 And I'm going to start by introducing Corina. And I've had the pleasure of talking to her on the phone and hearing a little bit about her work. And she'll talk to us tonight about that. She is a PhD candidate at AUT. And she has, if you look at her biography on our program page, she has quite an outstanding history of receiving scholarship awards for her research. And academics, her current research is looking at strengthening midwifery education in Indonesia using qualitative inquiry. So I'm going to go ahead and hand it over to you now, Corina. And hello, everyone. Thank you for having me today. And as Cindy mentioned earlier, that this is one of my PhD project. And I want to share one of the preliminary findings of this project. So before we start, I want to notice about what Nelson Mandela said about education. So what Mr. Mandela said about education, he said that education is the most powerful weapon, which you can use to change the world. I believe this to be true and applicable across so many areas of life, not least midwifery and maternal newborn and child health. So what if Mr. Mandela's quote, it would be adopted? So it would read, education is the most powerful weapon, which you can use to change the maternal neonatal child world to achieve sustainable development goals 2030. So now I'm doing PhD in Ovan University of Technology. And I want to acknowledge my fantastic supervisors. So I feel privileged under Supervision Associate Professor Judith McAra Cooper and Dr. Andrea Gilgason. So the rationale and significance of my study, so there is a research currently research about newly graduate midwife, especially in lower and middle income countries. Usually they face a myriad challenges as it's feeling less confident because they may have fewer opportunities for hands-on clinical practical. So at this point, sound that midwifery education has been associated with competent and skilled midwife. And it is in line as well with the ICM when they said that midwifery education is one of the three pillars to strengthen midwives globally alongside with legislation and regulation. So that's why the high quality midwifery education is essential in developing competence and confident midwives that we, sure, if they produce from appropriate midwifery schools, so they will fit to practice to make a difference in maternal neonatal mortality rates. So this presentation is constructed on the central research question, how can midwifery education in Indonesia be strengthened? So the aim of this research is to explore the experience of the participants who involve in the midwifery school and to identify the barriers and enables how midwifery education in Indonesia can be strengthened. So this data, I took it from the state of the world's mother's report 2013. So when we see from this picture that most newborn deaths only occur in just 10 countries, which is Indonesia is one. But when we have a look from these countries, so India, they just built the nurse midwife. And Bangladesh and Afghanistan, they just have probably made much more than 10 years ago. But how about Indonesia? We still contribute to the trend largest maternal mortality rates in the world even. We have a long history and a lot of efforts of the development of midwifery school. So this is many, many efforts from my countries to reduce maternal neonatal mortality rates. So they start from the focus on the curative, they start. And then turn to the preventive approach until we have economic crisis and how the system changed. So we have a community health center. And we start a philatumid wife program. So this is the trigger to open and the proliferation of midwifery schools in my country because there is an obligation at that time that every village has to have a one midwife. So that's why we call it a village midwife program. And then we have mother-friendly movement. We call it husband alert. And now we have healthy Indonesia. So this is like a team approach, a team program approach that midwife is one of the team who deployed in the remote and rural areas in my country. So when we see from all these years and the history of the midwifery education itself, so we built the midwifery school from in the beginning under Dutch colonialization. So we start from 1850. So at that time, we're still under Dutch colonialization and the Dutch head of the medical service at that time, Dr. William Booth tried to propose to establish a midwifery school from Indonesian female because at that time, they just trained the Western midwife. And finally, 1851, a midwifery school opened in Jakarta with 20 Indonesian female students. But after that, many happened and there is a reorganization. So after this school closed and then reopened again, and then the midwifery school admitted students from junior high school. And then around 1990, some nurses were educated to be a midwife. So in the beginnings before the person being a midwife, so they have took the nurse program. And finally, in 1996, we have the direct entry program, the Diploma of Midwifery Education from senior high school opened. And now around 2000, we have already had several roots to midwifery education. We have a diploma, we have advanced diploma, we have bachelor, and we have master of midwifery and master of applied science in midwifery as well. But when we have a look the number of the midwifery education, and then it will become a big issue. So in the beginning, the proliferation of midwifery school designed by the government to produce the skill newly graduated midwife, and then they will be deployed in every village in my country. So that's why the government has made a proliferation of midwifery schools. It seems ubiquitous with more than 753 schools divided on advanced diploma, bachelor, and master. So from this moment, we also see it will become the critical to address quality of education. Because after the Indonesian government tried to accredit the midwifery school, the status of the category of accreditation, still most of the school is C. So there is A, B, C expired and not accredited. So this is not good result. And even expired, or most of these midwifery schools have a C status of accreditation. Even the number of the accreditation school being in E4, but still the result of the number of midwifery school with the good or outstanding result of accreditation is not most of this midwifery school. So that's why this is a very big problem in my country that in 2015, finally, we did not meet the millennium developmental goals target 2015, because there is still gap on the maternal newborn mortality rates in Indonesia. Even the government already put a lot of effort, especially, to improve maternal neonatal health outcomes. As well as if we use a different term of the newborn mortality rate, but the numbers still do not meet the MDG's target. So why, especially my government, my government put a lot of effort. So we believe it is a common misconception, probably, that probably midwives only concern about how to deliver a baby. But from this literature review, we can find that midwives is in a unique and privileged position to assist women staying healthy, making choices, through the women's childbearing circle. So she will be the incredible person to be part of a complex continuum of care, not only from the delivery process, but from the moment when a woman starts to think about having a child until they deliver a baby, probably around 40 second day after the child is born. So it's more than 10 months. And even for the development of the infant child health and the reproductive health as well in my country, so during the circle of the woman is the responsibilities of the midwife. So that's why the position of the midwife is very critical. So my study carried out with the qualitative descriptive as actually there is an alteration of the methodology. So my beginning, I started my study from the hermeneutic hermeneutology. And then we turn to the qualitative descriptive because of the nature and the size of the research. I got the ethical approval from AUTEC, Auckland, New Zealand, as well as from the Health Research Ethic Committee, Faculty of Medicine Pajajaran University in Indonesia. And I conduct face-to-face in-depth structure, semi-structure in-depth interview and the data thematically analysis. I also maintain how the rigor is maintained. So my study conducted, I gathered 37 participants from 12 different midwifery schools include two central boards of midwifery association in my country from eight cities in six provinces. I'm sorry, I couldn't show you. This is the summary of my data collection. So I have to travel from one city to another city in different provinces. But in this case, I just want to show you the data from the midwifery educators. So this is the number of the participants that I gather. So there is some Indonesian midwifery educators, midwifery students, newly graduated midwife and obstetrician. So why I also gather the obstetrician? Because in the beginning of the settlement of midwifery school in Indonesia is set by the obstetrician. And even now, most of us in some of midwifery school, obstetrician still hold the position as the head of midwifery department. So this is the summary of my data from 37 participants that I have. So I have more than 400 pages transcription. And with more than 2,539 minutes, I conduct the in-depth interview and analyze more than 100,000 words. And this is the preliminary findings. I'm sorry. Or the slow motion. Wait. So this is the preliminary findings. And we still build it about the same. So we call it midwifery teaching and learning, midwifery clinical experience and structural and external factor. What the midwifery educators most of state in this research? So what motivated lectures of midwifery? So most of the midwifery teachers, or we call it midwifery lecturers, they feel passionate about midwifery because one of the reasons also because the blessing of Allah. So this is like the cultural, the religious belief that what we have done, it will reward it by the God. So even probably they stress that even they don't like it or they want to give up, but they believe that what they motivate to stay in midwifery because the religious belief. So they call it blessing, blessing of Allah. It's like we got reward the good when we have a good deed. So the God will give a good because of that. So this is what they believe. And they said that we need to improve the midwifery competency based curriculum. So even we have this data gathered from broad midwifery school. But most of the midwifery teachers said that we still need to improve midwifery competence based curriculum. So even we already have the midwifery curriculum like competency based curriculum, but still they said that it still needs to improve. Basically the ministry of health, they produce the core curriculum for the diploma or midwifery program. But for the advanced diploma and the bachelor, they still build it. So that's why they say that we have to improve our curriculum. This is why the important, I want to stretch why the improvement of the midwifery competence based curriculum is needed. Because they said there is no standard size it's midwifery program in all the school because we have a different kind of midwifery school that I mentioned earlier. We have diplomas. We have advanced diplomas. We have bachelor. So currently there is no differences or competencies between all these programs. So that's why it's quite confusing for them. About midwifery teaching and learning, they said they just built the tutorial system. So that's why they have to want to improvement on the midwifery teaching and learning. They said that they are participating in class because they just become a tutor. They will become a facilitator and it is divided in some small group. And it's totally different when they was in school. So that's why they call it is a different system. And they also mentioned about the need to improve their English because many of this midwifery lecture they feel that they don't have enough knowledge in English to know and understand the material, especially in English because they used to read the journal and the textbooks in English. But because of the language barrier, they said they're not really have a good understanding to read good references about midwifery. So that's why they want to have a mastery in English. And another one, why the midwifery teaching and learning need to be improved because they have to make sure how the class is run from unmotivated students become motivated students because most of this lecturer found that most of the students, they entry to midwifery school because of their parents or their family, not because of their own intention to become a midwife. So that's why it's very challenging and it's very hard work for them if they want to build and because they said that cannot force someone to become a midwife but they have to finish it in class. So that's why how they build the interesting teaching and learning to make midwifery students passionately want to become a midwife. The another one is the ability for them to do a clinical practice. So they said that most of this teacher, they're not currently they don't do any clinical practice anymore. So that's why they said that it's very dangerous if they just transfer all the knowledge and skill based on the textbooks, not really from the daily practice as a midwife. They say that, so one of this one of these teachers said what happened then? I feel that I did not have my soul at all during my teaching time when I thought about palpation. I feel empty because it's been a while I haven't done palpation. I decide to with several of my friends though. So they tried to open independent practice to maintain our ability because as a lecturer we do not only have the theory, there is a skill I experienced was if we wanted to be considered as a midwifery lecturer, we should be practiced in the real setting service. My hands have become numb to not have skill. But most of these teachers, they don't have enough clinical practice to do it. Another one about the midwifery clinical experience. They know that the midwifery students burden with the number of midwifery target. So from this project I found they said about, they said about, we call it about Partis Pandang. Partis Pandang is only feel or watch the delivery process, but they raried down as a skill. So they know it about that. And even they passed from the midwifery school, we call it the literary midwife because they have, they raried down the midwifery skills that they not really competence on it. So they said that there is a target for midwifery students to achieve the skill. Sometimes I don't know whether this is true. They are sincerely honest or not because the target is too much. So each midwifery student they have to assisting the woman minimum 50, 50 delivery process. But they said they not really know this is true or not. Next about the continuity of care. So they know and understand that the continuity of care experiment is very beneficial for midwifery students, but they still have to learn how to provide the good way for the student because it's not like how to prepare for the method, the schedule about the fee, about the feel as well as about the mentor. And the next is about the process prior to clinical experience. So basically the midwifery student have to attend the classroom and have to know the theory. And then they have to be practice and demonstrating their skill in the laboratory. And they have to pass the examination before the clinical experience. So they have to pass it before do the midwifery clinical experience. But they just wonder why the students still cannot do the competencies in the real setting. So that's why they call it, it's complex, it's complicated and made me sometimes want to give up because so tired. The bureaucracy, the system offer again and again makes me occasionally desperate. So this is about the clinical placement. So when the midwifery students go to the clinical placement, each clinical side have to memorandum of understanding with the midwifery school. So they have the specific timeline or the period to arrange all these place. So they don't have the exact place to go to the clinical placement. So that's why the process for the arrangement of the clinical side made some of this midwifery lecture like want to give up because the system. And about the structural and external factor, they said that it's very hard and difficult when say about the accreditation moment. So they said that they put a lot of energy on it because the status of their midwifery school will be defined by the result of the accreditation process. So that's why they pull all the energy, all the time, all the feeling for it and not really make the prioritize of the teaching and learning process. So that's why they need want to improvement of the accreditation process. And about the different kind of midwifery program as well. So as I mentioned earlier about diploma advanced diploma bachelor. So they said that the different kind of midwifery program raise the confusing feeling to all these midwifery students. They noticed about that the collaboration needs between the midwifery associates and the government because we, of course, we cannot give the good support for the midwifery school if we don't make the good collaboration with all parties. And this is about the standard size of midwifery school. So one of the external factor they call it how difficulty all this party to make a agreement about different kind of midwifery school. They also mentioned about the cost. So they mentioned about the cost of being a midwife because this is like they feel prefilled to become a midwife. So in the beginning, they have to pay a lot of, so this is like one of the expensive school in Indonesia to entry the midwifery school. So each stage or it's, they have to pay even for the clinical experience. And after that, they have to pay as well to apply for the registration as a new midwife. They have to hold the training before to apply for the job vacancy. So that's why they said it's very costly to become a midwife. This is one of the notification about the structural and external factor that they need support from the midwifery association or the midwifery school because of the requirement as a new midwife. So from this preliminary finding from the midwifery lecture, I can't make a discussion that the efforts to deliver high quality education have to deal with the various challenges and a broad coalition of national authorities, professional association and communities because if we want midwifery education and to meet the global standards, of course, that the status of the midwife recognized by the government. And at this stage, the midwifery association is a significant catalyst to work together with midwifery education in the promotion of the women's healthcare high quality or midwifery school can lead midwifery student to demonstrate essential competencies and produce fully graduated midwife who provides midwifery care to mother and baby. So fully qualified midwife as health provider are playing a profound role in the partnership with women and baby. So it is believed that the strengthening midwifery education to produce qualified midwife seems to be inevitable in my country. I think most of across the world for this. So thank you for your attention. Back to you, Cindy. Thank you so much, fantastic. It's really amazing that you had so much information gathered there and your synthesis of all that information was really pretty telling. It's really interesting the spirit of the midwives that feel like it's difficult and such a challenge to do what they wanna be doing and continue to feel supported in that. So we did have one question here on the side to begin with. And that was the question was, are the students required to get their experiences signed off in the practice setting by the midwife overseeing them? Yes, thank you so much for your question, Jane. So, yeah, basically before the, so the midwifery students have the mentor in the clinical side. But the mentor, who define the mentor? It's like, if you are a senior midwife in the maternity ward or in the clinical side, it's like automatically that you will become a mentor for the midwife. So they have, they know the midwifery target of the students and they just signed it because filipiti of the student because of the target. You know what I mean? So sometimes they just signed out the target of this midwifery student. So, like there is the cases like this. I give you the only example, one woman divided into five students like first student, student A did the first stage, student B did the second stage, student C did the third stage. But all these students write the delivery process completely. And the mentor will signing out, sign out this report as a midwifery target that all these students assistant the woman to deliver a process, to delivering the baby. Is it answer your question? It seems like that might be an issue then of oversight, like who is monitoring that these evaluations, is there a governing body that's making sure that the mentors are really exactly who is monitoring the monitors is the question. And it sounds like that might be what you're looking at really as part of the systems approach of what you're looking at. Yes, that's the big gap for that. So, we have midwifery association. We have like the, we call it be done dilemma. So it's like the standard of midwifery, the private midwifery practice or the standard of the maternity clinics. But because the order of number of the midwifery students. So that's why we're not really, we're not really monitor each, like it's competencies for its students. Is it answer? I think so. I'm wondering if as part of the school system are there precepting coordinators that come out and interact with the midwives who are overseeing the students to check in and kind of talk to them and see what's happening. Yes, Jane, absolutely. So that's why most of this midwifery lecture and say that is very complicated. Even we try to coordinate it because the, because we not really have to manage the clinical sites because all these clinical sites not under the midwifery school. So it's like a different body. So we have to manage the administrative thing prior to midwifery clinical experience. So yeah, it's complicated system for that. We try, based on my data, they try to manage, they try to make a coordination between all these parties, but still the big gaps, it happens. I'm wondering, Karina, do you have a sense of how the system might change in looking at all that data? Do you see a pathway for change? Yeah, so that's why from this data, when we found about the theme, how we make improvement, so we have to make sure from A until Z, I mean like how the class run, how the laboratory, how about the learning resources, how about the human resources. So all these parties will be involved, not only single way to make improvement. So that's why I call it like a symphony in the compound world. And you have pretty good governmental support with this project? This project. Yes. So I hope, yes, I hold the scholarship from my PhD scholarship funded by the Ministry of Research, Technology and Higher Education, and this project funded by the Ministry of Finance. Yes, so both of my, so my government, yes, very, very support. And you can see actually from all the strategies in front how my government try to reduce, make an improvement to strengthen midwife especially, and midwifery school in my country. So the effort is very, very big. They just want to reduce the maternal neonatal mortality rates. So that's why it's still like a big question, why the maternal mortality, maternal neonatal mortality rate in my country is still not reduced significantly. Even we already have all these efforts, especially when we try to build the midwife and put a village midwife program. There's a question here. There's actually a comment and a couple of comments. One is, is that picture of your students in this picture, this thank you page? So yeah, when I mentioned about why they not feel competent after the training because when they did the clinical experience, they're not really do it. So that's why they call it only few, only watch the delivery process because they not really do it from the beginning until the end. So that's why they not really feel competent and confident after they complete their school. And about the critical thinking, we have the midwifery curriculum and it is said that yes, it's based on the critical thinking. But I think there is a still gap between the implementation and the theory. Fantastic. I think we have time for one more question. If anybody has another question or comment for Corina. Lots of thank yous. Thank you so much. Excellent. Okay, Corina, I'm gonna just. Yeah, thank you Cindy. I want to add something about the continuity of care. So the number of the continuity of care, most of these students only have to follow one or three continuity of care experiences. We have the continuity of care experiences but only one or two for its students. Okay. So yeah, that's not a lot. Okay, Corina, I'm just gonna close, get ready to close this session so we can get ready to open the next. And I just wanna give everybody in the room a few closing comments. So.