Midwives in Action:

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Midwives in Action: Improving Childbirth, Newborn and Young Children’s Health with Continuing Education Updates and Neonatal Resuscitation Courses for Global Peers. Terri Clark, PhD, ARNP, CNM, FACNM Associate Professor Seattle University College of Nursing Circle of Health International - PowerPoint PPT Presentation

Text of Midwives in Action:

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Midwives in Action:

Improving Childbirth, Newborn and Young Childrens Health with Continuing Education Updates and Neonatal Resuscitation Courses for Global Peers

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Terri Clark, PhD, ARNP, CNM, FACNM

Associate ProfessorSeattle University College of Nursing

Circle of Health InternationalVolunteer and Member, Board of Directors

2Healthy Mothers, Healthy Babies

3More than 7 million infants die 0-12 months.Almost two-thirds of infant deaths occur in the first month of life.Among those who die in the first month of life, almost two-thirds die within the first week.Among those who die in first week almost two-thirds die in the first 24 hours of life.4Nurses and midwives are the most needed health care providers around the globe today. They provide three-quarters of the worlds skilled health care.

5Skilled nurses by day, midwives at night

6Highly experienced midwifery and nursing educators and clinicians from capacity building countries can contribute improving nursing and midwifery care in global settings which have low educational resources. 7Some countries have excess educational capacityMany countries around the world have a chronic unmet health care need.8Midwives want to be able to make a contribution besides writing a check.

9US Midwives are already contributingA substantial proportion of nurses and midwives work in or volunteer in global sites

Many CNMs/CMs would utilize their midwifery skills if they had access to appropriate opportunities and support and important niche for COHI.

A significant number have been employed or live overseas and can speak more than one language

10So how can midwife and nurse volunteers prepare for educational opportunities?Dont reinvent the wheel!

Anticipate what you will want to have or teach: Dont skate to where the puck is, skate to where it going to be.

Get as much information as you can about the situation your global partner before you travel.

Load up your laptop and take CDs with culturally appropriate educational material for updates on clinical practice.

11Resources for your laptophttp://www.midwife.org/global.cfmSource of information on Life Saving Skills, Home Based Life Saving Skills: Publications and course opportunities that adapt to many settingsOpportunities for Africas Newborns. Practical data, policy and programmatic support for newborn care in Africa. The Partnership for Maternal and Child Health. (2006 CD)http://www.hesperian.org/Hesperian works in close collaboration with health workers, grassroots groups, and community organizations around the world

12More resourcesWorld Health Organization has a modular Midwifery Curriculum adaptable to a variety of settings and available in 6 languages. It can be printed off the web or ordered as modular texts. http://www.who.int/making_pregnancy_safer/documents/9241546662/en/index.html

www.globalhealthlearning.org (USAID)

13Sample Topics for Midwifery Clinical Updates in Global Partner SettingsRoutine infection prevention practicesHygienic clamping and cutting of the cordTetanus immunizationsEarly and exclusive breastfeedingLimited number of vaginal examsNo routine episiotomiesProviding eye care to prevent GC infection where this is local policyPartographs to monitor labor progress14For example: Promoting family centered care

15For example: Promoting hand washing

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For example: Promoting Sanitation17Use Millennium Development Goals in Curriculum DesignGoal 3. Promote gender equality and empower women Goal 4. Reduce child mortalityGoal 5. Improve maternal health

18Elements of Curriculum DesignIdentify Educational Goal or Skill Specify Objectives: (At the end of the session the participants will be able to)Steps for Educational SessionIdentify the rational for training professional staffList the steps in the normal processIllustrate the pertinent physiology and anatomyDiscuss known risk factors and complications Identify indications for intervention and noninterventionDemonstrate the steps in assessment and in using the skill Identify benefits of professional staff being trained in the skillLink skill to overall local health and education strategic plan

19Sample CurriculumNewborn Resuscitation

At the end of the session the participants will be able to:Identify the rational for training professional staff in every birth facility in Neonatal Resuscitation List the steps in the normal process of transition to extrauterine lifeDiscuss the physiology and anatomy pertinent to immediate assessment of newborn well-being. Identify indications for support of the newborn and for resuscitationDemonstrate the steps in assessment and resuscitation Why should all birth attendants know Neonatal Resuscitation? It is never known for sure that any newborn will be in good condition at birth- even when there are no known risk factorsExtending neonatal resuscitation skills to professional staff in every birth facility would contribute to significant improvement in newborn survival and prevention of asphyxia at birthSubstantial improvements in child health outcomes cannot be made without improving newborn survival rates on the day of birth20Train-the-Trainers

Be prepared with educational equipment and supplies to donate21When you are at your siteObserve quietly and take in everythingNote equivalent ways of meeting the same goalsAcknowledge what they are teaching you, and offer to reciprocateEveryone likes a Clinical Update! Assume everyone wants to do the best thing Be very sensitive of consuming resources, even paperConsider that everyones behavior makes sense to them--What do you have to know to understand the context?

22Remember:You have an accent and probably talk too fast or too slow!If you are from the US your vernacular probably sounds ungrammatical to other English speakersWhen people correct you it is a sign they careInternational visitors are a lot of work for the hostsDress appropriately. To much of the world casual dress is a sign of disrespect it is assumed that you do have nice clothing and are choosing not to wear it because you dont care and dont take the hosts seriously.23Sample topics that travel well all supported by good evidenceRoutine infection prevention practicesHygienic clamping and cutting of the cordTetanus immunizationsEarly and exclusive breastfeedingLimited number of vaginal examsProviding eye care to prevent GC infection where this is local policyPartographs to monitor labor progress

24Potential limitations of working with translators and cultural interpreters: Interpreters are in a difficult position they feel no one trusts themEveryone wants to put the best face on, including interpreters If the interpreter thinks you are not making a good impression or missing the mark they will improve what you are sayingThey may asked to translate technical terms which they dont understandMake a glossary of terms with them before translation beginsSlides and glossaries can be translated and back translated

25Elements that contribute to successInvitations from local professional leadersWork with leaders and opinion leaders in planning.Use local documents that have already been approved. Seek local input on clinical issues, educational topics, cultural and language sensitivities Be flexible, sensitive, and practicalAdvanced preparation helpsBe prepared for things to move deliberativelyRemember, Americans are known for working too hard!26Use local documents, where possible

27Be alert to information that is important to your hosts

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29Methods of overcoming language and cultural barriersEnjoy social situations with your hostsBonds of trust are developedPeople get to know each otherBe cognizant of social normsEat what everyone else eatsFor example, your eagerness contribute to your share of doing the housework may be seen as putting someone out of workReturning to the same site is critical: It demonstrates commitmentBringing donated equipment may present problems: Ask first!30IF you are planning to teach a particular skill setExample: Neonatal Resuscitation ProgramSustainability:Be sure the equipment is already in place or bring it to donateDonors are easy to find! Mothers and newborns are very inspiring to them, and depending on the type of NRP equipment cost varies from $200- $1400.Resuscitation equipment is available from health education supply companies and can be ordered on line31Example: Neonatal Resuscitation ProgramUse the existing country NRP courses they are almost always based on WHO standards and curriculaThe curricula are more elaborate with the degree of development of the country, but principles are the samePlan a basic skills test and follow-on with a Train the Trainer sessionInclude principles of teachingHave a skills test-out (if not a paper and pencil assessment)Plan opportunities to practice their teaching skills with supervision32

33Local Leaders and Active Learning

34Training the Trainers

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36What did you learn that you liked best?

Before I always put a baby with a low APGAR to the side. I didnt know there was anything to do. Now I know if I follow the steps we learned, many babies can be saved!37

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