Ep 75 Faith Diorgu on perineal care, designing a birthing stool and capacity building for African midwives

Ep 75 (ibit.ly/Re5V) Faith Diorgu on perineal care, designing a birthing stool and capacity building for African midwives

@PhDMidwives  #MidTwitter  #research #midwifery  #Nigeria @world_midwives @uochester @uniport @MedicalworldNig @WorldBank @ProfMarySteen

Medical World Nigeria article HERE 

Imagine being the force that reshapes an entire healthcare practice on your continent. Today, we are honored to have  Faith Diorgu with us, the vanguard of midwifery education in Nigeria. Her narrative isn't just about personal triumph—it's a story that intertwines with the lives of countless African women, enhancing maternal care through her legacy. Join us as Faith recounts her journey, from her mother's influence to her pioneering role in establishing advanced midwifery programs. It's an exploration of dedication and the indelible impact of academic research in the evolution of midwifery.

Navigating a PhD is no stroll in the park—especially when miles away from the comfort of home. Our conversation turns to the emotional odyssey of a PhD student, mentored by the renowned Professor Mary Steen, as they chart a path through the rigors of academia. We uncover the vitality of small victories, the strength found in a supportive partner's encouragement, and the importance of maintaining mental wellness. Then, as the confetti settles post-PhD, we reflect on the quiet yet profound celebrations that accompany such an extraordinary achievement.

Innovation often springs from the well of knowledge, and we close the episode by marveling at how a newly minted PhD in midwifery took that leap. The story of an innovative birthing chair, fusing cultural wisdom with modern healthcare needs, is not just about utility—it's about revolutionizing maternal care. We discuss the challenges of protecting this invention amidst a pandemic and the collaborative effort to establish a PhD program under the auspices of the World Bank's African Center of Excellence. This is a testament to the transformative power of education and the future of empowered, research-driven midwives transforming healthcare practices.

Transcript

Impact of Midwifery Education in Africa

Speaker 1 0:27

Thank you very much for joining me today, as per usual. Can you introduce yourself please?

Speaker 2 0:34

Yes, I am a Professor, faith Diogo, a Professor of Midwifery from Department of Nursing Science University of Patakot, nigeria. I'm a visiting scholar to the School of Nursing Faculty of Health Sciences University of Waterloo in Canada. That's where I'm speaking from now. I'm a Nigerian first PhD holder in midwifery, as well as the Nigerian first professor of midwifery. That's about me.

Speaker 1 1:07

So what got you into midwifery in the first place?

Speaker 2 1:12

So what got you into midwifery in the first place? Yeah, I got into midwifery really because my mother of blessed memory she was a midwife, a good midwifery practitioner, and she enjoyed boni poli of community practice, you know, for a very long time in my community I was actually born in her facility. I later became her colleague as a board-certified and registered midwife in my country. I think I feel midwifery runs in my vein. Yes, yeah, and I learned the cues early in life as I watched my mother practice midwifery with passion. That also ignited my passion into midwifery it's well, you kind of.

Speaker 1 2:04

I can understand being bred into it, but absorbing all of that just as a child yeah in the clinic as a child as well and just kind of vicariously absorbing what she was doing and how she was treating women. Yeah, and that would go a long way to making who you are as an adult as well, because we know that what we see when we're younger influences us later on. Yeah, so how did you or when did you do your midwifery education and where did you work after that?

Speaker 2 2:39

Yeah, I did my basic midwifery education then was registered as a midwife back in Nigeria.

Speaker 2 2:54

I was registered as a midwife back in Nigeria and after that I went to the university to do PNSC in North Sea the university in my country, university of Ibadan and after that I went to the UK to do a master's in midwifery and PhD in midwifery. Even besides the master's and PhD in midwifery I had already done other degrees. After my first degree in nursing I did a master's in educational psychology and I did a PhD in educational psychology and I was still yearning for midwifery in my life, to go higher in education in midwifery. That prompted my going to the UK to do midwifery master's and PhD because as of the time I was there for the program, such program was not in my country. That was why I became the first PhD midwife in my country oh wow. And, incidentally, the first professor of midwifery in my country. Because right now I have brought the program down to my country and I'm now driving the course and supervising the program. We have masters and PhD midwifery in my country right now under my supervision.

Speaker 1 4:23

Talk about impact and changing the future of midwifery. That's a huge impact to have.

Speaker 2 4:31

Yes, and the program is not only for Nigeria, because I find that many African countries also lack midwife scholars. So as I came back to my country as the first PhD midwife, I felt others should also be part of that, I shouldn't be alone. So there came a call from the World Bank, you know, asking for if you want to be supported to raise some scholars in terminal degrees. So I put with my team, I wrote you know the proposal, I got the approval and the postgraduate program immediately started in my country for Africa. So that program have involved other African regions, candidates coming into Nigeria to do midwifery.

Speaker 2 5:22

At the moment we have got up to 239 masters in PhD in the country, you know, including for small part of it that come from other African region. And now we have moved on to a PhD program in midwifery in my country and we have the first set and we have a second cohort going on. Wow, that's so cool. Yeah, the first cohort will be projecting by next year, all things being equal. And then we are back, you know, admitting a third cohort of PhD midwifery. So after I got mine, I'm spreading in my country to get more of these scholars, you know, to the stream.

Speaker 1 6:10

How does that make you feel to know that, because of you and your work, that this pathway is now opening up for so many others?

Speaker 2 6:21

Yeah, it feels very, you know, privileged. I feel very excited too that I have this capacity to be able to drive that back in my country and all that I have learned from my postgraduate program in Midwifery. I'm able to bring it down home and spreading it across even the African region. I feel very, very, very happy with it. I feel satisfied.

Speaker 1 6:56

It's your legacy, yeah, it's, it's, it's. You're changing the future generations of midwives and future generations of the care that women get, which I think is brilliant. So, let's, let's backtrack a little bit. So what got you into doing your Master's? So what got you into research in the first place?

Speaker 2 7:18

Into research. You know, academic research facilitates learning, which we know, and it is the best tool to develop or to enhance knowledge. And since I was aiming for knowledge, research cannot be out of it. So it is an integral part of my knowledge acquisition. I'm going through all of my academic journey. Research was one of the accomplishments. So that's how I entered into research, because research is how we can come to understand what we know and how we can apply the knowledge to the problems. So it is never a separate entity from my academic journey, it's part of all my academic journey.

Speaker 1 8:08

So you've said you had some child psychology, previous degrees yes, with your master's in midwifery. What did you do that? On what area did you look at?

Speaker 2 8:20

You know, for my master's, I'm being educated in educational psychology. It was not child psychology, it was educational psychology because originally I was a trained nurse educator. Right, yep, nurse, yes, I was a trained nurse educator so, and I was teaching in-runner in teaching discipline. So I did a master's because I had a diploma in teaching. That's what gave me a license in nursing education. So with that diploma I entered into a master's in educational psychology to learn more under the rudiment of principles of teaching and learning and how learning can take place. So I did master's and I did PhD. But I was still not settled. That midwifery, in my way, was still not getting me have rest. I had to go back to school to do master's in midwifery and PhD in midwifery. That's why I came with the two disciplines in my hand.

Speaker 1 9:43

To the UK, and so what did you study in the UK?

Speaker 2 9:48

What I studied in the UK was my master's at PhD. Are you doing my research?

Speaker 1 9:53

Yeah, so what area did you focus on?

Speaker 2 9:56

Yes, my research, my midwifery, actually my focus was on perineal care. That was my focus. How to, you know, help women giving birth and making sure they have intact perineum after birth? Because many times, even in my own country, perineum is never, you know, taken care of or looked after, you know, seriously, and they do a lot of trauma around there during childbirth and all that.

Speaker 2 10:28

So, virtually my master's and my PhD, I was actually focusing on how perineum integrity can be maintained while giving birth. So my master's, I was actually looking at racial differences in the perineum and we find that the Asians have a more likely to have trauma perineum because their perineum we are thin and short, and why the Blacks or maybe Africans have a better perineum to endure stretch and all of that. Okay, yes, that's what I find in my master. Then, taking it up to my PhD, I began to look at how perineum can still be, you know, protected, you know, for it to be intact. So I then looked at, I did a mixed method study. I looked at perineal trauma and betting position. You know, african women experience.

Speaker 1 11:32

Yep. So what surprised you the most in your PhD experience?

Speaker 2 11:39

And what surprised me was that when I was asking in my interview about perennial experience, women that even had their birth many years ago maybe grandmothers, we are still very vivid with the experience of perennial trauma and they never forget that experience of perennial trauma and they never forget that experience of childbirth, how the perennial was traumatized and all of that. That experience lives so long with women and they do not like it. So that surprised me that even after a long time childbirth such negative experience is still lingering in the minds of the women. So that wasn't too good. And also for better position. I also find that in Africa, or in my country particularly, they use a better position that was not supported by evidence. They do the totter me position, you know, lying down to give birth, a betting position that was not supported by evidence, okay, they do the totter me position, you know, lying down to give it.

Speaker 2 12:48

Yes, and 100% of the women that gave birth said they gave birth in that position and there was a robust literature not supporting that position. There's a robust literature not supporting that position and the position my literature said is most likely the cause of perinatal trauma. So I was wondering why the position that works for perinatal trauma is what is being adopted, you know, in Nigeria and Africa, adopted in Nigeria and Africa. Why was that so? When the interview went on, one of the things I got from the interview is that that's the position that they know about. They never were told about any other position and this is a position that has been handed over from one generation to the other, from mother to child, and it continues. Even when midwives were asked why do you support women on this very singular position instead of giving them option of other position, the midwife said exactly that was the only position that they were taught, yes, in their program, in their learning program. I also asked the obstetricians why they should do that. The same reason that is the only position they know.

Speaker 2 14:13

So when we now begin to discuss what literature says about other positions that could be used, which is upright betting position, when that question was asked, they were just expressing. How would they support women in upright betting position? What could they use? They were interested to change practice, but they were asking for support, and what devices? What is it that they will use to support them? You know, support women in this position. That took me back after my dissertation. It took me back to think what I could do to really help the obstetricians and the midwives and the mothers to be able to change this position and use, what is more, recite supporting evidence in our position. So that took me to begin to think about inventing a chair to support, you know, midwives, for women to use. Yeah, that's what brought about the birth of migration.

Speaker 1 15:25

So what else have you done? How's it going now?

Speaker 2 15:30

Actually I would not categorically say that it has brought about change. Many of the centers are still using the same position because it has not been taken as a policy or protocol of the centers. But the information has gone in that women should make their choice of position and naturally the position they would like is upright. And naturally the position they would like is upright. So the betting chair I invented is not out yet. It's just got the paper. Copyright commission, you know that, got that one and it has also been patented. It remains to be in the market.

Speaker 2 16:23

You know the commercialization, yeah, but meanwhile people are asking questions where in the chair and some persons are trying to do squatting with whatever support they have at hand. Yes, so it is going in gradually and the information is also going in just for it to be in the protocol of each hospital. But some women have realized the importance and the midwife candidate that I'm teaching, I teach that as one of the evident practices, Global best practices they should have. So they are working in many of those centres, nursing centres, and they're trying to, you know, do what they can do by themselves. So it's entering, you know, in bits.

Speaker 1 17:17

And it's a multi-level problem that you need to educate the midwives so they can educate the women, but you also have to educate the obstetricians and the venues. So when the women come in and say I want to stand yeah that the venues will actually help facilitate that as well and make it possible and not go. No, you have to actually lie down. Yeah, change is slow.

Speaker 2 17:43

Yeah, change is slow.

Speaker 1 17:48

So who did you have for your supervisors? Did you pick them before you picked your topic, or was it part of being accepted into a program in the UK?

Speaker 2 17:59

Okay, I did not pick my supervisors when I did my program. I didn't pick my supervisor before having my topic. I got my topic first and applied to. You know, send application for PhD. Yeah, looking for who has the expertise. You know that will support me greatly. I find Professor Mary Stain because I was looking for a professor that can, you know, help me that have the biggest impact on my study. And I was told about Professor Mary Stain. Actually, when I was told of her, I searched online about her. I found that she has the expertise I was looking for. So I moved to where she was because this application was made in University of Nottingham While she was in University of Chester.

Speaker 2 18:58

I have to move to Chester and I sincerely thank her for accepting my request and for showing exceptional dedication, interest and faith in supervising my PhD products. After even leaving the UK to start Australian University in Canada, she continued with me. She's such an exceptional supervisor. I engaged her while I was in the UK, in the University of Chester. She accepted and she continued to supervise me with keen interest Up to the left to Australia and she continued till the end of my research journey. She was just a wonderful supervisor for me. So I sincerely appreciate her, you know, for sharing all that wisdom and knowledge with me. I couldn't have wished to have a better supervisor at all. That did go above and beyond for me.

Speaker 1 20:02

Yes was a good mentor, so you moved away from your home and from your normal social networks and your family to another country to study.

Speaker 2 20:15

Yeah.

Speaker 1 20:16

How did you keep your sanity? Because we know PhDs are a hard journey, especially when you're separated from your normal support system. So how did you maintain your mental health and the balance between that study and work and family?

Speaker 2 20:35

Yeah, you know, doing a PhD is hard.

Speaker 1 20:39

Yep.

Speaker 2 20:40

It's really hard it's once physically and mentally exhausted for me. So I established a routine and a structure to help me, you know, go through and also focused on the moments, on those structures that I established, like giving myself, you know, a target for a period. I focused on the moment, on those targets, and then, after, you know, achieving that target, I had a celebration. I celebrated the win of the target and, for me, what was going for me. I was celebrating, you know, the win. I was going to the malls and shopping centers Excellent To shop and look around. It helped me and it was helping my mental, you know, health, mental therapy. And then that change in this scene, you know, helped me to reflect and mentally transit to the next targets in that journey. That was how I was moving.

Speaker 2 21:51

Yeah, then I also had a strong support system and that my strong support system was my husband. You know he was away in my country. He was calling every day, twice, every day, yeah, encouraging me to continue to keep going, and he always was there listening to me venting my stress, important, so that so much, yes, helped me. He was not present with me at the UK, but he was all the time encouraging me to go on and giving me a listening ear to vent all my stress. So that support system helped me. So so much it helped me and in addition to structuring what I do, I think that's the going technology.

Speaker 2 22:44

Yeah. So put all of this together, I was able to maintain my sanity. You know when I put my structures. You know, and they retrieve, I follow them, focus on them. That same way, you know celebrate the wins of each of the segments. You know going out to refresh myself and you know wind down and all of that and getting ready to the next. You know target and then speaking with my husband often and telling him all the stresses and everything. All of that helped me.

Speaker 1 23:17

Excellent. So how did you celebrate when you finished and you are the first in your country how did you celebrate getting that kind of recognition or getting that final bit of paper to say you are now a doctor?

Speaker 2 23:33

Yeah, when I finished the PhD I was like I was empty. I couldn't understand. I could sit without looking into my system, without pressure, because while I was doing the PhD I lost all my friends, I was off social life completely and as I finished I felt emptiness. Yeah, and after a while I could adjust. And to celebrate my family and we had a get-together, you know, celebrating the end of the long journey, and we're happy, and I continued.

Empowering Midwifery Through Innovation

Speaker 2 24:21

So my celebration was not very elaborate, yeah, continued. So my celebration was not very elaborate, yeah, but in that in me, I was satisfied that I have come to the end of the road with a good, and again, I came from an institution that gave me permission to go. So I have to give reports back to the institution that I have finished and this is the certificate and all of that. So the university also celebrated me for achieving that and gave me success later and encouragement, with no good worse. So those also make me happy that I have ended the journey very well. So I now began to look for my friends.

Speaker 1 25:04

Did you catch up with your friends again? Yes, I catch up with my friends. When I talk to people, make sure that it's been at least six months since they've finished their phd, because that there needs that readjustment time to decompress, to get back and find your spacing again, because it is such an all-encompassing focus. Whether you're doing especially full-time but also part-time, is that it's what do I do now that I don't have anything to do and now it's getting back into life re-establishing.

Speaker 2 25:39

So that space of emptiness pushed me into another work. That's when I started thinking about the infection, and it kept me busy again for almost a period of one year. Yep, yeah.

Speaker 1 25:57

So talk through that, so talk through how that process happened.

Speaker 2 26:01

Yeah, you know, because of the fallout from the PhD thesis, women looking for support. It got me thinking on how best I can help from the results of this thesis. So, because while I was doing literature for my study, I found that a private position using Betty Chan and all of that could help. And I even find in literature chairs used back before Christ and even chairs used in Africa you know Africa for giving birth Back in the 17th century. So that gave me the concept that I could think of something in that line that could take the every. You know that one was only sitting, maybe a wood stool, but I started thinking of getting something that is a flexible and that could adopt many other operating position. So I started getting through in my the kind of seats that could take him for sitting, for squatting, for standing, for kneeling and could adopt with any of these positions. And I pulled this thing in a sketch, went to people that draw to put the concept in drawing for me, which they did, and I took it to engineering to say this is what I want to do. Actually, I took me the free into engineering. Yep, yes, but then to do the engineering drawing and the embodiment and everything, with me sitting over my sitting to say this is I want this, can it go, this, can it? So after that I begin to give description of the embodiment and why they should be that way.

Speaker 2 28:18

And I applied to copyright commission for Nigeria, presented it, it was assessed and it was certified and I was given yeah, it was registered. After that registration, that is not patent. Anybody could steal my concept. So I began to review it again and pass it through to a copyright I mean to patent office through my university. You went back and forth for correction, back and forth till it got approval and they sell it and the patent number and everything was given. Excellent, yes. And I was asked to come and receive the certificate.

Speaker 1 29:03

I have the certificate, yeah, so where is it up to in production and testing?

Speaker 2 29:10

Yes, what I plan to do now is because it has not been commercialised. What I plan to do now is I thought to do that before the COVID I was trying to bring out a prototype and I was looking for where to get a prototype for a few copies sent to betting centers for trial to see if they need more adjustment or whatever. So that interaction was with people in China. Then COVID came and we couldn't continue that process and that's why I'm not trying to get support to get the prototype done so that I can do a trial on the chair. Then it goes on to mass production. That's where I am.

Speaker 2 30:00

But my worries now is that it requires a lot of money and the economy in my country is very down. So I'm looking for a sponsor who can help, you know, or even take up the patent and produce, perhaps give me royalty and spread it to where it should be used. But for spreading about the chair, I do it in conferences, I workshop, I do a vision of it. So I have advertised it so much and the market is ready for it, but I am not capable to do the next level. So I'm looking for yes, any company that would be interested to partner with me and bring it to the markets.

Speaker 1 30:50

So we talked about at the beginning. We kind of talked about the changes and the impact that you are going to make and have started making by being the first midwife with a PhD, and how you're now bringing that into the local area because so many people, when they've had to go or wanted to do a PhD, have had to leave their country and go overseas. But now you're bringing that experience back home.

Speaker 1 31:21

Well, even if it's not in Nigeria and its surrounding African countries, it's still a lot easier to go to a local country than it is to go to another continent. What are some of the challenges that you're finding in setting up a PhD program?

Speaker 2 31:41

It would have been a very big challenge for me, just for the support of the World Bank.

Speaker 1 31:50

Yeah.

Speaker 2 31:51

Yeah, that's why I'm leveraging on, that's what is giving me the backing, because World Bank approved of that program and the program is called African Center of Excellence. So that is not only for Nigeria, it has to be for Africa. That's why I have African students in there. So the challenge I will say I have is not much challenge, it's just that it is very tasking, very, very tasking. I had to write the proposal, I had to, you know, draw up the curriculum and I had to drive the process, because you are the first PhD midwife, you have the subjects matter all by yourself, so no support from anywhere. But my professor, mary, was just backing me too. Yes, I'm just lacking. I want to ask some questions. I call her and she helps.

Speaker 2 33:02

So we now look at other faculties that are outside Nigeria. We know some in Canada, some in Australia, like her, and she brought some other colleagues of her. You know UK, us, you know so because the program I have to make it blended, yeah, so that those faculty members can teach from anywhere program. I had to make it blended so that those faculty members can teach from anywhere. So, yeah, so it's blended and I've gotten enough faculty that supported to supervise the research of the students and that's it. Just because when they hear that I am doing this and what I need to help, people are there to help. From all my connections, from everywhere they're helping me to pull the program through. So not much challenge. It's just that the stress of work we are very busy all the time trying to make sure the structure is being followed, calling up the lecturers, the students, the time for them, their internship, their practical it's all being driven by me. It's really sapping a lot of energy from me. Yeah.

Speaker 1 34:22

But hopefully as you grow you'll get more support and that you'll have that other people can take some of that away from you and then you get to focus on other people yeah, I have other people join me, like I'm in the university and I'm in the Department of Nursing.

Speaker 2 34:43

So my colleagues in the departments with my supervision because I am the one that had the vision with my supervision I could divide, you take care of this side, you take care of this side and I will observe what they are doing and we are carrying on. My colleagues in the department are also very, very supportive, yeah, Very, very supportive, and I'm happy with it.

Speaker 1 35:11

We keep talking about the need to bring midwifery out of the shadow of nursing, because it is its own profession and it gets caught so often under nursing that if we keep fighting for it, we will be able to stand on our own.

Empowering Midwifery Specialists

Speaker 2 35:29

Yeah, yes, that is always my interest and focus. That midwifes should stand out and stand alone, yeah, but the local qualities and all of that, because you are just only yourself and you cannot win the crowd. So by the time I produce more midwife specialists so we will be having a stronger voice, absolutely.

Speaker 1 36:01

That's what I'm looking at.

Speaker 2 36:02

Yes, I'm bringing up these midwives, phds, masters, because before now, if only me as a PhD midwife come to say that midwifery should be standing alone, I will not be allowed to even speak. Yeah, but now that I'm gathering specialists in midwifery, we will come together. I have a stronger voice.

Speaker 1 36:27

yeah, yeah I think you're amazing. I think what you've done is needed, obviously, but is going to be immeasurable in what it does in the future and that I just think it's brilliant and anything that brings more kind of research midwives and they don't have to go stay in research, they don't have to stay in education. You can still be a clinical midwife but have a master's and a phd and change practice, and that's, the more we have in that row, the more we're going to actually be listened to and our voice will be heard.

Speaker 2 37:10

Yeah.

Speaker 1 37:12

Thank you so much for your time. Thank you, too, for having me.