 We'll give you the microphone at the end of the session if you have a question, if you have raised your hand. Okay, so hopefully everybody is ready to go. I know our speakers are, so I'll just introduce the speakers. I turned it on. So our speakers today are three. The first speaker is Yvonne Simpson. Yvonne is the immediate past president of the Thoreoptimus International Federation of the Southwest Pacific and Project Liaison Coordinator. She's a member on the Committee of the Birthing in the Pacific Project, and in her personal life she works for Westland High School in New Zealand, director of international programs and career advisor. Our second speaker is Judy Malep, and Judy is from Papua New Guinea and is a member of the Thoreoptimus International of the Southwest Pacific. Her role in the organization is the national representative of Papua New Guinea, a member of the Ramu Club, and she's also on the Committee of the Birthing in the Pacific Project. In her personal life she works for Ramu Sugar as a Supply and Logistics Manager. And our third speaker is May Lamont, and May is the Thoreoptimus International Federation of the Southwest Pacific Project Manager. And in her personal life her background is in education, specifically that of teaching, the teaching of English as a second language. So welcome ladies to the virtual International Day of the Midwife, and we really look forward to your session. So Yvonne, I will hand it over to you. Thank you Gillian, and welcome everybody to our presentation on our Thoreoptimus International of the Southwest Pacific Project Dressing in the Pacific. This is based in Papua New Guinea to address the issue of maternal mortality. The federation project has started with support from our federation Thoreoptimus, and we had clubs in Australia, New Zealand, Mongolia, Hong Kong, Thailand, Cambodia, Indonesia, Malaysia, Singapore, Fiji, Samoa, and the Solomon, plus Papua New Guinea. Thoreoptimus International is an international organisation of multi-grave and business and professional women in 127 countries. We had general conservative status for the United Nations at UK SOC. Our mission is to transform the lives of women and girls, and our focus is on education and our freedom of Thoreoptimus education to lead. Now Thoreo means sister, and Optimus means the best, and so together they combine to mean women working for the best of women, and we aim to educate, empower, and enable women and girls to reach their potential. So having a safe delivery as a mother is one of those objectives. Our presentation today is for Gillian. Gillian earlier will come on next and see us from Rama, and Gillian has been a fantastic support person on the ground in Papua New Guinea. She's an amazing Thoreoptimus. I'm from New Zealand, and as you introduced me, I am the project liaison, and may be from this one, she is the project manager. Now we chose Papua New Guinea as a focus because we have three clubs there, Leigh, Ramu, and Port Nordby, and they are passionate women about maternal care and can provide the work on the ground. And the criminal mortality rate in Papua New Guinea is the highest in our federation. In Papua New Guinea, 100,000 live births equate to 733 women, mothers who die as a result of birth-related factors, and most of these are preventable. It started as a proposal from a modern plan for Optimus International Business on Columns, and was developed through that by our then-project manager, Janet Eston from Townsville. She's been in these photographs. And Janet was passionate about literacy and has done a lot of work to get our project to the stage it is. The appeal attracted that attention that our international president made it to the International President's appeal, and so this project went from being supported by our 13 countries to the 120th event of the International Organization. So we have well-supported biases around the world. Our goal is to make a difference for Papua New Guinea mothers and contribute to the United Nations' Development Goal No. 5 to decrease maternal mortality. So I'll now hand on to Jeanne Neely-App, and she will try to explain a little bit further. But the women in this project are very active and passionate to make a difference, and we would like to take this opportunity to thank Janet Eston for her work. Hello, Jeanne. This is Jeanne here. Hello, Judy. Can you just move the microphone just slightly a little further down from your mouth? It was just a little bit blurry with Yvonne. Hi. Is it okay now? Yes. Can I just have a soul of hands? Is that better for everyone? Can you just say, say, Virtual International Day of the Midlife for me, Judy? Yes. It's under my skin, so is it okay? Yeah. It's still a little bit blurry from my end. Just try and drop it a little bit further. Hello. Is it okay now? Yes, that's a little bit better. Thank you. Okay. Excellent. Yep, you want to go ahead? Thanks, Judy. Thank you. Thank you, Julie, for this opportunity. The project that the BIP, the South West Statistics Optimist International started its project, the project is located in two areas in Papua New Guinea. One is in Ramu, and the other one is in Lehi. The project means a lot to us Papua New Guinea women, and there's a lot of challenges that Papua New Guinea women face, and one challenge would be the geographical location of the areas within Papua New Guinea, as you know we have 850 languages in Papua New Guinea, and the isolation of the remote areas makes it very difficult for women, especially women are pregnant mothers to travel from the isolated villages down to the nearest aid posts or health centers. And in Papua New Guinea we have limited number of health centers operating within the rural areas, and quite a lot of these health centers do not operate, do not have the delivery facilities or birth facilities for mothers are able to deliver. So a lot of them would deliver in the villages, and again when they deliver in the villages the other women would help them to deliver, and that makes it so possible for them to deliver. The other challenges that mothers face are not enough money to pay for a book, to go for antenatal visits to the clinic or health center, and a lot of times these mothers just to get money to pay for that they have to go to a nearby market to sell their corpse, and they need to walk all the way from where they are, they need to cross rivers, even over mountains, and then to the nearest market, and to sell the corpse it doesn't take a day to sell all the corpse, and it takes about a week to sell the corpse. So these are the things, whether they get enough money to pay for the antenatal visits, or even they pay for their deliveries, because when they deliver at the health center it will cost them about $15 to $20, which is equivalent to $3 to $4. So these are the very important points that I've mentioned. These are the challenges that women face, and I will tell you a story for mother of how she traveled from a rural area called Tauta Village, and that is in Medan, and now she managed to get down to the health center. Unfortunately, she couldn't make it, and it took her two days to travel from where she was, and she delivered on the way. Unfortunately, she delivered the baby but the baby died, and she was hanging. They couldn't cut the umbilical cord because there wasn't any aid post-audility or someone who can assist to help her, and so she was taken by a husband and uncle down until they reached the road, and she also passed away. And they didn't know that she passed away. She was in the ambulance. Fortunately, she had made it to the hand-by-road and took care of the health center, and she lived her life. So that was another very, very sad story that she had gone through. The families who say they can't do anything, they cannot complain to the health center about what has happened to the woman because everything has happened that way, and even it's not only them. Other people that come to the health center, especially mothers, when they die, they cannot even complain or they cannot say anything. They just accept the fact that they lost their loved one. And why this training was important and we targeted the village that attended because we saw that the village that attended were the majority of them helping to deliver this woman back in the village. So that's why the project was targeted at that. So the village that attended, known as the local or the traditional, traditional breast attendants, they attend to women back in the village. And we brought this training up so that they are secure and they are taught to use the modern and clean tools and equipment. In the previous times, they normally used the bamboo to cut the umbilical cord and also they used the rope of the bush or the tree to tie the umbilical cord. And with this training, we trained about 39 village that attended and they've attended the training and a lot of them, most of them were illiterate so we also ran about literacy training for them and that was in talk teaching because a lot of them, they don't speak English, they haven't been to school. So that training was very fortunate to this woman and as soon as they attended the training, it gave them a lot of confidence now that they can help a mother to deliver using the modern technology and in a better and clean way using whatever was given to them. So one of the reasons we told the story was that she never knew that the job that she was doing back at home was just something like a woman going to the garden and she never felt so important but after when she attended the training, she felt so important, she felt that the role that she was doing back at home was very important that she needs to be acknowledged, she needs to be recognized by the community. And going back to the community, you cannot be made a very important person in the community. It's always the men, the men are known to be important in the community but this training has also taught them that when they go back to the community, they need to also educate or they need to talk to the community leaders to the men that that job that they're doing is very important. And a lot of these videos also face challenges that when they go and deliver a woman in another village, they need to work in the night. So this project, the upskilling program has also been given a set of equipment to use. I thought that they can use while they attend to a delivery in another village and that has really helped them and not forgetting, they have also been taught that they need to report back to the health center of how many babies that they have delivered. So far, about 39 babies have been trained. We had about 160 deliveries, all done without any complications. Half of them were delivered at the village and half of them were referred to the health center due to complications. But, you know, it shows that at least even now there wasn't any statistics kept in the past but we're trying to maintain that this project is a sustainable project and we want to live with the government to take that on board. Even though this project is going to go away, but still for us, we're still going to continue this project because it means a lot to us and we want the government to be very active involved and to know where we're coming at and to whatever plans that we want to put in there, they need to take on board and make it a sustainable project. The mobilization, during the reporting of the VDA, we did a mobilization program and upon the national policy of the VDA and VHB of the Health Department of Papua New Guinea, we had to follow a policy on the reporting of VDA. So we had to go to the villages in the community and they were the ones to choose which women were suitable to handle the job. It's not like we're just going and choosing ladies in the village now. It is through their community that they nominate the women who have been doing work within the same area, within the birthing project for almost 10 to 15 years and a lot of these women came to attend the training. They were in working, delivering medicine in the village from 10 to 15 years. We had quite a number of women in that sense, but we had a few of them away. They feel that they wanted to give back to the community and help the community. So far we, like I said, we had 39 village spread attendants, and we covered about 23 villages within the districts of the Utsino district and the Danhao Rau district. And also we went as far as Bogia in the Medellin province. So we've done a lot. We also came in contact with the World Vision which we are partnering with the World Vision. Like you can see as I've gone back, as I've mentioned about women dying, you see a lot of women dying. They reach the health center and unfortunately because there's no doctors there, there's no qualified doctors. So there's no assistance there. And also because they cannot get to the hospital. So unfortunately they die. And even now I'm talking, their mothers and ladies are dying. So I'll pass it to Amin. Go ahead. I am, I'm sorry. I am right to go ahead. Can you just stop your microphone slightly? This is a little bit blurry. We re-adjusted it. Is that better? It's still a little bit blurry. Just point it away from your mouth a little bit more. It's nowhere near my mouth. It's underneath my chin. Is that better now? I think that's a little bit better, yes. That's great. I'm sorry for the gap. I'm re-adjusting the headphones. They seem to be slipping. I'm Neil Mont. I'm the project manager of the Birthing in the Pacific project now. I was the assistant project manager with Jammuq before. And a company tour on many of her journeys. So the transition has been fairly smooth to my management. As you can see on your screen, the project developed out of the UN Millennium Development Goals specifically looking at the improvement of maternal health. But Papua New Guinea is concerned. You've already heard about the maternal mortality rate. It is very high. It's one of the worst in the Asia Pacific region. The Asia Pacific region, other statistics are better. But Papua New Guinea has been a nation now for 30 years. It has many difficulties that would compound being able to address this issue. But they are very aware that they will need to by 2015. As you can see, the implications for girls is very difficult. With a population of 7 million, 50% of whom are under 15 years of age. A facility rate of 5.6 children, which is quite high. Health expenditure, which is quite low, only 0.6% of the GDP. Whereas with comparison in other areas, the MOAs 4.9 and CG is 4.1, Australia is 8.8%, you can see that it's very low by comparison. The terrain itself that Julie was talking about, and you can see more slides here, is not the only difficulty where this project is concerned. Where the women are presenting pregnancy, the health of the women generally is a great concern. Many of the women are malnourished, suffering from TB or hepatitis. Anemia and heart disease are huge problems. Many of the pregnancies are too many. Many pregnancies are really too close. And they generally poor access to family planning services. There's also a campaign to really promote this. And a lot of effort being put into not only the improvement of the services, but the acceptance of family planning in itself. And of course many of these women leave it in extreme poverty. What I would like to say about the previous statistics is this particular project, of course, is covering none of that. The project is specifically looking at specific upskilling in various areas where the birth attendants are. And that word we're using generally to cover everybody from mid-wide community health workers down to the believed birth attendants that Judy is talking about. Where the lay province is concerned, that's where the SHI lay is in the Morabee province. And where that province is concerned, we could not start by looking at these statistics to build on the project. So that is why where the lay project is concerned, this concentration has been on two huge mobilization trips into very remote areas under very big difficulties in just the human district. They are building partnerships as they go along. This is the type of terrain that Judy has alluded to. And this is the focus for the project in lay. And as you can see with terrain like this, although the focus of all the programs, specifically the VBA program, is ensuring that in all possibilities, the first stage is to accompany these women to the health centers. Health centers are either not existent or the terrain is too difficult. We have to remember that 80% of the population live in the rural areas and many of them living in very remote areas. So the constraints there are being not only with transport though and access. These women have family roles. There are cultural constraints of going to a health center for a birth and of course as Judy has told you there is a cost. As you can see this young mother looks as though maybe this is her first baby and she actually looks very young. Many of the girls are married at 13. So this particular mother may well have a number of children that she has left at home and those children will be maybe in education more often than not, not because they're either the school is non-existent or once again it's in a remote area that they must walk to. Where the babies are bursting are concerned. There is a great difficulty with the gathering of statistics because there's a lack of registration and also where the maternal mortality figures are concerned. They really are quite rubbery. They are really a best guess and because many of the deaths are not recorded in the first place. Down in the market area these are the women that we are talking about that we need to within our project be resistant to the people who are working with them. So Optimist Internationally as you have heard are raising money for these projects. We also have a component of the project which is the major component and this is working on two national health departments, that's PNG National Health Department initiative. They set up a reproductive health training unit and there are two programs within that that we are beginning to assist with funding. The programs themselves are being run by the people who are experts in the field. Our role in that is really to assist in a very major component of the program actually and that's the provision of the teaching models and the teaching aids that are needed to ensure that that project works. So as part of the program, by the way the Community Health Worker Program is a pilot program in itself and it is quite unique there. It's hospital based at Mount Hargan. It's also a program that has an eight month course. It's residential and it's very much based on the practical work to give the community health workers who attend it experience a good practice as well as the lecture side of it which is a lesser component that occurs every day. So they get to know good birthing practices and the backgrounds in a good training hospital. The models that we've just looked at are models that will be distributed to the training hospitals where those courses have been facilitated. The resourcing of the midwives in the general hospital, this is one resource that we have found everybody has asked for and we are using this wherever training models have been given and the work villains that you can see there. They're also asking for many other things in terms of things as small as gloves for working even in the major hospitals. There is a midwives society in Papua New Guinea and we're helping to build that midwives society. The society itself is beginning to grow and that's a great joy to us. Where the birthing attendants are concerned who are in the villages to ensure that because their training is really based on good health and good practice yes they had to attend the birth and this is what will be contained in a kit that they will receive. There are other resources as you can see on the right that they will be given two quite simple resources that they will take back to assist them in their work. There is a huge emphasis on community support and so in the community centres that we are using we are also looking at what is needed in the community centres for the training to become much more professional. So in the goose up health centre which is in Ramu we have provided beds and also provided other equipment that they know are necessary. They know that they are able to use their training to use but that equipment doesn't exist and that's a stress actually not only for people who are at that midwife level it's a constraint for many of the specialised people who are working in the PNG health department. So our aim, our aim is safe and healthy mothers and babies but more than that we really are aiming that this project which has been today extended to 2016 as far as a project for our federation is concerned and the countries within this project is a one that we are hoping to build sustainability. The need is huge and will take many years to accomplish so as Judy has already said we will pass this on to hopefully the provincial government and the national government to take up as something that they can then perhaps sustainably support. We at the moment are doing this work with our own budgets mainly because the health department itself does not on the provincial health department do not have the money to facilitate this work themselves. They know for what they would like to do we are working within their programs we are trying to assist in achieving their goals so this doesn't stand aside. This is part and parcel of what PNG itself is aiming to do and within that though our hope is that in the end it will be a sustainable project. Oh Judy I'm sorry I finished. The time is up. Okay thank you very much for that May. That was an excellent presentation that was very clear your voice was lovely so thank you very much for that. Now we certainly have lots of questions coming through here so I'll maybe start with now her name on the thing is Tom down under so I'll just check. Tom would you like to ask the question you were talking about whether the high mortality rates were evident like quite a while ago as opposed to now. So would you like to ask that question. Thank you very much Hannah. I'll enable your microphone. I'm sorry I thought you were answering the question for that person. As I have said the statistics are very difficult and in fact many people who are working academics in this area are suggesting that we don't use figures at all. But of course we know how important they are. Statistically no the figures are becoming more and more apparent knowledge of the need and knowledge of what's been happening. Yes it's been known for many years especially by the professionals and the great deal of work has gone on behind the scenes in order to get the state government itself and the focus and the community, the big communities out there who are helping to fund this like I said are getting them more focused on this particular area. Excellent thanks Mae. There was also some questions that came through in relation to the training models that were used and someone made the comment that Ogade and who is supporting midwifery education. I think that was the rocker midwife made that comment. So are you finding that in all of the areas? You're talking about the Ogade funding. Just talking about the models that are used. You had a couple of models which I think were a prompt trainer and a thing like Natalie. Yeah that's Charlie Dolls and what was the question about those models? They're being funded through our project. We thought 60 of them and they will eventually as I say deliver back to people we have trained who will then use them to continue in their training in their training centres. That's great. Excellent. Yes we used the same model here in Australia so that's why I knew them so that's great. One of the other questions was around and we heard from the previous session in India that midwifery is taught as part of a nursing curriculum. There's not a separate curriculum for midwifery. Is that correct? The situation at the moment is very interesting in the country where the midwifery course is concerned at in the training hospitals where it still exists. There are four of them where it still exists because what has happened is the people who were up till in the past seven years who were attending those courses were not getting accreditation and registration. What happens now is that also aid has funded eight trainers from Australia headed up by Pat Brody who many of your listeners may well know and they are looking at the training component updating it assisting in that and so the hope is then that from now on that course will be a better course and the people finishing the course will automatically receive accreditation. Excellent. There's a question from Shannon and she'd like to ask a question. She's raised her hand so I'll just enable her microphone. Shannon would you like to go ahead? I think we've lost Shannon. I'm sorry. I can't read exactly what she's written. No, that's okay. She seems to have stopped off. Hello. This is Shannon. Hello. I just want to know that in India we have a lot of traditional midwives and government have started their training and now stopped but I want to know that what is one of the traditional midwives in your country? I didn't understand all of that. The line was very bad so I don't know what the question was. Julian, can you find the question? Yes, I think it was around the role of traditional midwives in your country. Yes, I think it was around the role of traditional midwives in your country. So the ones that were not or have not been trained, what is their role currently now in T&D? Are they still attending women? Many of the nurses themselves are instrumental in doing the birthing in the hospitals. They do not have midwifery training themselves but they become experienced in that birthing practice. There is such a lack of midwives in the country. The looking at retraining all of those women to get them all certificated is really too large. I have asked the figures how many midwives there are that are properly certificated midwives registered in the whole country and the figures have varied from just a little over 300 in the whole country to 270-ish within the public health system. Okay, all right, thank you for that. All right, it seems like Shannon's back. Sorry, Shannon, would you like to ask your question now? Yes, it takes me a second to get it on so you can hear me. Yes? I can hear you, Shannon, yes. There's a delay from back and forth. The question is, oftentimes those of us in the states are given things like this and so these little kits are told to donate or send these kits. And what we're trying to figure out is are these kits actually, are all of these items used per birth? Is this just something that people are doing to make them feel better on this side? Are these actual materials that you need? How are these being used in each individual birth? And would there be other things that would be better to send? Or are there different things that will be meeting real needs? Yes, the line once again is not good. I didn't understand all those questions. Are you talking about the slides that I put up to deal with the birth in kit that we're getting the midwives to work with? The one with the plastic? The one with the razor blade? Yes, the one with the razor blade. I think it was a razor blade. Somebody asked where the solar torch was. That, right there. Well, unfortunately, you've not got these slides that I've got in front of me that just say they're all scalpel. You've got one that says razor blade apparently. Scalpel is not a live scalpel. Everybody has seen the slide that you've got up here. May now called basic birth in kit with a plastic seat, soap, gloves, gore, square, string, scalpel and a seat to cover the mother. Are they all the items that are used? And I think she's asking, were there the other things that you would like in these kits that would be of more use to you? Oh, this is only in what's called the basic birth in kit. There are other things that these belief birth attendants go away with, disguise the limit not only with them but with the community health workers who are telling us what the situation is in their own health centers or they may be working in a clinic and of course there are also age posts here. All of them all need a lot of basic equipment which they do not have. I think when you said before that women have to pay $3 to $4 per birth and that's a lot of money for them and it's hard to find. From our perspective it just seems $3 is so insignificant for what we do and it really does make you want to, even if everyone donated $18, it's just such a small amount of money that could provide women with just basic items necessary to care. The interesting thing about that is that in fact there was a government initiative that suggested that in, which came from the women's movement, the NGO movement itself there, that there would be, that cost would be completely right. What I found in going back last time is it's not the case. Although there might have been government legislation, the people who are delivering the health services are the provincial government and largely, and they have the money, and largely the health centers and the hospitals are making their own rules. One of the reasons why they've retained having a structure for payment, and I agree with you, you sound very, very little to us, but if you're talking about a money employed person and you're talking about a person who is a sustainable farmer, that is a huge amount of money and the aid centers and the health clinics and hospitals are saying we're retaining that because in fact we are so short of other equipment that we in fact are using that money for that, and so they're very, very reluctant themselves to get it up. I know that there are, I've heard of organizations here in Australia who actually organize days where they get a whole group of people together and I'm not sure exactly what it's called, so if anybody knows please put it in the tab box, but where they actually have this making up of these basic birthing kits to send and I'm not sure they're sending them to Papua New Guinea, but I know that they're quite frequent around Australia. So does anyone know what they're called? Yeah, it's called Birthing Assembly. I thought what you might be calling the work that the Birthing Foundation in Australia is doing. And they are asking community groups to help them with assembling the birthing kits. They provide all the material. I actually attended one in Brisbane that was organized by Zonta and in that we had the CEO from the Birthing Kit Foundation there and we packed while they assembled the 10,000th birthing kit that they had sent off. They have their own way of distributing them and although Zonta provided that service they were not doing any distribution. We are going to link in with the Birthing Kit Foundation in order to set up within their organization the supply of birthing kits that we need. Lovely. Thank you very much for that May. It was a wonderful session and thank you very much to Yvonne and Judy and Christine being in the background for helping with the technical support. So thanks very much for those. I'll just go through a couple of the slides at the end.