Ep 59 Julie Kep on the importance of all levels of healthcare in PNG, how living in community enhances everyone's health, and sustainability

Ep 59 (ibit.ly/Re5V) Julie Kep on the importance of all levels of healthcare in PNG, how living in community enhances everyone's health and sustainability

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Have you ever contemplated the intricate journey of a midwife, working tirelessly across all levels of health facilities in a developing country? I have the honor of introducing Dr. Julie Kep, a deeply passionate midwife from the PNG Papua New Guinea Midwifery Society and the National Department of Health. We'll navigate her fascinating trajectory into midwifery and her experiences across the diverse health infrastructure in Papua New Guinea. Julie enlightens us on the country's new health plan, its impact, and her unyielding efforts to improve cesarean section capabilities across multiple facilities.

Imagine transitioning from having your boots on the ground, serving as a midwife, into the world of academia to pursue a PhD. Julie's journey took an unexpected turn when she received a scholarship, catapulting her into the world of academia. We'll discuss her successful venture of creating a maternal and child health program and the community's reaction to it. We'll also delve into the importance of education in disease control and the integral role of village health workers, the unsung heroes of maternal and child care.

Finally, we will explore the challenges Julie faced while moving to Melbourne to pursue her PhD, but the rewards outweighed the hurdles. She took on the unfamiliarity of a new environment and found her PNG community, proving resilience knows no boundaries. In our discussion, we'll tackle the significance of Australian Fellowship Awards for postgraduate students and the Association's support in empowering midwives. Tune in to hear about Julie's tireless efforts to strengthen the fabric of midwifery, her pursuit of knowledge, and her inspiring journey across Papua New Guinea to Melbourne and beyond.

Transcript

Speaker 1: 0:15

And welcome to Through the Pinard, your conversational podcast talking to midwives around the world about the research they are doing to improve midwifery practice. This research can range from small quality improvement programs and projects to those starting partway through or just finishing their postgraduate studies, and to those that have been there, done that and got the t-shirt. So settle back and enjoy the conversation and remember you can continue the conversation on Twitter after you finish listening From the ICM conference. thank you very much for catching up with me today. Can you introduce yourself please?

Speaker 2: 0:55

You're welcome and it's good meeting up with you. My name is Dr Julie Kepp. I'm with the PNG Papua New Guinea Midwifery Society, but I work at the National Department of Health with the Human Resource Division, mainly dealing with the staff development of all cadbury of health workers in my country.

Speaker 1: 1:23

So what made you become a midwife in the first place?

Speaker 2: 1:28

Actually I didn't choose to become a midwife. You didn't? No, i did not. I wanted to take up pediatrics but because someone had applied for midwifery, got pregnant at that time and couldn't go in and they couldn't find anybody else. So my supervisor said just come and go and take midwifery. Oh wow. So I went and took up midwifery in 1983-1984. That was many years back.

Speaker 1: 1:57

Yes, so you ended up enjoying it.

Speaker 2: 2:01

Yes, actually, when I went and joined the midwifery and you know, the exciting part is, you know, when you go and see a life mother and a life birth, it gives you the joy and seeing the you know, the life baby coming into into the world, it brings joy. Yes, and that was the exciting part of uh, exciting part and the starting of my midwifery journey.

Speaker 2: 2:27

So where did you work when you finished your training? When I finished my midwifery training, i went back to one of the health centers back in my own province, and that's in Cypric in Papua New Guinea, and I looked after the labor ward. And I used to work in the labor ward when I completed my midwifery studies. So how many births would you be dealing with then? Oh why I worked in many different settings, more in the rural health centers.

Speaker 1: 2:59

So, for context, for people that listen to this around the world, yeah, you have your tertiary education, your tertiary medical centers, your health centers, and then your regional kind of the smaller health centers in the regional areas.

Speaker 2: 3:16

Okay, let me just give you a background of how our health centers are. We have six levels of health facilities in the country. Okay, level number one is the eight post. Eight post, right, eight post. Yeah, well, we don't have any midwife, but we have a community health worker, right, yes. Then we have the community health post. Yes, recently it's a adb project and I said project funded They have a community health center, i mean community health post, built in all the in the in the communities. Okay, that one. For that we have midwife and a nurse right attached to that community health post. Then we have the health center right where we have the HEO health extension offices, yep, being in charge. Sometimes we have our nurses being in charge, and then we have midwives, pediatric nurses and our station endos health centers. And then we have the district hospital District hospital where we have doctors, we have midwives, but we have either cadre of health.

Speaker 1: 4:24

So they can do the district hospitals conducive areas, sections No, not the district.

Speaker 2: 4:31

Okay, okay then we. They can do minor, minor cases like incision and drainage, and the minor cases that they can do Preciotomy suturing yeah, the minor, minor surgery that they can do.

Speaker 2: 4:46

Yep, all right. But then we have the next level, which is the provincial specialist hospital. Now we've got all the all. The provincial hospitals are called specialist hospitals right, because we are putting specialists in all cadre of specialists into those hospitals Right, building them up now Okay. And our last level is our national teaching and referral hospital, which is the main hospital in Pogmos Midian Hospital, where we have all the specialty facilities. That's the one one, one hospital for one Yep. So with a new national health plan we've come down from five or seven levels to six Yep but only two of those levels can deal with cesarean sections.

Speaker 1: 5:28

Yes, and the other four are all to do with prevention, primary health care prevention postnatal care? that, yeah, emergent but not serious level. Yeah, yeah, and you've worked across all of them. I've worked across all of them. What did you enjoy the most? Where did you enjoy working the?

Speaker 2: 5:48

most Being in the rural because I have my boss of myself. I look after my mothers, yep, and doctors and nurses. I mean especially when I was at the district hospital. If the doctors or the health officers want to come into my labor work, they have to get permission for me. Excellent, i mean why, because I love, i'd rather look after my women and children, yep, and if they want, if I need help, i call them.

Speaker 1: 6:14

Yes, so and so that because you were working in the district and you were living in that area, yeah, did you have a continuity of care? You saw the same women all the time for antenatal and postnatal Ah, no, for each pregnancy.

Speaker 2: 6:29

Actually, antenatal was taken care of by the mch nurses. They go out. Oh, okay, then they. They go. If they go out to the for the clinics, they see the women there and by then, if they have, if they're coming for antenatal clinic at the health center, then from there they refer them down into the OMG units. Okay, we've got a labor ward and an antenatal ward, and that one I used to take care of all my antenatal mothers and the labor mothers at that time.

Speaker 1: 6:59

Yeah, so was there many home births, or was it all in hospital?

Speaker 2: 7:02

Ah well, the home births are mainly for those ones who are unable to make it to the hospital. Okay, yeah, otherwise, we encourage all the mothers to come to the hospital for delivery.

Speaker 1: 7:14

Yeah, yeah, got a safer conditions. So management then, so from your, your midwifery career. Then How did you get interested in research and then doing studies, post-grad studies?

Speaker 2: 7:29

From the health center. I was a midwife and then worked in the labor ward. And from the labor ward I moved into education. Okay, so I went into teach the post-basic midwives the midwifery certificate program. So I moved with my late husband to the hospital. I went to the main hospital and I started my teaching career there. Okay, so I thought at that time I used to be a clinical tutor going into the main labor ward. They put me in the general hospital working there supervising the midwives Yep.

Speaker 2: 8:03

From the role we moved to the main hospital because my late husband was teaching at the school College of late health. So I did some medical technologies. Okay, so because he moved, i moved and then while he was there, i went into teaching. That was my education career started. So I took part in training the midwives for nearly about six years. Then we moved back back to the province and I went back into general nursing teaching. This time I thought I was the team leader in teaching obstetrics and gynecology for the Diploma Nursing. Well, at the time it was certificate in nursing Right. Yep Students undergrad.

Speaker 1: 8:53

So getting in really nice and early Yeah, and teaching in ASIC. Yes So is in Hapenugini. Do you have to be a nurse before you can become a midwife, or can you be a midwife only with training?

Speaker 2: 9:06

Our curriculum is you have to be a nurse Yep, work for three to five years Yep, then you apply to come back and do your midwifery. Midwifery is recognized as a specialist program. Okay, For us. Yeah Right, Not only midwives, but with other care like child health, mental health and all that. That's one of those specialists that you can stream off to from a nurse.

Speaker 2: 9:28

Yep, we all graduate as nurses and then we stream off to, and then that was the part where I took to be a midwife and then into education and I taught at the School of Nursing, yep, and then from School of Nursing I came when I did my masters. Yes, after I did my masters I went back to the nursing school and they later moved into university.

Speaker 1: 9:55

So what did you do your masters? Was it coursework, masters or research Research?

Speaker 2: 9:58

I did research Aminotheases research at Monash Uning, yep. That was where I did my masters And I did a study on intuitive choices in the intuitive or conditional choice in nursing. That was my study Okay, and it's published online Excellent. The reason why I did that study was we found that there was a lot of a big attrition rate of nurses coming in and then they sort of drop out and then there's a big issue everywhere.

Speaker 2: 10:33

And then I was wondering why. and then I went part of my master's studies, i did my research on that.

Speaker 1: 10:41

So what did you find out? What was the?

Speaker 2: 10:42

reason why people were leaving. I think most of them were leaving because it was not their intuitive, it was not their real choice, it wasn't really from their desire of the heart. Yep, nursing is about wanting to do something for you, wanting to give. It must come from your heart, yep, it's not anything that will distract you and take you away. Yep, i found a lot of conditional choices at that time. Parents wanted them to become nursing. There were no other ways of them going into getting a job, so they came enjoying it. It was like they also somebody and wanted to be like them and they come in. And those were some of the factors.

Speaker 1: 11:21

But what surprised you? So, thinking back now for when you did that, what still surprises you about your master's and the results that you got?

Speaker 2: 11:30

I made a recommendation to the schools. I went ahead of presentation, made a recommendation to the schools and I said okay, if we're thinking of doing making selection for our nursing, if they're first choice, if they put their first choice as nursing, it's something that they really want to do, right? Yep, if it is second or third choice, they've got other, they have other desires, they want to do something else and then, no choice, they will come in and then you'll find that they will drop out or they will not give 100% to caring for our PNG population.

Speaker 1: 12:11

So then that kind of got you into ULU, to the university. Yeah, i did my master's.

Speaker 2: 12:18

And then, when I went, when I returned after doing my master's, i was given a job to go and coordinate the maternal and child health program at the university. Right, i was still working with the Department of Health, but second to university, so I taught the maternal and child health program where we trained. We trained midwives both midwife and a child health Right Yep, maternal and child health in two components, two major components. We trained one person Right, with the aim of placing that nurse at a community health post so that when a mother comes, they're able to treat, when a child comes, they're able to treat. They can suit what we call two birds with one stone. Yep, one person can end up And that's up until five years old. Yeah, that was until 2010. 2010, when I went down for my, that was the last year, yep. And 2011 because I went to do my PhD from the university. I went to do my PhD in Melbourne, right, so they have to solve that one and just go into Bure Midwifery, mutual Aid Midwifery Program. That was when Midwifery was introduced, right.

Speaker 1: 13:32

So did you move to Melbourne to do your PhD? Yes, I did.

Speaker 2: 13:36

I was in Melbourne for five years at RMIT, Royal Melbourne Institute of Technology. I went to a campus where they had a nursing program and that was where I went to.

Speaker 1: 13:47

What made you choose there to do your PhD?

Speaker 2: 13:50

I mean at RMIT. What I did was I went online. I was looking for civil rights Right. Yep, i had to, because when I actually going into PhD, doing my PhD was another miracle. I applied to do my PhD some years back and I didn't realize that I will be giving a scholarship. I was so busy with my job that I had no time to look for a scholarship Yep, but then one day I got a call from Australian Awards. Oh, yes, yes, australian Awards rang me up and said okay, we want you to come for interview. And I said for what They said you're going to, you're being so listed for your PhD studies. And I said so. I went back and had a look at my letter. The letter they sent me a week or a week late earlier was that, and I was not exact. I mean, i did not qualify for it, but that was the letter they gave me.

Speaker 1: 14:45

Oh, so then they told you, they put me up and they said no, you come for interview.

Speaker 2: 14:51

So they got me a ticket to go down to Putnosby. I went for interview and then I was successful and I went for my studies Excellent.

Speaker 1: 14:59

Yeah, so what topic were you interested in doing and did you still do that topic?

Speaker 2: 15:06

I still yes, i did. When I was at Goroka University we conducted the maternal and child health program where we got our midwives, then the child health, the midwife or the child health worker. We called the M6 student maternal and child health student to go and live in the community and in the community they trained village health assistants or volunteers. I wanted to go back and re-evaluate that program. What impact did it have? Because everyone was saying it wasn't about having an impact. But when we took the nurses and they lived in the community, the community had a lot of respect for those midwives. They listened And things that other people couldn't do like, for example, we had a men's house and a women's house and the ladies would go and talk to the women about women issues. The men would go and talk to the men about men's issues. They started coming out and they lined up. They HIV testing them.

Speaker 2: 16:13

They had lining up to know about family planning Because the midwife was there and they trusted them And the midwife lived with the people in the community and it created that relationship and trust. So I wanted to go back and re-evaluate that And within that time also we had LTHM programs that the midwife was supposed to come back. So we worked with the community leaders, with the community, and then, they know, the community built a we call it VIP toilets. We had VIP toilets, the environments garden, around the flower garden.

Speaker 2: 16:57

They had windows in their houses, because up in the highlands it's quite cold and all our houses did not have any windows Their houses, not ours, but their houses did not have any windows And most of them were having pneumonia and so much of a breath of asthma and bronchitis because they were breathing in a lot of smoke from that air. So when the students went out and looked at them and said, okay, now when you build a house, do a window, let some pressure come in, do a cloth line and your clothes outside, do a water tap, put it in the plastic. When you go to the toilet, put a lid. Do a proper toilet with a good sitting and put a lid on it.

Speaker 2: 17:42

When they introduced that method to them, people realized that we are the only ones that we are, the ones that are making ourselves sick. So education by leading by example.

Speaker 2: 17:58

So when we had at one time we had outbreak of cholera in Papua New Guinea, and that was in 2009. We had a big outbreak of cholera I think it was nine or ten And you know our hospitals were empty because people were scared to come. But you know what? We never had any deaths. The hospital did not receive any cases because people would prepare them in advance on how to wash and clean themselves go to the toilet, come back, clean themselves. They would not shake hands at that time with anybody. They would almost shake with people.

Speaker 1: 18:34

I still think we shouldn't be shaking hands. We should be bowing and kind of like yeah, we shouldn't shake hands, It's naughty. So you did most of your study here or you went back to do some data collection in Papua New Guinea and then came back to write up.

Speaker 2: 18:50

Yes, i did. I was in Melbourne from 2000. I went in 2011, july of 2011, and then did 30, i think 6 months of academic preparation and things like that It was. We were not allowed to do that, but I worked with my supervisor, preparing my proposal and doing the presentation and things like that. One thing good was that I had a very good supervisor. Who was your supervisor? Professor Eleanor Allroyd, okay, and she's now in New Zealand teaching at AUT and I was also wonderful with them. Yeah, so she was my supervisor. I was in Melbourne and I went back to Papua New Guinea for a year to collect my data. I went into those village settings where we went and did that training to see what was the impact of those midwives and the training they conducted to the people in the community, and at that time we trained village health volunteers and village health child health workers.

Speaker 2: 20:03

Child health, for the child health component, for them to identify babies at risk, bring them quickly to the hospital. And women at risk, anti-natal mothers, any women who are at risk, or if they have been pregnant and not coming to the clinic, this village health volunteer will bring, so they'll actually take them to the next level of care.

Speaker 2: 20:27

Take them to the hospital for the anti-natal check, yeah. But then they realized that it was very costly because they couldn't find it. They didn't have the money to pay for the mother plus themselves. Yeah, it was costly. So that was the whole thing that dragged them down, even though they wanted to do the job. They wanted to support the women in the community, to bring them in. Not only that, but they realized that they were nurses from the community, so whoever was sick they would come to them. They would come to them. Which?

Speaker 1: 21:03

is good. When you were back in Melbourne studying, how did you balance your study? Did you just study full-time like a job 9 to 5,? were you working as a midwife at all?

Speaker 2: 21:17

I was not working, i concentrated. I wanted to get it done in time and come back.

Speaker 1: 21:23

So your family was still in Papua New Guinea?

Speaker 2: 21:25

Yeah, All of them were big. All of them were big. Yeah, i had. One of my sons was at the university, the other one was at National High School. I took my daughter down. She was at a high school down there in Melbourne with me, but then, because she didn't live, i sent her back. I said you can't disturb me from my studies. If you don't, we have to go back home. She had to go back home. I stayed and then concentrated on my studies. I submitted on time. Thank you to the my examiners. Usually it will take them about 6 months to return your exam.

Speaker 1: 22:04

Sometimes yes.

Speaker 2: 22:06

But mine got it done in one month.

Speaker 1: 22:08

Oh wow, that's magic.

Speaker 2: 22:13

That's magic. I appreciate the special people that have reminded me of this.

Speaker 1: 22:18

So how did you cope being by yourself? Did you get lonely, or was there a Papua New Guinea community in Melbourne that you could connect with?

Speaker 2: 22:29

The house that I was living in. I shared it with a family. All right, this particular family, their husband, was doing his PhD at La Trobe Union. Ah, so they understood. Yes, so he had his family there and because he was constantly sick a bit, i had to go in and stay with them in courage and take him to those people. That was the thing that I was staying apart from my studies So you could live in care, yeah. But then I supported them and I shared the accommodation and everything with them. So we were together. I didn't really miss home, like I had The family there with me.

Speaker 1: 23:11

So they were Papua New Guinea as well, So that was a little bit of familiarity. How did you celebrate When you finally finished and you got your marks back? how did you celebrate?

Speaker 2: 23:22

As soon as I submitted my thesis, i got on the plane, i went to Western Australia, i went to Perth, got in the bus, i went to Calgulito to see my cousins. Oh wow, cool. Then I came back back to Melbourne and took hands. Oh wow, it was so relaxing, i could just breathe there.

Speaker 1: 23:44

Well, melbourne, considering you come from Papua New Guinea, which is a tropical country, melbourne is just bloody cold. I know It changes four times a day. If you're lucky, cans would be like home.

Speaker 2: 23:57

Yes, can, so it's like home, hotly warm Melbourne. It was quite cold, but I spent most of my hours at uni Yep. The good thing was like they had a 24 hours transport Yep, so I can go home late in the night about one o'clock, two o'clock, have a bit of rest because I'd rather work at uni, where I had a room.

Speaker 2: 24:19

for one thing good was I had a room for myself, the office for myself, Oh nice. I never shared it with anybody, even though there were other PhD students around who said offices. I think God was good to me.

Speaker 1: 24:33

That's what I can say. You had your own space.

Speaker 2: 24:35

Yes, i had my own space where I could work Yep, and then I go home and it was quite safe for me to travel in the night, going back one o'clock two o'clock in the morning, yep. And I worked because at home, because I was living with a family, I couldn't work, I go home nothing, yeah, it's just good to say. Yep, But I come out to uni I can work all through until nine o'clock, one o'clock, two o'clock, and then I go home.

Speaker 1: 25:00

And you go home. Well, that's kind of. everyone adjusts their routine to what works for them. Yeah, so what did you find surprising about your doing your PhD? Was there anything that surprised you about it?

Speaker 2: 25:15

Well, mainly you have to do a lot of reading. Yeah, you have to try and understand what those literatures were all about. You know reading here and reading there and having to put things together And that was mind blowing.

Speaker 1: 25:30

But that's what, especially in another language as well.

Speaker 2: 25:32

Yes, yes, But because English was my, our first language of instruction, i didn't have any problem, right, yeah, yep, i didn't have any problem about understanding. Yeah, and it was good because I had other colleagues of mine. They started their PhD earlier than me, two or three years maybe, or some of them They were still starting when I graduated. Oh wow, Yeah, i feel sorry for them. But because they used to understand how I got it done. Yeah, i told them English is our language of instruction back in my country And that is why I was able to understand and get the work done. Yeah, it was easier for me. Yeah, understanding.

Speaker 1: 26:11

English. So what happened when you finished your PhD? How did that change? or did it change your career directory?

Speaker 2: 26:19

Yeah, i went back. I was supposed to go back to university to teach Yep, but when I went back, the job that I had I didn't have a job. Oh, yeah They. What I did was they? university really advertised the position because it was a health department funded position to the university. So university had their own position And someone else was on that position. So when I went back I couldn't.

Speaker 2: 26:44

But I found that going back and when people realized that you become a threat to them, yeah, that's how I found it. Yeah, so, even though I didn't have a job, i was working at the department, just getting involved in anything and everything that I could put my hands on. If I was invited to take part in any meetings or policy development or any workshops, i would give my best to do those things. And then eventually, after maybe about after three years, i was given a proper job to which I could call it the job And overseeing the in-country and overseas training. I went training for all cadres And with that background, knowledge of education, overseas and in-country, i'm able to guide and direct people coming to SIG, you know, sig scholarships, sig studies. I'm able to assist them.

Speaker 1: 27:48

So how important do you think the Australian Fellowship Awards are for people to have access to postgraduate education?

Speaker 2: 28:00

Very important Because back at home we don't have some of those programs that The scholarships here are given, especially to our top beginnings to do their masters, if it is not offered in the country and PhD Otherwise, if we've got other programs, other courses or programs in the country, priorities are not given to that. So that is why if the nurses, for example, our midwives if they are applying for courses overseas to do their masters in a specialty area, or if they are specialist nurses, like in acute care, and they are applying for studies in renal or cardiac or things like that, they get scholarship easy. Yes, because we want to build our specialist. So scholarship support by OSA is very important Because our government cannot sponsor people overseas to go and study, even to do their PhD. They can't afford it.

Speaker 2: 29:09

But sitting in there now taking over the staff development of our section, and sometimes I'm thinking, you know, i have doctors coming in. They're coming in and telling me they want to go for attachment to China, they want to go for attachment to Singapore, and I'm thinking where do I get a money? Yeah, yeah, yeah, yeah, i've been there and I said okay, you have to give me your study plan. You have to give me your plan, so that I would know that you're going there, so that I budget for it. So I work with the chiefs of the hospital. Say, give me your plan, who are you planning to send for the next year? Because all of a sudden they come in. They tell me I'm going to Fiji to study, do my postgrad, i'm going to China to do my you know something, speciality in something. And I'm thinking you know, government has to have money.

Speaker 2: 30:02

But somehow, when I put in for one, million just for FES or a bit of stipend for them department gives because I've got my activity plan.

Speaker 1: 30:15

So is it. What would you like to see to improve midwifery in Papua New Guinea, because you've gone through working at all the different levels? Yeah, you've educated at different places. Yes, you're now the top midwife in the country. Really, what would you like to change to allow more midwives to have postgraduate education, masters or PhDs? How would that help?

Speaker 2: 30:46

At the moment we are talking to our government, we have put in requests to our health secretary, we have presented in different forums, different conferences. We have. I like to do them that we want midwifery positions created, yes, and we're still talking, we're still putting our recommendations into them, even to the provinces, to the CEOs, to accept divorces. Go back and create position for the midwives. If you want to attract midwives into your health centers, into your district hospitals, create a position, but then they think that you know what's so special about midwives, so we will create position for them. And I said no, if you want to create, we need midwifery positions for our midwives. Yeah, we are great with midwives, but they're going in and doing administrative work. They're going in and doing education jobs. They're going and being misplaced. Unless you create a position for a midwife and they have their package, that's when you're going to attract midwife into it. That's when the mental and infant mortality will reach us, because they are despicable people.

Speaker 1: 31:52

And that reinforces completely the state of the world. Midwifery will fall. Yes, and all of the evidence that we know. Yes, if you put midwives in, it improves health for the mother and the babies, but not just for them, it's also intergenerational Yep, it's the next generation as well, exactly That it helps. So, with the project that you did your PhD on, have you managed to expand that, now that you're in a different, a higher position to get more midwives into community health?

Speaker 2: 32:21

At the moment. With the research that I did, i was involved in writing the National Health Plan for 2021 to 2030. And in that plan we've got inclusive for village health assistant. Yep, that was one of my recommendations To train village health assistants in the villages. That would create an healthy home, healthy environment, healthy women, healthy child. Bring them in and link them in with the healthcare worker at a community health post or at the health center, and that recommendation is taking place starting yesterday. We've got a working committee develop. We've got a working committee which I was supposed to be in it.

Speaker 1: 33:10

But you're here instead at the conference.

Speaker 2: 33:11

Yes, but I emailed them and I told them I'll be still part of it For us to work with the training manual for the village health assistant. They did become the linkage. Previously we didn't have that linkage. Women would die because they had no one. They didn't worry whether they come to the hospital. But with the village health assistants and all our provincial hospital CEOs have put it on the budget now To fund those village health assistants. That was the recommendation And I'm so proud of it.

Speaker 1: 33:49

I was going to say that is an unreal feeling, from just listening to you to going from a PhD to now influencing national policy. That's the power of evidence. That's why we do research, that's why we do PhDs We influence change.

Speaker 2: 34:10

I was in the maternal and child health task force for the midwifery task force I went and attended their workshops, conferences. We had meetings and that was my recommendation going in. I had to push for it.

Speaker 1: 34:28

But it's an example to show. if we want to change practice and health care for women and children, we need a midwife at the table, at the table in the policy.

Speaker 2: 34:39

In the policy levels, in the leadership levels, in the government levels to make those comments.

Speaker 1: 34:44

That's so cool.

Speaker 2: 34:46

And also being with the association PNG Midwifery Society. I stand at the back of our president, mary, and I'll be coming in and advice her, to her Anything. she turns around and says how do we get it done? And because of the wide range of information that I have in the background, i support her and tell her okay, this is how we get it done.

Speaker 1: 35:06

And that's sustainability, that's helping build capacity for the future.

Speaker 1: 35:11

I've had the privilege of being a supervisor for Papua New Guinea master's students Who's now into education. So she's doing a similar pathway and kind of now starting it with education, and I'm hoping that we can kind of get her to come back and do her PhD as well, because it's that the energy. But there's so much that is being done. That's just amazing that we never get to hear about it. So what's next? What are your plans now? We're going to be retiring, oh, you're retiring.

Speaker 2: 35:42

I will be retiring maybe in two years, but I'm working with Midwifery. I'm working with the Midwives, the Executive Association pushing it. Make sure we get our subsistence after next level. Get all our Midwives signed up to form their own branches and build the strength up. We involve them, we bring them, we create environment for the group that we brought. The Association supported them a bit. We did the whole fundraising and things like that and we brought them. They paid half. We paid half in little things.

Speaker 1: 36:20

And I must admit that your team stands out your shirts. I want one of your shirts And I know you've got another meeting to go to, so I'm very aware of that. Thank you so much for your time for this kind of chat. I would love to chat to you longer. Thank you for joining us today. You'll find all the links on Twitter, instagram and on the podcast website. If you are a Midwife and you would like to share your research, your postgraduate studies or even the quality improvement projects you are doing now, then email me at throughthepinard at gmailcom, send me a tweet or send me a DM.