 So we've got Steph Marriott, who is a registered midwife and professional midwifery advocate from the UK. And at present, Steph is an international midwife mentor for the United Nations Population Fund in Cox's Bazaar Bangladesh, where she provides mentoring and technical guidance to national midwives and other professionals involved in sexual and reproductive health and rights. So, co-presenting with Steph today, we've got Miss Abiku Doreen Ambayo, who is an international midwife with 20 years experience in more than five countries, where she has focused on mentoring, clinical training, capacity building of the health workforce, programming and establishing new health facilities. She's a registered member of the Nursing and Legal Free Council of Uganda. She's been involved in many emergencies internationally, and at present works in the largest refugee camp in the world, Cox's Bazaar Bangladesh, as a midwife mentor for UNSPA. Here she is also a member of the Sexual and Reproductive Health and Rights Working Group and a member of the Maternity Mortality Review Team. And also presenting with them today is Emile Cheyam, who undertook a three-year diploma to become a professional midwife with Hope Foundation at the Brack University in Bangladesh. Since 2018, she's worked as a midwife and more recently as a midwifery supervisor for Hope Foundation, an NGO providing services to Bangladeshi and Rohingya refugee women and girls in Cox's Bazaar Bangladesh. So I will now hand over to Stephanie and the presenters who will talk to you today about the use of video and photo-sharing online chat group for the provision of midwifery mentoring in rural Bangladesh and Rohingya refugee camps. So Stephanie, I'm now going to make you the presenter and I'll go on mute while you come off mute to start. Thank you. Good morning everybody. I am hoping that you can see my screen as I have taken over sharing from Justine. Thank you for the introduction, Justine. So welcome everybody. I am Steph, as Justine explained. I am a midwife mentor with UNSPA in Cox's Bazaar and I've been working in my current role in Bangladesh for the past eight months. And I will now hand over to Amila to introduce herself. Assalamu alaikum and very good morning to everyone. This is Unmila Shem, the best of midwife and a midwife supervisor at Hope Foundation, UNSPA SRS Project for Humanitarian Response. Now, Doreen Unpresent has said thank you. If you just come off mute, if you're going to say hello, did you want to say something or shall I let Steph carry on? You just seem to be having technical issues with Doreen at the moment. I think she might be trying to log in and log back in again. Steph, are you happy to continue until you get Doreen back? Yes, I will begin. Hopefully she will rejoin us. So, excuse me while I multitask doing slides I've not presented before. So, this talk is going to be initially an overview of the world of Doreen in Cox's Bazaar, but it's mainly to focus on the use of a video and photo sharing online group. We use as a mentoring technique here. So, we are going to focus on four things. The background to the context of the UNSPA supported midwifery programmes in Bangladesh. Why a photo and video sharing group has been implemented, how that works, and then Amila is going to share some examples and her experiences of using the group. I'm just checking if Doreen is rejoining. She has not, so I shall continue. So, initially the background to some of the work that we are doing. So, for those of you who don't know about UNSPA, UNSPA is the United Nations Population Fund and is the UN's Sexual and Reproductive Health Agency. Our mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. And we base this around to align with the UN's Sustainable Development Goals, three main goals, that there are zero preventable maternal deaths, zero unmet need for family planning, and zero gender-based violence or harmful practices occurring where we work. So, some key facts about Bangladesh. So, Bangladesh had a population of 164 million, a life expectancy with an average of 73 years with 75% of the populations considered literate. Household electricity access is estimated to be only 56%. And the maternal mortality ratio, although difficult to estimate because of challenges with data collection in the context in which we work, is estimated to be 196 maternal deaths for every 100,000 life births, which puts as approximately 144,000 out of the 199 countries that have provided data recently. And of all births in the whole country, 49.8% are estimated to be attended by a skilled birth attendant and midwife being considered a skilled birth attendant. Now, the maternal mortality ratios are difficult to estimate for Bangladesh, partly because the most recent software that we now use, what's called the district health information software, actually only collects information from health facilities, not from communities where we know a huge number of deaths happen, but are not reported, which is why we give the data with some things. Are you here, Dorian? Yes. Lovely, thank you so much. It's okay, I have just finished this slide, you continue on. Okay, thank you so much. Yes, thank you so much, Steph and Justin, apologies for the internet interruption. I'm called Ababiku Dorin, I'm a midwife working in Bangladesh and I come from Uganda. I'm going to continue from where my colleague Steph started from. Key facts about Bangladesh. Bangladesh has a population of 164 million and 73 years of life expectancy. The literacy rate is 75%. 56% households has access to electricity. The maternal mortality ratio is 196% per 1,000 life birth and percentage of birth attendants by scale birth attendants is 49.8%. As midwives, we do not look at the mother alone, we also have to look at the newborn. I'm going to also talk about the new mental mortality rate in Bangladesh is 185% per 2,232%. That is a country data which was provided in 2019 and first birth rate is 218%. 231%, it's also a country-wide data which was provided in 2019 by UNICEF. Key facts about Bangladesh district. I'm going to most still talk about Cox Bazaar. About Cox Bazaar, it is the most suddenly district on Bangladesh and it's bordered by Indian Ocean and Myanmar. It has a 78.8% is a rural, 90% are Muslims and 33% life below poverty life and national average is 31%. 12% don't have access to electricity and the literacy rate is 29%. It has a population of 2289, 990 and household access to electricity is 32% and maternal mortality ratio is 158 per 100 life birth and attendance by scale birth is 46.8%. Next slide. Yes, Cox Bazaar district and Rohingya refugee. The Rohingya refugee, the first ones came into Cox Bazaar in 1970. This is a refugee from Myanmar to refugee in Cox Bazaar. In 2015, around 35,000 came to Cox Bazaar also. In 2016, 80,000 also flew to Cox Bazaar refugee camp. In 2017, 745,000 came in and in 2020, population in Cox Bazaar went to 8,066 and 4,075 and this is the most dense populated refugee camp in the world. The refugees in Cox Bazaar faced a lot of discrimination. They also faced stateless and targeted violence in Rohingya state that is in Myanmar. This followed attack in 1991, 1992, 1998 and 2016 which made the largest and the largest number of their population from the Myanmar flu to Cox Bazaar. Since then, the estimated population now in the camp is 745,000 Rohingyas including 400 children. Next slide. I'm just going to go to that slide and then I'll play with you. Yes. Thank you so much. Justine is going to play for us a video by a professional midwife. She's one of the third batch of the midwife and she's going to talk about Midwifery in Cox Bazaar in her video. Do you just want to talk to the stats on the slide first just while I get the video up? Yes, I feel. Yes, before this video goes on about Midwifery in Bangladesh. Midwifery in Bangladesh started in 2015. The first professional midwives educated to ICM standard in Bangladesh graduated. In 2016, the first newly graduated midwives were employed with the NGOs in Bangladesh, especially in Cox Bazaar. In 2018, the first batch of professional midwives were deployed to government of Bangladesh health facilities. Before in Bangladesh, there was no midwife. So there was no one who can take care only for the women. So that's how I think midwives can do something different for saving lives during their pregnancy time. From my childhood, my thinking is different. And I have a great vision to change the midwifery in Bangladesh. I am Kanata Akta. I'm a midwife. I'm 23 years old and I'm working as a midwife supervisor at Hopefield Hospital and Hope Foundation. I had a wish after giving my secondary school. I might be a lawyer. But somehow I had a dream and feeling like that maybe I can be a healthcare provider. I have seen my mom. Help others people. So I think midwifery services. This is the way to help the people. I can help the women. The Hope Foundation have a midwifery school. There is no other organization in the Cox Bazaar which are actually providing the training of midwives. Suddenly I heard one news from the Hope Foundation are recreating some midwives, such as applied for the registration and the exam. I did the best exam and it was 69 out of 70. So I was selected. And then this way I'm here as a midwife. This is a non-profit organization. We are giving full free services completely for the women and their baby. Our respected president Dr. Riftakar Mahaloz actually created a golden change. It means you have to give care to the women from the conception to the birth. For an example, antenatal care, postnatal care, mental health, postpartum psychosis, there is a lot of things. And we are trying as much as possible how we can serve the society. But they don't want to come here. Example, there is family reason because they are saying my husband is not allowing me to come to the hospital. Among them the fear is one thing, hospital fear. In the campsite there is too many houses in a small area. So it's too tough actually to maintain the hygiene by then. They are doing the delivery, giving birth in the mud. Infection can happen. Anything can happen. To improve the facility-based delivery. This is our main goal. It was in 2018 a woman came to our hospital but I didn't know her history. I said, oh, the baby is not crying after the delivery. And I started to give resuscitation to the baby. And during the 25th number of birth, the baby was cried out so loudly. Actually, I felt so happy and she was saying she had three previous stillbirths. Can you imagine that? I took history from her. How? How it just happened? She said, there was no drain midwives. That's why we always try to keep them in the facility and also to motivate them to go other's facility also, wherever you feel comfort. The midwives there, like sister as your sister, so we are doing our best to give you comfort. I always loved to empower the midwife. I want to involve the midwife in so many sectors. In every corner of the society, every corner of the village, every corner of the unity, I want to set up midwifery services within the second, within the minute, we'll be there. This is my vision. Thank you so much, Doreen. Doreen, how are you? Yes. Next slide. That wonderful and nice video is from one of the midwives founded by UNFPS. She's in Fadi Bad. So she's talking about the work she's doing and the work all the midwives are doing in Bangladesh, especially in Cox Bazaar refugee camp. So that is where we are and where I and my colleague, Stefan, is working. The background, about the background UNFPS supports 161 newly confide midwives through NGOs in Cox Bazaar district. And the video which was played is from Hope Foundation. It's from one of the UNFPS founded NGOs. These midwives provide comprehensive sexual productive health services to women and girls in 23 health facilities. I and Stephanie are mentor midwives in all these 23 health facilities. These facilities is comprehensive of hospitals, primal health care centers and health posts with the women-friendly spaces. In the women-friendly spaces, we offer the services for post-abortion care, menstrual regulation, family planning, clinical management of rape and other GBV gender-based violence services. And it's provided by the midwives. In the women-friendly spaces. These midwives are supervised by 12 national midwifery supervisors. And we have newly created three national midwifery coordinators who will be helping I and Stephanie in the mentorship we are doing. And they will also mentor the national midwives and the midwives supervisors. They are currently two international midwife mentors providing clinical mentorship that is I and my colleagues, Stephanie. Next slide. About our mentorship. UNFPA has supported international midwife mentors for three years in Cox Bazaar that is starting from 2018 till now. Mentorship is critical for a newly establishing profession with no national midwifery leadership, pre-service education gaps, high staff turnover and health facility, not providing double HR standard quality care. We always discuss with this midwife and the clinical, the clinical mentorship. We have a lot of topics and methodologies. We have online meetings with the midwives supervisors. We also have in that meeting, we have topics where the midwives will present their topics. And if there are questions, the midwives supervisors will also ask questions. We visit facilities and we train midwives. We do training. We also do case review. The case review are, for example, if a mother is referred with a PPH, we have to review the case and find out what the midwife has done and what the midwife has not done so that we can correct them for the next person. And we do clinical case mentorship, online photo, video sharing, chat group, which my colleague Steph is going to talk about. Over to Steph. Thank you so much. Thank you so much, Doreen. Can I get you to mute Doreen before I start talking? So, I'm now going to talk in a bit more detail about one of our mentoring techniques, which, as Doreen alluded to, is a photo and video sharing group. So why did we introduce this system? So like most places in the world, working in Bangladesh has been impacted by the COVID-19 or pandemic, along with some team members leaving and international staff not being in Cox Bazaar. This resulted in a reduction in in-person mentorship at health facilities. Some virtual mentorships were introduced, for example, online meetings, but there were still reduced opportunities for feedback from the international midwife mentors. Mentorship from Y is happening through other UNFPA Bangladesh projects and the sharing of photos has been an informal method of providing feedback in these other locations. How to monitor what is going on in all health facilities has always been a challenge in humanitarian and development contexts, especially when large numbers of facilities are supported by a small number of people, as is the case for our team. Through the sharing of photos and videos, it is possible to review the obvious. For example, is chest rise achieved during newborn resuscitation practice on a mannequin? But also coincidental observations can be made. For example, in a photo of immediate skin to skin, what position is the woman in? Previously there had been a paper-based system, which is detailed in the corner of the image here. It resulted in midwifery supervisors spending time in an office writing report, not in health facilities mentoring. There were also inaccuracies in information sharing, often due to the fact that the report was being written in English, not in English, but it was also not effective at achieving results. So let me give you an example. If a report states taught helping babies breathe, a program many of you will be familiar with for teaching basic resuscitation of a newborn baby versus reviewing a video clip of all midwives achieving chest rise on a mannequin, you can not only see that HBB was taught in that health facility without the need of written English, but you can also provide feedback on it. For example, on hand positioning. So how does the filtering video sharing group work as a reporting system? So this slide details who the members of the group are. The clinical coordinators and quality assurance officers are Bangladeshi doctors who work for national NGOs, partnered with UNFPA, and along with many other duties, manage the midwives. We are, as Doreen also mentioned, in the process of orientating a new role called a national midwifery coordinator who were very recently become members of this group as well. They are also holding the first national midwifery leadership position in Gotsbury Valley. So how does the group work? At the time of launching, and now when new members join, they have briefed on the guidelines of the group. Confidentiality of discussion is important, as is the consent process for the sharing of photos that include women. Midwives explain to women what the purpose of the photo is and show her the photo before sharing with the group. The option of blurring the faces also give them. This process contributes also to teaching or respectful maternity care, as we are constantly repeating the concept of consent. We meet once a fortnight with all midwifery supervisors, currently virtually, and support them to undertake mentorship in one focused area for the next fortnight. The group is flexible to meet the needs of what is happening in the response at the time. An example of this is following a recent massive fire in some of the refugee camps. There were changes to midwifery services in fire destroyed areas. This photo on the slide was shared in the group and shows the service midwives were providing in temporary shelters to the women in the affected areas. Any of the members detailed on the previous slide can provide feedback on anything shared in the group. This means that midwifery supervisors can learn from the feedback their colleagues receive, something that was not possible when feedback was given individually from a written report. The group is still working as a reporting system. Midwife supervisors are visiting health facilities frequently and are undertaking some supervisory activities at each visit. Because the group replaced a formal weekly report, the guidelines on what activities needed to be undertaken each week still needed to remain. So a basic report, which you can see at the bottom of the slide, is still completed by the clinical coordinators so that UNFPA are able to identify how frequently health facilities being visited by a midwifery supervisor and what activities have been undertaken during that visit. So a bit more about these weekly activities. So as this slide states, each midwifery supervisor needs to submit a minimum of one photo, one video to the group, her facility that she supervises each week. And these photos and videos need to demonstrate the following four activities. The first is that a teaching session is undertaken. So this photo demonstrates a group of midwives undertaking an activity about completing and interpreting a paragraph as part of a fortnight of activities surrounding identification and management for long obstructed labour. Secondly, that a role play or simulation was undertaken and that every midwife present undertook the simulation. Justine is going to show a video now which demonstrates two midwives on duty in a rural health facility, achieving chest rise on a mannequin when undertaking a simulation of newborns' ascitation. I will give a one baby chest rising media and we will see. 1, 2, 3, 1, 2, 3, 1, 2, 3 1, 2, 3, 1, 2, 3, 1, 2, 3, 1, 2, 3 1, 2, 3, 1, 2, 3, 1, 2, 3 1, 2, 3, 1, 2, 3, 1, 2, 3 1, 2, 3, 1, 2, 3 I'm a midwife from Ratna Kallung. But I don't lie, my practice is…不會, practice is the sports movement. B, 2, 3, B, 2, 3, B, 2, 3, B, 2,3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3, B, 2, 3… Thank you for sharing that, Giustie. So the third aspect is that the teaching video has been shown. Midwifery supervisors assign posted to either reliable sources such as medical aid videos, safe delivery app or global health media or a specific individual video for the topic. These pictures detail midwives undertaking an exercise on monitoring maternal and fetal well-being in labour, which is detailed on the teaching video. Finally, the midwife supervisors must demonstrate that evidence-based practice is being implemented at the facility. These photos detail the monitoring of the fetal heart rate during labour, a woman being supported to labour in an upright position and a baby receiving immediate skin to skin. These photos are the most effective for discussion feedback. For example, the photo is demonstrating a baby in immediate skin to skin, which is fantastic, but feedback was also given why the woman had IV fluids. Hopefully you can see the cannula in her left hand, a coincidental finding from a photograph, but it then led to a discussion on the use of routine IV fluids in normal labour and it not being evidence-based. So our progress today, the implementation of the group has an important system behind last November and to date I checked this morning there are 1,670 photos and videos that have been shared. From the perspective of the international midwife mentality, we feel that the ability to see what activities are being undertaken by the midwife supervisors and then being able to give constant feedback on this is the greatest benefit of the system. The system is responsive to the current need of the situation and because feedback is provided quickly, it does seem to result in midwives engaging well with it. We are able to observe whether the DOO2 is correct, plus any coincidental findings and provide feedback in text format immediately, but also we are able to then follow this up through asking the midwife supervisors and midwives in person about knowledge or experience. For example, if we provide feedback on a video of a roleplay about PPH, at the next visit to that health facility we ask questions about the management of the management of PPH to the midwives or we might review notes or case referral forms to cross-reference that the theory is being implemented into practice. This change in outcomes, appropriate management and referral of women is the most important part of the system. We have seen that the innovative solution is resulting in knowledge and skills being cascaded to midwives working in health facilities across the district. Sometimes it is difficult to assess whether roleplays are what midwives know is being theoretically correct as opposed to what they do in practice, so being in reference with cases is an effective way of assessing the implementation. Crisis has a new standard and now means that when travel to health facilities is not possible due to a multitude of reasons such as security concerns or poor weather conditions, mentoring is still up. Yes, I'm sorry to cut you off, just running a little bit short of time so I was wondering if we could hear from Amela. Yes, of course, I'm just on my last sentence so I shall hand over. The system is about challenges, especially due to internet connection, but Amela is going to tell us a bit more about what some of these are from her perspective and I shall hand over to her now. Thank you Stephanie and thank you so much for giving me a floor in this conference and on this very special occasion to talk about our profession. Today I stand for all midwives and survivors to give both of thanks to our perspective mentors Stephanie, Doreen and Rondi Mem for their valuable guidance and also thanks to our clinical coordinators, midwife coordinators and qualifications officers for their consistent support. Our midwives work in both low and high resources for girls and newborns, also all the productive age women in all situations. Due to media reporting, they gain theoretical knowledge and practice and there is a lot of ambition they enter in their professional life. They are alone to take vital decisions and lacking practical skills is not an option they are. So they need updated knowledge, what's up and also the mentoring process gives them a big platform to learn and device continuously every day. Before our midwives are ready to deal with complicated cases and would call us several times during managing a single case but now they can confidently manage every day, today situation as well as the stabilizes the every complicated cases before referring them to the higher facilities and also accompanying the patient with necessary documents all on their own. We are also getting updates from the WhatsApp group of everyone's daily activity and the receiving feedbacks within a very short time. By this group we are also following one standard protocol for managing similar cases without any confusion. While we are mentoring our midwives, we are also learning about clinical experiences from them at the same time and the midwives practice among themselves at night and teach the interns as well. So we supervisor also discuss and adopt new teaching and learning techniques from each other but it is a challenge to communicate and learn using WhatsApp as the internet network is valid for especially in camp level. Also role plays are difficult in busy facilities due to having many workload and facilities with a small number of midwives struggle to role play as non-technical people needs to be included and they don't understand what to do and also we can only share three to four minutes of video in this group each time. So due to the storage of shortage of phone rather than the whole cases and it must be deleted after it is uploaded onto the WhatsApp group to keep enough storage for the next video. Sometimes the patients don't give us permission to take photos of evidence based care for sharing the group because they think it will hamper their privacy and also the confidentiality. So in this case we don't take photo and not sharing this group we also only discuss the cases in the group. So in doing the crisis midwives work more and more to help the patients spread proper service by day and night and we are superb as are feeling so proud to help and support those heroes to handle and discover any kind of situation. Thank you for listening and we are ready to answer any question. Thank you. Thank you. Thank you very much Jamila really a wonderful insight into what you do and the support that you give so thank you so much. So yes please we do have one minute for questions so if you have any questions or copies of the chat just a reminder Cecilia has put in the feedback in to where to send your attendances and to provide your feedback and certificates and please do remember to send in your selfies and if you do have any questions for Amila or for any of the team please stick up your hand or write them in the chat or go off mute and ask them directly before when this leave the room. So thank you Stephanie, Doreen and Amila for a wonderful presentation. Thank you for hosting Justine.