 Okay, now I want to introduce you to today's presentation presenter is Stella Nikolai. Stella Nikolai is the mother of Helen Lohenstein, who worked as a midwife in Nottingham and coordinated an in-service midwifery training program in Liberia. A retired teacher, Stella's passion was embedding global and anti-racist perspectives in the national curriculum, and even in this context, she facilitated the training of both qualified and student teachers. Her interest in the international midwifery was kindled by Helen's tremendous enthusiasm for her work and their shared commitment to social justice. Following Helen's death, Stella co-founded HLMT together with Helen's close family and friends. It's welcome, Stella, and have a good presentation. Hi everybody, thank you Elisa for your introduction, very complimentary, and for all your help and support as we prepare to do this presentation together, and hello and welcome everybody to my presentation. As Elisa said, my name's Stella Nikolai. I'm one of the trustees of the Helen Lohenstein Memorial Trust. I'm Helen's mum, and the trust was set up in Helen's memory by her close family and friends after Helen died in December 2018. I'm going to tell you about the Helen Lohenstein Memorial Trust, which we refer to from now on as HLMT. What led to its founding, how HLMT works, and our plans for the future. I must emphasise from the outset that I don't have a background in midwifery. I was a primary school teacher, but I have learned a lot about midwifery issues since my daughter chose midwifery as her career. My presentation will include information about Helen and the reasons why her family and friends decided to set up HLMT and for choosing to focus on Liberia. It will describe how HLMT's aims link to the sustainable development goals to reduce maternal and neonatal mortality, and it will outline how we have funded our work, how we've built links in Liberia and used existing Liberian expertise to provide initial midwifery training to Liberian citizens, but at the same time ensuring that all our funds are used to achieve the best outcomes and ensuring our ongoing support in the future. HLMT's mission statement is really simple and straightforward. We aim to provide funding to enable aspiring midwives who wouldn't otherwise be able to meet the costs of training to achieve that ambition, and in doing so to contribute to the reduction in maternal and neonatal mortality in Liberia. As you will see, our work fits very well with this year's VIDM theme, birth equity for all. We've been very clear from the beginning that our funding would be used to train additional midwives, and in so doing it would help to increase the number of qualified midwives in Liberia. The Millennium Declaration which was signed in September 2000 led to the eight Millennium Development Goals, and that led to unprecedented efforts to meet the needs of the world's poorest countries. Worldwide maternal mortality declined significantly, and in sub-Saharan African countries it declined by almost 50%. The Millennium Development Goals were replaced by Sustainable Development Goals, a collection of 17 interlinked global goals which were set in 2015 by the United Nations General Assembly and intended to be achieved by the year 2030. Goal three is to ensure healthy lives and promote well-being for all at all ages with two specific targets that relate to the aims of HLMT to reduce both maternal and neonatal mortality. A description of the aims and activities of HLMT would not be complete without some information about Helen herself. Helen was born in Nottingham in 1983 and she grew up there and trained to be a midwife at the University of Nottingham. As a child there were family holidays in southern Africa including Zimbabwe and Botswana, and as a young adult she travelled to India and Morocco, Zambia, Malawi and Tanzania. These experiences all made a lasting impression on her and they were the spark that led to her passion and commitment to social justice. After qualifying Helen worked as a midwife at the Nottingham City Hospital which is part of the Nottingham University Hospital's National Health Service Trust. She eventually gained a position as a midwife in the Sanctuary Birth Centre there. The Sanctuary Birth Centre is midwife led. It specialises in promoting active natural childbirth and is committed to promoting normal birth and minimising intervention in the absence of complications. Helen's experience is travelling in economically developing countries in southern and east Africa coupled with her strong commitment to equality and social justice led her to volunteer with UK charity Life for African Mothers in Liberia. Two short visits to Liberia delivering in-service training to practicing midwives and birth attendants and she was then asked to lead a 12 month training programme across the country. During that year 375 Liberian midwives, birth attendants and ancillary staff attended a series of two-day in-service courses across Liberia. Helen's experiences during this time made a really strong impact on her as she witnessed at first hand both the need for training and the hunger and enthusiasm for training. In the very first training session she delivered she realised that not one participant knew how to resuscitate a newborn baby and in another session one of the midwives came with her baby breastfeeding as she participated in the training. Such was the commitment. In this picture Helen is training midwives in the use of the Partograph which none of them had ever seen but which is used routinely here in the UK. Sadly during her 12 months in Liberia Helen developed a medical condition which prevented her from returning there. She died in December 2018 leaving behind a legacy of almost 400 midwives and birth attendants who were better equipped to manage maternal care, labour and childbirths. Following her death Helen's family and friends decided to make a lasting testimony to her determination to create a fairer world where those who are disadvantaged are given opportunities usually only available to those with greater advantage. Whilst she was in Liberia Helen had discovered that the true ambition of the young woman who cooked and cleaned for Helen's programme was to be a nurse. However this was not possible for her simply because she could not afford to pay the fees required for the three-year training. Helen offered to pay her course fees and this young woman will actually qualify as a nurse later this year. Helen's action in response to the needs of this young woman became the catalyst for the founding of HLMT. We decided that we wanted to follow her example by setting up a charity whose aim would be to provide the funding to enable aspiring midwives who lacked the necessary funding to train in midwifery. HLMT became a UK registered charity on the 16th of January 2019. Some information now about Liberia and why support is so important in order to reduce maternal and neonatal mortality. Liberia is Africa's oldest republic. It's on the west coast of Africa. Liberia ranks ninth in the ranking of the poorest countries in the world using the United Nations Development Programmes human development reports. This ranks countries not just by their gross national income but also by other aspects like life expectancy at birth, expected years of schooling, mean years of schooling and their own human development index value. Liberia suffered from a series of civil wars over 14 years which devastated the economy and destroyed an estimated 95 percent of the country's healthcare facilities. An entire generation of children missed out on any education at all. After this Liberia was also hit hard by the West African Ebola epidemic of 2014 to 2016 which infected 10,675 Liberians and killed 4,809. The Ebola epidemic left Liberia's health system depleted of qualified staff and increasingly fragile. Many healthcare workers either died from Ebola or fled the country because of fear of infection. Liberia at the moment has a population of just over five million people but fewer than 200 fully qualified midwives and most of those qualified midwives work in urban areas not in rural areas. Ebola has had a lasting impact on the livelihoods of the survivors. The World Bank's most recent survey of the country in 2016 estimated that nearly 51 percent of the population were living below the poverty line. The average life expectancy there is only 63 years and this compares to 81 and a half years in the UK. There's poor access to clean running water 42.5 percent of Liberians have no access to protected wells and 23 percent of rural households rely totally on unprotected water. Poor nutrition has resulted in 35 and a half percent of children whose growth is stunted while malaria is a major killer of young children. 33 percent of females and 13 percent of males have never attended any school and gender inequality is widespread. While education is expected to last 10 years in Liberia most Liberians only complete four and a half years of schooling. There's a lack of safe roads and of transportation and that makes it really difficult for pregnant women especially those who live in rural areas to access safe healthcare before, during and after labor. In the two years since HLMT was set up we've raised more than 60,000 pounds towards our initial target of 100,000 pounds through donations from individual friends, fundraising events including sponsored walks, concerts and making and selling cards and gifts using like traditional Liberian lapper fabric. Ultimately we aim to fund ongoing midwifery training from the interest earned from investments and in this way build a sustainable financial model. However because of the current uncertainty around investment due to COVID we've had to draw on the money we've raised in order to fund the cost of training students. Our priority since 2019 has always been that we should build relationships with appropriate Liberian agencies and to evaluate the quality of midwifery training provision in Liberia so that we would be able to select the most suitable training institute as a partner for the trust. With this objective one of our trustees Carol McCormick who is an experienced consultant midwife from Nottingham together with a friend who's a senior lecturer in midwifery from De Montfort University in Leicester traveled to Liberia on a fact-finding visit in January 2020 they got there just in time before the pandemic. Abdul Rahman Bah a former Liberian colleague and a very close friend of Helen who has a master's degree in public health from Nottingham Trent University organized meetings for them with the Ministry of Health, the British Ambassador, the Liberian Board for Nursing and Midwifery and also the representatives of several training institutes. This resulted in an agreement being made between HLMT and the Esther Bacon School of Nursing and Midwifery in Zorzor which is a remote rural area in the northeast of Liberia. Following due diligence by HLMT a memorandum of understanding was later signed between HLMT and the Esther Bacon School of Nursing and Midwifery. The memorandum of understanding commits HLMT to supporting two midwifery students through their three-year course starting in the current academic year and Esther Bacon School to providing regular monitoring reports about the progress being made by these students who have been funded by HLMT. The cost for each student is 3,084 US dollars and that includes the cost of essential equipment and uniform, their accommodation and their final registration fees. In December 2020 after long delays due to COVID-19 a very thorough entrance exam and interview process took place at the Esther Bacon School. The interview panel included Esther Bacon School teachers and Abdul Rahman Bah acting on behalf of HLMT to ensure that the chosen candidates matched HLMT criteria in addition to the criteria set by the Esther Bacon School. We were absolutely delighted that two students Aminata Suimani and Sua Valai were selected. Both Aminata age 29 and Sua age 19 impressed the interviewing panel with their high academic grades and their passion to become midwives. Aminata and Sua also met the HLMT criteria. They had the appropriate academic qualifications and they needed sponsorship in order to enroll on the three-year diploma in midwifery training course. Both these students have indicated desire once they qualify to pursue their careers in the rural areas where they grew up and where their families live. Ever since its inception HLMT trustees have sought to avoid a neocolonial approach and the imposition of unnecessary conditions or demands on its partners in Liberia. The trustees only need to be satisfied that the funds we provide are used genuinely to benefit additional individual students who meet HLMT criteria rather than being absorbed into the general funds of an institution and we also need to know that the institution provides qualifications recognised by the Liberian midwifery accrediting body the Liberian Board for Nursing and Midwifery. And as long as these conditions are satisfied HLMT doesn't want to influence the curriculum or the selection or assessment processes of the institution. Aminata and Sua, our two sponsored students, began their three-year studies in January this year and we've already received reports from the Esther Bacon School of Nursing and Midwifery indicating that they're both doing really well with their studies and that their midterm reports were really impressive. We'll receive further reports when the semester ends and then we'll receive feedback on their progress in the future on a regular basis. In addition to the agreement with the Esther Bacon School of Nursing and Midwifery HLMT has established positive working relationships with other key stakeholders in Liberia and these include the Liberian Ministry of Health, the Liberian Board for Nursing and Midwifery and the Liberian Midwifery Association. Looking to the future HLMT is exploring funding support from other UK charitable trusts as a way to increase our impact by enabling at least two more students to begin their training courses each year. On a personal note together with Helen's dad Pete we're hoping to make a personal visit to Liberia later this year. This is a trip that we had to delay in 2019 for medical reasons and then the trip was made impossible in 2020 due to the COVID pandemic. With Abdul Rahman Bar as our guide we hope to explore the country and meet Helen's friends there and hopefully we'll also meet the direct dress of the Esther Bacon School of Nursing and Midwifery and if the two students we've sponsored would like to meet us we'll be delighted to meet them too. This brings me to the end of my presentation today. Thank you for joining me and for listening and I'll be really happy to answer any of your questions about HLMT and about my presentation. Thanks very much. Thank you everybody so are there any questions in the paper? They're in the private public chat and thank you so much Stella That was a truly amazing and really powerful presentation and thank you so much for sharing that with us. Yeah I'm just looking to see if we do have any questions in the... I think we have some questions received in advance as well so I can deal with those if that's helpful. If you have any I'm sorry I'm just I think Elita is muted and I'm struggling to unmute her. I didn't want to put it back but yes I do have a question I will post it in chat as well. And the question is the mortality rates in Liberia are shocking is there anything we can do to help promote your work and increase the number of midwives being trained? The most obvious way to help us to increase the number of midwives being trained is to probably have a look at our website which is here on this slide hlmt.org.uk If you're in the UK then there are lots of ways there that immediately that you can help to support our work and that could include fundraising events. Lots of people have done various different fundraising events on our behalf they could be concerts they can be stalls where you sell things they can be selling food they can be a sponsored walk or a sponsored run or a sponsored bike ride or a sponsored anything. Silence would be a good one I remember Helen wants Helen herself once did a sponsored silence for 24 hours in order to raise money to go to Zambia to do a place a midwifery placement in Zambia one of the hardest things she ever did anybody that knows Helen would know that. So lots of ways that you can help to raise money and perhaps publicize the work that we do which would be great thank you. Thank you and okay Pipa says will the newly trained midwives be tempted to emigrate better salaries in the USA or Europe? I think that kind of thing is always a worry but in the case of these two midwives they one of the questions that they were asked was specifically whether they wanted to continue to live and work in Liberia. One of them actually has I think three children and her mum and they all live in that in that rural area close to where the Esther Bacon school is but they have both got families in that area and they're both very committed to working in particularly in a rural area rather than actually in the city. As I said earlier there are very few midwives in rural areas and they during their interviews they show tremendous commitment to trying to change that and make the kind of situation for women who are pregnant in those areas a much better and safer one. Are there any more? Sorry. Yes one more since we have time. Are there jobs in Liberia for midwives once you are trained? Aha there's a very interesting question you could ask that in this country actually because regularly our government successive governments have talked about increasing the number of midwives that are trained only to find that what they didn't do was increase the number of jobs that are available at the end of the training so it's you know it's not something that just applies to Liberia. In Liberia there is a new Bachelor of Science midwifery program and that is due to graduate 50 to 75 registered midwives each year and that ought to be helping to staff more than 700 different health facilities across the country. I'm assured by Abdul Rahman Bah who's our our main contact in Liberia that there are many many jobs in Liberia for midwives but one of the difficulties is that because and this applies to a lot of other very poor countries really in a lot of these countries midwifery and nursing is seen as a job which is something that you really care about and therefore it's not a proper job in a sense and very often people don't get paid the full amount for the work that they've done and that often applies in Liberia where many midwives who at the end of each month don't actually get in their pay packets what they're what they do so that's an ongoing problem. There are many NGOs that work in Liberia and some of those are also undertaking midwifery work so they actually have midwives what trained midwives working for them and and also some other charities who are they're not doing training but they're supporting traditional birth attendance in their work. One of the challenges there is that if the NGOs leave the country then those jobs will disappear as well but Abdul assures me that you know the plan is very much to increase the number of midwives particularly in the rural areas but of course all of us are having to face up to the consequences of the of the COVID pandemic and how that leaves any country across the world in terms of what they're able to do in recovery. Any more? Yeah actually yes it is actually related to this one then why is training more midwives going to have such a huge impact? Oh where do you start? Most maternal deaths are actually preventable and you only have to look at the statistics in in countries where their health services their infrastructure is well funded and where midwives are well trained so the healthcare solutions to prevent or manage complications are actually very well known but they're known often only to those midwives who are fully trained and I think at some point in my presentation I mentioned to you the fact that in one of the first workshops that Helen delivered she discovered that not one participant knew how to resuscitate a newly born baby. Now bearing in mind these were not trainee midwives these were practicing midwives and birth attendants and they really should have known how to do that and that's a fundamental skill that all midwives and birth attendants need to have. So if we train more midwives then obviously we're increasing the number of women who can have access to high quality care during their pregnancy, during their labour and following childbirth that also obviously will have a huge impact in the number of babies that die at birth or very soon after birth a well you know well managed birth pregnancy and labour and delivery will lead to you know women not dying in childbirth and their babies not dying in childbirth and women who are well informed well educated in the run-up to the birth of their children are also educated in things like basic hygiene and if good hygiene is practiced then that eliminates early infection and makes sure that the circumstances in which the babies are being brought up in those early months are clean and hygienic and safe anymore. And last one for me. Okay, why did you assess the bacon school to train your sponsor student midwives? Well I have to say that for that I have to give credit to our trustee Karen McCormick and her friend Maureen who went to Liberia on a fact finding visit at the beginning of last year because that was the bit that we were finding really really difficult you know for us to be here in Nottingham in England trying to make those contacts and really talk to people was very very difficult you send emails they get lost in you know they don't necessarily end up with the person that you needed to talk to that you needed to correspond with and so that visit to Liberia and the fact that Abdul Rahman Bah was there and he's familiar with the health service he worked as a pharmacist in the Ministry of Health himself and has also supported life for African mothers training in service training for midwives so he knows the system really really well and he was able to enable Carol McCormick to visit key people in the Ministry of Health key people in the Liberian Board for Nursing and Midwifery and the Liberian Midwives Association and talk to those people about which training facilities provided the best training and were actually registered with the Liberian Board of Midwifery and Nursing so that the qualifications that that the students would achieve at the end were the best possible ones and Esther Bacon was identified as one such place and I have to say that our dealings with them our negotiations with them have been absolutely brilliant and they totally understood the concept of additionality that we didn't want to just give them a sum of money to do whatever they wanted to do with we wanted to give them the money to pay for two additional students to become midwives via their training program so that's why we chose them