 Okay. Once again, welcome everyone to Virtual International Day of the Midwife. We are so pleased to have you all here and so pleased to be part of this exciting presentation. I would like to take just a moment to recognize and to welcome our speaker, Patricia Ross. Patricia has over 30 years of experience as a teacher, trainer and organizational development consultant. She managed these functions in Fortune 500 and non-profit organizations. Patricia is a professional midwife education with the highest honors from the International School of Traditional Midwifery. She worked in the U.S. and abroad to include requirements for clinical experience and earn the Certified Professional Midwife Credential. As Education Director of Midwives on a Mission of Service, a non-profit agency which empowers birth attendants in Sierra Leone to provide maternity care and act as change agents, she developed the curricula and co-trained 500 students. She also taught midwives in Uganda and in the Philippine Islands. Trish revised mom's distance learning midwifery program and administered it for three years. The Episcopal Church ordained Trish in 1995, and she has worked with people struggling with domestic violence, HIV, AIDS and hunger. She has been on three non-profit boards. Trish lives in Guahalla, California with her spouse and dogs. The family includes five grown children and stepchildren and eight grandchildren. Welcome, Trish. Well, thank you very much. I just want to make sure that everyone knows that I am calling in on a landline. So, Nisa and I are working together closely. She's going to be feeding me a lot of information that I should be seeing, but I can't because of some technical problems that I'm having. I am very glad to be here. Nisa, if you could show the next slide of the gathering of people with their banners. This has taken a year and a half ago, almost two years ago now, at a jamboree. Every two years we host a jamboree and we gather all the women that we've trained and anyone else who wants to come. We party and we have a lot of continuing education and a lot of networking problem solving. I love this picture. I get real misty and dopey over this work, so I might choke up a couple of times. The next slide gives you an overview of who we are and some of the things that I'm going to talk about this morning. Organizations and individuals who try to help other people and make a real mess of things or they can do spectacularly well. One of the things that I want to do here is to share the things that we learned the hard way so you don't have to. Just point out some things that work in this kind of work. The next slide, you'll see a picture of two people. The person on the left is Chris McManus. She is our president and she is an essential person during COVID. She is the editor of a newspaper and she is at work today. Couldn't get off because they are working with a skeleton crew. The person on the right is me laughing and I am Trish Ross, the education director of MOMS. Next slide. You'll see a picture here of three groups of people and these are the people that really make up MOMS. MOMS is Midwives on Missions of Service MOMS. These are the folks that really make this happen. They are the heart of the program and the key to building the deep relationships. That is our primary success factor for the work that we do. Next slide. You'll see a picture of some women. This was taken last June and it was a class of graduates. They attended every day of class three and a half weeks and they passed a rigorous exam with 70% or better to graduate. They are illiterate. Two of these women could actually read and write at about a third or fourth grade level. They are intelligent and they are highly motivated. Next slide. A lot of people don't know where Sierra Leone is. We are looking at West Africa. You see a little green country that I have circled there. That is home. Most people know Sierra Leone for the blood diamond war and the Ebola epidemic that raged across West Africa a few years ago. Next slide. This is Sierra Leone. We work primarily in the southeast section. That little yellow county called Kailown was where we started out and then we had been moving east and south. We hope to move north from here in the next two years. We actually have a plan for moving north. Next slide. This is the southeast portion of the country. You see dots scattered across the countryside. These are the sites where we have trained. The size of the dot indicates how many people in that area we have trained. You see a ring around a little town called Bow. That is actually the second largest city in Sierra Leone. That is where our headquarters is. We use that as a jumping off point. To give you a little sense of perspective, just way south of Bow, the big, big dot at the south corner of the country, that is a town called Jendema. It took us 14 hours to drive that. It is about 150 miles. The roads are bad. The next picture shows you why it takes so long to get anywhere. This is a road. I have driven this road a whole bunch of times. I have had flat tires. I have had bridges collapse. I killed a chicken once. It is beautiful, but it is rural. It is remote. In the next picture, you see this is the first village that we went to to do our needs assessment and the first village where we did our training. This is a little larger village than usual for the rainforest. It has about 750 to 800 people in it. It looks typical. You see the thatched roof or the corrugated metal roof, mud brick walls. That is kind of our home there. I am very fond of this place. The next slide shows you our first classroom. This is a typical classroom for us with a thatched roof and the open air sides. This kind of building is called a barry. I might use that name when I talk about different things. But that is a barry. We had 62 people. We had told them we would work with 30 and 62 showed up. It was a mess. It was really, really hard to try to teach 62 people in this place. But we managed. We got really rigorous about the first 35 people and no more because that just didn't work. One more slide, Nisa. You will see some numbers. The maternal mortality, you can see that between 2007 and 2017, there has been a significant improvement by half. That is great. You can see the United States statistics as a reference. When we arrived in Sierra Leone in 2006, the rural areas where we were, that little town of Pelly, there had been about 50 births and 10 women had died. That is not uncommon for the rural areas. The rural areas have the higher mortality. Now, that very same village, there were 60 women who gave birth in 2019 and none died. We are really proud of the changes that have occurred there. You can see the rest of those statistics. I am not going to read them to you. Next page. When we talk about developed nations, developing nations, undeveloped nations, Sierra Leone usually ranks in the bottom three of being an undeveloped nation. It is in the bottom three of maternal mortality, childhood mortality, and all of these numbers. This gives you an idea of what we are talking about in terms of money. I am really upset about this number of MDs in 2007. There were 97. 10 years later there were 150. Today there is at least one fewer. A good friend of ours died yesterday of COVID-19. I am grieving him deeply. We found that the local birth attendants are ubiquitous, trusted, and highly motivated. When we did our needs assessment in 2006, it was like, hey, we have some really bright, motivated people here that the community trusts. They are all over the place. Why not leverage them? Why round up women and force them to go to birth waiting houses? Why force them to go to town? Why do all of this enforced travel of the pregnant woman, when you have a fabulous resource right here at hand, let's use them. The government said, no, you don't understand. We said, well, let us try. They agreed to let us try. We developed our vision and goals here. Next slide, Anisa. Many organizations have very similar goals. Women will have access to birth attendants and related healthcare services. The birth attendants will provide healthcare and lives are going to improve. What makes us different are these adjectives and these verbs that I've italicized. We aim at the women with the fewest choices. We want to make sure that they have ready access to well-trained birth attendants, not that they're being forced to leave their homes for six weeks to go to a birth waiting house, and that all the stuff that goes along with that. It's these italicized words that we are training the birth attendants to, and we're training them well. And they're providing excellent care. And they are partnering with the healthcare system to make sustainable change. And to make that sustainable change, we use a development model rather than a relief model. So that's my intro. Next slide, Anisa. And if anyone's been asking questions about who we are, where we are, I'd be glad to entertain those. Otherwise, I'll go on to the next slide and talk about what mom's model actually is. And our model is based on our values, and our standard is excellence, and the underpinning of it all is partnership. So the next page, I'm starting with values. And notice that our values are not a list of nouns. We don't value partnership. Our value is insisting on a partnership. We don't value capacity resilience. We value developing capacity resilience. And this moves us from sitting around pontificating about what we want to do to actually do it. We insist on partnership. We develop capacity. We exercise the self-control it takes to stick to our values. And sometimes that can be really hard. And we deliver on the promise of excellence. Next page. We started out with the idea that we were going to train women to be birth attendants. And so we started there at the left with training community health workers. That's what CHW stands for, Community Health Worker. And we found that they don't get paid for what they do. So if they're working in the clinic or if they're teaching childbirth education classes or providing postnatal care in the village, they're not getting paid and they're not working in their farm. And they're subsistence farmers. So if they're not working in the farm, the weeds and the rats are getting their crop. And that's not a good thing. So we decided to help with giving them seed money to form a small business. We talked to them about a business plan and we give them a startup grant for a small business. Most of them are doing savings and loans. Some are doing farms, have created mostly peanut farms or rice. And some are doing some other things that have a small used clothing business. And this is how they support themselves, support their families, and actually provide support to the community. They use the proceeds of the business to help buy gloves for the clinic or to help a woman who needs to be transported to a different town for higher level of care. And where we work, the ambulances can't get there. So they will ride a motorcycle. And so we pay them, this gives them a little bit of money to give the motorcycle driver and pay him to take the woman to Daenerys Hospital. With structuring these little businesses like this, they elected leaders. And we found that pulling the leaders together of the different communities where we work was fabulous because these are the women that we've trained respect. They're respected in the community. And we were leaving a whole lot of leadership on the table if we wouldn't pay attention to these women and develop them. So we've continued to develop them. They are point persons in the community. They meet with each other to set strategy and to solve problems and to tell us where we're screwing up. So they're great. And then we've also got professionally developed staff and trainers because we're taking this notion of independence very seriously. And if they're going to be moms, they need to know how to be moms and again to avoid the mistakes. So we have invested time in them sending them to school and developing our staff and trainers. And all of this just falls down like any house would. It will fall down without the foundation of relationships. Next page. So I've just quickly listed the success factors. Our values, the basis on relationship, the fact that these four programs are closely intertwined. And then another success factor is the professionality of our curriculum and testing and then our value of self-control. I pulled that out separately because it's just so important and we've seen so many other agencies crash and burn. And I'll talk about that in a few minutes. Next page. The values again are verbs. And this is where the self-control comes in. Having certain values means that we have to say no because we are emphasizing development over relief. We have to say no to lots of money actually. There are people, there are a lot of grants for relief work. There are very few grants for development work. It means that I say no to a lot of people who want to volunteer. They want to volunteer to preach the gospel perhaps. They want to get their students wanting to get their numbers. They are midwives wanting to get more skills. And they see mom's work as a venue for that. And we know we're not doing that. Our beneficiaries are the women of Sierra Leone, not student midwives around the world, but particularly in the United States because that's where I am. Midwives wanting more skill, nice. You need it just as the students need to get their experience. But that's not our mission. That's not our values. That's not our work to do. We have to say no. And I don't like saying no to people. There are times when it's really tough to say no, but we do that. Next page, Relationships. Here I like this picture so much. This is, we dance. We dance all the time with the women. And they've taught us many of their songs. And so we sing and we dance. And here you see Chris. This is a song and dance about you are teaching us so much, you've stuffed our head full, and now we have a headache. And it's just a fun song. And usually they'll jump up and start dancing and singing when we've taught them something that's particularly new or something about something that's been particularly puzzling for them. But we go in, we live for a month with these folks and we eat with them, we sleep with them. We're always white women with an American passport. That just is. But we connect on many other ways, many other levels as women, as mothers, as battered wives, as people who've been poor. So it's pretty wonderful, the relationships that we build. Next page. These are those four programs again. They all weave back and forth. And I'll just skip over that. I think that's fairly obvious. So next slide, this is about the mom CHWs. And so the community health worker role has four pillars. And they're the bridge between the people and the clinics. They provide evidence-based and maternity care. They teach the community all kinds of things about nutrition, hydration, sexually transmitted diseases, breast health, breast self-exams, childbirth education, all kinds of things. You name it, they teach it. And they solve problems, both at the level of their neighbors, but also larger-level problems with not having, with the farmers selling the best produce down the road in the larger city and where the people of the village are left only with white rice to eat for weeks at a time. That's an economic problem. And the women have approached the village elders in several places to talk about how they can do this differently. So especially the pregnant women and children have better sources of nutrition, have better options for eating. Another problem that many have focused on is domestic violence and gender-based violence. And in one particular village, they went to the local police force and talked with them about how to work together to reduce gender-based violence in their community. There's five characteristics that we teach them, and we weave these five things throughout the modules with a hard knowledge. And probably the most important is being a role model. And we hammer on that one. Next page. We have a 400-page curriculum, and it's lesson plans, the test resources, administrative stuff, and the trainer guide, how to train the material. We have it, our curriculum is professional. Lisa introduced me, she mentioned that I've got more than 30 years in career in instructional design, training, organizational development, change management, all of that kind of stuff. And I pulled in some of my former employees and colleagues, and we have a curriculum that would win awards. I've won awards on curricula that I've developed in the past. And I know the quality of this, and it's good. We brought in several people to help us with it, as well as subject matter experts, to make sure that the content is precise. And we revised the material at least once a year, usually twice, to make sure that everything is current in it. Most of us have had experiences in having terrible teachers or sitting through bad classes. I think about my college and midwifery school, as well as high school. It's not as easy to teach, otherwise we would have more memories of great teachers instead of just that one or two or three in our history of having maybe 40 or 50 teachers. Next page. Our lesson plans, our content is pretty much general midwifery types of content, from general health and anatomy and physiology through maternity care and women's health. And we also have a section on change agency, how to solve problems, systematic approaches to identifying problems, prioritizing them, prioritizing assessments and focusing on what to do first, and then to actually create a plan for solving problems and monitoring and evaluating the work. So it's a comprehensive change program. Next page. And here you see us teaching anatomy, this is actually fetal development. And we are in a barry, an open air building. This one actually has concrete slip over the mud brick, which is beginning to fade. And there was a big hole in the roof, and we got rained on more than once when we taught this class. This was last year. But again, our learner population is illiterate, and so they've never seen pictures like these. So these are definitely worth 1,000 or 10,000 words. Next page. And here you see them. I walked in the room to take this picture, and they're going, oh, please help us, please help us. And no, not going to. Here they were getting ready to organize themselves to form their group to figure out how they were going to work together. And it was harder than they thought, they did a beautiful job. They're a great group of people. Next page, our results. We've trained 500 community health workers. We've certified three trainers, and you can see our other things. And the best result and the hardest result is that we have a waiting list of communities that's about four years out. And so we're wanting to train more trainers so that they can work more independently and keep this thing running and growing. So, do you have any questions about that? Next page. I'm sorry, Nisa, I'm afraid I'm forgetting to tell you. I'm trying to be good. Do you have any questions about what our program is? Okay, let's go into the next page. And this is where I'm trying to really distill some things down. And here, I love this picture. This is Carol. The white woman is Carol Nelson from Minneapolis. And we are working to do the practicum in our class. And we were teaching Carol how to teach. She is with an agency called Rural Healthcare Initiative. And we partner with several agencies like this. Our HCI's model is very different. They are going deep into one area and they're doing all kinds of things in this one area supporting their clinic in many ways. We have full permission of this client to have her picture made. As a matter of fact, she went through the line four times to be a model for us and wanted us to take pictures of her each time. The woman who is learning how to palpate her belly is named Fatima Bangora. And she's a really good egg. Next page. We have to navigate all these challenges. And I think every organization and individual trying to help others has to face them. Patriarchalism and institutionalism is just a royal pain. And we came up against that, that first time we tried to talk to them and we told them what we had found in our needs assessment. And the government of Sierra Leone said, no, these women are ignorant. They're dirty. They're the problem. No. And so we begged and pleaded and cajoled and got them to let us do a pilot and the pilot was successful. So we weren't surprised how successful it was, but they were. And that was the start of mom's work in Sierra Leone. But they just knew that these women couldn't do this kind of work. And we proved them wrong and I'm glad we did. So next page. These are the easy lessons that we learned and that we knew from our experiences in other agencies and in other places. And I think I want to talk just a minute about the prioritizing our values to simplify decision making. And different agencies have different values. Some agencies have a high value on religion and on proselytizing, but what they need to do, and we see this a lot, what they need to do is really be honest about that and name that as a priority. And so everybody knows what they're doing because their choice of teachers is different than our choice of teachers because they're choosing teachers because their ideology is so important to them. Their ideology about religion is so important to them. They choose teachers with the right religious background. And we don't. Yes, I'm ordained and I care deeply about my faith, but my faith does not drive my choice of teachers. I want an excellent teacher, not necessarily a teacher who is an Episcopalian or a Christian or anything else. Our board of directors has atheists, Christians, Jews. We no longer have a Buddhist and we no longer have a Hindu and we no longer have a Muslim. And so we're hoping that at some point or another we might diversify further again, but we've had various folks on there. But that's... And then that last one, acting respectfully of the laws of all jurisdictions. We see a lot of midwifery organizations crash on this one. They don't want to follow the laws and they don't and they cause problems. And we've had midwives actually that have served in our same area who disobeyed the laws and people came to us to try to tell us to not let her come and work. And, you know, we can't do that. But that's the kind of thing that really... It sounds logical and sensible, but people don't do it and it causes all kinds of problems. Next page, Ugly Lessons. The road to hell is paved with good intentions. I remember my mother telling me that when I was a little girl. And boy, oh boy, I have seen that time and again and I catch myself saying, but I didn't mean that. Well, yeah. I may not have meant that outcome, but my intention is irrelevant. What happened happened. And I allowed it to happen through my own ignorance or my own naivety or just not knowing, not listening to good advice, not asking for good advice, letting my intentions drive my decision making. And this notion of creating dependence is easy and has terrible repercussions. We see that a lot with people who take supplies places. I know a woman who did a tour of Africa and she was a school teacher and she saw teachers teaching without paper and pencils. So she arranged to send a container of paper and pencils to this place. And the teachers went through it and then turned to her and said, well, we're out of paper and pencils. And she called me up all in a panic about how these people were taking advantage of her and saying, no, no, no, no, no, no, no. They're not taking advantage of you. You set yourself up to be a supply chain and you created dependence. And it's easy to do. And she certainly didn't intend to do it, but that was the result. And it reinforces the notion of people having to look at outsiders and other people for support when instead of finding internal solutions that work better, work more effectively. But she couldn't imagine teaching a class without paper and pencils. And her imagination and lack of imagination caused a problem in a community. And that's hard. Next page. So any questions? This is your chance to say, Trish, that sounds nice, but really. Are you dead? Trish, is this the end of the presentation? Because I have a few questions, but I didn't want to interrupt if you still have more. Yeah, no. This is the time for you to ask. If you want to flip forward to the contacts page, I think it's two more pages. That's how people can get a hold of me if they want to ask questions offline. But ask questions now. Okay, so Becky asks, do you do ongoing training for your trainers? Yes, we do. Every time I go to Sierra Leone twice a year and sit with them and do updates on content and have them practice their training skills with me, they also meet every other month themselves and go over the material to deepen their understanding and to keep really current on their skills. So I was curious about whether or not other midwives around the world, midwives in this room right now, are there things that we can do to support you in the work that you're doing? Because I find it really impressive. Well, we always take money. You know, that's always a big need. We do not take a lot of volunteers to teach with us because we go to these tiny little villages where a team of more than two or three or four people would just overwhelm the village. But if somebody wants to send us copies of a book for midwives, they have a new edition out and I'm wanting to get them. We leave a copy of that at every place that we teach. And if somebody would like to have, if you have instruments that you don't use anymore, we take those and leave those at the clinics where we teach. We don't want to become part of the supply chain, but they don't have good instruments. So we try to balance that, you know, some gifts. One time we position as a one-time gift for when we come and teach. So take care of these things. And so if people want to send us stuff to take over, we will take those kinds of supplies. We'll take copies of the book for midwives. We'll take money. And if you really want to volunteer, get in touch with me. And I can start putting you through that process. Or if you're interested in being on our board, get in touch with me. We have lots of comments in the chat box. And I've taken pictures of lots of those for you to send to you for later. But lots of people saying things like, thanks, and you're doing a fantastic job. And thank you. This was inspiring. And I think anyone who read your results slide would absolutely find it inspiring. Oh, good. Go ahead. I just wanted to know how you first got involved. What led you this direction? It sounds like your life has taken many, many times. Yeah. When I was 53 years old, my daughter had a baby at home with a midwife. And I told my wife, you know, if I had it to do all over again, I would grow up and be a midwife. And she said, well, you're not dead yet. So I started Midwifery School. And we had met in seminary. And we both had this desire to do something. And we were both working with people with HIV-AIDS at the time. This was in the early 90s. And so we knew we wanted to do something like this. So I started Midwifery School. And we found out what, you know, what the global needs of women were. And it was like, you know, we need to be doing something about this. We've got the skills. We've got the resources. Let's do something. So we got in touch with some people and started, we went to Senegal. And it was a wonderful experience, but it wasn't a model that worked for us. And so we thought, what are we going to do? And then we got a phone call from a woman who said, will you go to Sierra Leone and teach midwives? And we said, no, we'll go there and we'll do a needs assessment. And we went to this little village of Pele and did our needs assessment in our first class there. And it's grown from that. So I mean, this is definitely a case of, you know, we've been figuring things out as we've been doing it. Well, that is exciting and wonderful. And I think probably exactly how, the direction that that is supposed to happen. So again, thank you so much for that presentation. It was really, I think the words of our participants are probably the best words. It was just really inspiring to see someone identify a need and then all the effort that you've thrown into making a difference. Well, thank you very much. That feels good. It was really weird to do this over the phone and to not have any feedback. You know, I, you know, there were a couple of times when I felt like saying, you know, is anybody out there? We were here listening. Oh, good. Good. Good. Thank you. And please contact me. Send me the best way to reach me is actually email or the phone number. The 1-707 phone number is my home phone. My cell phone doesn't work up here. We're in this little tiny corner of Northern California that's hard to get to. But follow us on Facebook. Send me emails and talk with me. I love to talk with people. I love to listen to your ideas.