 which means that the floor is all yours now, so I'll leave it for you to introduce yourself. Okay, well good morning everybody, or good afternoon or good evening to those of you who are further east than the UK. Can I just check that everyone can hear me fine and the volume is okay? Yep, I'm not getting any, oh lovely, thank you Tanya, you can hear me perfectly, that's brilliant. So I'm going to introduce myself, hopefully you can see my photo there. I work for the Royal College of Midwives, I'm the Global Professional Advisor, and that means that I'm responsible for the international work outside of Europe that the RCM undertakes. And I want to share with you a project that the Royal College of Midwives UK and the Uganda Private Midwives Association have been working on for the last 20 months. I bring greetings from Mary Masoki who is President of the Uganda Private Midwives Association. This presentation is a joint presentation between myself and Mary. However, unfortunately today, well fortunately, Mary is helping to organise Uganda's celebration for International Day of the Midwife, which is taking place in Fort Portal, a town about eight hours drive from Kampala, and she wasn't able to get sufficient internet connection to present this jointly with me. However, I was in Uganda last week, I just came back on Tuesday, and so Mary and I have prepared this presentation together, and we've included some quotes from our Ugandan midwives and students, so hopefully you'll feel that this is very much a joint presentation. And we do hope that the Ugandan celebrations go well today and bring people together to hear the voice of midwives in a country where the maternal and newborn outcomes, although gradually improving, still have a long way to go and where not every woman receives care currently from a competent, well trained and regulated midwife. I'm just working out how to move on to the next slide. There we go. Lovely. So after the International Confederation of Midwives Congress in Durban in 2011, where delegates heard about the twinning project between midwives in Sierra Leone and the Netherlands, the Royal College of Midwives became very interested in twinning with other midwives' associations. And through the International Confederation, we were linked up with Nepal, Cambodia and Uganda, and together we implemented the Global Midwifery Twinning Project with funds from UK aid between 2012 and 2015. And if you're interested in that project, a short report is available on the RCM website and I've put the address up for you there and you can download it. So that project finished in 2015. And at the end of the project, we undertook a needs assessment in each of the countries to prepare for future projects if we were able to get further funding. And in Uganda, it was identified that newly qualified midwives were not fit for practice at the point of registration. And this was attributed to the theory practice gap between the midwifery schools and the clinical placement sites and a lack of mentorship for student midwives on their clinical placements. So right at the end of the project in December 2014, we helped the Uganda Private Midwives Association to run a small pilot project between the association who have a network of private maternity homes across the country and the Chibuli School of Nursing and Midwifery in Kampala, which is one of the largest Muslim training schools in Uganda. And this pilot project was really successful, with students giving very positive feedback about the quality of mentorship that they had received. And you can see on the screen a lovely photo of the seven, I think there's six there, but there were seven student midwives who took part in that project. And on the left hand side, you'll see me with Mary Masoki, who's in the orange jacket, who's president of the Uganda Private Midwives Association. And on the right of me with her red and black outfit is Halima, who's the principal of the Chibuli School. So with that project having been successful and at the end of the project in March 2015, we undertook a needs assessment and found that the desire for a mentorship program was expressed by all of the midwifery stakeholders within Uganda, including the Ministry of Health and the Uganda Nurses and Midwives Council. And on my recent trip to Uganda last week, I interviewed Mercy Mwanja, who you can see in this photo, who's the quality assurance manager of the Uganda Nurses and Midwives Council. And she said the following, we had issues with the nurses and midwives being produced in training institutions, but we didn't know what was wrong or how to put it right. Then we realized that the students hadn't been mentored in the rightful way. And we had a belief that if we trained our mentors, they would be able to bring out the quality nurses and midwives to serve the people of Uganda. And so we welcomed the momentum project with both hands. Momentum, by the way, stands for developing a model. That's the MO bit of mentorship, M-E-N-T, for Uganda and Midwifery. And so happily in July 2015, we were successful in getting funding again from UK aid, otherwise known as DFID, and that money was channeled through THET, the Tropical Health and Education Trust, who managed the health partnership scheme. And we got that money to implement another twinning project, if you like an add-on to what we'd already been doing in Uganda, this time for 20 months, to develop a model of mentorship for Uganda and Midwifery, the momentum project. And this project was a gain in partnership with the Northern Private Midwives Association, but it was working with many stakeholders, such as the Ministry of Health and the Ministry of Education in Uganda, the Uganda Nurses and Midwives Council, several universities and Midwifery training schools, and various clinical placement sites across the public, private and faith-based sectors, which in Uganda are the people who deliver healthcare. And as we were developing a model, something new for Uganda, we planned to use a participatory action research approach. I'm not sure if anyone listening is familiar with action research, but action research emphasizes participation and action, and it seeks to facilitate change and joint knowledge production through collaboration and reflection. So although we had to submit our draft project plan to the donors in order to elicit funding, at the beginning of the project, we took that plan apart again. We undertook a participatory situational analysis. You can see on the screen a piece of paper with lots of post-its where we designed a garden for Midwifery mentorship with a big tree and talked about the roots of the problem and the fruits and the branches and all the tools we had in our toolbox. And that was a truly participatory event. We undertook a stakeholder analysis and we rewrote the whole project plan together and designed the monitoring and evaluation framework as a partnership to ensure participation from everyone who would be involved in the project's implementation. And on the right-hand side at the bottom you can see all the various coloured bits of paper on the wall as we designed the monitoring and evaluation framework together. So as I've said, our funds came from the DFID Health Partnerships Scheme and this scheme was available only for UK healthcare organisations working in partnership with a national organisation in a developing or middle-income country that utilised the expertise of UK health professionals in the delivery of the project. So as we wanted to continue twinning both as organisations and individuals, this suited us very well and we recruited seven UK midwives as volunteer consultants for the duration of the project and we matched those UK midwives with midwives in Uganda in similar roles. So for example, we chose someone with experience of working with the UK Nursing and Midwifery Council to work and be twinned with a representative from the Nurses and Midwives Council in Uganda. We matched midwife teachers from the UK with midwife teachers in Uganda and we matched midwives who were responsible for organising mentorship in their workplaces in the UK with midwives who would be responsible for implementing the mentorship programme in their clinics and health centres in Uganda. We knew that face-to-face contact between the twins would be essential. So we planned for the UK midwives to visit Uganda for two four-week periods each year and also for the Ugandan midwives to make an exchange visit to the UK. But we also hoped that they would engage in virtual twinning, that is keeping in touch with each other by using smartphones in between visits. The goal of the project was to improve the knowledge and skills and attitudes amongst the targeted student midwives and the outcomes to increase the capacity of the Ugandan Nurses and Midwives Council to develop a mentorship standard. To improve the knowledge and skills and attitudes of midwife mentors by developing a work-based learning module and training the midwives as mentors and also by making improvements in four clinical pilot sites. The outputs from the project, well we hoped that at the end of the project there would be a draft National Standard for Mentorship having been produced by the Nursing and Midwifery Council that we would have a work-based learning CPD module to train midwives as mentors, that we would have mentored 84 students, trained 40 mentors and made improvements in four clinical pilot sites. And all of this was to be achieved through three cycles of action reflection based around workshops, the visits to and from the UK, the virtual twinning and support in between the workshops and visits from the RCMs Global Team and the UPMA, the Uganda Private Midwives Association's project management team in Uganda. One thing we found is that the needs assessment and stakeholder analysis that we undertook are iterative. That means you need to do them over and over again in many layers, continually assessing needs as they arrive and identifying who are the important gatekeepers that can either facilitate or block the project. And it's very hard if you don't understand the country and the players and that highlights the importance of long-term partnerships where partners know who is who and who themselves are also known. So this is a lovely photo of our team of UK volunteer midwives and I think there's at least a couple of you listening in. So hello to you both. These, our lovely midwives are standing with the Commissioner for Nursing and Midwifery at the Ugandan Ministry of Health, Catherine Betio-Deckey. And it's so important when you're working in global health to ensure that your programs are fully supported by the relevant ministries and are in line with national priorities and strategies. The International Confederation of Midwives suggests that there are three pillars of a strong midwifery profession in any country. Education, that's pre-service and in-service midwifery education, regulation and association. So these three pillars are really important for the Royal College of Midwives in our global work. We recognize that to make lasting change in midwifery, you need to engage with all three of these pillars in working together. That's why it's really important for us in this photo to engage with the regulatory bodies such as ministries and the professional councils. So when the UK midwives visited Uganda for the first time, they met their twins, they traveled out to the project pilot sites and they helped their twins to conduct a baseline assessment where they were and to see the situation on the ground. Following this, we had a series of three workshops each approximately six months apart which formed the basis of the action reflection cycles. On the first day of the workshop, everyone from each one of the three work streams, so that's developing the standard, developing the mentorship module and those from the clinical pilot sites, everyone would gather together to listen to each other and hear stories of change, identifying any challenges that had arisen and the strategies that people had used to address those challenges. We were informed by a method of data collection called appreciative inquiry which focuses on the positive change that you want to achieve rather than focusing on problems and so celebrating success became a really important part of our reflections. On the second day of the workshop, we piloted some of the content for the mentorship module, therefore during the workshops training a team of trainers who could take the module forward by the end of the final workshop. The content of the module is really simple, how students learn, some simple strategies for teaching and assessment in clinical practice and a focus on communication and simple behavior change theory and we also included teaching on reflection both for students and for mentors which is a very new thing to Uganda. And then the final third day of the workshop was about planning, making action plans for the next six months and also developing communication strategies to ensure that the twins could keep in touch. So you can see here some lovely photos of the participants of the workshops. And as a partnership, the RCM and the UPMA also spent an extra day after the workshop reflecting on the workshop developing work plans to ensure effective management of the project including monitoring and evaluation activities and reporting back to various stakeholders such as our donors and our own executive management teams. It was really important that representatives from all three work streams attended the workshop together so that the standard and the module would reflect the context of midwifery in Uganda and would be rooted in reality. So at the end of 2016, six Ugandan midwives visited the UK to understand how mentorship works for midwifery students here. You can see a couple of photos here from their visit. We took our colleagues to visit regulatory bodies, universities and clinical sites, hospitals and birth centres and we hosted them in our homes and attended conferences and events to publicise our work and give our partners a chance to practice their presentation skills. It was absolutely exhausting, but it was wonderful and it's clear several months on that that visit to the UK was an absolute turning point, especially from the representative from the Ugandan Nurses and Midwives Council. You can see her here. She's on the right hand photo sitting behind two suitcases in a white cardigan, that's Mercy. And for her, this was an absolute turning point. She was able for the first time to see a working model of mentorship in practice and to actually visualise what it could look like within a different context in Uganda. So again, when I met Mercy last week, she expressed really clearly how the visit in the UK had impacted her. She said, mentorship is a burning issue for Uganda. My visit to the UK in October 2016 was the turning point in the development of the National Standard for Mentorship. This work has also captured the interest of others. So the Ministry of Health now has a programme to harmonise mentorship tools and the Parliamentary Committee of Education and Sports is also interested in our mentorship tools. The momentum workshops had a great input into the standard and we would really like a follow-on project for rolling out mentorship. So we found that really, really encouraging. And of course, when you work globally, what you want more than anything is the work to be sustainable. And I think what Mercy has said there with other people expressing interest in the tools has been really encouraging for us. So very quickly, just to tell you about data collection tools of course we were doing action research and every piece of research needs data collection tools. So we had to develop a number of tools. One was a clinical learning environment audit tool. Those of you who are midwife educators will be familiar with these tools but it needed to be something that was really simple and something applicable to the Ugandan context. We tried to use locally available tools that were already in use wherever possible or if they weren't, we tried to develop ones which had already been tried and tested in low resource settings. But we did end up having to develop a few tools ourselves. So we had a skills framework for mentors. We needed a tool to assess student midwives in clinical practice. What we found was that the tools that were already in use in Uganda didn't tend to measure the student's knowledge, knowledge, attitude and skills around midwifery, or midwifery skills. What they tended to measure was things about how neat their uniform was, whether they were prompt and whether they knew how to clean the ward. Those things are important but they're not actually measuring the capabilities that students need in order to qualify as midwives. We had to develop a tool to try and measure the capacity of the nursing and midwifery council. We tried very hard to find an existing tool for measuring the capacity of a regulatory body to develop standards. But we don't think such a tool exists and if anyone's listening who does know of such a tool I would love to hear from you. We developed very simple reflective grids. The students, we gave them an evaluation form to evaluate their mentors and that was so empowering because students' voices are just not heard in the Ugandan context. So to be invited to evaluate their mentors was such a new thing. Yes, and various other tools that I don't need to go through here but you can imagine that's a lot of work. So what is the model of mentorship? What we've said, of course, is that we were going to develop a model. Well, one of our UK midwives who's been involved in the project together and I think it's a marvellous and simple diagram. So you can see that it includes the triangle of mentorship. When you're mentoring a student you need to have three things in place. Of course you need a student ready to learn but you also need a mentor who's trained with the skills to mentor and then you need the clinical learning environment to support the student's learning. So just simply, for example, a student needs to take a blood pressure but the blood pressure machine is not there in the clinical environment. They won't learn that skill. If they need to do an apesiotomy but there are no apesiotomy scissors the student won't be able to learn that skill. These are not vast improvements but simple improvements may be needed in a clinical learning environment in order to support the student's learning. So that's a diagram that just outlines the whole of the model that we've put in place which includes not only that triangle but the module for training the tutors module for training the midwives the national standard for mentorship that sets out all of the standards required for students to be mentored effectively and then of course you need the schools being ready to send and support their students in the clinical learning environments and you need effective and sustainable supply of equipment for the clinical sites and importantly at the bottom you need enough midwives to be able to achieve the minimum number of mentors and this is such a big problem in Uganda because the number of midwives per women falls far short of the WHO standard at the moment that's 175 175 pregnant women per one midwife and I think at the moment Uganda has around 3000 pregnant women per one midwife and of course in the UK we have approximately one per 30 so the numbers that's just such a challenge so moving on to the results I think we're doing okay for time what were the results of the project well I'm happy to say that we met all of our objectives and outputs at the nurses and midwifery council from having had no capacity to develop a mentorship standard it was set as a specific objective and the NMC developed a functional technical working group to work on the standard and that standard exists our goal was to have a draft because we knew that within 20 months it would be outside of our control whether that standard was actually taken on by Uganda but we thought that at least we could have a working draft and that draft now exists in its second form and it's currently being reviewed and there are plans to validate it at an event on the 6th of June so that's really exciting and additionally the work-based learning module has also been developed and I know that Anya who's one of our midwife UK volunteers who's doing her PhD in work-based learning is listening into this presentation we really appreciate the huge amount of work that you and your Ugandan colleagues put into developing the module and that module has already peaked the interest of the ministry and education of sports and they've taken it to look at it to see how it can inform the new midwifery curriculum planning so that's really exciting of course we've had lots of challenges the nursing and midwifery council had a very limited budget limited staff a lot of staff changes due to sickness and maternity leave which meant engaging with those key stakeholders was quite a challenge work-based learning itself as a concept is a very new approach for Uganda and took some time for people to get their heads around it was so important to us that this module should be about work-based learning because when there are so few midwives in Uganda if you take them out of the workplace to train number one we know that taking people out of the workplace isn't a very effective model of training it's much more effective to train people at work in context but also it means that they're not removed from the workplace and they're still available for mothers and they're still available to work with midwives one of our UK twins was sick so a number of challenges but really happy to say that the outputs or the objectives that we've set in terms of the standard of individual development have been achieved really well and then in terms of the students we had hoped to mentor 84 students and actually we've ended up mentoring 142 students from eight midwifery schools and they've all shown improvements in knowledge skills and attitudes so that's been really marvellous and the students reported that their experience with mentoring was significantly improved that the learning environment was more supportive of them and they had an identified person to contact in the clinical sites and that they were better skilled in relation to reflection on their learning we did have challenges again with students we had low numbers we had to really work hard to make sure that we could reach the number of students that we'd planned for there were some changes in the allocation systems that really caused us challenges there was a strike at one university another university changed its curriculum so the students were coming out at a time when we didn't have any of our volunteer consultants in the pilot sites and as we've said the assessment tools from the students didn't always set out to capture changes in knowledge skills and attitudes but again we developed strategies to deal with those challenges and very pleased that we've reached the required numbers so I just wanted to include a quote here from Grace who's a student midwife who undertook her placement at one of the government public health centres that were in our project she said during my placement in Macono I've been mentored by sister Christine I've learnt many new skills and I feel more confident now because I can deliver a mother independently I can repair an apesiotomy and tear I can resuscitate a baby I've learned about good infection control and I can give a report and I've had a good time with sister Christine that doesn't sound particularly exciting to those of us who work with students all the time but it's really important because what we've found is so many students in Uganda had never had the experience to have their hands on a mother and many of them qualified as midwives with hardly ever having actually delivered care they were only allowed to observe and so to get hands on was such an achievement and Grace really positively illustrates the impact that being mentored had on her confidence and her skills in the clinical sites we had aimed to develop mentorship support systems at the four clinical sites and to have 40 mentors trained 43 mentors have been trained during the project this was only a pilot so the numbers are small and as you can see from the summary of the clinical sites we measured in January 2016 June and then January 2017 and in all of the pilot sites the scores had increased in the audit so that was really exciting and just a quote from Rabina who is one of the midwives again who works in one of the public health facilities about how the clinical learning environment has improved for her so she says since participating in momentum all five midwives at Wokiso level four health centre have been trained as mentors and we in our health centre have mentored 14 students with Caddy's help, Caddy's a consultant midwife from London who's involved in this project and has been twinned with Rabina with Caddy's help we've changed the systems and the patient flow the health centre has been upgraded with solar lighting solar lighting is brilliant they can now see to deliver 24-7 much other equipment and we focus much on infection control our staff have changed their attitude and they're now willing to work with students our deliveries have increased so that's really great the number of women who've got confidence in the facility who now want to come and deliver there have increased and we have far fewer referrals for sepsis or asphyxiated babies and we're much better at managing obstetric emergencies and I still communicate regularly with Caddy via WhatsApp so that's really great so I'm nearly done what's coming next I've told you about the background to the project how we designed the intervention using action research and appreciative inquiry the methods that we've used the data collection tools the activities of the project and the results so what's coming next well looking to the future the RCM and the UPMA now have a well established long-term partnership and a deep relationship with the key stakeholders and we know that in terms of future funding for global work there's an interest amongst funders in long-term partnerships and we really hope that we can continue to build on that we know from our experience it takes about three years to build a partnership to see any results so we really hope to get some ongoing work as a partnership we have a plan to publish the results from the project and disseminate it widely last week when I was in Uganda we developed together everything we do is together we developed a publication strategy so those of you who are listening that were involved in the project we're looking to you to help with that we also have some further research planned simply the experience of mentors and students who've participated in the project we've now got ethical approval in Uganda for that project and we're about to start data collection we're continuing to undertake an assessment of needs and the Ministry of Health and the Uganda Nurses and Midwives Council have asked us for continued assistance to roll out mentorship on a wider scale and interestingly the Nursing and Midwifery Council have decided that this is the standard they've developed should not just be for midwives but should also be for nurses so that's really encouraging too of course there are funding uncertainties and the recent decision to hold a general election in the UK has not helped as no more funding schemes will be announced imminently but we're really confident that this is good work and that there will be funds to continue it in time so that's it really thank you for your interest in the project for participating in this conference today and I would encourage you to take a look at the Royal College of Midwives website for further information the address is there on the bottom www.rcm.org.uk forward slash global work and you can see if you visit that website you can see information about this project you can see information about past projects and you can also read my blog and there's a few other people who also do a guest blog but you can read the blogs that I write as I travel around conducting monitoring on the projects and meeting our partners so thank you very much it's been lovely to see these positive comments coming through thank you Anya, thank you Tanya, thank you Fishy and Ginger we really appreciated your involvement in the project the way that you've really supported us and this is your work I just have the honour to present it but the credit goes to you thank you very much Joy, thank you very much and on behalf of all the audience we're all clapping silently we are all clapping for you so thank you very much indeed I'm going to ask the audience to post some questions to you and write them into the chat box and while they're thinking about that I see that Lindsay has already posed the question a little bit earlier she was congratulating a great project and very excited by the perhaps full liberal support of the world she asked the question will we be able to apply some of these tools into the new cave what might come back into the new cave that's a really great question Lindsay and of course I haven't specifically focused in this presentation on the reciprocal benefits of twinning but one of the great things about twinning is that the learning is not just one way we learn so much in the UK there's a body of evidence which is now becoming evident for the impact for individual midwives and health professionals who undertake global health placements about how that impacts them when they come back to the UK particularly in terms of growth of their leadership skills, creativity thinking outside of the box and we recently did a survey at the RCM of our members who participated in global work and our findings very much mirrored those that others are finding but I think also we can learn a lot in terms of structures, system structures so curricula and many of the tools that are coming out of projects and I do think sometimes in the UK we vastly overcomplicate things and one of the things that we've learned here is that when you have a simple project with a simple design you can actually make deep changes these we're in the process of producing the final model we've got a mentors handbook we've got a students handbook and all of the tools and those certainly will be available I think we just need to badge them so that everyone knows who produced them and then we will definitely make those available on the RCM website Joy, I have a question here that was on my mind as you were talking this is very much about Uganda that's where you're pilot studying do you have any thoughts about its transferability across other countries other uniquenesses to Uganda that need to be considered if we work with other countries? Yeah that's also a great question I think it's really important that we don't just take tools and approaches and assume that because they work in one country they're going to work in others and that's why I think in this project when we've used action research that was one of the reasons we used it because we wanted this to be participatory and we wanted the solutions to the problem to be found by everybody and to be unique to the Ugandan context but I do think that there are lots of transferable things I think Uganda is in many ways very similar to other low resource countries with some of the same issues in terms of low numbers of midwives difficulty in accessing sites lots of the same problems the ICM interestingly is very interested in what we've been doing they are doing a similar project in French speaking Africa and are very keen to utilise the tools that we've produced in Francophone Africa so that's really encouraging yeah I guess Ugandan's unique, all countries are unique it's a wonderful place to be people are incredibly friendly and we've been welcomed with open arms and we're very grateful for that so yes of course it's unique but I do think that there are transferable lessons what about scaling do you have any thoughts on how you may bring this to a wider community it appears to be a one on one small scale at this stage how would you go about bringing this to thousands I don't know is the honest answer I think the approach that we've used in the momentum project where the solutions are found from people on the ground can definitely be scaled up and I think if we were lucky enough to get funding to roll this out it would still be really important that the solutions were found by the people who need the system and not by us but the fact that the Ministry of Health and the Ugandan Nurses and Midwives Council and the Ministry of Education and Sports are so interested in what we're doing I think is one of the key things I think you have to have the involvement of those key stakeholders to make it successful but I think it would be incredibly difficult there have been lots of limitations of our project one of them is that because it was a short time frame and because of the model that we were using we didn't go anywhere that was further than three hours away from Kampala but there are parts of Uganda particularly up in the north in the post-conflict zone which are deeply inaccessible and I think it would be much more challenging to roll things out up there so yeah, lots of challenges ahead and I think if we get funding we're going to have to make sure that we consider all of those issues very carefully Have you done any studies on the benefits that come back to the UK participants of these networks are you able to identify why it's a benefit to the UK that would help scale I imagine Yes, I mean as I think I said at the beginning of the presentation we used UK health professionals UK midwives in this project partly because that was a requirement of our funding stream this was a funding stream that was about health partnerships between the UK and low and middle income countries and we had to include UK health professionals as one of the ways that we would deliver the project I've been absolutely wonderful but it's not always the right approach to take people from the UK I think you can often find solutions locally and flying people to and fro is expensive and it's also damaging for the environment so I think we need to think about different approaches but yes we have as I said we conducted a survey towards the end of last year of around 80 people who were Royal College of Midwives members that had participated in global work and all of them said participating had had a very significant impact on them it had impacted them in three different ways one it had impacted their personal development so people found that personally they developed hugely they discovered depths of resilience about themselves that they didn't know were there it gave them courage to tackle all sorts of things in life because they had managed to cross cultures and be in much more difficult and challenging environments but it also developed them professionally and that was broken down I can't remember all of the categories right now but it developed leadership skills it developed people's clinical skills it helped them to remember why they had wanted to be a midwife it helped in terms of retention several of our volunteers wanted to go overseas because they wanted to do something different they were really fed up and were even considering leaving the profession altogether and then participating in global work had made them completely re-engage with the profession and want to revisit why they wanted to become a midwife so that was really exciting lots of other ways but then interestingly for us as a professional association what it also did for our members was to deeply engage them with us as their professional association so many midwives said to us you know before I went overseas I was just fly on the wall with the RCM I paid my membership fee but I've never really engaged as a workplace representative I've never been to RCM events I've just if you like been a member of the Royal College as an insurance policy and what participating in the global work has done is bring people back as passionate advocates as professional association and wanting to get more involved in it themselves because they've seen the potential for professional associations in strengthening midwifery overseas so I think that's been really interesting data Joy I'm going to put a pause on you there now because I'm conscious of time we need to get set up for our next presentation so once again on behalf of everybody we're all clapping here for you thank you very much for your very insightful presentation just before we close I'd just like to go through a couple of closing slides that people need to know about we'll switch off the recording now I think Sarah will do that for me