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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

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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

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Page 1: Midwives in Action:

Midwives in Action:

Improving Childbirth, Newborn and Young Children’s Health with Continuing Education Updates and Neonatal Resuscitation Courses

for Global Peers

Page 2: Midwives in Action:

Terri Clark, PhD, ARNP, CNM, FACNM

Associate ProfessorSeattle University College of Nursing

Circle of Health InternationalVolunteer and Member, Board of Directors

Page 3: Midwives in Action:

Healthy Mothers, Healthy Babies

Page 4: Midwives in Action:

More 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.

Page 5: Midwives in Action:

Nurses and midwives are the most needed health care providers around the globe today. They provide three-quarters of the world’s skilled health care.

Page 6: Midwives in Action:

Skilled nurses by day, midwives at night

Page 7: Midwives in Action:

Highly 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.

Page 8: Midwives in Action:

Some countries have excess educational capacity

Many countries around the world have a chronic unmet health care

need.

Page 9: Midwives in Action:

Midwives want to be able to make a contribution besides writing a check.

Page 10: Midwives in Action:

US Midwives are already contributing

• A 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

Page 11: Midwives in Action:

So how can midwife and nurse volunteers prepare for educational opportunities?

1. Don’t reinvent the wheel!

Anticipate what you will want to have or teach: “Don’t skate to where the puck is, skate to where it going to be.”

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

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

Page 12: Midwives in Action:

Resources for your laptop• http://www.midwife.org/global.cfm• Source of information on Life Saving Skills, Home Based Life

Saving Skills: Publications and course opportunities that adapt to many settings

• Opportunities for Africa’s 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

Page 13: Midwives in Action:

More resources

• World 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)

Page 14: Midwives in Action:

Sample Topics for “Midwifery Clinical Updates” in Global Partner Settings

1. Routine infection prevention practices2. Hygienic clamping and cutting of the cord3. Tetanus immunizations4. Early and exclusive breastfeeding5. Limited number of vaginal exams6. No routine episiotomies7. Providing eye care to prevent GC infection where

this is local policy8. Partographs to monitor labor progress

Page 15: Midwives in Action:

For example: Promoting family centered care

Page 16: Midwives in Action:

For example: Promoting hand washing

Page 17: Midwives in Action:

For example: Promoting Sanitation

Page 18: Midwives in Action:

Use Millennium Development Goals in Curriculum Design

• Goal 3. Promote gender equality and empower women

• Goal 4. Reduce child mortality• Goal 5. Improve maternal health

Page 19: Midwives in Action:

Elements of Curriculum Design• Identify Educational Goal or Skill • Specify Objectives: (At the end of the session the participants

will be able to…)• Steps for Educational Session

– Identify the rational for training professional staff– List the steps in the normal process– Illustrate the pertinent physiology and anatomy– Discuss known risk factors and complications– Identify indications for intervention and nonintervention– Demonstrate the steps in assessment and in using the skill – Identify benefits of professional staff being trained in the skill– Link skill to overall local health and education strategic plan

Page 20: Midwives in Action:

Sample Curriculum• Newborn 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 life• Discuss the physiology and anatomy pertinent to immediate assessment of newborn well-being.• Identify indications for support of the newborn and for resuscitation• Demonstrate 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 factors• Extending neonatal resuscitation skills to professional staff in every birth facility would contribute

to significant improvement in newborn survival and prevention of asphyxia at birth• Substantial improvements in child health outcomes cannot be made without improving newborn

survival rates on the day of birth…

Page 21: Midwives in Action:

Train-the-Trainers

Be prepared with educational equipment and supplies to donate

Page 22: Midwives in Action:

When you are at your site• Observe quietly and take in everything• Note equivalent ways of meeting the same goals• Acknowledge what they are teaching you, and offer to

reciprocate• Everyone likes a Clinical Update! • Assume everyone wants to do the best thing • Be very sensitive of consuming resources, even paper• Consider that everyone’s behavior makes sense to

them--– What do you have to know to understand the context?

Page 23: Midwives in Action:

Remember:

• 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 speakers

• When people correct you it is a sign they care• International visitors are a lot of work for the hosts• Dress 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 don’t care and don’t take the hosts seriously.

Page 24: Midwives in Action:

Sample topics that travel well— all supported by good evidence

1. Routine infection prevention practices2. Hygienic clamping and cutting of the cord3. Tetanus immunizations4. Early and exclusive breastfeeding5. Limited number of vaginal exams6. Providing eye care to prevent GC infection where

this is local policy7. Partographs to monitor labor progress

Page 25: Midwives in Action:

Potential limitations of working with translators and cultural interpreters:

• Interpreters are in a difficult position– they feel no one trusts them

• Everyone 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 saying

• They may asked to translate technical terms which they don’t understand– Make a glossary of terms with them before translation begins– Slides and glossaries can be translated and back translated

Page 26: Midwives in Action:

Elements that contribute to success

• Invitations from local professional leaders• Work 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 practical• Advanced preparation helps

– Be prepared for things to move deliberatively– Remember, Americans are known for working too hard!

Page 27: Midwives in Action:

Use local documents, where possible

Page 28: Midwives in Action:

Be alert to information that is important to your hosts

Page 29: Midwives in Action:
Page 30: Midwives in Action:

Methods of overcoming language and cultural barriers

• Enjoy social situations with your hosts– Bonds of trust are developed– People get to know each other

• Be cognizant of social norms– Eat what everyone else eats– For 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!

Page 31: Midwives in Action:

IF you are planning to teach a particular skill set

• Example: Neonatal Resuscitation Program• Sustainability:– Be sure the equipment is already in place or bring it to

donate– Donors 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 line

Page 32: Midwives in Action:

Example: Neonatal Resuscitation Program

– Use the existing country NRP courses– they are almost always based on WHO standards and curricula

– The curricula are more elaborate with the degree of development of the country, but principles are the same

– Plan a basic skills test and follow-on with a Train the Trainer session• Include principles of teaching• Have a skills test-out (if not a paper and pencil

assessment)• Plan opportunities to practice their teaching skills with

supervision

Page 33: Midwives in Action:
Page 34: Midwives in Action:

Local Leaders and Active Learning

Page 35: Midwives in Action:

Training the Trainers

Page 36: Midwives in Action:
Page 37: Midwives in Action:

“What did you learn that you liked best?”

“Before I always put a baby with a low APGAR to the side. I didn’t know there was anything to do. Now I know if I follow the steps we learned, many babies can be saved!”

Page 38: Midwives in Action: