 It gives me great pleasure to welcome you all to session 21 on the Rohingya humanitarian crisis stories from the field, and today we're going to hear from two wonderful midwives, Lorelai Morrow and Melissa Dore. Lorelai Morrow has been serving women since 1987 when she first began her training as a midwife. With years of experience in home and hospital care, she also volunteers in developing nations, providing care and training to traditional birth attendants, students and other personnel. She also oversees midwife pilgrims programming. Her personal work includes developing a curriculum to train healthcare workers and safe maternity practices in crisis such as the Ebola crisis, helping in Nepal and assisting with the refugee situation in Europe and Bangladesh. Our second speaker and final speaker will be Melissa Dore. Melissa Dore is a midwife originally from the United States of America. She completed her studies at Bustier University, which is in Washington state, and she qualified there as a midwife and natural path in 2002. Two years later, she moved to New Zealand and began working at a hospital in Auckland. In 2007, she became a self-employed midwife and a home birth collective. For the next 11 years, she's been a lead maternity care provider teaching education classes and childbirth, teaching midwifery students and completing homeopathy courses, and she also has a diploma in acupuncture. In 2014, she left New Zealand to travel and in her travel, she's met many midwives and has also worked as a facilitator while living and working at a mine birthing centre in Guatemala. She's also worked in Indonesia, also at refugee camps on the Greek island of Chios, and there she has also worked in Bangladesh and worked with volunteers during the Rohingya crisis. So it gives me great pleasure to welcome Laura Lai and Melissa. I'm handing the moderator button across to Laura Lai now so that she can take it from here. And thank you so much. We're very honoured to have you. Thank you, Jane, and thank you everyone for joining us for this discussion. I'm going to start by giving a quick history of the Rohingya crisis, and then we'll go to stories. Unfortunately, one of our midwives, Gina, is not able to attend, so we're going to be changing it up a little bit, so hopefully it'll flow smoothly. Among the most urgent humanitarian crises in the world, the Rohingya crisis has been growing for years as a Myanmar or as some people call it, the Burmese military has targeted the Rohingya tribespeople for ethnic cleansing. The Rohingya are a persecuted Muslim minority. Most of Myanmar is Buddhist. In the past months, actually, the crisis has exploded to epic proportions. The military has torched over 60% of the tribes' villages to the ground. Women and men have been killed. Women have been raped. Children also have been raped and killed indiscriminately. Because of this, over 700,000 Rohingya fled to Bangladesh. Many of them within a few month period, and this all began in August of 2017, the end of August last year is when the huge migration began. Bangladesh is a very small country, and so to have that many people show up at once has been quite a challenge for not only the Rohingya themselves, but for the Bangladesh on the ground working there. So we partnered with the Hope Foundation for Women and Children in Bangladesh, who happened to be in the area already with an amazing hospital, and they are being overseen and working with the UNFPA. So we're providing basic health care needs to the refugee population, setting up field clinics, providing maternal, newborn, women's health care, as well as mentoring and ongoing education. And we're going to share some of our stories, but we're also going to give you some really interesting statistics about this work and what some of the challenges that we've been facing are. This slide shows a typical day in one of the camps where it just seemed endless, the lines of women and even men and children showing up, and so it can be overwhelming. When we first arrived, we were one of the few, Hope was one of the few clinics there now. There are many, many more NGOs, which has helped the situation, but there's still much to be done. This is another example of one of the camps there, or the clinics there, I believe was the beginning of Balakali. We saw women, men, children, this infant in this photo actually arrived and was very malnourished. The mother came in just upset her baby, wouldn't stop crying. Come to find out this infant was about a month old and was being fed only three times a day because there just wasn't enough milk. This woman reported she had a toddler that she was nursing and just could not find the energy, the resources, or she was also malnourished herself to try to feed two babies full time. So she was getting her supplements of rice and sometimes milk and dribbling it in the baby's mouth when the other times during the day. So as you can imagine, this baby was severely malnourished. This was a situation that we saw over and over again. And while we do of course want to support breastfeeding on all levels, how do you feed a baby when you yourself are completely malnourished and there is no water to be had. Things are improving somewhat, but there still is not a good source of safe water for women. And so that's one of the challenges we faced. And this photo was immediately after a birth in one of the tents. Many of the women who are living in these camps and there are many camps there, but they've all seemed to have come together and created this huge area. It's quite overwhelming to look at when you're in one camp and you go to the top of the hill, you can see it just looks like tents forever. And then you go to the next hill and you realize, oh, you're looking at another camp that will do the same thing. So there are many challenges to providing care for women, especially during deliveries. And with how large these camps are, one of the issues is that women can't actually get to the clinics or the hospitals, especially at the beginning when there were so few and they were so far away. So if we heard about anybody who was in labor or who had had a baby, we would go up to them as soon as possible to help them. And this woman had just given birth when we arrived and everything was well. You can see how healthy and robust that baby is. What you can't see in this photo is how incredibly hot it is as well. So when I was there to do the initial assessment in mid-September, the average temperature was about 100 degrees Fahrenheit. And we would climb up to the top of these hills into these tents that were black tarps with no real openings. So they were like ovens themselves. And so you would have women who are in these ovens, basically, with no food, no water, and very limited resources. So those were some of the issues that we came across. And I'm going to start by talking a little bit more about that, including the sheer scope was unfathomable for us, and it still is in some ways. Just that number of people in such a short time is completely overwhelming. And I am very impressed with how well it's been handled, given the complication of the situation. Other barriers or complications or things that made it more complicated for us were language barriers. Many Rohingya do not speak Bengali or Burmese, but their own dialect. It is similar to one used in southern Bangladesh near the Myanmar border, and close enough for some of the Bengali midwives and nurses who could translate. But often there were gaps in times making it difficult to provide adequate care. In addition, we worked with a lot of Bengali midwives, and I'm going to talk about that in a few minutes. And most of them do speak English, but not fluently, and that sometimes there was some very interesting communication gaps. So it was it was very tricky at times. The access to care, as I mentioned, is what's difficult. There are more and more NGOs on the ground and people providing care, but they're just too many people to reach everybody. And the fact that the camps themselves are so massive that we, you know, it's difficult to reach people to make sure that they're getting the care. Many of the people that were targeted by the Myanmar army were men, and so women fled often alone, which makes this refugee situation very unusual. They, in most cases when we've worked with refugees, we've found that it was the majority of the population were male, but in this case, they were women and often unattended. And sometimes they would have their families and some did have their husbands with them, but the majority that we were that we were able to reach at the time I was there or not. And so one of the issues is that women were actually could not come to us to get care, whether they was prenatal care or care for sexual assault or they were in labor because they were afraid of losing their tents. If they left their tent, somebody else would take over and they wouldn't have a place to stay. And how desperate of a situation that is the vulnerability of the population. We've learned a long time ago that those who are most vulnerable women, children, elderly disabled, often cannot access care easily for a variety of reasons. And for some they are just not physically able to get to the clinic. And so that's been a challenge that we're working on. Cooking was a big issue for people and getting adequate food supplies, even though there were often NGOs passing out food, sometimes you would have to wait all day in line and then still not receive your food and then you have to go back. Sanitation is another huge issue that they are still struggling with. So a lot of the issues that occurred were related to that and the vector of disease that was being presented. So those are some of the things that that we found happen. I'm going to talk a little bit about midwifery and Bangladesh themselves so you can see why there are some of the challenges. In Bangladesh alone, there are 5 million pregnancies each year. And that is before the Rohingya moved in and Rohingya are in a very small area and I should have posted a map. I'm sorry about that, but I'm sure you can Google one and find a map to see what a small area this is. Most of the women in Bangladesh themselves live in rural areas where health care is limited or non-existent. And as of 2014, there were no legally recognized midwives in Bangladesh. This is very important because they're training approximately 500 midwives over the span of four years through a community-based midwifery diploma program, but that is very, very new. And so while we are midwives, volunteers that would come to support these Bengali midwives, these are brand new midwives and midwives that have learned in very rural areas. And now, all of a sudden, they are with 700,000 people and are overwhelmed. It's like being thrown right into the fire. And so there's a lot of challenges with offering these midwives the support, the mentorship, the preceptorship they need, in addition to making sure all the care is provided as well. I've been very impressed with the midwives that we've worked with and very proud to be part of this program. And they will be the ones who are providing the care long after all the NGOs are gone. So it's very important that we work with them to help them gain the confidence and skills that they need. The UNFPA is in charge of that program and they are doing a phenomenal job. Sexual and reproductive health statistics. So on-site blood testing, urine testing, and tetanus vaccination is still lacking in many of the clinics. And while it is improving often, improving each month, it's getting a little bit better, it's still a very, very difficult task. There are currently 15 facilities providing high quality 24-7 sexual and reproductive health services. As of February, so just a few months ago, there were an estimated 53,266 pregnant Rohingya women. So just that number itself is daunting for such a small area and for the few providers that are able to be there among the Bengali midwives and then the NGOs that have arrived. So just between February and May, so I guess between until now, they expected over 16,000 births. Out of that, about 2,500 pregnancies are expected to have obstetric complications. As of January 2018, 4,350 births by skilled birth attendants in the facilities were reported. But that does not include the births that took place in Tensor at home. We don't have a record of that. So some of the challenges of that are because, as I mentioned, getting to the camps or getting to the clinics is difficult at night. People don't feel safe and a lot of the facilities are closed. So the fact that now there are 15 facilities are open are better, but there's still a logistical situation of how to get people there because emergency transport is a challenge. The camp is situated in an area of very steep hills and ravines. Lights, there are no lights at night, no way to safely navigate those paths in and out while labor. And then there's a personal safety issues that women face in addition to the other issues. So we're also working with the traditional birth attendants of the Rohingya population to help them contact us, make sure that we are there to support them. And we have received a lot of calls, a lot of support in a really incredible working relationship with them. Hope itself, as I mentioned, the Hope Foundation for Women and Children of Angladesh trained the first class of midwives beginning in 2013 as part of a hub and spoke program funded by the British Department of International Development and in partnership with Brack University. It's a three-year intensive with classroom and field-based training. And the selected midwives are from rural area of Cox's Bazaar with the intention that these midwives will return to their local communities upon graduation to meet the needs of maternal health care in the surrounding remote areas. In that region of Cox's Bazaar itself, 90% of women give birth at home without the help of any attendant. So as I mentioned, Midwife Pilgrim has partnered with Hope Midwives, and it's been quite a great privilege and honor to work with them and with UNFPA. We have deployed 14 midwives to support the local efforts on the ground, including providing resources, medical supplies, physical support in the field, educational program, mentorship, and ongoing support. We've spent time reviewing the midwifery program and helping to identify gaps in knowledge and practice and provide supplemental teaching and hands-on workshop is another aspect of what we do. One of the most important aspects of maternal health care, especially in settings like this, is to identify the midwives within the community to empower them because they are the ones who will continue the care long after we've gone. As a midwife, as health care providers, we have a responsibility to educate and empower the local midwives. We have a responsibility to use our privilege and access to resources to extend that to those who do not have the same level of access to resources. We have a responsibility to lift them up and help them break down health care barriers in their communities so that they can carry on the work and make the impact. When it comes down to it, it is all about them. It is about what they can accomplish and how they can accomplish it. We are there to support them, to empower them, to give them a leg up in a set of circumstances that otherwise denies them of this. Thank you for your time and now on to Melissa. Hello and thank you for all those out there that are listening. I'm really excited to share my stories from the field. I was in Bangladesh for three weeks in December 2017 and I wanted to move on to start the presentation with this picture because this is where our day started once we entered the camp. This is the Hope Emergency Clinic that provided primary acute pregnancy and women's health care. The Hope Midwives worked alongside the Med Global Doctors and Nurses, which was another NGO that partnered with Hope. As you can see, it's a pretty basic structure. There's seven rooms for the Med Global staff and one for the Hope Midwives. It was really helpful to have this medical team working with us. If any of the women that we saw in the clinic or out in the fields needed medical attention, we knew who and where to send them. Hope had their own tomtoms, the little vehicles, so we could use those and provide reliable and free transportation from the field to the emergency clinics. This continuity of care allowed us to easily follow up with our clients and with the women and their plans for future care. Here is a photo of women waiting to be seen by the midwives in the emergency clinic. The Med Global volunteers were very supportive of the Hope Midwives. In fact, one day there was a woman that was in early labor and she presented to the emergency clinic and the Med Global team gave the midwives a room for this woman to labor in. A couple hours later when this new mom emerged from the room holding her baby, I think the doctors and the nurses from the Med Global were pretty surprised. I think that they were expecting, I don't know, maybe a little bit more drama or a little bit noise, but this woman just labored in births beautifully and she was very well supported by the Hope Midwives. So here is a photo of one of our favorite tomtom drivers. You can see that they're very, they take a lot of pride in their vehicles and love to decorate them. And a photo here of the birth that I was just talking about. And I did learn that I found out later that that was actually the first baby that was born at the emergency clinic. Hopefully that was a turning point and that they've had more births there. So like I mentioned before, we started our day at the emergency clinic. That's where the van from Cox's Bazaar dropped us off. And from there we had to take tomtoms to the field clinics because most of them were in very remote locations, down narrow steep muddy tracks. At that time, all the clinics were staffed with Hope Midwives health care assistants and interpreters. And thanks to the previous midwife program volunteers, the clinics were very well organized and well equipped for births. They also had solar panels and which meant that they could, they could put fans in there, which was very well appreciated by all because like Lorelei was saying it was incredibly hot there. So this is a photo of the clinic at Balukali. It's the largest and the busiest field clinic. This is also where we held the weekly teaching sessions for the Hope Midwives. So there's a photo there of one of the sessions. There was an outbreak of diphtheria in the camp during my time there. So on this particular day, the med global doctors came to one of our teaching sessions to this teaching session and gave a talk to the Hope Midwives about diphtheria, the signs, the symptoms and what to do in a suspected case. So by the time I got there, the Hope Midwives were pretty confident providing antenatal care and they were running the clinics independently. The Hope Midwives were less confident in when they got called to emergencies or to births in the tent. So one project that I took on was to assemble emergency birth kits as sort of grab and go box to take with them when they got called to a birth or an emergency in the field. And I also held the teaching sessions explaining what everything in the box was used for and did some practice scenarios. And as you can tell, a little support and encouragement goes a long way. As you can tell from the proud faces on these lovely two midwives alongside their new emergency birth kits. So ironically, the very next day, we did have a husband arrive at the clinic asking for a midwife to come in to see her wife who was in extreme pain and bleeding. So one of the Hope Midwives and I jumped into the tomtom with the husband grabbing one of the Hope escorts as well to help carry our gear. And we hiked a fair bit in through the camp to get to the tent where the woman was. And so I wanted to include this photo so that it gives you an idea of what it was like trying to navigate your way through the camp and finding your way back. So now I arrived at the tent. There was this mom that was lying on the ground with her newborn baby wrapped beside her. And as we enter the tent, there was this very proud auntie or grandmother that started talking to the Hope Midwives explaining what had happened patting her chest and smiling proudly. And I thought, aha, this is one of the traditional birth attendants. And she wasn't worried about the afterpains that the new mom was having. And she wasn't worried about the bleeding because she knew that the afterpains were what was necessary in order to stop the bleeding. And she was explaining this to us. So it makes you wonder, why did she summon us to come if she wasn't actually worried about anything? I've heard from other midwives that the traditional birth assistants are very proud of their badges. They have these little badges sort of recognizing their qualifications. And they're really excited to meet the local midwives. Or maybe she knew that we were going to bring postnatal supplies like pain relief. We would usually take pain relief, rehydration crystals, some undies for the mom, some food and some biscuits for the other children. So whatever the reason was, we were glad that we got to meet her. It was really an incredible experience. And there's the traditional birth attendant there with her badge and with the new mom and baby. So Lorelai has already spoken to us about many of the reasons why, many of the obstacles to why we were not able to give a lot of maternity care to the refugees. And so I'm going to not go into that. But what I will do is just finish out by showing you a couple slides about what it was like sort of to be in the camps. I do get asked a lot about, you know, what was it like to be in Cox's Bazaar and the refugee camps? And really all I can say it was like nothing I had ever seen before. The UN presence and the number of NGOs that was there and the scale of aid was just massive seeing the huge trucks every day with the water and the food and the supplies. It was just absolutely incredible. So this is a photo of a queue of the refugees for a food drop. And this is something that we would see every day was absolutely amazing. One afternoon I had some time to walk around and visit some of the other NGOs and there were two of them that really stood out that I just wanted to share with. So the blanket supplementary feeding program funded by the United Nations World Food Program was in one of the tents and their goal was to identify vulnerable persons, pregnant women, new mothers and children between the ages of six months and five years to provide them with supplementary feeding. Regardless if they've been identified as malnourished kind of as a way of preventing it. So the worker that I spoke to said that they feed over 300 people a day is the amount of food that they're handing out. So it was pretty incredible. The other thing that was really interesting is that although there was these lines of, you know, mums and babies, you would think that you'd expect a lot more noise, especially if they were children, but it was actually just dead quiet, which really gave you, you know, really sort of sunk in about how malnourished and how these children and babies weren't thriving. So I'm pretty sobering to hear that. Sorry, this slide is out of order here. So the other NGO that was there, the UNFPA had a women's safe tent that I visited where they provide talks to women about gender based violence and offer counseling to those that have been victims of gender based violence. And on this particular day, they were celebrating a 16 day of activism against GBB. The tent was decorated with banners and paintings you can see here, and the women were singing and they were joyful and they were smiling. And it was just really stood out because you something that you just don't see in the camps you don't see joy. In fact, my impression was that these people were just not only in despair, but they were just in shock and just sort of had a bit of a blank look to them. Okay. Okay, so the last slide here depicts two big concerns facing the refugee camps. So how quickly the camps are growing and the inevitable monsoon season so I borrowed these photos for my friend Mike Kai, who's a photographer. The photo on the left was the latest area of expansion of the Kuta Palang camp at that time. So he told me that when he arrived just one week later the hill that you see in the background was completely covered with a sea of tents. And so this was sort of the magnitude of how quickly the at what rate the camp was expanding. And finally the photo on the right gives you an idea about what the land and the terrain was like in the camps that the camps that are built on. And these tents are actually really flimsy structures and so they're just bamboo and plastic. And so in monsoon season comes with heavy rains and flooding. There's potential to be absolutely catastrophic for the camp. The winds would destroy these flimsy makeshift tents and the mudslides from the rain could potentially just wipe out villages so that's something that is really being addressed at this point. So that's all that I have for my presentation. I hope this gives you some insight into the ways that Midwife Pilgrim has contributed to the Rohingya refugees midwifery in Bangladesh. And it gives you a glimpse of some of the realities of this devastating situation. Again, thank you so much for listening. Thank you so much to both of you and it's been a really, really active chat board. I know that you've responded shortly to it, but one of the questions that did come up earlier. Can you speak about how you both felt coming from a very perhaps westernised eye to going to places which are very low resource? Can you talk about the shock of that when you first arrived to start doing your work? Because I know you're both very experienced aid workers, but how did that really impact you? Hi, this is Lorelai. You know, it was interesting because it is a low resource area, but many of the areas that Midwife Pilgrim volunteers work in are low resource. So in that sense, it did not seem much different. We brought a lot around medications or certainly hope is providing a lot of support the UNFPA. There's something called the minimum initial service package that I recommend all midwives get training in, especially if you want to do this work. And there's a lot of resources available through that that we were able to get through the UNFPA. So in that sense, it was, it was, it didn't seem that different. What was different to me was the sheer numbers in such a quick amount of time with and by the time Alyssa got there, it had expanded tremendously to not only with more people, but also more NGOs. When I was there, few NGOs, at least a half a million people, very few latrines, no safe water sources at all. And that was the part that was very different from my perspective was not so much the resources in order to do births. And I tend to bring what I need anyways, just so I have it. But the number of people that we were going to have to try to possibly assist and how to begin with that and how to reach them. But in that sense, there were certainly wasn't enough resources if everybody showed up at once. Maybe Melissa has more a different outlook than I did at the time. Not sure. Hi, it's Melissa. I completely agree with what Lorelai was saying. I mean, I had done work in the Hills of Guatemala and in Bali in some remote areas. And even here in New Zealand, but by the time I got there, there was a lot of organization. There were these field clinics and they were, every day they got medications and supplies from UNFPA. And the UN had had lots. I mean, there was so much UN involvement at that point that we were seeing, you know, most people had water and food and what they needed. But again, it was just the rate of people. It was just because so many people came so quickly and the way that they had set things up. It's just, it's just not really sustainable. And I would have to say that the most overwhelming part was just the vastness of it and just how many people there were there. And it just went on and on and on and on. It's just really hard. I don't know, Lorelai, if you agree, but it was just so hard to fathom how big the camp was and how many people were there. And I think the most difficult, I think, part of for me was just hearing some of the stories and just really getting the sense that, you know, they're coined as some of the most unwanted people in the world. And it is just, it's just, it's heart-wrenching. It's really, really just quite a situation. Yeah. I agree. It was incredibly overwhelming. And, you know, as I said, when I would go to the top of a hill, you know, and it's hot and I'm climbing and I finally get there, and I couldn't see the end of the 10. And you realize I was in one small area. It actually made me cry. It was so overwhelming. Yeah, I guess that's the word. And there's been a couple of comments and I know Celine had a specific comment and I know Lorelai has replied. Could you speak a bit about third stage management to use any kind of medications or what's the usual management of third stage in this situation? Well, Bengali midwives are taught to use active management of third stage just in their training. And so that is what is required and expected given the malnourishment of these women. I think it's a very prudent idea. However, as you know, most of the women are not delivering in facilities with any midwives or possibly they have their traditional birth attendance but are not having any management of care. We can't speak to that. But the Bengali midwives do carry oxytocin. When it is available again, you know, that is true. Sometimes it's not available. But they do carry it and that is how they would manage the third stage. There were some pretty severe hemorrhages that some of our midwives encountered. In fact, when I was there, no, it was soon after I left, there was maternal death related to third stage management. Sadly, while I was there, and I was there for a short time, as I said in September early October, there were two maternal deaths that we knew about. Third one happened while I was there. Fourth one happened soon after I left. Those are the ones we know about because they were in facilities. We can't speak to the ones we don't know about. So, yeah, I hope that answers your question. And there's a couple of questions. Cindy Nellie asks, do you know what the pregnancy rate is there? She's saying, can you hear about the M? I just, I just wrote it back. So usually it is about 4% will be pregnant. I'm not sure what the exact percentage is. We have a general idea, remember, of about 53,000 women are being pregnant as of February, which is about, what is that, much, much higher than 50%. I'm trying to think that if there's 700,000 and 50,000 are pregnant, the difference is that this population, the majority are women. Usually in refugee populations, they are mainly men, as I mentioned before. And this is very different. Also, a lot of the pregnancies, especially when I was there, the report of sexual assault and rape was astounding to me. You know it happens. You know that it's a high percentage. You know that's one of the devastating aspects of these kind of situations. But to hear story after story of the Myanmar Army and how they would rape these women. And then by the time the women got to us, they would be pregnant and find out that. So I think that may have a lot to do with it as well. But again, I don't have exact numbers. I would like to answer Celine LeMay's question about resuscitation, if that's okay. That'd be okay. Celine LeMay asks, any technology for resuscitation? Here's what gets interesting. Yes, we would like all midwives to have at least a bag and a mask. And that is encouraged whether or not they have them. That's debatable. Some of the clinics do, some don't. Though one of our jobs was to make sure that every clinic, every midwife that we were working with had their own bag with this information. You've got to remember Midwifery is very, very new to Bangladesh. It just started. And you're in a country where the majority of women live in rural areas and don't have access to health care and give birth on their own. And a lot of these midwives are being trained in settings that are very different than westerns. For example, in the hospital, it's very, you know, you get your pitocin, you get your miso, you get your IV, you get your episiotomy, they pull the baby up, boom, and then they sew you up and you're gone. There's no postnatal care, things like that. While resuscitation is taught, it's not something that is done often because a lot of the clinics, the facilities that midwives work in don't have all of the resources they need in general. So, and now they're coming to these camps and these clinics and while we're working on it and the NGOs are doing a really good job, it's still something that the Bengali midwives are, some feel very confident in it, some don't. And so that's one of the programs that we've been working with is teaching, helping babies survive the HBB portion, helping babies breathe, and so that the midwives themselves feel very confident and feel better about it. But it's not, it's a different world and different, you know, when you're not, when you don't have the equipment, you do your best as Celine saying, doing mouth to mouth, I would not recommend that. There is a very high HIV rate in this population. So, yeah, mouth to mouth would not be good. So that's one of the things we're working on is getting, making sure all the equipment is there, and making sure that the midwives feel very confident in how to use it too. And so far they've been doing a great job in the trainings that we've been part of have been phenomenal. Are there any other questions? Well, I think you've really had a great response here. People are very impressed and it seems like you all are doing really powerful work. They are really empowering women and families with your work. Absolutely. And by the time that we got there and even over the three weeks that I was there, you could see the clinical skills of the hope midwives just really improve. By the time I got there, that was the majority of what I was doing was spending time with the midwives mentoring them and not doing so much sort of hands-on clinically myself, but actually just helping, you know, working alongside them and doing more education. And what I found is that their program is in English and the students, the midwives that were actually doing really well were the ones that understood that English better and then the ones that were sort of struggling with English. I think we're also struggling with some of the clinical skills, which I think is really understandable. And again writes they didn't, they were lacking in some clinical skills, but they just didn't have the equipment to be practicing with. And so, you know, they do the best that they can. But once we were getting equipment in and they were the clinics, the field camps were well stopped. They were doing a great job doing, you know, routine antenatal care. And the midwife that I worked alongside for that birth was, it did a phenomenal job, very, very hands-off, very compassionate, very good care. And it was, yeah, it was just a really, really lovely experience. Well, that's great. So we're just going to finish up now. It's about 10 of the hour. Our next speaker will be over in room two. Well, we've got a few minutes. We do have wonderful posters over here. And Susanna's got a great resource here. She's got some newborn respiratory bundles. And there's a link right there if you want to access it. Also please access midwifepilgrim.org. Also look up PBS, which is public broadcasting service in the United States of America. They had a recent many features on the Rohingya Muslim crisis. So thank you so much. You've given us so much food for thought.