 Felly, mae'n gweithio'r gweithio ar gyd, a dwi'n meddwl i'n gweithio'r seirau. Mae'r meddwl mewn ffordd mewn i'r sydd mewn uchydigweithio ar gyfer y swydd. Felly, mae'n rhaid pethau i'r byw sydd, byddai'n gweithio'r gweithio'r amser i'r amser, i'r cyfrifiadell yn ei wneud gan feithio a'r gweithio'r syniol a'r sgolwm a'u sgolwyd, a'i wneud i'r pwylliannod a'i gweithio. Sara yng Nghymru a Llorun yn ychydig i eich cyfnodd yn ymddangos y gweld a'r gwaith i'r gweithio'r gweithio'n gwneud i roedd y gyfnodd y rhan i'w gweithio'r gweithio'r Gweithio'r Gweithio, a'r gweithio'r Gweithio'r Gweithio'r Gweithio. Felly, yna'n golygu Sara. HELLO! Fel ddau'n dweud yn ysgrifennu i'w gweithio'n gweithio'n gweithio'n gweithio. I'm really excited to get to talk about our experiences in Greece, and so I thought, first of all, we'd maybe just discuss the reasons that we wanted to go and just a bit about organising an elective placement. So Lauren, do you want to start? It was kind of your idea wasn't it? Lauren is the brains behind the operational just to make the spreadsheets. So I asked Sarah if she would like to come with me on an elective placement, and what got me interested was, it was kind of twofold one. I saw an advert on Facebook asking for volunteers to go to Greece to assist women with breastfeeding support in a refugee camp, and with the fundamental role that breastfeeding has for midwives, I just thought that would be an excellent opportunity for a student to have to be able to build their skills but also to give something back, because it's a very privileged role that we have and the skills that we build are just, I felt quite a strong connect with giving something back. And unfortunately, by the time we were able to organise an elective, that opportunity was no longer there, however, everything worked out the way it was meant to, and we found Amartel. And the other reason that we wanted to go is just the fact that Glasgow is a dispersal city in the UK for refugee and asylum seeking women, and the rich culture of women that we have in Glasgow, it just felt like a good opportunity to learn more about the culture so that we can bring that into our practice when we're back here in Glasgow. So I suppose, from a practical point of view, if you're a student midwife and you're interested in arranging elective, our first step was discussing it with the university because really they didn't have the capacity for elective placements prior to us, we kind of started a revolution. So basically all our subsequent years now are able to apply for elective so people have done lots of different things haven't they? Like from just, you know, spending a few days at private scan or people have been volunteering with different third sector charities in the UK that support women and families who are perhaps vulnerable but not necessarily in a maternity context, just that outreach in the community. And I think just the fact that we kind of opened that door has just made the experience possible. It wasn't that the university didn't want us to go and do it. It's just that no one had ever really approached them about it before. So from our point of view, from making the decision that we wanted to go on an elective placement to actually be able to have the permission from university find a slot in the timetable that allowed us to go and get all of the paper work in the forms filled in. It was quite a lengthy process. The original idea to go actually happened in first year and we actually went to Greece at the end of our second year. So we know from the students that are coming after us that are in second year now that their process is much smoother. One of our amazing lecturers, Shona, has worked really hard on developing a much easier pathway for students to be able to apply for electives and she's able to help them facilitate their journey much easier than what we did. That's incredibly encouraging. She's really forged that path for the uni curriculum, which is great. So Shona was really supportive and really helped us out and helped to get all the paperwork in order. And then from our point of view, in terms of organisation, it was just trying to fundraise and we wanted just to get enough money to cover our flights to our accommodation. So we set up a Just Giving page, which is probably something I would recommend. And we had a kind of expectations that we might be able to just cover the cost of that, but we actually raised way more than just those costs. So we're able to make a big donation to Amartel, which was fantastic, but really, really good. One of the key things that we found on this journey that we're doing is just how incredibly generous and supportive the people in this midwifery and birth community are. We have friends and family who are supportive of us because they're friends and family, but there were also donations and support from people all across the world, basically. And just people even from logging in to look at our blog when we were there. Yeah, just being really supportive and giving us encouraging messages. I was quite overwhelming, something that we probably hadn't considered when we started on this journey. And, you know, it just made it even more worthwhile for us, I think. Yeah, absolutely. It was great. And we also, we had been in contact with Amartel and asked them if there was anything that they needed. And they said kind of basically sanitary wear and breast pads. So we just kind of put a bit of a call out. And we had to talk with an absolute mountain. Cases, how many cases did we end up taking? Three big cases and bags. You know, after we were only going to take hand luggage just for ourselves, for our clothes. And we ended up having to take that plus three huge cases full of things that people donated. Very creative packing. The tricks that you learn. So in terms of organising it, we just agreed the date of Amartel. We booked our flights. And we booked an Airbnb, which is like a five minute walk away from Amartel. So Amartel is a charity that is based in Athens. And it was started up by this absolutely extraordinary woman called Didi, who originally, her kind of original work in Athens was when people started arriving in the ports in Patras in Athens. So she kind of set up almost like a caravan. To provide her dirty care and really, really crucially infant feeding support. There's a lot of other charities working in Greece that have proper dedicated breastfeeding support workers at its core. And actually in any humanitarian crisis, breastfeeding support infant feeding is massively important. Because obviously people don't have access to water, being able to boil water, being able to prepare formula safely, can't afford to buy formula. And I think it's probably quite well known that vulnerable people are kind of preyed upon often by formula companies who maybe want to make a bit of money for other people suffering. So the work that they were doing down there was really, really quite extraordinary. And a lot of the people that kind of started with Didi there are still with Amartel now. So they kind of moved from the port into bigger premises within the city centre. And that was where they were at when we arrived. So when Amartel first moved into Victoria Square, a lot of the refugees would actually had left the camps because of just overcrowding. The government couldn't get them housed quickly enough and we know that even today there are still vast amounts of overcrowding in camps all over Greece. So the reason that Didi chose Victoria Square was because that was where refugees were camping out in tents. They made their way from the coast into the city and that was where Amartel needed to be. They wouldn't have to travel to access the services. The workers at Amartel could walk about the square and they could see the pregnant women, they could approach them, they could do outreach work. And that was how Amartel started to kind of have themselves known in Greece and spread the word about the work that they were doing. So from Didi and the women at Amartel having to go to do outreach till 2018 when Sarah and I were there and women were just lining up at the door in the morning for Amartel to open. They were spreading the word themselves, friends were bringing in friends. It's incredible the work that they've done in such a short space of time and the difference that they've made to so many people is just incredible. So I think just now, if anybody doesn't have any questions about that, we'll move on to our next slide. Does anybody have any questions, anything yet? Any comments? So I'm just going to talk a bit about the women that we met, where they came from and how they get to Europe and what kind of happens then. So these are just some of the figures from last year about people travelling to Europe. So the main entry points would be Spain, Italy and Greece. So a lot of the women that we met there, they were from the Middle East, so Afghanistan, Iraq and Syria of course. We have met women who had trekt for days and days and days on end through mountains. Nothing with them but their underwear when they arrived, with children heavily pregnant. We met other women from Africa, so we met women from the Congo and Eritrea. A lot of those African women had been trafficked for the purposes of sex or exploitation at the time they arrived in Europe. And they've kind of built these really perilous journeys across the sea. I'm sure that everybody's kind of seen those terrifying images and you just think what power these women have actually. We see refugees in their asylum seekers as a vulnerable group, but actually there was a midwife of soldiers this week. She is the lead midwife for caring for asylum seekers in Glasgow. She's really wonderful and she made a point to that really. I totally agree with what she said. My clients, the women that I work for, they are empowered. They are the most powerful people that I have ever met and she's completely right. You see somebody who's kind of vulnerable before you but actually when you think about the strength to do what they've done and the journeys that they've made, it's just extraordinary. And you can see there that the number of people that kind of made those journeys that are dead or missing is 1,530. And actually the year before that in 2017 there was 3,139. And in 2016 the number of people that died on those journeys was over 5,000. So obviously there are just figures, there are just statistics, there are just numbers. And the European Union seems to be slightly obsessed with the numbers of migrants coming in. If you look at Lebanon for example, which is adjacent to Syria, they have 1.5 million Syrian refugees. We've got 2,000 in Scotland. Scotland has got the same population size as Lebanon. So when people talk about a crisis in Europe I think that they are grossly exaggerating the problem. And this is obviously a wealthy part of the world. So anyway, that's my political rant over and I just want to get excited. So I just want to talk a bit about the difference between a refugee and an asylum seeker and what if anybody wants to join in their experiences of working with these women. So a refugee is somebody who has received their asylum status. So a lot of the women that we were working with were asylum seekers. So they were waiting. And one of the women that we were working with from Afghanistan, she had been waiting for over two years to receive her refugee status. Whereas the Syrians kind of had almost a fast track process just because the scale of the devastation in that country, the European Union has prioritised giving asylum to those women. So obviously a big part of what we're doing also involves the maternity care that's given in Greece, which was fascinating. You think the UK, you think European country, you think it's going to be relatively similar. And it's not. I wonder if Lauren, you'd like to talk a bit about what we learned and what we miss. We were very lucky when we were there to be able to have an insight into the three main types of maternity care in Greece through meeting an independent midwife, a private midwife and a public hospital midwife. So in Greece they have a 40% unemployment rate. They just have a bit of a crisis going on and yet they have opened up their country and their arms to all of these asylum seekers coming in. But what that's doing is putting an extra strain on the public health system. So a lot of women will seek care from independent or private midwives during their maternity care. So an independent midwife we think costs about in the region of 3,500 euros. And those independent midwives I think there's about 40, did we say 40? Round about in the kind of greater Athens area. So the greater Athens area has a population similar to Scotland, just under 5 million. And you know, with a 40% unemployment rate and some of the people that we met are actually paying. If you are working, you have much more heavily taxed. So for example a doctor earning a decent salary will be paying 75% tax. So money is kind of tight. So to find 3,500 euros for maternity care is these women, they know what they want. They know that they want to have the best care available to them. It's just not an option for everyone. With regards to the private care it's about the same cost but your private maternity care gets you care not just from a midwife but also from a doctor. So midwives and obstetricians will work in partnership. And the private midwife that we met is actually married to an obstetrician and she trains here in Scotland. So it was really nice to meet her and hear about her story having gone through kind of similar training to where we're at just now. And part of the allure of private care and working with a midwife and a doctor in Greece is that it actually goes kind of quite against what Sarah and I have learned. Is that it comes with a five night hospital stay and nursery care. So one of the selling points for private midwifery care in Greece is that they'll actually take your baby away during the night to let you heal and rest. So we were very interested to hear that given how much we are working in Scotland in the UK towards keeping mums and babies together and never separate them. But again women are paying a lot of money for this because they're being told that it's best for them, it's best for their health to be able to have a rest and heal after the birth. And then when we went to the public hospital there were two kind of extremely large public hospitals near the centre of Athens. But we kind of went to when it was a bit further out in the greater Athens area. It was about a 40 minute journey from the centre and it was one of the few hospitals in Greece that have received their baby friendly accreditation from UNICEF for breastfeeding. And one of the few that has rooming in with the babies and the mums in the public maternity care you can still access better care if you have more money. So if you access public health care and you have money to pay for the doctor you're likely to get your cesarean section faster. You're likely to get one to one care for the women that we were working with, the asylum seekers. They just don't have that money. And quite often they were at the bottom of the chain. They also don't have money for things like interpreters. They don't have money for, you know, anti-natal education the same way that we do in this country. So a big, big difference. Some of the other kind of statistics that we were kind of shocked to hear was the extremely high epiziotomerate. The extremely high cesarean section rate is up to sort of 70% in some hospitals. So in some of the private ones was it almost up at 90%? Yep, and that's just because the doctors can then plan their life. They can go and have their weekends and women can also plan and know that they're not coming into uncertainty and that they can give the doctors some money that they can sort of have a little bit of control in this kind of uncertain system. Something else that shocked us in the public hospitals was the neonatal services. In the big hospitals in the centre of Greece they only allow access to parents for two visits a day to see their baby. So half an hour in the morning and half an hour at night, which just... I think we were shocked to see what I said. We were going to a European country in 2018 and we just kind of felt almost like we had gone back into the 1950s or something. Absolutely, Max, feeling very grateful to see the NHS. And I would say as well that every midwife that we met, regardless of whether they were private or working in a public or independent, because we met one of each, and said, stay in the UK! Stay where you are, you're so lucky. You don't know how lucky you are to have the system you have there. Honestly, it really, really gave you a bit of perspective on how lucky you are here. I think I'm very grateful. And actually, interestingly, the private midwife we met and the public hospital midwife had both spent time either training or working in the UK. So they had had experience of working within the two systems and both of them were doing their own little things. It was really inspiring to see that even in this huge pressure system that they were both working away, doing their own little things to make things better for women as much as you can when you're in a system. That is under such strain. Could you tell the story about leaving the doors open? That's quite a nice story. Yes, so the private midwife that we met, who is married to the obstetrician, has worked in Greece now for 18 years, was it? 15, 18 years? She is Scottish, so she trained in Scotland. She met her husband working in London, working at a hospital in London. And they moved back to Greece, since Greek. One of the things that we saw in the public hospitals we heard in the public hospital when we visited was that privacy isn't a huge thing for them. It's much easier when they don't have one-to-one care necessarily in a way that we do. So it's much easier to keep control of everything if the doors are opened. But the midwife in the private hospital has just been working away for years trying to change that. So she had raised the issue with the sister in the hospital, and they couldn't quite reach in agreement about closing the doors. So this midwife just started closing the doors. So every time she would walk past the door that was open, she would close it on a woman who was in labour. Given that privacy, she would come back maybe an hour later and the door would be open, so she would close it again. So she would just keep working away doing her thing until the culture started changing. Other people started closing doors, and eventually now she showed us some pictures. She's actually now at the stage where the private hospital she's working in has been renovated. She is actually having a birthing pool installed, light dimmers in the room, just creating this change that's taken her years and years to get infiltrated in the system, but creating and easing changes for women and just shifting that culture. Little changes lead to big changes in the long run. Yeah, absolutely. It's like you say there, Ali, every little bit counts. It may seem like a small thing, but actually we know about the physiology of labour and needing to be in a safe, comfortable environment where you're not being watched. So how are we expecting women to labour? And then I suppose you look at their statistics at their section rates. All of that is really down to who has the control in that room. And it's certainly not the woman. No, and it's just as you say, Ali, it's about making these little changes to change the power shift. Give the power back to the women because it's their bodies, it's their birth, it's their moment. And as Sarah says, we know all of the evidence that surrounds it, but even just on a purely common sense and just kind and compassionate level, at this completely private and vulnerable moment, I wouldn't want the door to be open. So very interesting. Wow, that's really interesting, Ali. What you're saying there, three bedded bay, no silence. Wow. How do you place that? Was there a pressure on women to be silent? Yeah, if they made any noise, they were tapped on the foot and told to be quiet. They were often naked and had to just lie on their back and wait. As soon as they were classified as being in established labour, they were moved to this three bedded bay without any birthing partners and just left to birthing silence, really. There was a great physiological expectation that they would just birth naturally. It was a bit of a surprise if they ended up with any complications and had to go to theatre. So it was nice to see that kind of physiological belief that their bodies could do it, but it was also a bit startling to see this isolation and loneliness as well a little bit in this very intimate time. And who else would be in the room with them? If you had three women, would there be three midwives or how did that kind of work? The midwives did congregate, but they just chatted to each other. They didn't pay much attention to the women at all. They listened in once an hour and that was it. They were just left to get on with it and then they just sort of announced when they felt they were ready to push. It was very eye-opening. And how did you feel like within that environment? Did you feel like in a position to be able to challenge some of that? It was a little bit difficult because of the language barrier, particularly with the women. The midwives, they were a little bit rude to the women sometimes when they were making noise. They didn't understand why they needed to and it was a bit of a tension-seeking they saw it as. But they also just had this belief, which I was amazed at. Because I think in England sometimes that belief that physiological processes can happen has gone. I would agree with that. And I think if you look up right across Europe actually, I mean look at the States as well. The kind of maternal outcomes that they're having over there, not good. Well it's interesting as it's trying to find that balance between safe maternity care, safe and respectful maternity care. It's so, I feel like depending on whether you're in the developed country or developing country, you kind of drastically... I think we have lessons to learn from each other. Exactly, that's a really excellent point. And also just like where midwives fit into all of that. I think midwives in the UK are, as a general rule, quite a respected profession. I think in the working environment midwives are respected by their colleagues. Obviously not in every case but largely there's respect between the multidisciplinary team. But in Greece there's no national guidelines. They don't have nice, they don't have hospital policies and protocols. And basically as a result of that it means that anybody more senior than you can throw you under the bus. So because you can't say I have followed our hospital guidelines or I have followed national guidelines, this is what I did. So somebody more senior than you can say, well if I was in that situation this is what I would have done. So you've gotten, there's no support for you, which is why everybody's just scared. And of course you have a culture fear here as well but I think over there it's worse. It's a vulnerable place to be, a junior midwife or doctor in the healthcare system in Greece. And the statistics from 2018 were that of the midwives who qualified, only 40% of those were going to work as midwives. So they're losing 60% of the people that they're training to be a midwife. But also there's no role for a midwife there, they're obstetric nurses. So I don't really know why they're bothering to train midwives if they're not allowing for midwifery within the maternity care system. They're not utilising them. And just kind of going back to what Linda was saying about Iran. I think Sarah and I have both heard Linda speak about her time in Iran, which was a great presentation and very interesting for us as we were first years at the time. But I had been as a first-year student midwife after hearing that talk. I cared for a woman who had had her first two children in Iran. So she was having her third child here in Glasgow and her partner did not know what to do with himself. He was beside himself because it was just not done. None of his male friends, none of his male family members had ever been in, where their partners had given birth. And your talk really kind of came back to me at that time, Linda, because I had that awareness from hearing your talk. So yeah, thank you for sharing with us. Absolutely. And for the women that we were kind of caring for when they arrived over to Greece, over to Europe, obviously that's going to be a massive culture shift for them. You know, when they arrive in hospital and neighbour, their partner is not on their team with them. They don't have an interpreter. They don't know the culture. They don't know the language. They're completely alone. I mean, it's just extraordinary that they managed to navigate their way through this. And Amartel, who we were working with, had a hospital system, I think. Actually, a bit more on that. They had like a buddy system for the hospitals. A cultural mediator? Cultural mediator, yes. So they had a Farsi translator and they had an Arabic translator who would go with the women to the hospital for their appointments. So Amartel provides a midwifery antenatal appointments and they do ultrasound, but they don't do what would be over here, your 12-week scan and your 20-week scan. So they don't do the anomaly scan. So you'd need to go to the hospital for that. And they also do a doctor in Greece as well. And every women gets a glucose tolerance test also. Although very interesting in terms of being an evidence-based practitioner because of all the midwifery that we spoke into. I think one of them had worked with the women who had gestational diabetes once, but yet they have this kind of every single women gets a glucose tolerance test. Because there are no guidelines, it was hard for us to navigate and see why they do the test that they do and where their thought process comes from. And they also gave, in the UK, all babies are offered vitamin K at birth, whether that's injection or a drops. But in Greece they did that, but they also gave, there was other vitamins, wasn't there? Vitamin D, everybody got. All the babies got vitamin D as well. And it was about 40 degrees when we were there, sunny every single day. I think the only people that probably needed vitamin D were Sarah and I and our nice kind of Scottish and Irish illness. But yeah, interesting because as student midwives going through this journey where we're constantly learning about evidence and we're learning to navigate an evidence-based profession to go to Greece and it was just your luck of who you got and how they wanted to practice that day. It was quite interesting, wasn't it? It's also just going back to midwifery training in Greece. A lot of the midwives were there to get their statutory numbers. In the UK you have to have your 40 births and that's an EU directive. So that's right across all EU countries. You need to get your 40 babies and all of your antidecatex, post-ecatex. But they weren't able to catch babies because there's such a high C-section rate. So for a lot of those student midwives catching a presenter, counts us delivering a baby in your statutory numbers, which we both found quite shocking. Yes, and when we met one kind of recently qualified two years ago, a midwife, she was absolutely ecstatic to tell us that she'd caught 41 babies and they were actually babies. That was how we found out about this because we were both saying... What do you mean actual babies? As opposed to... Five minutes. That's right. I'll just move on to the next slide. So, just to run down of some of the different services that Amartel gives. So they do also work as a distribution centre. So they provide baby kits, which have got some clothes, naffies, wipes. Whiskey teammates, that kind of thing. And they also have regular donations of kind of like Moses baskets, which the women lost. And they also distributed food. But they had quite a good system in that if you came to an educational class, then you could go in and get some underwear or get some food. And I think it's a really good system because it means that they can come in, they can rest, they can learn something, they can meet some other people. It's practical for them as well. Yeah. So, yeah, actually, one of the lovely listeners today, Mags McCullis, a midwife from Glasgow, and she is heading over to Amartel. I'll start with you in a second. Mags has collected 500 raths. Is that right, Mags? Wow. So Mags is heading to Amartel. She's also got a fundraising page. So she's raising money for Amartel. And maybe you could share that link with us, Mags. That would be really good. They are extraordinary because caring for a woman isn't just about the anti-natal care or the post-natal care that she's receiving. It's also providing a safe space for women to meet each other. A lot of these women come from cultures where they have their family around them. Having children, you've always got a support network and they don't have anyone they come with potentially nobody, no friends, no family, all on their own. And coming to Amartel, they're able to meet other people, they make such good friends. It's such a supportive community. It's just the nicest atmosphere to be in because you just see all of these friendships being formed. And Amartel, they say that everybody that comes to them tells them it's from word of mouth, they've heard from somebody else. So they are kind of, you know, they're talking to their friends, they're saying, you know, this is a great place to come. They do classes, they do baby massage, which is just gorgeous. So a lot of the classes are run in both Arabic and Farsi. So you've got that kind of peer-to-peer support. But in addition to that, Amartel, they've been doing a training programme for infant nutrition. So some of the refugees that come have been learning to become infant nutrition teachers themselves. So that's amazing. They've all graduated now and they're so... We've got to see some of them sit in on their classes. And also you see how it makes them feel. These are strong women, as Sarah already said. They're strong, they're independent, they're already empowered. They've made this decision. Some of the words that they used to tell us why they made the decision was because they wanted their children to have a life. They wanted their children to be human. They're all here for the same purpose. So that initially bonds them. But also to see them now furthering themselves in this new environment. It's just absolutely incredible. And they just all build each other up. And they just all want each other to go further. And they just want all of their children to just have a better life. And it's just what DD and Amartel have created is beyond incredible. And Mags has just posted a just given link. So if you've got a couple of pounds to spare, that would absolutely help them. Pop onto their website and see, you know, find out more about them. We can't see enough about them, can we? Just wonderful. And they have a playroom as well for older children. So if pregnant women are coming for appointments or if they're coming for classes, it means that there's a safe space for the kids to be. And there's obviously somebody in there playing with the children. And it's just lovely. Really just special. Such a nice environment to be in. It's just, yeah. When Mags, you'll know once you go. It's just, when you walk in that door, it just feels like a safe place. It just feels like a good place to be. And yeah, it's amazing. DD is amazing. I think you've all. I think you've enthused us all to go to Greece. Let's all go. Let's all go. Does anybody have any questions for Sarah or Lauren? If you have a mic, we can have it orderly or if you have them in the public chat. Any questions? Maybe you've been on an elective and have seen some amazing things to share. No? Yeah. So can you sum up in one sentence why somebody as a student should go on an elective placement? It's just so important to get outside of yourself. It literally changed my whole life. It's just changed. It was such a transformative experience for me. I've learned so much about myself as a person, about myself as a future midwife. The bond that Sarah and I have in our friendship has been cemented. And it was just an absolutely incredible opportunity to meet these amazing, strong, powerful women and bring some of their culture home to help other people feel like Glasgow is their new home. And it's just... I mean, we just keep saying to everyone at UWS, go on an elective, go on an elective. There'll be no students left. They'll all be on electives. It's just so... It's just so important to get a bit of perspective during your midwifery training. Yes, it really is. I think it's... Because it's full on, you know. I'm sure everybody knows the ups and the downs that you go through while you're training to be a midwife. And I think it's very, very easy to get caught up in the system and sometimes forget who you are and why you're doing it and what your true motivation is. And I think just kind of getting outside of your own world really, really, really helps and really helps you to kind of find yourself in that again. Diversity is strength. And if you fear a difference, then you're not going to learn anything, are you? You need to embrace it. Thank you. Thank you so much for sharing your experiences. Inspiring us all to take up another elective if we've already done one or to go on one if we haven't.