 So we're now recording our meeting, and I would like to go ahead and do a short introduction for Midwifery Education. In our lives, we can just unmute your mic for one second about the institution. Our library has been serving women since 1987, when she first began her training as a Midwife. Years of experience in home and hospital care in the Delta Nations, providing care and training, and she's worked with many people all over the world. She's also included developed and correctional and trained healthcare workers in the midst of the Ebola crisis, and earthquakes, and has assisted in the refugee situation in Europe. Our second speaker is Tia Wola. She's a certified professional midwife, licensed midwife and clinical herbalist. She's been working as a women's healthcare provider and educator. She's been working internationally as a midwife for midwife children, and she's been providing care for the refugee crisis in Europe and the Middle East. Her passion is helping women in low-resourced settings by bringing compassionate care and resources to the most vulnerable in the world. Our third speaker is Cindy Nelly. Cindy Nelly is a certified midwife who was born and raised in Maine, USA. She's a very experienced and diverse midwife. She's served as a coordinator for International Maternal and Child Care Care Projects in the Gambia, Kenya, Rwanda, the ERC, and in Colombia, South America. She's also taught for arts and medicine in Spain in the Morroconas of disaster relief first responder, and she provides relief for us for a week and 80, and posts 16 in Mississippi and Louisiana and the USA. She's currently in the streets and has been working with Syrian refugees in Turkey and Lebanon. And our final speaker is Tia, who's worked to began her career in midwifery in 2016, combining midwifery with her background in foreign politics for years of experience in international work, and the career has led to work in global health and other communities of global reproductive life. She's been providing the different reproductive health care services in several countries and now focusing on the refugee crisis then in Syria. So thank you so much, midwife pilgrim, and I'm going to go ahead and mute my microphone. For moving the slides, and I know you don't know how to do this, as you told me, Laura Lai, if you look to the bottom of your slides, which are called arrows, where you'll be able to move your slides backwards and forwards. Should you have any problems, please let me know. Thank you. Thank you, Jane. So midwife pilgrim is a U.S.-based NGO, and we focus on global reproductive health needs. We are dedicated to responding to global communities in crisis and disaster situations, which in this case means a refugee crisis. Since 2015, when we began, we have sent 30 volunteers on 35 missions, impacting over 10,000 women and their families. Last year alone, we provided care to 3,500 refugee women and children in four countries. In honor of today, three of our volunteer midwives will be sharing their experiences in Turkey, Lebanon, and Greece, though we have worked in other locations. We've worked in Sierra Leone, Nepal, Kenya, Haiti, and Jordan. And actually we are looking into projects in Iraq and Serbia now. So keep posted. By the end of this presentation, we hope the participants will understand more clearly the living conditions and health care needs of refugee women and their families, the barriers to care for women in the humanitarian setting, the role of volunteer midwives in this particular crisis setting, and also ways that you can help on a way forward. So I'd like to turn it over to Kayla Moller, a licensed midwife who worked with us in Greece and Turkey. Okay, hi. My name is Kayla Moller. I'm a CPM in L.M. and I live in Northern California. I have a small home birth practice here, but within the last year and a half or so, I've mostly been focusing on helping to bring care and aid to the women of the refugee crisis. And as Laura Lai said, I've worked in Greece and Turkey. My last two trips over, I've primarily been in Turkey and working with a project that is continuing. So I'll speak a little bit of that in my presentation. But first I just want to talk a little bit about Turkey and what's happening there with the refugee crisis. There's about 3.2 million registered refugees living in Turkey, making it one of the largest host countries of refugees in the world. This includes Syrians, Iraqis, Afghans, Iranians, Somalians and other nationalities. But out of this 3.2 million refugees, almost close to 3 million of them are Syrian in the country. And about a little over 200,000 are hosted in camps. But other than that, the people are just displaced and living either in the southern area by the Syrian border around Istanbul or in western Turkey. And that's where I work is in Izmir. I don't know how big the map is for you, but it's over on the AGMC. And we service about a two hour radius there and there's probably at the height of the season in the summer. When I was there this summer we were bringing aid and care to over 5,000 refugees. The camp sizes, conditions, a number of people vary. Sometimes it'll be a camp of 20 to 30 people. Sometimes it'll be a camp of a few hundred people. Most are either in some sort of warehouse setting where they set they inside. They build little kind of homes with tarps for themselves to for their families. Or they do that out in the fields next to where they're working. The unique part about the demographic that I've been working with in Turkey is that they are, most of them are farm workers and we're farm workers in Syria. And so now since the war had started and they've had to flee their homes and leave their land, they've now become migrant farm workers. So they move around Turkey depending on where the food is being grown and what the needs are and things like that. Most of them are paid, but whether or not they get paid is the question. And if they are, it's very little the wages. And the landlords, they're also having to pay rent for these pieces of land that they're living on. And the landlord, sometimes they don't pay them. And like I said, if they do, it's very low wages and they mostly hire women because they're cheaper to hire and averages about seven American dollars a day that these women are making. A few of the things I'm going to talk about today are the living conditions and healthcare needs of refugee women and their families. This includes prenatal and postpartum care, well woman care and primary care and contraception, clean water, basic hygiene and access to resources, shelter, safety and education. And then the two pictures on this slide, this is one of the bigger camps that we worked with in a warehouse and it's kind of both sides of the camps. So you'll see like they, so that's the warehouse they're living in and then inside would be their shelters. As you see, there's a lot of standing water on the ground. And I'm going to talk a little bit about that later in the presentation. So the scope of practice for midwives is a little bit different. We're working overseas, especially for us that are licensed midwives in the States. We do do well women care here in the States but over there it also consists of doing primary care. So midwives, sometimes I would be the only person there and sometimes there would be a doctor or a nurse with me. So depending on that, you're holding the space for everybody, women but also men and children included. But one of my primary focuses being a midwife is of course bringing maternal health care and that includes of course prenatal care. And so it would be like you would imagine like a basic prenatal appointment. You know, I carry a Doppler, we do the vitals, we do urine analysis, you know, distribution of any kind of supplements or prenatals or maybe nutrition kind of help that they need. If we can, we try to get resource, you know, if they need like something for like they're like a belly band or some kind of like clothes or something like that. We do help with that as well, but not quite as much. And we do it within the last six months now, we have access to labs. So we're able to draw blood in the camps and then there's a private lab in Izmir that will run the labs for us. It's been a big thing that's been added to the care. And so most of the women there do give birth in the hospital and the C-section rate is high, but it's not as high as it is in Greece, which is good. But the care in the hospital is still not that great. And depending on where the refugee is registered, they might even be turned away at the hospital. So we bring them to the hospital or they go, but then we usually visit them and also make sure they get home, bar back to their camps. And then that's where we continue on with the postpartum care. And as the same with prenatal care, it would be the same postpartum care that we offer here or that I would offer here. But the follow-up care continues after a six-week period, which would leave my practice in the States. We follow through with babies of all ages. And so, yeah, one of the biggest things is the high need of resource for the people. This can include anything from access to food, shelter, things like that. One of the biggest things that I deal with as a midwife is resource to hygiene and education around that. Because it's not like the women aren't capable of taking care of themselves, but there's just such little resource. And the toilets are really dirty. Most of them are just a hole in the ground where they're all shared, sometimes by hundreds of people, like I was talking about, if the campsite is that. And so there's been a really high, I see a really high rate of vaginal infections in UTIs. So, you know, most of it we treat allopathically. But we also try to get women like clean panties so they at least have a couple changes of panties, access to feminine products. Soap that isn't like chemical soap that's going to aggravate that because, yeah. So a lot of it is about education and just bringing resource. And one of the biggest things that we did is what we've been doing in Turkey is bringing clean water to the camps. And last summer we were given a donation and also paid for part of this water filter system. And we were able to bring in this very simple water filter. They hook it up to the main source in the camp with these five gallon buckets. And they were able to get filtered water, which was huge because we were seeing a really high rate of parasites. And especially in the children, it was bringing a lot of diarrhea and vomiting and bloating and things like that. So we treated almost all the camps at that time, which was about 5,000 people, as I said, with parasite medicine. And we saw great results with it. And that's continued as well, the Clean Water Project, and treating people for parasites. The next thing I want to talk about is contraception needs and distribution and education around that. Personally, that's one of my, especially these last two trips, I've just seen such a need for that. And women are having babies, you know, they're having their babies. They're getting pregnant at two months postpartum and having another baby. And they're young and their families are growing and it's not healthy, obviously, for the body, but also they need the contraception care and a lot of them have reached out asking for it. And so we started doing a distribution of oral contraception, IUD placement as well as condoms. And so a lot of that entails like counseling and just like talking to the women to finding what the right choice for them is. And I'm actually currently working on getting some grant money to start a distribution program that can connect just resources with other NGOs that are doing women's health care out in the fields. So realities of maternal outreach care and the barriers to this care. One of those things is continuity of care, lack of access to women's health care due to the nature of migrant life and fear of the system, bridging the gap between health care systems and also meeting challenges due to police presence and coordination with other NGOs. So in these slides, this is the picture with all the people. That's kind of a typical look of inside of a tent in one of the camps. And I took that picture so I was sitting back and we kind of just set up with all of our medicines and our translator and then everybody kind of comes in and we see everybody one by one. And one of the biggest challenges faced here is treatment and follow-up care. Because one, some people won't even take their medicines and then the other is having access to medicines because of the movement with the people. And so about six months ago, one of the ways that we decided was a good way to keep track of people is we thought, oh, we should start charting. So we've developed the system where now we have charts and information on all the people we've been seeing and they're organized by camps. And if there is a phone number or something like that, we are able to do the follow-up care with them. And so that's been huge in kind of jumping over this barrier. And the other problem with this though is that a lot of people have fear of the system because there is such a challenge in bridging the healthcare gap and people fear either deportation back to the Providence in which they were originally registered which is usually the south of Turkey when they crossed over the border or just being deported altogether back to Syria. This last trip when I was there, this was especially present because the police started showing up in the camps and one of the times I was there and we were asked to leave and that if we continued offering care, then we would risk the same thing and that our NGO could be shut down and as well as international volunteers deported, things like that. And they also started to remove the refugees from the camps. And some of it was a little bit brutal but most of it, you know, refugees were asked to go. The buses came, they loaded them up and they were bringing them back down south. So this picture right here with them loading up their stuff and that was one of the days we were out there and they were loading up everything to go. So one of the ways though that we've been able to continue to bring cares to coordinate with other NGOs and we as midwives pilgrim, you know, we place midwives in the situations of crisis and the main NGO that we've been working with in Turkey is called Medvent and it's a European NGO but because of the risk of working as an international NGO in Turkey, we've partnered with some Turkish NGOs that have helped us to kind of bridge those gaps that I was talking about in the healthcare systems and help people get seen in hospital as well as to continue to bring care into the camps. So I'm just going to tell this story about Ayat. This is Ayat and she's the woman in the picture and then the picture next to it is where she lives and she, I met on my last trip and her family, they work in the lettuce field so you'll kind of see where the clothes are hanging and the greenhouses with all the lettuce. They just like stretch on for miles and miles and miles. And to the left there you can kind of see the porch but it's just kind of a shanty kind of shack house, two rooms and there was about 30 people living between the two rooms. Why I want to tell Ayat's story is it's not too crazy of a story but it's just a success story of why what we're doing and bringing care is working and why it's so important. So when I met Ayat she was about 37 weeks pregnant. She was the first time mum and 19 years old and she had no previous prenatal care whatsoever. Being pregnant to her it wasn't even really a reality yet even though she was so close to giving birth. So the first appointment we did we found that she was very hypertensive like 140 over 95 or something like that. And so that day luckily we were able to draw labs and run a liver profile and check kidney function and do a CBC and all those sort of things and they came back mostly normal. Some things were a little bit on the high end but so we started visiting her like every other day checking her blood pressure. We ended up giving her a blood pressure cuff so that she could not have made anyone but like a electronic one or this one that she could use to keep a log and we were able to continue to draw labs to monitor as well as put her on a hypertensive medication for pregnancy or that is safe in pregnancy but over about like a week and a half to two weeks of this of just like back and forth, high blood pressures, all sort of things. It just wasn't going down. We were able to get her an ID where she was able to go to the hospital and she actually was induced and ended up in the C-section but both her and her baby are now well and this is just, I use this as an example because like so many women that I've come across in my work in Greece but especially in Turkey is that they have just been totally lost into the system and they don't even, and there's just no education around even how to do that and there's no one there to help them and so she was just a success story for that because had we not been there and not been able to help monitor her blood pressure and get her to a safe weeks of gestation to deliver her baby that maybe she wouldn't have, you know, I'm not sure what the outcome would have been. So, yeah, thank you. Up next, the next speaker is a colleague of mine, Cindy Neely and she's going to be talking about her work in Lebanon. And actually, Cindy Neely is having some microphone issues. So, this is Lorelai and I will be doing my best to do her presentation. Cindy Neely's worked in a lot of different places and spent some time in Turkey just before prior to Teah last year and has recently been to Lebanon. There are one and a half million refugees in Lebanon and if I'm correct, I believe they are considering a small population. They have the most ratio of refugees to the general population. I believe it's one in four. She worked in the Becca Valley, which is north of Tripoli, and which is an area where a lot of refugees have settled. I will do my best to go through her presentation. I've never been to Lebanon personally, but have spoken with Cindy a lot and she's going to help me as we go along. The living conditions and healthcare needs of refugee women in their families. Very similar to a lot of the other places that you have been hearing about. Teah's discussion of Turkey, the presentation given before by Lillian about MPI in Greece, a lot of areas that have been set up for refugees, but not given the best of living conditions, so tents. In fact, there actually are no official refugee camps in Lebanon at all. They are just areas where people are brought, which is what we found in Turkey as well, because they don't want permanence. A lot of people go to a place, they set up their tents, they get everything set, and then they're given 24 hours, sometimes less notice, that they have to leave. Then they have to find another place, sometimes an even smaller area, try to house these tens of thousands of people who are being moved from this piece of land. Some refugees have actually been there for more than 40 years, the refugees of Palestine, for instance. 70% of the refugees in Lebanon are not registered at all, which is again another typical thing we are finding in a lot of different countries that we work, which makes it very difficult for them to get jobs, to get care, to be considered official, so they're outside of any system at all. Most hospitals are private, so therefore very expensive. Health care is an issue. 47% of the pregnant women that Cindy was seeing in her area were receiving prenatal care, which was very, actually, I think, obviously not a great number. We should be getting 100%, but better than what I expected, and that goes to show the dedication of these volunteers to get out there and to do the work. Cindy is actually trying to send me some information as we go along. There is not a signatory in the human rights for them, so therefore their protections are limited, these refugees. In this case, Cindy worked with the Syrian American Medical Society. They had a program there. They have actually several different programs at different times where they go in and provide health care, primary care, maternal care, things like that. They did a whole week of GYN surgery using private hospitals, and they were able to provide contraception, which is a huge issue of refugees that we have found. I'm trying to change the slide. I don't personally know the story of this child. If Cindy could get on and tell me, that would be great, but you can see an example of the living conditions in some of the situations that these children are facing and the people. Very, very ill sanitation, so water is an issue, hygiene is an issue. Children are often alone in the camps because there's no clean water to drink. There's no clean water for hygiene as well. You can imagine the amount of parasites that are around as well as situations like in this child. Sadly too, because of the number of children. Cindy and Ellie, if you could possibly write in the chat box because the bugging, and I can either text Cindy tomorrow or I is disturbing the course of the conversation. Oh, sorry. That's okay. It's just when we're trying to listen and we keep hearing your phone going off. Oh, and I think you wouldn't mind. Yes, no, I'll comment. Great. Thank you. And I'll just read it from there. So, Cindy, if you'll start writing in the chat box, you can even do a personal one to me if that's easier. And I'm sorry about the buzzing sound. I don't know how to turn that off on my text, even though the volume is turned way down. One of the other issues of the risks to children and to women is there is a lot of sex trafficking, which sadly is typical in these types of situations. So there are a lot of health care risks, a lot of risks on a lot of levels. Here are some other photos that she has been able to... Oh, I'm going to go back one second. She wrote me and said that there are 250,000 children that are not in school right now, which, as you can imagine, is going to lead to some major implications in the future. Barriers. Because it's a diverse cultural, religious, and ethnic population, you have refugees coming in from a lot of different countries. That's going to... I mean, not so much the care you give. That's going to remain the same, but how you give it can be tricky, as well as language issues. There's a huge country burden in Lebanon. One to four persons is a refugee. So that means three out of four people are native Lebanese, but one to four is a huge burden on the resources. Jobs, sources of health care, sources of water, things like that food will be very, very difficult. Movement within the country is restricted to refugees, which makes it very, very difficult. And they have a lot of curfews, so arrests are made, therefore putting the refugees at further risks and making it more difficult for them to receive care that they need. Distance to health care facilities and modes of travel. Transportation is a big issue. A lot of people are afraid to travel because of their fear of deportation, which has happened. In fact, it's happened in a lot of the countries that we have worked in, and something that we are seeing as being a big barrier for people wanting to move, or even to go to try to get health care. They're afraid. It's been mentioned in other sessions that I've seen people are afraid to go to the hospital. They don't trust the health care people, and they don't trust that they're not going to get sent back to their country of origin. There's a lot of abuse within those health care facilities, too. There's a lot of tension within the local culture, so people who are trying to gain access to health care in a facility are not necessarily treated well. And that's why mobile clinics tend to be better. We have found in a lot of places with NGOs or independent volunteers going in and meeting the refugees where they are at so we can see them. They don't have to worry about finding transportation. They don't have to worry about finding a place that will actually give them compassionate and skilled care, and they're able to get the health care that they need. In all of our programs, Lebanon, Turkey, Greece, we've had great success with the mobile clinics. Cindy was able to put IUDs in tents. People are more willing to talk more when you're in their space. There's less of that feeling of hierarchy, but you are coming to them. They are welcoming them into your home and therefore them into their home. And therefore you are a guest. And it changes the whole dynamic. They are a partner in their care then. So it changes the way that people view health care and they trust their providers more. There's a lack of pharmaceuticals, a lack of able to get the correct medications and things that are needed. But on the other side, there's often too many different NGOs trying to do the same thing. So there needs to be a way of coordinating. We have found that everywhere we go, you have all these different NGOs going in and doing their thing. And while they're doing great work, it just seems if people could coordinate, you could reach so many more people and be more effective actually with that type of system. But that's a whole different topic on how NGOs need to learn to work better together. Medication was brought into Turkey, as Taya had mentioned, and you're able to get it. But it's less expensive to buy things locally. And it also actually helps local economies. So in places where there is a lack of essential medicines, that can be a problem. Because sometimes bringing those medications in is too costly. Or you have problems at customs, not in general, but we have had issues with that. And so one thing we want to do is try to encourage local economy too by purchasing medicines when they're available. The role of the midwives. So as you can see here, they are in a makeshift tent doing their work. In this case, they're providing emergency response training and trying to train other healthcare workers and how to respond to situations. Mainly because in Syria with the Civil War, there's been no training of a large amount of midwives. There's some programs here and there, but by and far, midwives are not able to be trained. So there is a push to train local people in these different areas who have any skillet all in their interest in how to provide the care for their own population. Which is what we hope to do anyways. It's always better if care is provided among your own community instead of depending on volunteers coming in from different places. And as midwives, we connect people to services. So trying to connect them to social services or psychological services, whether it's contraception or primary care, whatever is needed. We often have that role of education, support, advocate, and just doing those sorts of roles means that you're seeing a lot of people and you're trying to coordinate with a lot of different areas. So in some cases, you may have a situation where you have a baby that you are doing an exam on and realize this baby has some serious health issues. So trying to coordinate with local facilities or to a higher level of care at a hospital, finding funds in places where it is a privately owned and you need to pay. Ensuring that they get the care that they need, you know, coordinate. Make sure that when they're in that facility, they actually are getting the care, as mentioned prior, because refugees are often not given respectful care. They're often not taken seriously. So having somebody advocate for you, having a midwife come up and say, hey, this baby needs this ultrasound and this echo and possibly surgery. So making sure that gets followed through can make a huge difference in the lives of these women, children, and families. Oops, I missed the slide. So if you want, I think there's something. Yep. Okay. So we've talked about most of these. So I'm going to just go on talking about all the different ways that midwives. Marla, I think Jane was letting you know, excuse me, I think Jane was trying to tell you that it is now 20 minutes to the hour. And if you need to have time for questions, you're going to have to wrap up in the next five minutes. Okay. And we're going to, okay, thank you. Sorry about this. I'm going to, we're just going to go on then and go to Gina in Greece, who will be able to tell about her time in Greece. Hi. So with only five minutes, I'm going to have to really skim through this kind of quickly just to touch on the main points. And that's so hard to do. So just really quick, my name is Gina and I am currently in El Paso, Texas working with an established midwifery practice as well as continuing to work internationally in Greece, Lebanon and Mexico. So I had traveled to Greece initially with the intention of volunteering in Lesvos, but by the time I arrived, the situation had shifted further north into the border of Greece and Macedonia. And I ended up working primarily in a camp called Echo Station Camp and Echo Camp held anywhere from 2000 to almost 3000 refugees at any given time and depending on who was counting. The unofficial camps, which was Itomini and Echo, they had a lot of limited resources, leaving countless individuals without basic access to food, adequate shelter, electricity, and of course healthcare services. Several international organizations and smaller NGOs and independent volunteers flocked to the region to assess the crisis and begin to provide some structure and basic services until the larger organizations could come in and establish care and services. As we know, the need for reproductive health is immense and most care in the camp was and continues to be provided by volunteers and smaller NGOs. Some of the biggest barriers to care that I encountered were just simply a lack of providers who were qualified to provide services. In Itomini, I was often one of two midwives available and in that camp we had an unofficial tally of 600 pregnant women. In Echo, I was often the only women's healthcare provider available and we had anywhere from 30 to 60 pregnant women and that doesn't include the postpartum women. There is the issue of birthing in the camp versus birthing in the hospital. Birthing in the camp is considered unauthorized as it was not done with an authorized provider and unfortunately birthing in the hospital was preferable for the sole purpose of establishing registration for the newborn. But even in the hospital setting, we found that this was often difficult to achieve. And as we know, unregistered newborns and refugee children face an increased risk of exposure to violence, abuse, and exploitation. And in Greece alone, almost 77% of newborn refugees were unable to be registered or obtain an official birth certificate. There is a lot of miscommunication about the importance of birth registration and a lot of refugees are frustrated and overwhelmed with the process of it. And in addition to that, the process requires proof of marriage and other identity documents that were often destroyed in Syria or lost and route to Greece. And so that adds to the difficulty of being able to establish birth registration. The inability to establish birth registration makes it more difficult for the families to seek asylum further into Europe and to make forward movement in that capacity. The hospital setting also has a lot of obstetric violence. There were women who were performed, one of the women that I transported to the hospital. She birthed in route and when we arrived in the hospital, the placenta had not been born yet. But the doctor who was attending the delivery cut an apesiautomy after the birth of the baby for no apparent reason. We saw many women that we transported received C-sections without consent for no medical reason. The hospitals are overburdened. They don't have enough staff to handle the volume of the influx of refugees in those areas. And then there's because of that, they don't have the space for appropriate follow-up care. And we had women who received cesarean sections being returned to the camp less than 48 hours post-op. We met women that had not been given any medication for pain management and they were not properly educated on proper hygiene for incision sites, which we saw a significant amount of post-op infections as a result. In ECHO Camp we established a mobile healthcare clinic designed to meet the needs of the women in the camp and provide a spectrum of care ranging from well women to prenatal and postpartum, as well as being able to provide resources for education and contraception. However, many of the women who would come from the camp to the clinic would do so for well women care and the pregnant women and postpartum women were more inclined to stay in their tent. So in order to reach out to the women in the camp, I set up a maternal outreach program and in doing so it turned into a daily routine. I was able to keep the mobile clinic staffed with a rotation of GPs that came through the camp. Every day I would make rounds through ECHO and check in with the pregnant moms that I knew of. In the process I created a registry of all the pregnant and postpartum women in the camp and added to it. It created almost like a follow-up log where we could check in daily and make sure their needs were being met, check in on them and their babies. And as the bigger NGOs like MSF and other groups like NPI established in the camp, then we were able to use that registry to identify women who were good candidates for proper referrals for external resources. In the camps, part of the mobile maternal outreach program included spending the nights in the camps because with such a high-level PTSD there was often a lot of episodes that would occur at night. There were people having severe PTSD attacks, resulting in disassociation, violent outbursts. There was a lot of sexual abuse and assault that occurred at night. And we quickly realized that we needed women health care providers as well as emergency health care providers maintaining a present in the camp 24-7. And so that's part of what I did with the maternal outreach program. And the outreach program also just provided another great form of support for the women who were enduring those difficult situations. Contraception in refugee camps is always a difficult topic to navigate. There's an absolute need for contraception and education. We received tons of donated condoms that found that there was a reluctance from the men to actually use them. And the women in the camp were desperately trying to avoid pregnancy. And on this photo or on the slide you can see a photo of a broken spoon. And the head of the spoon was being used as a makeshift diaphragm type device. And I also removed pieces of kitchen sponges that had been caught up and even saran wrap type plastic from women who were attempting to use these as makeshift barrier contraceptive devices in lieu of condoms and other methods. The pill and IUD and injection are other methods, but it's difficult to maintain consistency with them. It's difficult to maintain follow up. We distributed birth control pills and we had many situations where the men were very upset about that. They took them from their wives and brought them back to us at the mobile clinic and felt as if we were interfering with their families and their family planning. They were very, very upset about this. And so the women would come back to us and ask for the pills. I'm sorry? You'll have to conclude now. You'll have to conclude because you have questions and we need to hear the room for the next few persons. You can conclude and there's a couple of questions, but if you could just take one question from the audience, that would be great. Okay. So just to quickly wrap up, I'm going to flip to the next slide. Establishing a sense of community became an imperative way for us to bridge health care gaps and provide support and networking services for the women and their families in the camp. So, yeah, so now we'll open it up to questions. I will take one question and I think the question is really relevant here. Somebody asked, how could you all get registered to work there? How did that work? So I think that's the question that you came in and then we'll have to finish it. I'll answer that. So it's an interesting situation with the refugees. Most providers are not registered. For example, in Greece, only physicians are registered. We have not been able to find a legal way to register midlife and it hasn't been required. When most of the situation with unlawful, we were working toward that, but then they switched. Everybody was moved to the mainland or most people. And what we have found is that registration occurs depending on where, what location, which camp. It is almost impossible to do. So no, we are not registered as midwives in that situation. The midwives that work with NGOs that are registered in Greece go under their requirements and their rules and regulations and whatever they have set up with the government in that location. The independent midwives are working independently and a lot of the NGOs, in fact, I would say the majority of the NGOs doing the majority of the work are actually not registered. While you will find there are a lot of registered NGOs, our assessments have shown that the NGOs reaching the most people in Greece at least are not registered. In Turkey, it's even more tricky. They're not even allowing NGOs to register right now. In fact, you may have heard in the news recently the arrest of a lot of international medical corps volunteers who were legal and registered. A lot of NGOs are being kicked out. So no, nobody is registered there. So it is an issue and something that we talk about with our midwives that you are potentially exposing yourselves. You are working in an area where you are not licensed. We ask midwives to not practice out of their scope of practice. And yet we also know that that's also not a reality sometime when you have somebody coming to you with a serious health condition and the hospital is absolutely refusing you care. You know, ethically, we do not feel we can turn these people away. So those are the issues. I'm not sure about Lebanon, but I have a feeling it is the same because it is what we are finding everywhere. We are registering as an NGO in Iraq and are very excited about that. And then we will have to see how that works with our midwives. Midwives that work with Midwife Pilgrim or that we send to other NGOs are licensed in their country of origin and have gone through specific trainings that we require. And we're actually going to increase those trainings. We do not send people that are not ready or have the ability or without the licensure. We feel that that is very important. Does that answer your question? I believe it was Joy Kemp who asked that question earlier, but I hope that answers your question. Okay, that's great. You can finish off Midwife Pilgrim. Thank you so much for such a wonderful presentation. It's a very moving and important provision that you're providing there. I really appreciate you. I'm going to go ahead and...