Optimistic Voices
Vital voices in the fields of global health, global child welfare reform and family separation, and those intent on conducting ethical missions in low resource communities and developing nations. Join our hosts as they engage in conversations with diverse guests from across the globe, sharing optimistic views, experiences, and suggestions for better and best practices as they discuss these difficult topics.
Optimistic Voices
Empowering Sierra Leone's Midwives and Health Workers: Charting the Future of Newborn and Maternal Health
Step into the heart of Sierra Leone with us on Optimistic Voices, where Carrie Jo Cain from CHAMPS imparts her wisdom on neonatal mortality and the life-saving power of evidence-based training. Through our conversation, we celebrate a major leap in maternal and child health, with 80 trainees now armed with the expertise to tackle challenges like bleeding after birth and birth asphyxia. Witness the embodiment of hope as these professionals, with Carrie Jo's guidance, forge a path towards a healthier future for mothers and their newborns.
Joining us with tales from the frontlines, Dr. Andrew Justice, a pediatrician with unwavering dedication to global health, recounts his serendipitous journey to Sierra Leone and the transformation he's witnessed by educating nurses and midwives in Essential Newborn Care. His narrative not only highlights the resilience of healthcare workers but also the innovative teaching methods that cross cultural and language barriers. Dr. Justice's reflections provide a vivid account of the complexities and triumphs in elevating healthcare standards under challenging conditions.
Lastly, we pay homage to the midwives of Sierra Leone, true vanguards in the realm of maternal health. Their tireless work and relentless pursuit of excellence are not just improving outcomes but also inspiring change across communities. From their expanded roles to the leadership they embody, the strategies for community engagement they employ are nothing short of revolutionary. Their stories, alongside those of Embrace International nurses like Betty Tenga, underscore the significance of compassionate collaboration and the enduring spirit of those dedicated to nurturing life in its earliest moments.
Kathleen Pfohl is the maternal Health mission intern with Helping Children Worldwide. She is currently pursuing a Masters degree in Global Health Policy at the George Washington University Milken Institute School of Public Health in Washington, DC. Through this program she has been building upon her academic foundation in international conflict analysis and resolution, for which she obtained a bachelor's degree from George Mason University. As a full time manager of training coordination with the National Coalition of STD directors, she is am actively involved in advancing public health initiatives. Her professional passion lies in addressing global health challenges, particularly in low and middle-income countries and conflict settings, with a special focus on reproductive and maternal health.
Helpingchildrenworldwide.org
Welcome to Optimistic Voices, a podcast of helping children worldwide. We help children worldwide by strengthening and empowering families and communities. This podcast is for people interested in deep conversations with thought leaders in the fields of child welfare, global health and international missions. My name is Kathleen Foll and I am the Maternal Health Mission Intern with Helping Children Worldwide. I am currently pursuing a master's degree in global health policy at the George Washington University Milken Institute School of Public Health in Washington DC. Through this program, I am building upon my academic foundation in international conflict analysis and resolution, for which I obtained a bachelor's degree from George Mason University. As a full-time manager of training coordination with the National Coalition of STE Directors, I am actively involved in advancing public health initiatives. My professional passion lies in addressing global health challenges, particularly in low and middle income countries and conflict settings, with a special focus on reproductive and maternal health.
Speaker 1:In January 2024, the Together for Global Health Network members, helping Children Worldwide, healy International Relief Foundation and Tanki Forborne hosted a maternal and child health conference and training program in Sierra Leone. This conference and concurrent training sessions convened health professionals from both Sierra Leone through the development of the region's workforce. In part one of this podcast, we spoke with Josephine Garnum, executive Director of Healy International Relief Foundation, and Dr Mariamma Masakoi Gartman, founder of Tanki Forborne, about the creation of this program. Today, we will hear from the partners that supported the On the Ground initiative to deliver these maternal and child health trainings.
Speaker 1:Throughout this week-long training, nurses and midwives were trained on the ground in the Bleeding After Birth, essential Newborn Care and Helping Babies Breathe curriculums. In total, 80 trainees participated in these interactive and hands-on training modules. Our rising trainer cohort, which included 18 additional participants, were prepared and assessed by national master trainers to deliver the Bleeding After Birth curriculum in their health settings. At the conclusion of the training, 78 certificates were awarded for the completion of the Essential Newborn Care curriculum, 67 certificates for the completion of the Bleeding After Birth curriculum and 12 certificates for our rising trainers. In order to accomplish this initiative, our implementing organizations recruited support from both international and in-country partners. Our supporting organizations provided facilities for training, delivery, certified labor and delivery nurses, instructors and national master trainers, without which we could not have implemented this program. First we will hear from Carrie Jo Cain from Child Health and Mortality Prevention Surveillance, or CHAMPS. Carrie Jo served as an instructor for the Child Health Track of this training program. I'm Carrie Jo.
Speaker 2:Cain, and I'm currently the CHAMPS advisor for Mortality Surveillance here in Sierra Leone. I'm a pediatric neonatal intensive care nurse by background, but my last 11 years have been really in healthcare program management and that's been because of the Ebola crisis onward, being part of helping rebuild the healthcare infrastructure, again focusing mostly on maternal and child health. So that's a little bit about who I am.
Speaker 1:Great, so you live and work in Sierra Leone. How is that kind of informed or knowledge going into this conference? Sure?
Speaker 2:So I live in Sierra Leone. I've lived here consistently since 2014, but I also had the privilege of growing up here. So my parents came when I was a little baby and my first 12 years were spent here consistently, and then after that my parents were back and forth and so I see again as a teenager and then as a young adult, and then throughout the years I've been back and forth. So all that has definitely influenced who I am today. That's why I am a nurse. That's why I chose to be a nurse. That's why I chose to do pediatrics and neonatal intensive care was because of what I saw as a young person, and then that's influenced what I do today. I'm involved in child health and mortality prevention because it's such a high rate here in Sierra Leone and that's what I wanted to do is be part of the solution.
Speaker 1:Great, and can you talk a little bit more about the research that CHAMPS is doing with neonatal mortality and how it can kind of be tied in with the training topics that we're going through this week?
Speaker 2:And in fact the CHAMPS research really helped formulate what we chose to do. So when we first started talking about this conference in Together for Global Health, we were just kind of shooting all over and a lot of different ideas and a lot of them were great. And I said well, you're knowing CHAMPS, where you're doing research on the causes of death, so we can tell you where the highest, where the biggest bang for your buck is and where we're focusing on and influencing other people to try and put emphasis on these areas. So when we look at that, both in stillbirth, stillbirth is usually because of a maternal factor. So if we're talking about maternal and child health, our research is directly going to give you those answers.
Speaker 2:What are the highest causes of stillbirth? They are preeclampsia, pregnancy, induced hypertension and malpresentation. So that means undiagnosed twins breach, just not managing the labor correctly. So prolonged labor, all these. If we corrected those alone we could potentially prevent about 70% of stillbirths. That's huge.
Speaker 2:So then we look at the rest of it. It goes into clinical management. Well, clinical management and even those right there, that's a lot of clinical management. But then the other causes have to do with clinical management of the pregnant woman which influences the death of the baby. So these are, like, really not difficult things to focus on and teach.
Speaker 2:Then you talk about the neonatal population. It follows suit. The biggest cause of neonatal death is birth asphyxia caused by those three factors that we just talked about. And then sepsis. So sepsis comes in because those babies are at high risk. So, again, that's something that is very easy to focus on and prevent and it's not like it's not unreachable, it's not unattainable. So in a conference like this, where there's already groundwork laid at the national level, this is a great place to come in, utilize resources that are already on the ground and national trainers just hold hands with the Ministry of Health. It ties right into the SDGs and it ties into what the focus is reducing maternal mortality and infant and child mortality. So that's how CHAMPS Research just played directly right into this conference.
Speaker 1:Yeah, that's wonderful and you have been teaching the essential newborn curriculum and helping babies breathe curriculum throughout the week. What kind of skills do you feel like the participants, the nurses, midwives are walking away with and how that's a value to them and their work?
Speaker 2:So one of the basic ones is just having the hands on practice. It's something in western settings that has been really valued to not just sit and watch a slideshow, discuss, but to actually do hands on, to practice with the equipment over and over again and have different kind of scenarios thrown at you. So we learn critical thinking and in this conference that's what we focused a lot of our time on the videos, the discussion was a shorter time and then a lot of hands on and a lot of critical thinking. So throwing different scenarios and allowing and fostering discussion and teamwork to get at what would be the best answer, what would be the best option.
Speaker 2:Then, secondly, going a little bit deeper, because a lot of times people will know the steps like I should bag the baby, but not understanding why, if I don't ventilate this baby, what actually happens? So the steps that lead to death. So then you can start thinking of well, if I don't have this and I don't have that, what can I do? And utilize critical thinking better. So we were able to go deeper, having this much time to give more thinking skills and adaptation skills. So when we're talking about E and C2, which goes a little bit more advanced and with the sick baby, with the danger signs, it really helped being able to talk through, talk through jaundice, talk through the hypoglycemic baby and then do case scenarios with those and it was exciting to see the change in being able to problem solve and work through and pick correct to actions.
Speaker 1:Wonderful. So this conference is planned to be a low dose, high frequency training program. Where do you believe the training is going to lead to in the future? Any type of mentorship, additional training opportunities, anything of that sort?
Speaker 2:Yes, both all of the above and one of the ways I saw that was a very key person in a district who is in one of the most influential positions came and was observing and came and sat in our class for quite a bit and said to me I need this, this is what my nurses all need in this district. Can you get this for me? Are you guys going to share this? How do we get this? Because what I see here and she said exactly what we had seen is my nurses need to be able to practice this. They just learn it. They hear a seminar, but we need to practice this. I'm seeing that now. I'm watching them do it with their hands and being able to be corrected and then do it right. They're beginning that muscle memory for the correct. So that was just brilliant to see that and say, okay, that's a big win and that's what I see.
Speaker 2:Going forward is now we have some believers, some big believers, and if we can carry that momentum forward, we can equip, stay alongside, and I think part of it is us mentoring some of the leaders in how to do it and bringing that the possibility to do it, Because it doesn't happen easily.
Speaker 2:I was part of helping babies breathe. I'm rolling that out in three districts and what we realized was a key, key gap is simply fuel and transportation for those doing the monitoring to get to the PHUs. It takes a lot. So how do you actually carry that forward and how do you make it doable so that a small team can go and mentor and be there for more than 20 minutes when it takes you four hours to get there and you have to get home before dark? How do you get over some of those roadblocks and make this happen? So we did a lot of planning in that and I think that's the kind of thing we need to think about here how we do that, how we apply it and be able to walk alongside the districts now to be able to continue to mentor. So we get to mentor the leaders, possibly, and then provide mentoring as they go alongside and do that on site at the PHUs. This is something that needs to happen from within Sierra Leone.
Speaker 1:That's awesome and just wanted to close out by saying thank you. Do you have any final reflections on what we've been working on this week or any of your experiences with the participants throughout the conference?
Speaker 2:I think, something that really really spoke to me and resonated when, I think the chief nursing midwife officer said it at the beginning this is the first time that we have such a variety of groups coming together from very different backgrounds. We have research JAMPS, we have faith-based NGOs, we have ministry, we have private companies. We have all these different groups, we have the educational centers, the universities all coming together to meet a very universal need, a huge gap that affects everybody, and I think that is very unique. So to me that's a huge positive and if we can get that happening more and get this everybody working together, getting rid of the barriers and just doing it, I think that was really huge and I was very excited about that.
Speaker 1:Great. Well, thank you for joining us and thanks for sitting down and talking about your experience and insights.
Speaker 2:Thank you. It's been a pleasure to be you. Thank you so much.
Speaker 1:Our next guest is Dr Andrew Justice, a pediatrician from Wilmington, north Carolina, and a partner with the Together for Global Health Network member, umc Rodefunk. Dr Justice joined Kerry Jo as an instructor on the newborn care curriculum and he sat down with us to share more about his previous experiences in Sierra Leone and reflections on this conference.
Speaker 3:My name is Andrew Justice. I am a physician. I trained in internal medicine and pediatrics and so I'm board certified in both, and in terms of my background in Sierra Leone, I kind of fell into it, accidentally or luckily. Early in med school I had some time before classes started and I was trying to figure out what to do, and my uncle's church at the time was sending a team over. I think this is 15 years ago, but he went to Florida's United Methodist Church and so he asked if I wanted to go and of course, in my mid-20s that sounded fantastic and so I jumped on the opportunity and was over here and had an absolute blast. Just the things I was able to see, seeing the spirit of the people, watching what they were able to do at Mercy Hospital as it was just starting, and it somewhat served as a driving force for the career route I took and what I tried to do and why I'm back here.
Speaker 1:Great, thank you. So throughout the conference this week you've been presenting on Essential Newborn Care, which is a curriculum developed by the World Health Organization to address care from 60 minutes after birth to discharge. So what has been your experience? Teaching this curriculum to the nurses and midwives here in Sierra Leone?
Speaker 3:Yeah, it's been fantastic. So I have a good background in teaching this. So I've taught helping babies breathe, which is the core of the curriculum. It's somewhat morphed now into early newborn care one and early newborn care two, so I taught that before in other parts of Africa and the difference I've seen this week is the baseline skill level.
Speaker 3:So I think the midwives and also the people here who are training it, who aren't midwives, have a different level of functional capacity with it and I think they have a lot more exposure to it repetitively and so it's much easier for them to continue to add on to their skills and, just like a lot of things you see here, they are hungry to learn, they are excited to learn and they're like sponges and they respond great to different opportunities. But the most fun I've had is working with the master trainers, so the Sierra Leone and master trainers who are just taking over and they're leading things, they're pushing and driving and doing it and it's fun to add a little bit of knowledge where I can, but also learn from what they're doing.
Speaker 1:Great. So what core knowledge and skills did you want the participants of this conference going through this particular curriculum to walk away with?
Speaker 3:If you had asked me a week ago, I would have said two big things Identify a newborn who needs help, which baby is not breathing, which baby needs help.
Speaker 3:And then, number two, having good technique and being overly just completely confident that you can breathe for any baby, that you have the skills you need and there's no nervousness, there's a calm, relaxed demeanor as they learn to resuscitate kids. If you ask me today, they have done above and beyond in that measure and now it's more of the advanced, essential newborn care. It's doing great temperature regulation, good cord care, making sure the eye care is where they want it to be, stratifying, classifying babies that are normal care, intermediate care, versus hey, this is a baby who's sick, we need to watch them closer. And also I've been really impressed with their understanding of their facility. And there's people in groups who say this baby's too sick, I need to refer, and they need to go. And then there's midwives from the referral hospitals who would say this is where we would put this baby, we would need to monitor them differently this way, and so they've even individualized it to their own, I guess, work context.
Speaker 1:Yeah, and that's a shift in kind of knowledge and skills in just a matter of three days too, which is really incredible. So what like focusing on the teaching aspect of this? What methods and techniques do you feel like worked best with the groups that you were presenting this curriculum to?
Speaker 3:You've gotten to spend time around me and so I am a very excited person. I get pretty energetic and there is a difference between our education systems and how we teach things. One of my biggest things and this goes back to training in medicine I feel like people learn best if they're in a comfortable environment. If they feel safe, they may throw something out and it's wrong. They're not going to be degraded, yelled at. So just getting to know the people by name, joking with them, understanding where they come from and letting them just take a breath and relax, and having just a nice easy going group and breaking into small groups so you can get to know everyone, letting them know this isn't rigid.
Speaker 3:I want to see what you can do and we're going to maybe make some small minor changes work with where you are and tweak a few things if your technique is off or if you need help here, but just making sure they're comfortable to speak up. There's a little bit of a language I wouldn't say barrier, but if I speak too fast I know they don't grasp everything I say. So the nice thing we've done is we've paired ourselves with master trainers who can break things down, speak in Creo if needed and ensure their understanding, and there's a nice balance with the two of us Giving a little back and forth maybe good cop, bad cop approach with just hey, this is more of what we do here and I'll give a little different perspective and they're able to blend things.
Speaker 1:And kind of going back to something you had mentioned, you had said that the nurses and midwives had a good understanding of their clinics and their health settings. Is there anything that came up when you were talking with them in these kind of informal almost aspects, about any challenges they face in those settings or even some areas where they feel like their clinics very well suited and well equipped to deal with these topics?
Speaker 3:Yeah, so today, for example, we had two out of six in our smaller groups who were out more in a peripheral health clinic, and if they had a sick baby that required a lot of care they were great at doing identifying, resuscitating, doing exactly what we wanted. And then they understood this is a high risk kit, we need to refer, and then it would sink in. But that can be hours and hours to even days to get them to a center with a child war, and so then they would say, well, okay, what do we do next? And I think that was one of the things is they were able to say this is what we have. What do we do so?
Speaker 3:we're able to not go off script but give a little more tailored advice to people depending on their setting. So that was one thing they would say is we've got to be able to try to keep this baby alive to get referred, because it's not hey, a helicopter's flying them, they'll be there in an hour. It's bumpy roads, it's dirt roads and places it's in the backwoods, so it can be. It can be a long time. In the, I guess in the bigger settings, in the more centralized governor hospitals they were, we take the baby, we send them down the hall, we take care of the mom and try to get the mom to the baby and what would be, I guess, best stated is like a child's work with a little closer monitoring. But they knew exactly the protocols and they knew how to get the baby. They are in transfer and they were pretty good with that.
Speaker 1:Yeah, and you have mentioned to us just you know in conversation throughout the week that you have experience in rotofunk, which is another area within Sierra Leone, so you are more acclimated to some of the settings there. How has that experience kind of shifted your understanding but also maybe differed from what you're experiencing this week and learning and hearing from the participants of the conference?
Speaker 3:Yeah before we. I would even kind of go into that. I think it's really interesting to talk about the difference, even in governmental hospitals, and it's how the healthcare system is Some people come from places like.
Speaker 3:Mercy Hospital, you have other religious organizations, you have governmental hospitals, so there is an interesting, I guess, utilization of resources there. But now, prior to being and working in rotofunk, my experience was in Bo. So Bo is a much bigger city than rotofunk. So rotofunk is in the district over Moayamba and it is no paved roads in, no paved roads out, so it is a completely different setting. You don't have a governmental hospital, you don't have the support or just the population, so you see a lot more people coming from villages and having to come longer distances and difficult to get out, especially in the rainy season.
Speaker 3:But working there has been fantastic. We had five people come from rotofunk with us here, so I work with Mission of Hope there and we're based out of Wilmington, north Carolina. But we were able to bring five members and staff members all different levels, so some would be the equivalent of a physician's assistant in the US, down to midwives and even more of an anesthetist nurse, and so they all have been unbelievably excited to go to this training and the first thing that they've said is we want to take this back and consistently do this in a rotofunk at our hospital. This is what we want to do, and so they've already talked about planning. Hey, how can we do this? Every three to six months, take an afternoon and go over essential newborn care, and then maybe another month or two helping mothers survive and really making sure everyone is not just exposed once, but just continues to go over and over.
Speaker 5:And that's similar to what we do.
Speaker 3:You know neonatal resuscitation program, acls. You're always renewing it. It's not a wanting done thing. So I think that's seeing the excitement in. That was one of the best things I saw in this trip.
Speaker 1:Yeah, and that's exciting to hear. In our last podcast we had spoken with Mariamma Masakoi, who is kind of helping with this, as well as Josephine Gartner, and their intention when creating this training conference was to have it be low dose, high frequency and for people to attend the conference learn a lot but also take that back to where they're practicing. So that's exciting to hear that everyone and that you have talked to also has that feeling and that optimism about taking it back with them.
Speaker 3:The midwives kept lacking me today because they would be breathing for a child and they would do it, and do it wonderfully and be successful. And they would stop and I'd look and say do it again. And they'd look at me and I would just say okay, do it again. And I'd say everybody 20, 30 times today. We're going to just repeat it over and over until you're done with me, and so great Well, thank you for sitting down with us.
Speaker 1:Just wanted to give you the opportunity if you have any other final reflections on the conference thus far. We do still have two more days ahead of us, but I know that you have been really instrumental in getting some of this curriculum out there for trainers this week and participants as well, so definitely appreciate that.
Speaker 3:The final thoughts I would have is the excitement of all the learners to learn and how much they've taught us while we're here is definitely one of the biggest things. But watching all of these different groups come together and work together for one purpose it's been. It's just really neat to watch, to get to know the people behind the training and to see all the work that goes in Waking up at you know six o'clock in the morning, being done at six at night, and then watching everybody get together after dinner to talk about how can we make training better tomorrow. Are we meeting their needs, what do we need to do? And seeing the support between all the groups. I'd encourage everybody to check the other groups out that are working here and seeing just the really neat work that's going on in Sierra Leone.
Speaker 3:And I guess the last thought I will leave anybody with who's listening to this I don't know if these will be available, but if you can somehow find some of the songs and dances that were going on to talk about breastfeeding, to talk about saving moms from dying or getting to the hospital, or watching a whole auditorium of midwives singing and dancing to these songs, that is my takeaway. I mean it just. I can't stop smiling when I think about it. So hopefully we're able to get some of these videos, because that is by far the neatest thing I've experienced.
Speaker 1:Definitely. It's definitely been a rewarding experience so far. Well, thank you for sitting down with us and talking about it.
Speaker 4:Anytime.
Speaker 1:Great. Our next guest is Emmanuel Sonneau. Emmanuel is a native Sierra Leonean serving as a country director for Midwives for Haiti. A together for Global Health Network member, emmanuel returned to Sierra Leone to present a conference session on administrative and management functions in maternal health care.
Speaker 5:My name is Emmanuel Sonneau. I'm currently the country director Midwives for Haiti. We are based in Haiti. My background is I have an advanced master's in business administration, which is management, so today I talked about administrative and management functions in maternal health care.
Speaker 1:Great, and you mentioned that you work in Haiti. What has been your experience coming back to Sierra Leone to help with a conference like this?
Speaker 5:It was quite. I was happy One. I'm coming to give back to my country because this is my native land, it is my motherland and we share a lot in common because we are in maternal health care and we are working just with midwives. So if the training is all about maternal health care, so it's like we are doing the same thing. Maybe we are the other side of the globe and they are here, but we are all doing the same thing. We are in maternal health care, we deal with midwives and the conference was only about midwives, maternal health care.
Speaker 1:Great and in your conference session you had I quoted you as saying we are on top in Africa. I want us to stay there. So what are the necessary steps do you think, in the context of administration and management functions, to get to that or to maintain that?
Speaker 5:Yeah, to maintain that, first and foremost is to ensure that what we have learned in a conference like this is really put into practice, because this conference is meant to sharpen our skills and this conference is meant to ensure that Any new ideas that have been there rolled out by other world health organizations. But these are best practices and those best practices want to take them to the field, because we want to stay on top when it comes to world health organizations Analysis and their own evaluation of how far we have gone into reducing maternal health mortality rates. So what we are saying here is that I am encouraging my sisters, my brothers, all midwives that keep on Shapting your skills, keep on implementing these best practices.
Speaker 1:If we continue like that, we always stay on top in Africa great and in the presentation you had mentioned the importance of Knowledge and harmony with those best practices and those international laws. How have you seen that in action in Sierra Leone and what ways do you think we could stay aligned with these standards of?
Speaker 5:care. This conference itself is an answer to that question. The fact that we have people from almost the whole world here, we converge there and we are here for five days Shows that we are bringing, trying to bring into harmony what we have as international laws and what have us national laws. Sierra Leone cannot function on its own we are not an island and because world health opposition so that we have been maintaining best practices, that is why they gave us the first position on Africa. So the fact that we have our brothers and sisters coming from other parts of the world and we are in the same room, we are exchanging knowledge, that shows that we are ready to always implement International laws, standards and procedures, and that would be the only way we can continue to improve on maternal health care.
Speaker 1:Yeah, and in the presentation you had kind of gone beyond some of the standard responsibilities for midwives currently, which could include processing insurance claims. Why do you feel that equipping these midwives with that knowledge and familiar familiarizing them with it is so important?
Speaker 5:It's important because we've got to be prepared. We are in the first in 21st century. We just cannot stay where we are. We got to get ourselves ready. Just in case we reached that point, it will not be difficult for us to cross the bridge.
Speaker 1:Yeah, yeah, and definitely contributes to their training and learning.
Speaker 5:Exactly, exactly. Thank you very much.
Speaker 1:You would also mention leadership. I was hoping you could expand a little on how we can build up our midwives to become leaders in their clinics and health settings, even if they feel you know they're stuck within this narrow scope. How can we equip them to be better leaders?
Speaker 5:Yeah, the way we can equip them is create an enabling environment for them to Dispense their duties. I mean because if the environment is there for them, it is encouraging them, that gives them like an incentive that stimulates them, that motivates them to give their best, despite all the challenges that they may need. So we, like leaders or others around them, will have to make sure that we encourage them with, stimulate them. That will Inspire them to do more, and even what we've learned there that will help them to implement it in the field. And they will also feel free to come back and give feedback and work on the feedback to ensure that we continue to improve on what is happening in the field.
Speaker 1:Great, and I want to get to the theme of engagement that you had discussed how, what techniques or ways have you seen midwives engaging with community leaders, or maybe, perhaps, how they could be in the future?
Speaker 5:Yes, the ways I've seen them is like having meetings with community leaders, which is very important because they Are the gateway we cannot get into their community.
Speaker 5:They already have the trust and confidence of their people. So if we go and try to just bring in new knowledge or bringing something new, well, although it may not be new and it will be for their benefit, but if we try it so just like bypass or take our community leaders without engaging them, without them being Like patterned personal in front of it and participate, that would be disastrous for all. So our midwives have seen them like holding meetings with them, involved in them, like sensitizing them first of all and engaging them, make sure that they participate in all spheres. Yes, they cannot do the technical job where they can create an enabling environment For midwives to work, and that's what we want. So when, once they are all thinking, they like, they tell your community people that these people trust them. They are here to help you. You need to trust what they are doing, have confidence in them. I tell you that our midwives can do better.
Speaker 1:Great, and you started your presentation with this figure, but I kind of wanted to wrap up our discussion with it. You had said that Sierra Leone had reduced maternal mortality by 74 percent and expressed that a lot of the credit should go to these midwives. Do you have any reflections on this progress that's been made in Sierra Leone and what specific role the midwives had in it?
Speaker 5:Yeah, so, like this was in April 2023, the World Health Organization representative worked towards state house and and congratulated the president of Sierra Leone. So I just told the midwives that we were told through the World Health Organization representative, that we have reduced maternal mortality rate by 60 percent. So that 60 percent that was not done in the office, that was something that was done in the field and who did it? The midwives. So that shows that they, what they have been doing, have been recognized by the world. So that was exactly what I was saying and if they continue to sharpen their skills, as we've rightly done here and we are on track, that to just let us continue to now rise to 70 or 80 percent in the nearest future.
Speaker 1:Great. Well, thank you so much for sitting down with us. We appreciate you joining us for the conference itself.
Speaker 5:Okay, thank you very much. I want to thank the organizers and I truly appreciate the resources Invested into all of this cutting across the board. Thank you very much. I'm looking forward to more of this and I'm looking forward to like monitoring and evaluating what has come out of this conference. Definitely.
Speaker 1:Definitely.
Speaker 5:Yes.
Speaker 1:Finally, we sat down with the labor and delivery nurses from embrace international. These nurses joined us from the Canmore General Hospital in Alberta, canada, to support their friend and native Sierra Leone, betty Tenga. In our discussion, the embrace international nurses share some of the transformative moments they experienced while in Sierra Leone.
Speaker 4:My name is Betty Tenga I, surreal Union by birth and now living in Canada. I am a registered nurse. I work at the Canmore Hospital in Alberta.
Speaker 9:My name is Liz Demers. I am registered nurse also. Never can can more with all these fine people. I've been friends with Betty for a number of years and she was really the inspiration for this trip. We talked about it at work I think it was on a night shift, betty where you mentioned that you wanted to go back to Sierra Leone. You'd been in 2016 and you wanted to go back to when you'd retired to help out, and we started brainstorming how we could do that. And Betty had mentioned the very high rates of maternal and infant mortality here and I hadn't really thought to research it until she said that and when we found, when I saw what the statistics were, they were quite compelling and, knowing that we all work in labor and delivery and we resuscitate babies and moms and we have lots of resources to do that, so it felt like a very important and, yeah, interesting mission, I guess, to come over and try to help effect change on the statistics that they have here.
Speaker 9:That they've been trying to effect change on for quite some time. But to be able to be a part of that and return with Betty to her country was, yeah, just an opportunity you couldn't pass up. And then, at the same time, we were Betty and I were both on the Board of Directors for Embrace International and there's some projects. We've been looking to support a project in Sierra Leone for some time because of Betty's connection here, so we were able to look into a number of projects that we'd like to support ongoing from Canada.
Speaker 7:I'm Susie. I'm Susie Van Boom, I also registered nurse and work with Betty in the Canmore Hospital and was inspired to come along because Betty asked me to and Betty's been a mentor and, I think, an inspiration and I would do anything for Betty. So she said, will you come? And I said yeah, and then I thought, oh, I'll leave my kids for a long time, but I'm very passionate about education and I think on one hand it would have probably been easier to come and just be in Senuhun and help out for a while, but I think the impact of education to those that are going to be here long term it's a lot of hard work but I think the impact hopefully speaks for itself and, yeah, reaches a lot farther than I could on my own.
Speaker 8:My name is Jasper Jasper Van Manen. This is my second time here. What really drew me to this trip is what I really believe in is leaving behind knowledge rather than physical projects, because knowledge can be handed over to multiple generations of midwives and nurses, and to put it in one location that Betty is associated with where Betty is from, that made a lot of sense to me, so that's why I came along for a second time.
Speaker 6:I'm Carrie Mason. I had the pleasure of working with Betty in Camar for a couple of years when she was like my work mom. I heard that the team was going and I attacked Betty and asked her if I could join. I am passionate about labor and delivery and I really enjoy teaching and I honestly didn't know what I signed up for, but I'm glad it is what it was. For the same reason that you guys said that leaving equipment behind doesn't go that far. They run out of batteries or the supplies that go with it, but you can pass on education to more people. That was very fulfilling and very cool to come back with Betty to her hometown and meet her wonderful people.
Speaker 1:Yeah and Betty, what has your experience been, coming back to deliver this training, but also with the support of your friends and colleagues?
Speaker 4:Most of all, I am happy that I can come give back. If I work in a very wonderful environment, I am able to be part of other people's lives by attending their deliveries and supporting them. I always felt that that should be happening where I come from. Even though there is limited resources or nothing, I think I can come back home and even just say one mom and one baby. And this time, what even made it more interesting is the fact that we had to collaborate with the Haley Foundation and all the other organizations to come and teach the midwives themselves Most of the things they are doing.
Speaker 4:I know they have learned how to do them, but coming to teach them hands on and maybe new methods, I am really happy about that. I am only praying that when we leave and when everybody else leaves, they will go back now to their different units and train the other staff that were not fortunate to come to the training, and I hope this is something we will continue to do in the future. So it does not lack whatever it's lacking right now and that will help reduce the maternal rate in the country and infant mortality rate as well.
Speaker 1:And you all presented or trained on essential newborn care at least a portion of you. What was it like to deliver that content and what topic areas did you feel were most important to pass on to these midwives?
Speaker 9:Well, I think it was difficult for people because it was in a second language. So, of course, when we are speaking English, there is always a moment of we understand what she is asking or what she is saying, but so, getting that feedback and then, when you understand each other, what you are meaning to say, I found the collaboration between students and instructors very interesting and rich, because there is a lot of things that we maybe take for granted, that we have and we have access to, and so it was very interesting to understand the context in which many of these practitioners practice and trying to adapt what we know as best practice to those environments and how we can make that happen for them. How can we reduce those barriers and make that happen?
Speaker 8:Okay, so jump in Jasper here. I think that one of the ways that at least for me personally, the communication or working over the language barrier was really the hands-on component where we got to show I mean, I'm mostly talking about helping babies breathe in a practical way just by showing and then duplicating them, having to duplicate what our motor skills were, and those things are international and it is amazing that you don't need many words to get that message across.
Speaker 9:I agree. I think that was so valuable. It was just as much hands-on as possible that seemed to really make the difference and needed very little language on, so we actually got to the skill itself.
Speaker 6:I mean, the physiology of birth is the same everywhere, but the teaching style really differed from what we were used to. So, yeah, they knew the physiology, they knew everything that they needed to say to pass the test, but I think that the hands-on was really missing. So they were starving for that. They gobbled up everything we had to give.
Speaker 1:So getting back to the communities that you have both visited, but also kind of learned a little bit about through the participants. Do you feel that the conference has lend itself to your understanding of what those needs are, especially in terms of the resources in the clinics and the hospitals? Just how has this experience shaped that understanding? Maybe a reflection on what you were anticipating to see when you came, versus what you've experienced now?
Speaker 8:On the second day that we were here, you guys helped deliver two babies in the clinic and I think that was probably the most eye-opening because that gave a direct connection to what we had been talking about that day and seeing what was available and how it actually works in practice. During the conference there was a lot of exchange and there was a lot of people explaining to us what the resource was. But to see it firsthand and to be in that situation, that speaks volumes.
Speaker 6:We were invited to come to the clinic. Josephine knew them well, so they offered to give us a call if they had someone in labor and low and behold the phone rings.
Speaker 6:We ran in there all excited. We were happy to watch or get hands on if it was safe to do so. The second we walked in, they were trying to resuscitate a baby, which is always nerve-wracking, no matter where you are, even if you have all the resources. Me and another nurse that was with us for a few days, bernadette. We walked in and all we have is a bag valve mask, that's it. We were like well, if I was at home I would do this, but I don't have that. So what do I do? It's scary, because we come from a place where we have all the options and then you come here and you know that you could do more, but you can't. They are improvising and doing their best to lack every resources.
Speaker 6:That poor midwife was having quite a day and she had just delivered that one, and then there was one in active labor, almost ready to have her baby, and then someone rolled up and launched out another baby Bad choice of words. So Betty and I were assisting with a young mom. It was her first baby. Her family was kind of anxiously waiting outside the doors. She progressed well and then she was just absolutely exhausted. We were there for an hour and a half, dripping sweat every ounce of water we drank that day, wearing plastic gowns. There's no circulation. We were walking five foot by 20 foot room with eight people and we were doing our best with what we had. But we discovered that her IV wasn't working and we wanted to use her. So we were going to replace it, but there was none.
Speaker 6:They used all of the IVs in the clinic. So, because we were there, josephine ran around and grabbed us more supplies to do what we needed to do. But how do we provide the best care we can for these women if you just don't have it? She ended up needing to be transferred to hospital and if we weren't there, I honestly don't know how she would have gotten there, and that breaks my heart. She needed to be delivered shortly afterwards, but we loaded her into our own rental vehicle and sent her on her way. I don't know if family would have come with a motorbike and rolled her over there, exhausted and ready to collapse. I don't know what she would have done. There's just no ambulance service. That felt good, but that's you know. It's only one case that we need. It's just hard to watch.
Speaker 1:Yeah, and the good news is that some other colleagues in this group were able to visit her at Boe Government Hospital a couple days later.
Speaker 7:They're going to know she was doing well.
Speaker 1:It was great to hear and share for you all as well.
Speaker 6:Oh yeah, so it's a big weight off the shoulders.
Speaker 1:Yes, yeah, and that really does hit exactly on the curriculum that we were walking through this week, so definitely very valuable to see it in person, but also that midwife was able to join us for the. Hopkins this week so she was able to get some more hands-on experience through that as well.
Speaker 7:And the first baby, Mrs Susie. The first baby that Kari was talking about was resuscitated.
Speaker 6:Oh, yes, sorry, really left hanging.
Speaker 7:Yes, that baby also, we heard the next day was doing well, yeah, but I was kind of close to with that mom who had a hemorrhage and continued to bleed and then that baby was continuing to have like a high breathing rate and a high heart rate and so kind of seeing like the things we were teaching were a hundred percent practical to that setting helping babies breathe and helping moms survive. And the baby was showing some dangerous signs and was able to get a clear communication when we left for like what to watch and to call for help if they needed it and yeah, I'm lovely to be able to follow up and hear the next day that that baby as well is doing, and really well and feeding, and the mom was also doing well.
Speaker 7:so, yeah, being able to be in that setting was very impactful to be able to realize the impact, the potential impact, of the education.
Speaker 9:I think it helped us see what the people in our training and in fact a lot of the healthcare providers in the country are up against really, because we heard also that night so you know we leave and these emergencies had happened and very serious patients.
Speaker 9:And that same midwife delivered two more that night and she was by herself and so realizing that these folks are going to be by themselves delivering multiple babies with, with risk factors, babies that are sick, moms that are sick, and so, like Susie spoke about realizing how impactful the curriculum can be and and how important it is hopefully and this is mentioned at the conference that these folks can bring their training back to their facility and then it keeps spreading outwards so that this reaches more and more people. Every time there's an update or something they learn, then if they can keep sending out that information, hopefully that will yeah, they'll keep reaching further out and and impact those mortality rates, like we were talking about so great.
Speaker 1:So to end it, we are four days done with our conference. One more day left. What are your takeaways thus far?
Speaker 4:I am happy we did it and I know the last time we came we did some teaching but it was in those small, small villages we went to. But to do it on a large scale like this, I think it is needed and it needs to to be continued. So I'm happy that we did it. And now we know, if you say I am going to go help, you know exactly what you want to bring and what you want to come do. We've seen things first-hand. We've seen, we've seen the midwives who've been with them for the last four days in fact, from the mid-riff school to the conference, who've been with them. We know the things that they can work with, the kind of education that we need and what other other hands on we can help. But so next time you want to come, you know exactly what you are coming to. Then you know how to prepare to come and what to come to.
Speaker 6:I found it pretty amazing to see all the different foundations come together to put this on. It was a pretty huge undertaking and a lot of communication and everyone's communication mishaps, so that happens when you've got a lot of different people and working parts and different continents yeah there was what eight, eight foundations. It was pretty cool to see everyone in their gear that they had to provide or were able to provide and how everybody could lend a different helping hand.
Speaker 4:Pretty neat and the Ministry of Health also gave a lot of support yeah they had all these officials come. So that's really good, because the last time we came we had no support from the ministry, but this time that's why I think it's the unity and the collaboration with all these other organizations that that time it was just us and, course, canada, but this time, with all the other organizations, the ministry really gave us their best support, and the university. It was awesome great.
Speaker 1:Thank you so much for sitting down with us and answering some questions and reflecting on the experiences you all of us- thank you for all your hard work.
Speaker 1:Put that in the podcast a big thank you to all our guests for their support throughout the conference and sitting down with us to discuss their reflections on the work done, and a thank you also to our listeners. If you're interested in learning more about the 2024 eternal and child health training conference, a comprehensive report on the activities and lessons learned through this initiative will be published on our website. If you enjoyed this episode, please subscribe, share it with others, post about it on social media or leave a rating and review to catch all the latest from us, you can find us at helping children worldwide on Instagram, linkedin, twitter and Facebook hashtag optimistic voices podcast you.
