 Thanks for joining us. Like Pandora said, my name is Lillian Medis, and I'm a nurse midwifery and women's health nurse practitioner student at Georgetown University. Today, I'm going to be talking to you all about work my work with women in crisis and specifically refugee women in the US and in Greece. This will be in a storytelling format and I plan to share stories about how I got involved in the work and then how also you can prepare for humanitarian work, how students can get involved early in their careers and share some of the stories of the women I've come to care so deeply for. So I was happy to see in some of the polls that there are a few students and educators joining us. We'll have time for discussion and questions and sharing of some of your experiences at the end of the presentation. If you do have a question, please feel free to put it in the chat box and if I can all address it at the time. Otherwise, I'll address them all at the end. And also, while I want, I want to address that there are refugees from many nations and cultures. My experience is with Muslim refugees and that will be the focus for today. So before I begin, I just had two quick poll questions. I'm not sure if the polls are set up, but otherwise we can put them the answers in the chat box. So I was just hoping that if you're joining us today, you could tell us if you have ever worked internationally and if so, where and also if you have ever worked with refugee women or infants. I think it just gives us a good gauge of what's going on. What are the experiences that we have in the room and then also gives us a place where we can start a discussion at the end if you all have stories or experiences that you can share about. So I'm going to continue on. And I thank you all for answering those questions and please feel free to continue to put your answer in the chat box if you haven't had a chance yet. So peace on earth begins with birth. I wanted to begin the presentation with this quote because I think it sums up why midwives must be part of the crisis work around the world. We're champions of women's health and we can play a part in the empowerment of women to change communities. This is just a bit of background on me. Like I said, my name is Lily and I'm a student at Georgetown University. I live in Fremont, California. And I'm a registered nurse and certified as a domestic violence and sexual assault counselor. And I'm also certified in trauma counseling. And I'm the incoming student representative to the American College of Nurse Midwives Board of Directors. So I wanted to share a bit about how I got started in crisis work as I started my career pretty young and also just to talk about how educators can be part of this process as well. So this picture is from my first experience in crisis work when I went to Southeast Asia as a high school student. I worked with an organization called Rafa House that seeks to love, rescue and heal victims of child sex trafficking. While I was there, I was able to learn about trafficking, the work of Rafa House, as well as the immense emotional, social and physical needs of women and girls who have been sexually exploited and abused. I was able to spend time with a women's health care provider who worked at the safe house, learning about her work and the needs of the girls and the women. One of the young girls I met who had been trafficked was only four years old at the time. Several other older girls came into the safe house pregnant and terrified about what was going to happen to them. My idea of health care expanded and I began to see how quality women's health care empowers women and girls. I didn't know it at the time, but of course we all know that midwives do more than just deliver babies. We care for women across the lifespan and we're uniquely equipped to work with women and girls like this in crisis. I knew that I had to do something to engage in justice work through reproductive health services. So when I came home, I began speaking and fundraising on behalf of Rafa House for a few years. I first learned about midwifery care as an undergraduate nursing student at the University of Iowa. My professor for maternity and women's health was a nurse midwife and after I expressed my interest to her, she agreed to be a mentor for me throughout school. She had worked extensively in international aid work as a midwife and also started a clinic in our hometown for low income women. She taught me through mentorship stories and she would even take me to the local free clinic and help with women's appointments. I just mentioned this briefly to highlight to any of you that may teach at nursing schools or in midwifery programs that even if you're not able to do the work itself, such as my mentor was retired from clinical practice at the time. Mentorship of students is integral to increasing the number of midwives who are working in crisis or low income areas. So after undergraduate, I moved to California and my city in Greenmont, California has the largest population of immigrants from Afghanistan and refugees in the US and it's estimated to be anywhere from 60 to 80,000 Afghan refugees. For the past three and a half years, I've been working with an Afghan social services agency called the Afghan Coalition on Serving Refugee Women. The needs in the community are vast, from language to financial empowerment, chronic health conditions, post-traumatic stress disorder and domestic violence. Despite all of the challenges that Afghan women face, they're hopeful and resilient. I'm currently the facilitator of domestic violence services at the Afghan Coalition and help to create a support group specific to Muslim women who have survived domestic violence. And that's called Strong Together and I can give you the link to that if you're interested to learn more. I'll share a few stories of the women I have worked with in the past years in this presentation. Prior to beginning Midwifery School, I also worked as a nurse at a small community hospital where many Afghan women delivered their babies because it was the only hospital in the area that took on or underinsured women. So I'll share a bit about the care that these refugee women received as well. And of course, all of the names and pictures have been changed to protect the women that I work with. So while working as a newborn nurse at the hospital I just referred to, I had an experience that helped to guide and solidify my calling to Midwifery. As a newborn nurse, I attended all the deliveries and provided newborn care and resuscitation. I would sometimes be a support for the woman but was not actively involved in her care. Fatima was a young refugee from Yemen that spoke little English. She had received all of her prenatal care at the women's practice associated with the hospital. Throughout the prenatal period, she was seen by only the female provider in the practice who also happened to be a Muslim immigrant, which helped the transition to the U.S. medical system. However, it wasn't made clear, unfortunately, to Fatima or her family that this provider may not be able to deliver the baby. When she came to the hospital, delivery was imminent and the only obstetrician available was a male who she hadn't met. She was frantic and afraid, preparing to deliver her first child in a foreign country without an Arabic translator and only a male provider, which is strictly prohibited in her culture. Having worked with Muslim refugees for several years, I understood some of her concerns and her fear, but most of the staff did not. There was yelling, frantically trying to convince her to let the doctor in before the delivery, and finally, her mom convinced her to let him come inside the room right before the baby was born. There were many insensitive comments. I even remember one of the providers saying, if she doesn't want me to care for her, then she can do it herself. Her eyes were wide and afraid during the delivery, and I think possibly she may have walked away traumatized by the situation and may not want to seek health care the next time she's pregnant. Refugee women and women of other underserved populations in my area lack access to midwifery care. While the hospital and the obstetricians tried to provide care to them as best as they can, these women would benefit from care with a midwife. Our hallmarks of culturally competent care involved in a family in the health care system and advocating for the woman to be an active member of her health care team may have improved the situation and possibly helped Fatima have an empowering and a beautiful experience delivering her first child. So this painting was made by one of the participants in the domestic violence support group that I helped facilitate. Nazia was an Afghan woman and she was part of one of the groups. She's another woman who inspired me to pursue education as a nurse midwife. She was married to her husband for many years and was never able to conceive. We all know how heartbreaking this can be from women of any background, but specifically women who are Muslim and Afghan infertility is a huge shame in the community and can be the source of much violence in the family. So her husband grew more and more upset about the infertility and eventually became emotionally and physically abusive of Nazia. She went several times to the local free health clinic where many Afghan women received care to talk about fertility issues with her provider. Unfortunately, she was never provided a translator and the physician didn't realize that Nazia didn't understand what was being explained to her. She continued going back but was never able to conceive. Eventually her husband divorced her and married a younger woman. Several years later a social worker went with her to an appointment. She learned that all along Nazia could have had a simple procedure and likely achieved conception. By then it was too late for her. The lack of understanding of the Afghan culture and the struggles the Afghan refugees faced inspired me to become a midwife. Finally I want to share with you about Shukria. First story expands on the needs of immigrants and refugees in the U.S. and how I believe midwives are uniquely prepared to handle them. Shukria was a young Afghan woman, even younger than myself. She had a daughter who was a toddler and had recently delivered another daughter. Her husband, who was also emotionally and physically abusive, took the family for a visit back to Afghanistan. He left early to return home to California and prepare for the new family to permanently settle in California. When Shukria came back several weeks later, she learned that her husband had stolen everything, including her immigration paperwork, got rid of their apartment and disappeared with another woman. She was left without knowing the language or the system to care for two young children. For many nights they slept in a 24-hour laundromat because it was the only place that they could find shelter. Until a social worker at the agency where I work was able to get them into a Muslim domestic violence shelter. There were many emotional, financial and physical needs for this family, but I noticed after taking her to several health appointments that when the free clinic she attended provided a Dari translator, understood her culture and asked questions about her, not just her situation or her health, she walked away feeling more optimistic and capable. I think midwives are prepared to walk with women through the lifespan, especially at trying times like the one Shukria was going through. They can be the hub and the wheel. We can connect women to the services she needs. We're also educators. In addition to everything else Shukria was going through, she didn't have any knowledge of basic nutritional or health topics for her children or herself. Midwives can provide culturally relevant education to empower women to be their own advocate and to be part of the healthcare team. So after working in the Afghan community for several years and meeting many, many women like the ones I just shared with you about, I decided that I would go back to school to become a midwife at Georgetown. I was having wonderful clinical experiences and learning a lot from the midwives who were precepting me. However, I was still feeling distant from the reasons and especially the women who I wanted to be a midwife for. I knew when I began school that my calling was to provide midwifery care to those who have little or no access to it, specifically Afghan and Muslim refugees in the US, as well as one day hoping to work internationally in areas of conflict or crisis. As I continued clinical rotations in a wealthy area of California, I was learning a lot but didn't feel connected to my true passions. That's when I began researching how I could use my skills as a nurse and as a student midwife in the refugee crisis in Greece. So how did I choose the organization that I was going to work with? When I decided that I would go to Greece over the winter break to use my skills and experiences, I began to do a lot of reflecting and thinking about the values that I would look for in an organization. I think it's important to know your skills and your limitations, especially as a student, as well as the values that are important to you when deciding where you're going to volunteer. For me, cultural sensitivity, empowerment of individuals and working on a team were important. For instance, I was asked to work with several organizations where I would be the only women's healthcare provider and I knew that as a student I wasn't prepared to do that. So I decided not to accept those invitations. The organization that I did work with in Greece is called Nurture Project International and I'm going to share a lot about their work with you now. So before I share some more stories about the women that I met and the experiences that I had in Greece, I just want to give you a brief overview of obstetric and women's healthcare needs in Greece. So from the Nurture Project International website, it says that according to the International Rescue Committee, there are 62,000 refugees currently in Greece. Over half of them are women and children. The demographics of the population require specialty care, which we all understand, regarding infant and young child feeding and support for pregnant and lactating women. While a significant amount of resources have flooded the area since the beginning of the crisis, challenges remain inadequately addressing individual needs, more so than just donations or the large amount of resources that have come into the country. With the Balkan countries closing their borders in early March 2017, the refugee population remains stranded in Greece for the foreseeable future. And then from an article that I'll share with you at the end from the Guardian on healthcare in Greece, a preliminary report on anti-natal care birth and postnatal care refugees in Greece shows that of the 29 women questioned, 60% had received C-sections, in line with the extremely high Caesarean rate in the general Greek population. Of these women, only one was given an epidural, and all of the others were given full anesthesia, even though there was no way to take any medical history because of lack of translation. So women recovering from the trauma and stress of fleeing war in their home countries, caring for their children and refugee camps, are being re-traumatized by the lack of choices, unsafe conditions, and fear surrounding birth and breastfeeding. And that's where Inerture Project International comes in. So I provided their website and I highly encourage any of you who are interested to go and look at some of the resources and information that they have available. So the vision of NPI is a safe and supported motherhood is a human right. NPI works to create a world where that right is upheld in every crisis and emergency. They provide technical lactation support, reproductive healthcare, and nutrition support to families on the front line at the time they need it. They also work closely with other organizations such as MSF, Syrian American Medical Society, and Refugee Trauma Initiative. They work to develop innovative technology to provide access to lactation support to vulnerable families, advocate for change in the humanitarian field by informing policies specifically on lactation and women's healthcare rights, and they facilitate access to and train healthcare providers within their own organization as well as others to apply technical skills to the unique needs of vulnerable families and refugee camps. NPI began in 2016 when founder Brooke Bauer, who is a lactation consultant from the U.S., saw the need for breastfeeding support in refugee camps in Greece. They're currently working in Greece and have a new project in Iraq as well. As we go through some of the photos from the camps, I'll talk about how I saw them filling a specific need in the refugee camps in Greece. In Iraq, they are currently doing mentorship and training of Iraqi midwives and traditional birth workers on lactation support and prenatal care rather than just bringing in Western midwives to take over the role that Iraqi women can fill themselves. The next few slides are going to have a lot of pictures that I think help to tell the story of what's going on in Greece better than I can by just sharing with you my experiences. This is a picture of a man cooking a meal for his family inside one of the tents in a refugee camp in Greece. I just think it shows not only how real these families are. I think that was one of the first things that struck me was that these families came from highly educated, wealthy backgrounds and all of a sudden are living in a camp and still need to learn how to provide food for their families. How do they get education for their children in this setting? And then even a lot of them would say, what do we do with our time? Because just sitting in a refugee camp all day long with little resources or things to do. So I think that just brings light to that. This is another picture of one of the camps in Greece in some of the tents that families would live in. So one of the unique things that NPI does is they provide prenatal care to all pregnant women in the camps that they're located in. So one women's story that I wanted to share with you is just a good reminder of the importance of midwifery care for all women. I was providing prenatal care in her small room that her family called home. She was a young woman 37 weeks along with her fifth child and alone. Her husband was in another European country and the rest of her family had been scattered when they fled Syria. As we sat there, one of my colleagues helped play with her children and it was probably one of the first times that she had had a chance to sit down and just take a breath in the last couple of weeks trying to care for all of her children and find something for them to do all day every day in this setting. So I empowered her to care for herself by teaching her simple ways to reduce the discomforts of pregnancy. She was having a lot of lower back pain so we talked about how she could even use a scarf that almost all Syrian women have with them to support her lower back and taught her how to do that herself when she was alone. And we brought back a sense of normalcy just by sitting, talking and listening to the baby's heartbeat and just letting her be still in that moment. This is the beauty of midwifery to me, helping bring normalcy, health and wholeness, especially to women in crisis who might not otherwise experience it. This is a picture of one of the young NPI babies in one of the camps. And right now many of the camps in Thessaloniki, which is the city that I worked in in Greece, the camps are closing or half closed and that brings new challenges to the work that NPI is doing. During the winter the camps got so cold that it was no longer safe for the refugees to continue living there. And the UNHCR began to move refugees from the camps into what they call hotel settings. So they're small rooms. Each family has one small room. They're communal bathrooms and possibly a communal kitchen. Sometimes no kitchen is available and just food is provided to them when the food is available. So while that means that there is access to a bathroom and it's warm, it brings other challenges, specifically that NGOs such as NPI are having a harder time following up with refugees and a lot of people are getting lost in the shuffle as they try to figure out which hotel and where in Greece the refugees have been taken and how to continue to follow up with them when they aren't just going from one tent to the next but having to take the mobile unit and drive from hotel to hotel and how to first provide those services to all pregnant women that have now been scattered. And the reason for closing some of these camps is because some of the camps in other parts of the country were becoming overfull and so eventually these camps will then be refilled with people from the camps that are now full but that hasn't happened yet. So I think one of the things that's unique about NPI is that they see these needs and they continue to try to fill them even when it's not necessarily how they began their work. So when they saw that refugees were being moved to the hotels then they developed a protocol for a mobile unit and continued to provide care for these women as they were moved around. This is just another picture of one of the tents and then this mom you can see she was washing her family's clothing and was hanging it outside the tent to dry. So NPI began with breastfeeding support. Lactation consultants provide support to all women in the camps who are breastfeeding. They provide extra help to women having difficulties as well as to women who have stopped breastfeeding and want to relaxate. They also educate pregnant women and even women who aren't pregnant about the benefits of breastfeeding so that they can support each other. As I'm sure you all know it's especially important to breastfeed in this fragile environment. There's no access to clean water. Sterilization equipment is obviously not available and there's an unstable access to an ongoing supply of formula. What happened, what they saw was that many NGOs just immediately began giving pregnant and pregnant women an infant's formula without having a long-term plan in place about how that formula would continue to be supported. And as we know with bottles not being sterilized many infants were getting sick. Some were malnourished and even dying because of lack of access to clean water to make the formula. So that's when NPI stepped in and began teaching other NGOs that breastfeeding really needed to be supported and encouraged as the only safe way to feed an infant in a refugee camp. However, something that some people ask sometimes is if a woman is unable or unwilling to breastfeed. NPI does continue to support them and they support with one-time use bottles so that the lack of clean water or sterilization equipment is not important because they give pre-made one-time use bottles and then they give them to the women every several days. So they're following up with them making sure that they are feeding them correctly and then disposing of the dirty bottles afterwards. So nutritional support is another area that NPI is now currently providing help with. They give meal packs to women and children every week from six months to two years old and then any pregnant or lactating women. They do this because, as I said, they believe as we all do that breastfeeding is the best way to support an infant in this unstable environment. So the best way to feed a baby is to feed the mother to make sure that she's getting adequate nutrition so that she's able to provide breast milk to her children. And it's really just important to them that they provide culturally appropriate food. They provide halal food, so that means no pork products. And it's fresh. So whereas the UNHCR provides some staples such as rice or other dry products, NPI is providing additional support with fresh foods, fruits and vegetables, and meat that they wouldn't otherwise get from UNHCR. NPI also has support groups. So while I was there, it was over in New Year's and we got to have a New Year's party and this is a picture from a party like that where we would get treats and fruit that were just special to them in their culture and they didn't have access to very often. And so it would just be an exciting time where women could come to the women's tent that NPI has at every camp that they work in. And it's just a sacred space. No men are allowed in that tent, only women and children. And it's a protected space for women to come, to talk and to bond, not only between each other but also with the NPI volunteers who are there. They also host women's classes in these rooms. So sometimes that means a breastfeeding class or breastfeeding support group. When I was there we had a contraception class. So one of the organizations that NPI works closely with brought in obstetricians and they talked about contraception and what the options are for contraception even in the camp. These women as long as they're in a camp where these NGOs are supporting them do have access to IUDs. They have access to birth control pills and then NPI provides condoms whenever a woman needs them as well as referrals to long-term birth control. And like I said, it's a safe space without men that they can process the trauma of their life, the trauma of coming to the refugee camp. They can talk about their birth experiences. And if it comes up that one of the women needs more support with mental health issues, NPI will provide referrals to refugee trauma initiative or to MSF, Doctors Without Borders. So every camp that NPI works in has two tents. The first is the women's tent that I was just talking about and the second is the baby hamam. Hamam means bath and in the Syrian culture giving the baby a bath is very important for the mother. And there was no safe bathrooms. Many women even had their older children begin using diapers again at night because of the risk of going to the bathroom outside in the middle of the night. There was cold dirty water in the showers and lack of soap available. The baby hamam provides a private, warm and safe place for the mother and the baby to bond. Volunteers do not give the bath to the children. Instead, they give the power back to the mom to have that sacred part of her job back as a mother. Soap, towels, hot water and diapers are provided and closed on a case-by-case basis if needed. And then lastly, infant health is another aspect of the care that NPI provides. So diapers and wipes are provided to all mothers who need them. And then frequent weighing and measuring and doing health checks of all the babies who are breastfeeding or beginning on solid foods to make sure that babies are growing adequately and don't need extra support in that way. And then as I said, referrals to MSF and Syrian American Medical Society or other NGOs are often done if the midwife or the nurse thinks that it's necessary. So finally, I want to share a quick story about a woman that I worked with in Greece. Lila was a young woman. She was living in the refugee camp and went into preterm labor, which is quite common. She was transported to the hospital and delivered her first child at 36 weeks. The infant was kept in the NICU for four weeks after delivery for breathing support and for feeding. Lila, however, was discharged back to the camp. She would travel to visit the baby as much as she could, but as you can imagine, it's quite difficult having to find a bus and the money and support to get there. The baby was discharged at four weeks of age. And when we did the first check when she got back to the camp that day, we noted that the IV location was infected. There was a large wound on the foot because the IV hadn't been rotated probably the whole time that she was in the NICU. So as you can imagine, the wound was quite large and infected. So we didn't have many supplies and it was over a holiday when this was going on. So myself and the other midwife created a dressing as best as we could and tried to sterilize the wound as well as we could. The baby also continued to lose weight as they had been giving formulas only in the hospital and then mom was trying to breastfeed when she came back to the camp. We talked to the family about needing to take the baby back to the hospital for weight support as well as to get the wound treated and for needing systemic antibiotics. However, the mother and especially the father were traumatized by seeing the care that was provided to the mom and the baby and he didn't want to take them back to the hospital. He was just trying to protect his family. He even told me at one point we would have gotten better care at the hospital in Syria than what we got here. So NPI hired a Syrian translator who had also been a refugee and she helped with cultural understanding and with translation. Eventually she was able to explain to them why it was important that we took the baby back to the hospital and the midwife and the translator went with them to the hospital. So as you can see that one-on-one support of moms and babies is a key role that NPI plays. They build trust with the women so that even as volunteers come in and out they trust anyone who works with NPI because they've seen how they continue to show up and help with their needs. So how to prepare for this work. I know many of you may have experience so this is coming more for students or people who don't have experience. So I've learned a lot of lessons these are just a few of them. My first is prepare before you go. Research, learn about the situation, the culture and maybe even a bit of the language. Evaluate your ability and capacity to cope with harsh conditions but I think more importantly to be able to engage with women who have experienced trauma and loss without re-traumatizing them by becoming overwhelmed to carry the weight of their experiences that they're sharing with you. There are many roles for individuals who aren't able to go to the field as I'm sure you know. Fundraising, raising awareness, education and mentorship. It's important to have someone who you can debrief with after returning or if you're working long term on a regular basis. So I have a friend who's a therapist and I talk to her almost every week about the domestic violence work that I do. Have a sense of humor and don't take yourself too seriously. When I went to grace it was much different than I expected and like I think I noted the bathrooms need to be clean. The storage area needed to be organized and even if that's not our specialty we need to be able to step in and do those things so that we can see the long term success of the organization you're working with. And lastly something I'm continuing to learn about women, the needs and the work is so much bigger than any of us. It was before it was there before us and we'll continue to go on when we leave. So that reminds me of two things. One is that it's okay to take a break and to take care of myself when I need to and second is that I am not the savior. I simply have tools and skills I can bring to the table to help the women help themselves. So these are just a few resources some things that I've done that were helpful and I'm sure if you end up going working with an organization they'll have extra educational resources for you. The first is an excellent trauma counseling certificate that I would recommend anyone working with women in any setting look into. It's an online graduate level certificate and it helps you to learn about trauma, how to provide trauma informed care referrals and many other issues in trauma. And the second is the minimum initial services package. It teaches about reproductive health care and crisis settings and the minimum care that must be provided to all women no matter the setting. So I would highly encourage anyone who's even interested in this kind of work to take the MISP it's also an online course. These are several organizations and PI like I talked about and Midwife Pilgrim will be doing the next presentation so I highly encourage you to stay and learn about the work that they're doing and how they place midwives around the world for volunteer work. And lastly these are just a few articles that I found helpful and that you can look into and read about the work and how to prepare. So I just wanted to finish with this quote from Brooke Bauer the CEO of NPI in reference to the work with refugees the time is now to hold space for our fellow woman to take a step back and say I might not fully understand what's going on here but I will stand back and give you the platform. In our work we are not the saviors that go in with all of the answers the mothers have the answers we just hold space for their voice. So I thank you all for your attention and if you have any questions I would love to open it up for questions now. Thank you for the informative presentation giving us a snapshot into life in the refugee camp. Can you tell us a little bit more about the concept of living safe spaces within refugee camps? Yes, so as you may have heard if you've been following the refugee crisis or reading articles about it there is a high number of sexual assaults in refugee camps in Greece and a need for a safe place for women to be with their children without the risk of sexual assault or violence or exposing their children to violence that's going on between other men in the camps and so that's why for NPI the safe space for women is so important it's literally a safe space from the risk of violence as well as a safe space to share their thoughts and their feelings surrounding what they've gone through surrounding being a mom during this transition in their life, breastfeeding all of their issues around women's health care and contraception so NPI has a small it's a tent but it's a permanent tent that stays in the camp and they made it into a beautiful space for dogs and pillows and places to sit tea is available to the women and it's just a place to come and sit and take a breath to be around other women and to just know that they are able to talk about the issues that are going on in their life quite amazing and definitely required so I think for those of the Western perspective you can think of a continual standing red tent concept of women who are displaced let me briefly touch on the concept of safety again because the toilets and the latrine situation that can actually be one of the most dangerous points for women in camps going to the bathroom so that actually leads to another women's health issue of a lot of the UTIs or the latrines actually being the site where women would report sexual assault is happening so something that can be quite a scary thing and not just for the participants but for sometimes the volunteers and workers so Lillian one last question how did you deal with the fear associated with you know going to this place where there's people from everywhere what would you suggest to them considering volunteerism deal with any fear yeah so I think that being aware ahead of time so I did a lot of research like I said I knew that that was an issue when I went in that there was a risk for violence and for assault so I think NPI does a good job of preparing their volunteers we did a lot of reading and many many oh no we've lost Lillian we seem to have lost Lillian she was speaking to the issue of preparation for these experiences the reality is that you read, you prepare and go into it with the knowledge that as much as you prepare you have to remain extremely flexible because the textbooks and the newspapers are never quite able to give an accurate position at their Lillian coming back and having an open heart and not letting negative reports stop the progress thank you all are there any last questions before we close our discussion I saw someone said do men in Greece give support to women so the camps that NPI primarily works in are camps that are primarily women and children and possibly some men if they're married but more of the young men single men live in the other camps to help mitigate some of the risks that we were talking about and I would say that it all depends on the family some men are not supportive of women they're not supportive of breastfeeding and other men are some men are especially helpful with the children they're supportive of their women like the husband that I was talking about with the young infant who was sick he was extremely supportive of his wife and of his family so I think that that depends on the unique family situation thank you very much Lillian for the transformative presentation in a time where issues of disaster and conflict are hugely in the news and in our realities and with some say it's more dangerous to be a woman in times of conflict than to be an armed soldier thank you very much we'd like to remind everyone that the sessions are recorded so that you can go back and refer to