcasing the type of decisions that are and will be made in the USA with the current government. Even though I’m an Australian citizen, I lived in the USA for 10 years. I completed my Physical Therapy degree there and worked an additional 5 years. I love America and I love Americans (I married one 🙂 ) Watching women march around the world a few days ago was so inspiring. I know many people criticised the events for various reasons but to me it symbolised a moment in time where women (and some men) found their voices. I’m hoping this is the beginning of many many more moments where women stand up and be heard.

On one of the last few days I was in Nepal I had the opportunity to speak with a Nepali lady who was working for a reproductive health NGO in Nepal. It was the first time I thought about the global impact of Trump being in office. She expressed concerns that the USA would cut funding to her NGO and similar organisations in developing countries. Her organisation provides contraception, pap smears, prenatal check ups, medications, counselling and educational services. It also provides abortions….

Over the years my opinion on abortion has changed and it doesn’t really matter what I or you think about it. I am a privileged white female living in a developed country where I can access any healthcare service at my fingertips. I am literate and ‘wealthy’ and have the luxury to form opinions and express them out into the cybersphere. I know I have absolutely no place to have an opinion or form judgement on a woman who has NOTHING. The fact that a white rich man in a suit can form any sort of judgement on these women is horrendous and makes me feel so sick.

During my field trip in rural Nepal this past November, I met the most beautiful Nepali woman. She was 65 and had never been to the Doctor her whole life. Her five children were born at home and she had never been to school. Not only was she illiterate with no education, but her husband was physically violent towards her. Through a translator, she disclosed sneaking out of the house that day so that she could come and see me. She said she didn’t care if her husband found out and ended up beating her. As I was holding back tears hearing this, she was thanking and blessing me for seeing her that day. I couldn’t grasp how vastly different her life was compared to mine and how gracious her spirit was.

We have no say over where we are born, into what family or what health services we will have access to. As educated and privileged members of our world, it is our duty to show empathy, kindness and generosity to those who were born into dire circumstances.

That is my rant for the day 🙂

Post data collection reflections

I can’t believe it’s been 4 weeks since I returned from Nepal. In some ways it has gone so quickly with all the holiday festivities but then again it feels like a distant memory. I have this slight anxious feeling in my chest that I’m going to forget all the amazing moments, feelings and stories from my 5 week trip. Although I kept a daily journal, it is impossible to capture all the BIG heartfelt moments I experienced while away. For most of the trip I was travelling with dear friends so together we can relive the funny stories and adventures.

For the first post of 2017, I wanted to take a moment to reflect on the highlights of my trip. Here are the top 3 insights that surprised me, warmed my heart and brought me joy:

Nepali people have the most gracious and warm spirits. Throughout all my experiences and travels around Nepal I never met anyone who was aggressive or demanding. While conducting our studies we utilised resources, facilities, space and personnel but our research partners always made us feel so welcome and thanked us so warmly. Often participants in the studies travelled many hours to meet with us and would finish the session blessing us and being so grateful to be involved in the study. It is striking to me the women in Nepal often have so little but give so generously and graciously of their time. What a contrast this is in Australia!
Nepali people are so laid back but also so productive. It took a little while for me to get used to ‘Nepali time’. Trying to arrange meeting times would often end in a rough ballpark timeframe with a response ‘maybe this, maybe that’. Not wanting to be controlling, I just went with the flow and was amazed over and over again how things would work out so perfectly and better than ever imagined. Again – this is something we could definitely learn from in Australia!
Nepali people are doing the best they can with what they have. I believe this 100% and am thoroughly inspired by everyone I’ve ever met there. As one of the poorest countries the people don’t complain and get on with making the most of their situations. This can be seen in the hospital where equipment is scant, to the kids who happily run off to school and play with weeds and rocks, to the small business owners trying to sell a variety of goods and to the amazing women who have nothing but continue to work hard on a daily basis without complaint. Not only are they incredibly resilient but their eagerness to learn is so inspiring. We take for granted all the modern luxuries we have access to in Australia but still find things to gripe about!

It has been a huge privilege and blessing to be able to have a small glimpse into the lives of Nepali women. I have learnt so much from them and know my life has changed for the better.

In this new year, I will aspire to be more gracious, less controlling and aim to do the best that I can.

Happy New Year and Namaste!!

The magic of saying ‘oh, OK’

At the beginning of my PhD journey I had the most amazing ideas for my research project. A little naive and idealistic, I thought that everything would fall into place and I could fulfil my dreams. As I started to plan my projects reality sunk in and I had to compromise on some of my ideas. My initial goal of conducting a full RCT didn’t seem feasible and regrettably I had to pursue a more achievable study methodology.

Sometime later I was encouraged to meet with a specialist who is the world guru on pelvic floor muscle damage due to childbirth. I wasn’t sure what would come of this meeting but was staying true to my mantra of being open to all possibilities that come my way.

When we met, I was describing what I was hoping to do with my PhD and immediately he said ‘NO’ you must first know what the baseline is before attempting any interventions. He then told me what needed to be done and introduced me to his PhD student who would help me. This is how I met the amazing Dr Friyan Turel. We were introduced to each other, told what study we were going to do and both said ‘oh, OK’. We departed, she thought we’d never meet again and I had no idea what was just agreed upon.

Fastforward 8 months later and we found ourselves in Nepal ready to commence our research study. We laughed about how neither of us really knew what was going on and never thought it would actually work out. Now looking back over the past 3 weeks of data collection, we feel a sense of pride of how well it all worked out. Not only did we achieve our participant numbers but we worked beautifully together. Sharing the same passion for women’s health in low resource settings, we formed the strongest partnership and are both determined to follow this cause where ever it takes us.

The most beautiful part of our openness to saying ‘oh, OK’ is that Friyan believes we can conduct my initial study idea of an RCT in India. She has the contacts, resources and determination to make it happen. What I had resigned myself to accepting was not possible has now been put back on the table as a very doable option. Our chance encounter has not only allowed me to pursue my research dreams but has also given me a passionate research partner and lifelong friend 🙂

Week 2 of PhD data collection in Nepal (half way mark)

Another week down of performing 4D pelvic floor muscle ultrasound for Nepali women and we’ve really hit our stride. My research partner and I are in a good rhythm now and have become super efficient. We have a local Nepali intern helping us who is an absolute gem, we really couldn’t do it without his help. The hospital has been so accomodating and supportive of us, allowing us to use their space and recruiting participants for us.

The participants are so adorable and gracious. They often give us blessings and thank us for letting them participate. They have also shared that they feel very comfortable with us and end up sending their family and friends to also participate in the study.

There are a few initial thoughts my research partner and I have noticed in collecting the data thus far:

Nepali women have very strong pelvic floor muscles
Even though they often have home births, they have far less injury to their anal sphincters (when comparing clinical findings to women in Australia)
They have a very difficult time figuring out how to do a valsalva push
While many have mild-moderate prolapses, they have minimal symptoms

It will be really interesting to analyse the data and compare the results to a Caucasian data set. So, it all seems to be coming together nicely. We may never get used to the air pollution, dust, noise and chaos but we are really enjoying the people, culture and food 🙂

Stay tuned for more updates next week!

Week 1 of my PhD data collection in Nepal

There was so much anticipation and anxiety leading up to commencing my PhD research projects being conducted in Nepal this November. Having arrived now and completed 2 days of data collection has significantly eased my stress so now I’m feeling quite calm about the upcoming 4 weeks.

Partnering with groups overseas can create an element of stress in regards to project planning but at the same time can also be very inspiring. The Nepali people continually surprise me in their quiet but competent manners. They have been so accommodating and gracious meeting our research needs and have made us feel very comfortable and at home in their space.

Being able to work with health professionals from another country provides an amazing opportunity to learn from each other. The Nepali people are always so eager to learn and take every opportunity to engage and ask questions. While some of the clinical protocols are different it is not from lack of knowledge but from difficulties with expense, resources and accessibility.

Watching the Nepali health professionals in action has taught me how to show compassion in difficult circumstances. It is obvious to me that they value people over time management and don’t cut corners in providing education and advice. These people are making such a significant difference regardless of limited resources. It is inspiring watching people doing the best that they can.

It is easy to take for granted all the medical services we have in Australia. It is even easier to complain about the inadequacies of our health system. We are so lucky to have every health service at our fingertips. Just spend a few hours in a Nepali hospital and you will feel grateful for what we have in Australia.

Stay posted for updates on how the next 4 weeks go in Nepal!

My other Sydney Uni Phd student partner, Friyan, and the local Nepali Doctor

What doesn’t kill you makes a good story

I have now completed my first full year as a PhD student and wow… has it been a learning experience on so many levels. So many highs and lows, ups and downs, wins and losses. Looking back over the year I feel a small sense of pride that I have made it this far and have grown so much.

I also look back at my naïve 12-month younger self and chuckle at her innocence. There was even one point last year where I actually thought ‘what is all the fuss about, this PhD thing is a piece of cake’. At the time I was feeling guilty about not being more stressed about it all. Well, how things have changed over the year.

A few weeks ago I was feeling particularly stressed about a specific research related incident. Generally a calm and level headed person, I didn’t even recognize this feeling of tightness in my chest. A friend recommended an acupuncturist and at the time I was up for anything to help reduce the tension within myself. I walked into my appointment all fired up and angry about a very confrontational conversation I just encountered and all these awesome ‘comebacks’ were racing through my head. Never having had acupuncture before, I didn’t know what to expect. Let me tell you, it was the most amazing thing I’ve ever experienced. An hour after walking into my appointment, I walked out feeling light, happy and with no negative thoughts in my head. I am now a huge believer in the power of needles 🙂

The acupuncturist easily sensed my stress and gave me some guided mediations to try calming my body. I had tried mediation before but found my daydreaming tendencies were too strong to allow for a clear my mind. I hadn’t heard of guided mediation before but I found it worked so well for me. Being guided through a snowy forest is a magical experience for my body, mind and spirit. These guided mediations have worked wonders on calming my mind and helping me get a good night sleep.

While this year has taught me loads about research methodology and concepts, it has also taught me important life lessons. I have learnt how to ‘manage’ people so that it makes my life easier. I have learnt how to stand up for myself and voice my opinions. I have learnt I am disciplined. I have learnt I have tenacity and I have learnt how to be kind to myself. Being resilient doesn’t mean you won’t feel stressed at times or your feelings won’t get hurt, it means that you recognize and acknowledge these feelings and take action to address them in the best way you can. That is my story and I’m sticking to it 🙂

Time for review and reflection

At my University, it’s that time of the year where PhD students meet for their Annual Performance Reviews. While some of the paperwork may seem like an unnecessary time waster, it’s actually been a worthwhile task for me. Sometimes it’s easy to get stuck down in the day-to-day grind making you feel like a mouse in a wheel trying to reach some delicious cheese only to be kept feeling tired and irritable instead.

Taking the time to reflect over the past 12 months has given me a much needed boost. To be honest, I feel quite proud of what I’ve achieved over that time and have given myself a little pat on the back. With this new perspective and motivation, I feel confident in pushing forward into the next phase of my research.

As I look forward to the next 12-24 months, I give myself some friendly advice-

NOTE TO SELF: make sure you place some small reachable chunks of cheese for you to race towards so that you don’t tire out running towards the main wedge of perfectly aged Brie 😉

ADDITIONAL NOTE TO SELF: you’re not at all like a mouse, you’re more like an adorable bunny 🙂

Don’t be a mouse! Original cartoon by ME 🙂 )

Riding the PhD rollercoaster

I know it’s been said before, that doing a PhD is like being on a rollercoaster – so many highs and lows, ups and downs. These moments of extreme can very easily happen in the same week, day or even hour. This past week I was feeling very satisfied with myself, being able to check off my to-do list so efficiently. Submitting a few documents for review in the morning, I even allowed myself a few hours of couch time watching Netflix in the afternoon. Later that night I received a few emails back with very ‘thorough’ feedback. My brief moment of smugness was quickly exchanged for stress and self-doubt.

I’m in a phase of my PhD journey where I’m submitting applications and ethics and budgets and study plans and am so reliant on other peoples feedback. With so many unknowns and things up in the air, my stress and anxiety is running a little high. I realise that it would be easier if I could meet face-to-face with the people I’m partnering with but alas they are in Nepal. I also realised this week that I should schedule a meeting with my supervisors as we have predominantly been communicating via email. Some of my questions would be easily answered in person and it is up to me to schedule a meeting.

So, things I’ve learnt this week:

This season of unknowns and stress will pass – keep pressing forward knowing it will all work itself out in the end
Don’t feel guilty when enjoying some downtime – the periods of pressure and deadlines outweighs the moments of reprieve so relax and enjoy them while you can
You’re not doing this alone – schedule a meeting with your supervisors to talk through the factors that are causing stress as they are there to support you and may have some great ideas and resources
Things WILL work out – the process of a PhD is largely problem solving so even if your initial plan doesn’t work out, something else will and it may even be a better one in the long run

Well, that’s my advice for myself so hopefully I’ll listen to it and learn 🙂

Pelvic Organ Prolapse Month

June is Pelvic Organ Prolapse (POP) month and is a great way to increase awareness and conversation around this common condition. POP effects women all around the world but there is a very high prevalence for young women in Nepal.

POP is a condition where the uterus, bowel and/or bladder fall into the vagina. A minor one may remain symptomless but a more advanced POP can cause considerable morbidity for women. Some symptoms include pain, heaviness, incontinence and difficulty with sexual relations. This reduces the ability for women to comfortably sit, stand, walk, lift, do housework, engage in paid work and engage socially. These symptoms have a devastating impact for a womans’ general physical and emotional wellbeing.

I have had the privilege of working alongside an NGO in Nepal who provide screening camps, education, conservative treatment and arrange surgeries for women who have POP. This is such important work and is making huge impact on the quality of life for the women they help.

I remember observing a local doctor assess a lady in her 80’s who had a POP for 40 years. It was a very advanced POP and she had been suffering considerably. Due to her age and comorbidities, surgery was not a good option for her. The doctor fitted a pessary ring for her and I will never forget the look on the womans’ face when she stood up. She had the biggest smile and tears in her eyes and couldn’t stop thanking the doctor. This simple and inexpensive intervention provided immediate impact to her quality of life. My heart filled with joy and hope watching the doctor give care and support to this lady.

Women in rural regions of Nepal are the primary caretakers of the home and farm. Every single day of the year they get up early to cook, clean and look after their family. Not only that, they do the physical labour required to maintain the farm. Often this involves collecting heavy bundles of foliage, carrying it on their backs for miles, so the goats can be fed. They also tend to the chickens and other livestock while maintaining the crops. This work never stops and is essential for their subsistence lifestyle.

One of the reasons for the high prevalence of POP in young women in Nepal is their role as primary caretaker of the home. Their husbands are often away for paid work leaving the housework entirely on their shoulders. I heard stories where the pregnant woman was out in the field working, delivers her own baby, wraps it up, then continued working. This may be an extreme example but is not far from the truth. The women can’t even take off one day to walk to the nearest health post for a medical check up because who will feed the goats?

The issue of POP in Nepal is complex and multifactorial. The government has identified it as being a priority and has assisted in funding screening camps and surgeries. This is a great start but far more work is needed. As with any medical condition, more attention is needed on prevention and education. I’m hoping I can do a small part in creating more awareness and resources around POP prevention for women living in remote regions of Nepal.

If you’d like to support an Australian NGO who fund a women’s health project in Nepal – visit: https://www.asianaid.org.au/health/