 We go. So I'm just going to run through a few housekeeping things first. Are we missing a few slides? It appears. I would just like to thank the University of Lillibet in Denmark for the use of this Adobe conference room and also the Association of Radical Midwives. And if you need any help with setting up sound, you click on the little if you need audio setup, you click on meeting and then you complete the audio setup on the drop-down menu. To switch your microphone on you press the little white microphone at the top and you select your speaker and we should be able to hear you. If you'd like to select a status, you can click on the little drop-down menu of the man with his arms up and you can applaud. And if you would like to ask a question we would love to hear from you. Please raise your hand and then afterwards you just clear your status. We love chat in the chat box and I see Trisha's also got a dog that she's had to send to another room. You just fill out the chat box it will be taken down and saved so we can use it down in the future. Have I remembered everything Deb? So you did a brilliant job. Okay so now we have the lovely Trish Ross from California. She has had a long career in training and organizational development. In 1995 Trish was ordained as a deacon and at 53 Trish trained as a midwife. Currently Trish works as an education director of Midwives on a Mission of Service. You can see their slide up on the screen and at the moment they work in Sierra Leone teaching birth attendance to broaden and deepen their knowledge and encouraging them to become community change agents and maternity care providers. So welcome Trish. Thank you very much. I am hoping that the story of what moms does is something that everybody can relate to to some extent or another. Making change happen to improve the care that women get is important and I think it's a worldwide issue. I really want you to ask questions. I'm going to tell you some things about what we do, what we have found to work. I'll also talk about some of the problems that we face and hope that we can learn from each other. So if anyone has some ideas, questions, comments, please either put it in the chat or wave your hand and I'll be glad to address the issues. Well, that's kind of what I was just saying. It's really easy to do a lousy job of training. Most of us have the experience of having some really terrible teachers in their lifetime and it's a shame. And in the case of dealing with the traditional birth attendance of Sierra Leone, which is where I work, usually it is the women group that gets the blame for not learning. Midwives and Missions of Service is a teeny tiny little NGO. Our annual budget is under $40,000 which is a rounding error for many of our larger colleagues like, say, the children in the World Vision who are also working in Sierra Leone. Sadly they don't have the kind of results that we do and it's interesting and that's one of the things that I want to address is what makes us with our low budget and really in some ways an efficient methodology a lot more effective than some of the folks that have a lot more money to put into this. We have made about 15 trips to Sierra Leone since 2006. In November of this year will be our 10th anniversary in Sierra Leone and we're going to have a big party among all the women that we've trained. We've actually trained over 290 women. The government wants us to call them community health workers so we do. The women want to call themselves traditional birth attendants so we do that too. So I'm going to use both terms and I know that both of those are fraught. They're emotionally related and I tend to use the term TBA because that's what the women want me to call them and so I do. We've worked in seven different classes and over the 10 years we've had some timeouts because of world economic conditions and personally almost going bankrupt during 2009 and that set us out. We also had a year and a half layout during Ebola because of my age I was not permitted by the government to go back into the country. I'm 64 now and they would not let people come in over the age of 60 to be volunteers so that really hurt us and our work and slowed us down. But even so we've made some significant differences. Here are some quotes. I think throughout these presentations you guys are going to get a lot of numbers so I was excited to give you some words about the effects of what we do. These quotes come mostly from the medical health team at the district level and for those of you not familiar with Sierra Leone's policy, the district is like a county in the United States or perhaps a parish in some states where it's a smaller than a state and there is a district medical officer and a district medical health team in charge and they're the folks in the government at the part of their Ministry of Health and Sanitation that we work with. These are also quotes from the paramount chiefs who are the regional kings and some regular folks. Basically they're happy with what we do and they want us to do more. We have four primary success factors let me say that differently. There's still things that we do that seem to us to be the things that differentiate us from other people and contribute to our success. As time goes by I figure these things out a little differently, gain some insight and talk about them differently but this is where we are now. The most important aspect is relationship building and this is part of why we have a hard time getting grants because the grantors look at our model and say this is too relationship intensive, you have to keep going back, you have to keep spending time with these people and that's just not the way we want to do, it's not effective. We've been told if we used more technology if we used fewer people that or if we did a one time training and didn't go back and do continuing education that they'd be much more likely to give us grants and those are part for us are integral part of our program and we're not going to compromise on those things. I got some input to put the mic away from my mouth, I'm sorry if I'm spitting at you guys. Another success factor from my perspective is we use really good teachers. There's an ongoing discussion in the field of training which is actually my professional background between the subject matter expert sharing knowledge expertise and the professional trainer who is often perceived as somebody who doesn't really know anything. And what we try to do is find someone who has both sets of skills. Somebody who knows lots and lots and lots of things but can't communicate can't teach effectively is not, is wasting everybody's time and if you don't know what you're talking about you're also wasting everybody's time. So we look really, really hard for people who can teach, who can teach using adult learning methodology and do it right. We also provide structure for ongoing support. We talk about some agencies that parachute in, do their thing and then bug out using military language. We don't do that where we make a commitment for the long term. The long term commitment is not to build dependence. It is not to, we don't take over their jobs. We don't do their work for them but it lets them know that we are with them, that we are as committed as they are to doing the work and making the changes that need to be made. That we will support them. This is something that's really a key, another key factor for us and that has to do then with continuing and deepening the relationships. So we face a lot of questions when we talk about this and how do you build relationships across cultures and distances. I live in Northern California. I'm three to four hours away from San Francisco international airport. Then I have a 12 hour flight, 10 to 12 hour flight into Europe, a layover and then a 7 to 8 hour flight into Freetown and then a 4 to 5 hour flight that drive to our headquarters in Bowell and like on this last trip we had an 18 hour drive to the site of our training. How do I maintain a relationship with these folks and the answer, the short answer is it's hard. It's really hard. Another big issue is prioritizing the various groups of stakeholders. The Ministry of Health has some really strong opinions about how to do this work and what they want to see. The women who are pregnant have really strong opinions about how they're cared for. These opinions often differ and we balance that. When I talk about reciprocity, I'm talking about the whole notion of post colonialism. We insist that we have a reciprocal relationship between moms and the women that we train, the TBAs and we build relationships between the two of us and then we also loop in the district health team, the district medical officer, the paramount chiefs the local village leaders, the leaders of the women society and we sit down together and hammer out a relationship from the very beginning and then we work to maintain that and again it's hard. We build relationships one person at a time. I delivered this baby by accident. I typically don't deliver many babies when I'm there because if I do, it sometimes sends the message that the local people are not adequate or that for some reason or another I need to do it and it also sets up a strange dynamic where people will come in and want me to deliver the babies. I don't want that. I want to elevate the status of the women that we're working with and if I'm going in and delivering babies, that doesn't happen for a variety of reasons. This baby was I was in the clinic answering some questions from the staff and a woman came in pushing and I delivered this baby and it was premature probably gestational age of about 34 weeks and here it's several weeks old and she's thriving and doing well and I just couldn't resist cuddling her. That's how we build relationships. One person, one baby, one woman, one of our learners at a time. This is a woman who is now the newest member of the mom's leadership council and she knew that she was supposed to do prenatal exams but she didn't know what she was looking for and so in spending some time with her and letting her listen and talking, okay so what are you hearing? Tell me what you're hearing and so she's beating out the heart rate that she's hearing and we're talking about how to discriminate between the mothers and the fetal heart rate and she didn't know that you could do that so it's taking that time and interacting with them one on one and doing this kind of teaching that's side by side and you know sweating together in a tiny little room that's 95 degrees when it's raining outside and learning to work together like that is critical. This is one of my favorite pictures, I'm sorry I had to show it. One of my favorite volunteers she had never danced before, she was brought up in a religious organization that did not support dancing but it is common for the women to dance and I dance and the other volunteers usually dance and so this volunteer decided to dance too and she was really having a great time. There's a question in the chat for Monique and member of what, I'm sorry I didn't hear it up and I'm not sure to what you're referring so if you could clarify your question I'd be glad to answer it. Hi Trish, Courtney has her hand up. Oh I'm sorry. Can I ask a question Courtney? Yes. That's alright I will give you the microphone Courtney you're up. Hi Courtney, ok if you go to the top you see where the microphone is you select the drop down menu and select your microphone and then you click on the mic to make it turn green. Ok well we'll keep trying Courtney, you just let me know if you'd like the mic back again. Ok thanks Courtney for trying, if you can get it go for it. I talk about instructional soundness a lot and it actually has a technical definition but briefly it is effective training and there's a lot of factors that go into making it effective and there are training geeks that get PHDs in this kind of stuff and part of it is to we make sure that we have professional trainers develop and edit our programs and validate them. With my background I am a professional instructional designer and was for 25 years and did organizational development consulting so this whole notion of how people learn, how people work together to form an organization that works is something that's kind of in my wheelhouse and the other primary person, the president of moms also has a background in education and she has a bachelor's degree in education and an MBA so this combination of business and education and midwifery we're able to bring that all together and ensure that everything is done well. How do we set effective criteria for volunteers and this has been a trial and error and we've made some mistakes fortunately I've managed people in my previous career for a bunch of years and I made some terrible, terrible, terrible hiring mistakes, very nice people in most cases but just a lousy hire and I learned how not to do that over the years and I try to apply those things here when we talk to volunteers and I'll talk a little bit more about that A third question is keeping clear on who the client is and there's a lot of nonprofits that start conflating the volunteers with the clients and they start redesigning and shifting their program around to accommodate the desires of the volunteers and we kind of hard-nosed about that and we just don't do that and if that means that Chris, the President whom I referred to just a few minutes ago, if it means that she and I are the only teachers on the trip, we're the only teachers on the trip. We prefer to have more. We take small teams because the villages we go to are very small, very poor and a team more than four or five people would overwhelm the village. It would cost them money and set them back economically for months to have us there so we kind of don't do that. Teaching effectively we choose people who have proven themselves to be effective teachers, to be thoughtful and have appropriate experience and we just, as I mentioned before, we just simply insist on that and it's hard sometimes. We have taken some younger people and they have been good and we've taken some younger people and they are just really in over their heads. Part of the issue is that Sierra Leone is the poorest nation on earth and has the world's worst maternal mortality ratios. The maternal mortality rate is 1,360 per thousand and it's a hard place to work. It's really hard. Recorders of the population live below the official World Health Organization poverty level and it's grievous to witness that. Here we've got I love this volunteer. She's demonstrating, she's being the patient or the client while the learners are practicing how to work with her, how to treat her more gently, how to offer support in labor. This is a concept that's utterly new to them. They've never done this kind of thing before. It's just not something they know how to do. We take them a lot of opportunities to handle our bodies and to let them experiment with us. Somebody will put counter pressure on my sacrum and it's like wow that's too hard. I'm able to give them good feedback. This kind of modeling and this kind of hands-on interchange with them is something that we do and you can see the smiles on the faces of the other learners that they're really enjoying. Yes, it makes it memorable. In this particular class, only one woman spoke English. Two people, two of the women had attended some kind of school. The more experienced scholar there had gone up to the sixth form or the sixth primary, sixth year in primary school. The other one had dropped out of school in the second year of primary school. So we're working with women who are very inexperienced in the classroom and so this kind of hands-on relaxed attitude and interaction with them is very helpful and helps make things memorable because they don't have a book. They can't read. We give them a book. We give them a copy of the book for midwives. And usually there's somebody in the village who will read to them read and translate for them, but not always. So they can't take notes. They can't refer back to their notes. They can't refer to a syllabus. They can't refer to a book. So everything we do, we have to make memorable. And so if this is what we need to do, this is what we do. Hey, this is me. I am deleting a baby and Chris is the woman who is getting birth here. And again, this is how we do things. We demonstrate. We're very visual, visually oriented. Everything in our lesson plans is tested and tested and tested again. We have it vetted by senior midwives and by instructional designers so that we have it checked out from both perspectives. So the next series of questions has to do with sustaining a program. And a lot of times people start talking about relief or development. And you can clear on that difference between relief and development is an important part of doing this kind of work, this non-profit work. We ensure sustainability in several ways. Each of our groups that we teach elects a woman to be part of our leadership council. And here are five of them. They usually meet regularly. Usually about every other month, depending on the weather. So every season they can't leave their villages. But during the time season they meet monthly. They meet together and talk about their problems. Some of the groups have been together for ten years. We talked about them ten years ago. Some of them are brand new. They've had different experiences. They've had different problems. So they share those. And look together to find solutions. We come to them with questions. We come to them in education. Providing the guys what kind of support should be provided. And so they work together to answer those kinds of questions for us as well. I really like these women. They're great women. We have two paid staff in Sierra Leone. And the woman on the left is Chita Rogers-Sasse. And she is a full-time staff person. She visits during the dry season. She visits our sites every month. And she brings them supplies. This was actually during the time of Ebola. She snuck through the blockade. This village was blockaded. But she snuck through to take them some gloves. They didn't have gloves to begin with. Ebola was one of the very first in Sierra Leone to be hit with Ebola. And everyone at the clinic died of Ebola. And they didn't have gloves. So we raised some money, sent her some money. She went out and went to Liberia actually and got some gloves. And then ran the blockade to come in and bring them gloves and bleach. So she's here delivering that stuff and talking with them doing some teaching about hand washing and how to teach the community about sanitation. So these folks were doing the work of education before the government actually even acknowledged that there was Ebola outbreak in this area. They were the ones on the ground doing the work before anyone else was. I'm really, really proud of Jita for risking a lot to go up there and do this teaching and to take the supplies. And then to the people for being willing to listen and apply our suggestions at a time where they were really, really frightened. We do continuing education. We come back routinely. We make two trips a year. And part of those trips is usually to go around and visit all the people and to do different kinds of continuing education. Here we are doing the Helping Babies Breathe program where we take a group of four to six people and teach them the Helping Babies Breathe model of newborn resuscitation. And we take all day and they do it again and again and again and again and again. And we have a great deal of fun doing it but it's a lot of hard work. We've also done continuing education programs on breast, self-exams, and a variety of other things. Whatever they ask us to do, we try to do. So this whole notion of continuing relationships across a distance is hard. And Jita has a lot of it during the year. She lives in a house where there's no electricity and she has a cell phone and is usually in cell phone range. The villages where we teach are seldom in cell phone range and don't have any electricity. So electronic communications is not effective. So Jita is out every month in the dry season in these villages talking, listening, listening, listening. And then when we go back, we usually go in the dry season so we can get to these places. And we listen. We'll just sit around a mango tree and they talk and we listen. And that's an essential part of what we do. And it's critical. So we make the time for these small groups. That's me over on the left. You can see my feet trying to cut myself out, but I see I didn't do a very good job. This is six women of our leadership council. One woman's husband had just died so she was not able to attend. But it's six of the seven women on the leadership council talking about what their issues are. One of the groups is having some problems. There's a faction that doesn't want to participate with the others. And so they're talking to each other about how to help with that. And we kind of sit there with our mouths shut and let them solve their problems. They're illiterate, but that doesn't mean they're stupid. And they're very experienced, very skilled. And we just provide them moral support and encouragement. And we have faith in them and their abilities. And we find that they have the strength and the knowledge to do these things and to make these changes. Right now in the process of training four new trainers, we always had the goal of this being a whole entirely self-sustaining program. We're looking at development rather than relief. We're not solving problems in a crisis. We're building capacity. We're creating independence. So we're training these four women that you see here to train the program and we're doing it rigorously as we do everything in terms of the instruction. This is not a one-day train-the-trainer kind of thing. We spent five days with them talking about how to train and their values and philosophies and how that affects our decisions and then they watched us train a class and we're going to do that two more times. So two more weeks of training and they're going to be with us on two more classes. The third class they're going to do most of the training with our supervision. And they'll look at their certificates and they'll be able to do four times as much work at about a quarter of the cost that we can and I think that's fabulous. We'll be able to go on to other areas of the country. And again, dancing is a big part of what we do and we get out there and dance with them and have a wonderful time. This is again another celebration at the end of a class session. We give the women their certificates and have a great time. They show the community skits and teach backs and sing songs that they have created during class about family cloning, about breastfeeding about how to know the signs of labor so that you can walk the ten miles to the clinic and get to the clinic and time for the birth. All these kinds of things. And we applaud and cheer and laugh and it's absolutely wonderful. And we dance. So this is this Christmas Remus and me and under my arm is Jita Rogers, our staff person. And to her side is Alphys and they got married a couple of years ago actually. So they're now a married couple. And behind this slide which you can't see behind this photo is my contact information. I thought I had made this photo transparent. There's a question about our key workers in the level of education. Yes, Jita is a public health nurse in Sierra Leone. And these two women, the two women on the left are maternal child healthcare aides who also had additional training. The third woman from the left is in the maternal child healthcare aides school. She also has high school education and actually has attended some college classes and used to work with Oxfam during the war. So all of the women have additional education. Oops, let me go back. So if you want to ask me questions get in touch with me personally. Our website is Google Midwives, G-L-O-B-A-L Midwives. Let me write it in here. Yeah, I'll answer questions. I was wondering, you were talking about resources. What resources do you use with the women? We use as little as possible because again of their emphasis on sustainability if it's not at the end of their own country, we try not to create, then be dependent on us for material. We do take grants, we do send money and buy them bleach. For training materials we take inexpensive matters and charts that we use when they do their continuing education. Most of the groups meet monthly after we leave and they continue to meet the class will continue meeting monthly and they will use the charts and models to practice with and to refresh themselves with. So it's all cheap stuff. And you were talking at the beginning about some of the challenges that you come across when you're working over there. Well, first of all, the government of Sierra Leone tends to not take us seriously because we're so small. And so we had a hard time even giving to the table with some of these folks. Actually on one of our early trips the district medical officer sent us home because he said we had nothing to offer and what we had, nothing was a gratuity to help him consider us. And we don't pay bribes and that means that a lot of doors don't open. We're small and so a lot of folks just simply don't think we can do much. We're women and that also fill us to open doors for us. Most of our fundraising is from me and Chris Berlin people and I'm a large fundraiser honestly. I'm a great trainer. I'm a good midwife and I'm a large fundraiser. So we face those things. As I mentioned, many of the large grantors struggle with our model because it is so oriented and they want us to create PowerPoint decks and leave those they want us to create apps for the cell phones with protocols and different things on it. And those folks who do those things are getting a lot of money. And sometimes they get really sad. But we just keep doing what we do and it works. It works. It's effective. It's slow and it's effective. Yeah. Well that sounds like that's about it. Well thank you. Yes and if you ask me an NRI answer, that's again I'm not a good diplomat. If you go to either our website or our Facebook page and you'll find donate buttons all over the place on our website. Our Facebook page is facebook.com slash globalmoblives. Let me keep that in. There's a donate button there under the cover photo. We're also always looking for volunteers. There's a process for that. And on the website there's a page for volunteers and some stuff you can download in an application and some discussion or philosophy. And again just raising awareness about what we are doing is really important. You know Jenny says, you know I will spread the word. Thank you. I just love that. I love knowing that people in my labor know what we're doing and care what we're doing. That means an awful lot to us. When I'm itchy and sweaty and hot and have malaria and I have to take a bucket bath in cold water knowing that somebody throws me a lot. I do. I do. I'm just absolutely in love with this work. I'm silly. Okay. Thank you.