RCM global midwifery update from Toronto

I am currently in Toronto, attending the International Confederation of Midwives 31^st Triennial Congress and the preceding council meetings.  It’s a fantastic opportunity to meet midwives from all over the world and to consider the role of the Royal College of Midwives in strengthening midwifery globally.  It’s particularly special to be here with our twinning partners from midwifery associations in Cambodia, Nepal and Uganda.

With Ann and Address, midwives from Malawi

Since April 2017 I have travelled widely around the UK; twice to Cardiff for global health events, to Edinburgh and London for the launch of a new leaflet for nurses and midwives interested in working internationally, to Liverpool to give a keynote lecture for International Day of the Midwife, teaching student midwives at Kings College London, to Oxford for the RCM’s Zepherina Vietch Lecture, to York for another keynote lecture and to Salford – to talk about writing up some of our work as a PhD!

I have also travelled to Uganda to close the MOMENTUM project, which was implemented in partnership with our twinned association The Uganda Private Midwives Association.  This project aimed to develop a model of midwifery mentorship for Uganda.  The final evaluation found that the project had achieved its objectives and also had many unforeseen benefits. I coordinated the closing workshop and remaining data collection and co-hosted the international/Ugandan team conducting the final project evaluation. We also conducted a needs assessment to inform any future projects and facilitated a development opportunity for one of the RCM’s staff members, Jack Andrew (Data Analyst), to visit Uganda and experience and understand our global work.  Whilst in Uganda we also offered peer support to RCM members living and working there long-term.

With Diane, RCM member working in the Kampala Slums

With Fishy, RCM member working in rural Jinja

Presenting certificates of appreciation at the final MOMENTUM workshop

'‘MOMENTUM has been crucial in not only developing the mentorship model, but also getting various stakeholders to talk to each other and work together to address professional issues and challenges’

(Final Project Evaluation)

I have been involved in the RCM’s ongoing review of its global work – since February we have had a task and finish group to develop the RCM’s global strategy.  This work will be presented to the RCM executive later this month.  We have also been developing resources, such as the leaflet mentioned earlier, for our members who have an interest in global work.

So, as for many others, this has been a busy but fruitful few months.  Sadly our global projects officer, Eleanor Shaw, has moved on from the RCM and I want to take this opportunity to thank her for being such a wonderful colleague, for keeping me sane and for helping to shape and develop both the MOMENTUM project and the RCM’s wider global work. We wish you well and will miss you Eleanor!

We have been successful in getting funding from DFID through UNFPA to start a new twinning relationship with the Bangladesh Midwifery Society and so I will be travelling to Dhaka after my time in Canada, to undertake activities to establish the new partnership.

With Halima, President of the Bangladesh Midwives Association, in October 2016

Meanwhile, here in Toronto I will be leading a symposium with our twinning partners on the long-term impact of midwifery association twinning.  We also have a poster presentation about the MOMENTUM project and I will be representing the RCM on our exhibition stand at regular intervals.  It will be a very busy 10 days of networking and meetings, so all prayers and good wishes for stamina are appreciated!  Thanks for your interest in our global work.

The world needs more midwives!

Guest blog from Jack Andrew

Hello All!

This is Jack Andrew here. Joy has kindly given me opportunity to write a guest post for her blog so here I am! A little information about me and why I’m here to begin with before I delve into my experiences with the MOMENTUM project in Uganda.


I am the RCM's data analyst, a job which I fulfil part time as I'm a keen sportsman and still compete in the decathlon both nationally and internationally. I was given the chance to travel to Uganda with the RCM’s MOMENTUM project team through a career development opportunity advertised internally.  Admittedly I am no expert in midwifery, international development or Uganda but I got the travelling bug a few years back and have enjoyed experiencing new places and cultures ever since. I saw this as a golden opportunity to experience part of the world I had never visited from a completely unique perspective, so I applied and it turns out it was possibly the best 300 words I ever wrote!

Jack's first official meeting in Uganda with Joy Kemp (RCM Global Professional Advisor), Catherine Odeke (Centre: Ugandan Commissioner for Nursing and Midwifery, Ministry of Health) and Sarah Najego (Right: UPMA Monitoring and Evaluation Officer)

I left Uganda yesterday after a busy final day capturing some more videos  of key stakeholders, saying my goodbyes to the friends I have made during my visit as well visiting the slum with RCM member Diane Lockhart. I am currently sat in Brussels airport on a three hour layover trying to put fingers on keys about my experiences and what I have learned. Unfortunately I don’t think it has all sunk in yet but I’ll do my best to get what has down for you.

The past week has been a very steep learning curve for me not just in terms of how the MOMENTUM project has run and trying to understand the impact it is having but also in maternity services in general (let alone maternity services in Uganda!). Joy and Eleanor have been tremendous in helping me get up to speed with the project, explaining maternity services, giving me a heads up on local customs and introducing me to the key stakeholders so after just a week I felt I had good overview of the project and its intended impact.

Jack meeting the RCM's partners, The Uganda Private Midwives Association, for the first time and understanding the process of developing the Inception Document for the Final Project Evaluation.  The evaluation is being undertaken by an external team with both Ugandan and UK consultants

It’s been a very busy week with some long (lunch-less) days which admittedly was a struggle at first as I'm so used to regular consuming  vast amounts of food at home due to my decathlon training. I’ve had exposure to all levels of the Ugandan maternity services, from meeting with Commissioner for Nursing and Midwifery at the Ministry of Health to visiting families in the slum. Meeting key stakeholders at MOMENTUM project pilot sites in the government health centres and UPMA clinics was a fascinating experience even for someone with limited knowledge of maternity services.

The MOMENTUM project is coming to a close at the end of this month and although I haven’t been involved all the way through I was lucky enough to interview almost all of the key stakeholders and hear their views on the impact the project is having. Different stakeholders had encountered different challenges during the course of the project, but were all united in the fact that they all had such positive things to say about the impact of the project, the changes it is starting to bring and the working relationship they have developed with the RCM.

Jack and Joy visit Robinah's maternity home.  Robinah and two of her staff have been trained as mentors during the MOMENTUM project and have now mentored 4 student midwives for their domiciliary placement

Jack doing video interviews with Robina and Rose, two midwives in government service at the Wakiso Level IV Health Centre.  Robina was twinned with UK consultant midwife Kade Mondeh during the MOMENTUM project and they communicate regularly via Whatsapp.  Robina and Rose have both been trained as mentors, along with 3 other midwives and have now mentored many studentmidwives.  The clinic has also been upgraded with solar lighting and basic midwifery equipment to enable the clinic to work safely 24/7 and the students to practice all the necessary skills to become competent midwives.  Quality of care has also improved; many more women are coming to birth their babies at the Health Centre and far fewer women and babies are being transferred out for sepsis or asphyxia

For me the highlight of the trip has to have been the people. The people of Uganda are so friendly and seemed happy to stop and talk at any time of day. Although this did prove to be a bit of an issue during the walking tour we took around Kampala at the weekend as I was often left 20 paces behind the group after becoming engrossed in a conversation with a local about English football, I wouldn’t have changed it for the world. I also had the chance to meet two RCM members, Diane Lockhart and Rachel Haddock (Fishy),both incredible people, both based in Uganda and both doing some amazing work out here.

Jack saying goodbye to new friends: Lamula (left, UPMA's secretary) and Bonny (right, UPMA's driver)

RCM Member Diane Lockhart from Northern Ireland, living in Uganda long-term and working in a Kampala Slum.  MOMENTUM donated her a new fetal doppler which was immediately put to good use with a client in her slum clinic.  Jack had the opportunity to visit the slum, meeting families in their homes and sharing a plate of matoke (steamed plantain) with the chief, 'Mr Chairman'.

Joy with RCM member Rachel Haddock (Fishy) who lives in Uganda long-term works in a community health outreach project in Jinja.  RCM staff try to meet up with Fishy on every visit and provide a listening ear.  We also supported her to revalidate with the NMC last year by acting as 'confirmer' for all her documentation.

Jack saying goodbye to midwife Mary, UPMA's president

It’s also been nice to get out and do some training sessions on the Kampala hills, the temperature at 6:30am was very pleasant and perfect for getting an early morning session in, that said I did have to run in a monsoon one morning!

Anyway thanks for reading, I feel like the above has only scratched the surface on my time in Uganda but I hope it’s been informative none the less. I am also hoping to put together a short video about the MOMENTUM project and my time away here so stay tuned for that!

Closing out the MOMENTUM project

I'm in Uganda again for 2 weeks to close out the RCM's MOMENTUM project (Developing a Model of Mentorship for Ugandan Midwifery).

Opening meeting with our partners UPMA and the Ugandan project evaluation team

MOMENTUM is a twinning project between the RCM and the Uganda Private Midwives Association.  However, we've also been working closely with the Ugandan Nurses and Midwives Council, the Ministries of Health and Education, various universities and midwifery training schools and seven clinics or health centres.  The project aimed to develop a national standard for midwifery mentorship, to develop a work-based learning module to train midwives as mentors (and test the module by training 40 mentors) and make improvements in 4 clinical pilot sites (8 clinics, a mixture of government, faith-based and private facilities).   Our team of 7 UK midwives have completed their assignments and all our targets have been met.  Our team is here to collect the last of the data, to conduct a closing workshop presenting the model to all the stakeholders, to coordinate the final evaluation, to undertake some qualitative research and to generate ideas for follow-on projects.  

New solar light at Mukono Level IV Health Centre installed by the MOMENTUM project - 20 deliveries a day and previously delivering babies by candlelight when the power was off.  One candle nearly caused a catastrophic fire.  Now students can get experience of conducting deliveries round the clock

 ..

Alex, lead midwife, proudly showing us the solar light switch

Our team is comprised of 3 RCM staff members: Eleanor and I from the global team and Jack Andrew, the RCM's data analyst, here as a career development opportunity and also helping us with data collection and analysis and by making a video about the project.   Eleanor's partner Sean and baby Etta are here with us too so it's lovely having a baby to stop us working too hard in the evenings.  Apart from working for the RCM Jack is a Decathlete with the British Athletics Team so he's used to training a lot and eating lots of healthy food at regular intervals.  The long lunch-less days and lack of fruit and veg are challenging him; today we had to make an emergency stop at a hotel when Jack turned pale and wan!

Always an important visit at the start of our trip, to make sure that our programme continues to align with MOH priorities and to meet important officials who can ensure the sustainability of the project's outputs

Jack and I meeting with Catherine Odeke, the Commissioner for Nursing and Midwifery at the Ministry of Health.  Sarah (UPMA's M&E officer) on the right.

 Tomorrow we are meeting with midwife tutors and visiting one more clinic.  Jack will spend some time in a Kampala Slum with RCM member and midwife Diane Lockhart, working there doing an incredible job.  Also 'Fish'y (Rachel Haddock) another UK midwife and RCM member will join us for the weekend.  It's great to connect with our international members and offer some encouragement whilst we're in-country.

With Rogers, Brenda and Patrick, tutors from the Mukono Diocese School of Nursing and Midwifery

Jack videoing Robina and Rose, two midwives who have been trained as mentors at Wakiso Level IV Health Centre

Sarah Mwanje, Private Midwife and trainer mentor, proudly showing her trainer's handbook

A visit from our Ugandan Twins

23 October 2016

Looking back over the past almost 4 years as Global Professional Advisor for the Royal College of Midwives, there have been several periods of intense activity during which re reassure ourselves that calmer waters are ahead - only those peaceful pools seldom occur.  The past few weeks have been packed with logistically complicated programmes and the days ahead offer little respite.  However, we wouldn't have it any other way.  We know that investing in midwifery is the most cost-effective intervention in public health and working with our partners so that, in the future, every woman and newborn receives accessible, acceptable, affordable and quality midwifery care is an enormous privilege that drives us to respond.

Introducing our twins to a Full English Breakfast on the morning they arrived in the UK

Over the past few days, five of our Ugandan midwife partners have come to the UK on an exchange visit.  Three of them had never travelled outside Africa so we knew they would need careful nurturing to best make use of the experience.  We therefore arranged for them to stay in homes rather than hotels and to make sure that they were always accompanied on visits.  We exposed them to as many British experiences as we could - traditional tea rooms, Lancashire Hotpot, Tube Trains, propeller planes, high speed railways and the the M25, Poundland and Primark, London buses, village greens, churches and castles, country parks, crumble (lots of it!) and of course, our unpredictable Autumn weather.  We reassured them that it was safe to walk through long grass without fear of snakes or lions; we instructed in proper escalator etiquette, equipped them with coats and warm jumpers (donated by kind friends and colleagues) and spent weeks prior to their visit cooking and freezing tasty traditional meals and bakes whilst also trying to provide some more familiar flavours of home.

Walking in a Kentish Country Park.  Why don't we eat the ducks?!

Of course this visit was not just about sharing cultural experiences.  Our programme 'MOMENTUM' is helping to develop a model of midwifery mentorship for Uganda.  We therefore planned as much exposure (as was possible in a short window) to UK midwifery and mentorship as we could for our twins.  Together they visit hospitals, birth centre and universities in Kent, London, Surrey and Northern Ireland.  They met policy makers, professional and regulatory bodies, midwives in many different roles. maternity support workers, student midwives and lecturers - and of course - women and their partners.  They observed PRROMPT training, explored database systems, had presentations by Skype from Scotland and marvelled at student midwifery societies.  Together we did 2 conference presentations and met ministers of state, funding bodies, the President of the International Confederation of Midwives and our own chief executive, Cathy Warwick.

Visiting a midwife-led unit in Belfast with RCM volunteer Elizabeth Bannon OBE

We also took time to reflect formally on these experiences and make individual and collective work plans for how this learning will influence our MOMENTUM programme and midwifery in Uganda. It was a time to deepen individual twinning relationships and we were delighted that almost all of our 7 UK MOMENTUM midwife consultants were able to give time out of their busy lives to meet and host their twins.

Introducing our friends to tube travel!

Two of our Ugandan colleagues work in government health centres, delivering up to 21  babies per days in just one room with a total staff of just 13 midwives and one doctor to cover all aspects of maternity care.  Compare that with my local NHS Trust in Kent - a similar number of deliveries but with its own free standing birth centre containing all home comforts, a referral hospital with 14 delivery rooms and staff of almost 300 midwives plus countless doctors and other professionals. Over and over again we heard our guests say 'you have so much space' and goggle at the wastefulness of resources through away after each use when every swab, glove and instrument would make the world of difference to their constrained services.  Perhaps every midwife from the UK should spend some time in a low-resource country to appreciate the privilege that it is to work in our own settings.

Enjoying an English Country Garden with our host (centre) Helen Cooke

Update from Uganda

Update from Uganda

I am halfway through a 2 week visit to Uganda with the RCM’s MOMENTUM project.  As the RCM’s Global Professional Advisor I am also the programme leader and responsible for ensuring that we reach our objectives and reporting to our donors (UK-Aid through THET).

(right) Kade Mondeh, Consultant Midwife from London, with midwife Brenda who has been trained as a mentor during this project.  She came in to work on her day off to go through the mentorship paperwork.  Thank you Brenda!

Our programme is a pilot project, testing whether mentorship for midwifery students by midwives works as a concept here in Uganda.  There are three separate but connected work-streams: first, helping the Ugandan Nursing and Midwifery Council to develop a national standard for mentorship; secondly, developing a work-based learning CPD module for midwives to train as mentors; thirdly, working in partnership to improve the clinical learning environment in four pilot sites that represent a breadth of maternity care provision (public, private and faith-based).    The project finishes in April so the next few months are pivotal in ensuring that all steps in the model are established and widely communicated and evidence collected of any change that’s happened thus far.  We also want to ensure that these changes are sustained as far as possible and we’re pleased that our long-term partnership with the Ugandan Private Midwives Association makes this more achievable. 

Student midwives from Jinja and Mengo schools of midwifery who have received mentorship during this project.  Robina, the lead midwife from this Level IV Health Centre, is twinned with Kade Mondeh, a consultant midwife from London.  Robina has participated in our workshops and has trained as a mentor.  Four other midwives at this site have also been trained by Robina and Kade.  There are up to 3000 births per year at this clinic and 80 antenatal visits per day as well as running the postnatal ward, the family planning clinic and other services.  All this with a total of 5 midwives, between 1-3 per shift.  And still we complain in the UK!

Thankfully I don’t have to do this alone!  Six experienced UK midwives, all RCM members with different and complementary skills, are twinned Ugandan counterparts and responsible for different areas of the programme (see here for an earlier blog about our fabulous team http://kempskronicles.blogspot.ug/2016/01/building-momentum-in-uganda.html ).  Additionally, back in the UK, our Global Projects Officer and the wider RCM team provide essential support and guidance.  This time I’m here with our UK ‘twins’ and we’ve been out in the field this week, visiting all the pilot sites and reconnecting with our Ugandan twins and wider stakeholders.  I’ve travelled many miles and the roads are dry and dusty – there’s been little rain here for 6 months and it’s unusually hot – up to 34c during the day.  Not as hot as Cambodia but still sticky and no aircon or other creature comforts!  Thankfully our guesthouse has a good water supply and the dust can be washed away at the end of the day. 

Some of our UK team enjoying meeting again in at our Guesthouse and catching up on news, sharing photos

Our Ugandan 'twins' visited the UK in October and December (one of them even met HRH Princess Anne with me!) and this has been a great time of reunion, sharing stories and memories.  Yesterday our twins hosted a lunch for us in Mukono with traditional Ugandan food, dancing and an enormous cake!

Evelyne and I at the EMA midwifery education conference in London in December 2016 on the day we met Princess Anne

The amazing cake that our Ugandan colleagues had made for the party

Dancing at the party

This week I’ve had meetings at the Ministry of Health and the Ugandan Nurses and Midwives Council, visited hospitals, health centres and clinics within 100 mile radius of Kampala, met with tutors and students at midwifery training schools and universities and spent much time reflecting, discussion and planning with our team.  Next week we hold a workshop where we bring all the project participants together to reflect, learn and plan together.  This time we are co-teaching with our Ugandan colleagues to ensure that they can cascade the mentorship programme in their own sites.  We’re trying to model ‘learning on your feet’ in the workshop with minimal presentations and lots of participation and movement;  a counter-cultural approach to learning!

Midwife tutor Evelyne with her twin Aine Alam at Kiwoko School of Midwifery

The workshop also gives us a chance to reach out to RCM members who are in Uganda for the longer term; they have helped us to shape our programmes in Uganda and the support we offer to our volunteers.  We’re proud of them and the work that they do.  We look forward to welcoming Professor Grace Edwards, Diane Lockheart and Rachel Haddock (Fishy) tomorrow and hope that they find the stories of success and challenge, the learning and reflection and the future planning helpful and inspiring. One of our volunteers is also using her long weekend off to fly north to Arua, an underserved and remote town on the border with DRC, to visit and offer support to another RCM member (Kate Quarrell) who is teaching midwifery there.  Sisterhood rocks!

Visiting midwives and students in their clinics, hospitals and health centres

I’m grateful to everyone who supports this project and me personally.  Thanks for reading.

Chestnut and veggie stew with herby dumplings

In the depths of winter there's nothing quite like homemade stew, preferably with dumplings.  Before my daughter became a vegetarian (nearly a year ago) I relied heavily on my slow cooker for hearty, warming dinners on a weekday, normally with beef or chicken as the star of the show.  Until now I hadn't made a such a stew with veg, fearing a loss of flavour, relying more on Asian or Middle-Eastern spices to add flavour.

But yesterday I watched Nigel Slater make a delicious-looking vegetable stew so adapted his idea to make one of my own today for Sunday dinner, with very pleasing results.  Here's the recipe if you want to try it - or add your own twist.

2 tbsp olive oil
2 large onions, peeled and cut into wedges
1 bag of frozen casserole veg (I know, the lazy option).  By all means chop your own selection of carrot, celery, swede, parsnip, or any other root veg.
3 medium sized potatoes, peeled and chopped in large chunks
1 pack cooked chestnuts (you could also use chick peas but chestnuts are seasonal right now!)
1 spring fresh rosemary
1 tsp dried thyme (use fresh if you have it)
6 chopped sage leaves
4 juniper berries
small handful of porcini mushrooms
1 veg stock cube
1 tbsp plain flour
2 bay leaves

Soak the porcini mushrooms in around 200 mls boiling water.  Meanwhile, heat the oil to a heavy lidded casserole dish, add the chopped onions and sweat until lightly golden.

 Add the rosemary, thyme, sage, bay leaves and juniper berries and stir around for a minute or so.  Add the bag of frozen veg (or your chopped celery and root veg) and continue to saute for around 10 mins until the veg is looking glossy.  If it catches on the bottom, don't worry - that all adds to the flavour.

Sprinkle on the flour and stir well, then drain the porcini mushrooms and add the liquor to the pan, reserving the mushrooms to add later.  Add the potatoes, the crumbled stock cube and some salt and pepper. Chop the reserved mushrooms finely and add them to the pan. Add enough water to barely cover the vegetables.

Bring the mixture to the boil then simmer on the hob for around 1 hour or cook in the oven at 180c.

20 mins before the end of the cooking time, make the dumplings.

In a mixing bowl measure out:

100g self-raising flour
50g vegetable suet
1 tsp dried mixed herbs
1 tsp dry mustard powder
Small handful grated strong cheddar (optional)

Check the fluid levels in the stew.  If drying out, add more water so there is plenty of gravy.

Add approx 5 tbsp cold water to bring the dough together and drop heaped teaspoons of the dough into the stew.  Bury them slightly so they pick up all the flavour and leave gaps between them as they will spread.  Cook for a further 20-25 mins until the dumplings are cooked through.

Serve the stew with lashings of Dijon mustard and some steamed and buttered greens.

Correspondence from Cambodia

I'm currently on a 2 week visit to Cambodia, following up on the twinning project between the Royal College of Midwives and the Cambodian Midwives Association (CMA) that ran between 2012-2015. During that time around 25 UK midwives visited Cambodia for short-term placements with the CMA or its partners (NGOs and various clinical and academic sites).  We also had six workshops, addressing various needs identified by the CMA and six visits from RCM staff (me and others).  We hosted 2 reciprocal visits to the UK and all attended the triennial International Midwives Congress in Prague in 2014 together with other twinned associations from Ugandan and Nepal.  This project was funded by UK-Aid through the Tropical Health and Education Trust (THET).

What difference, if any, did these activities make to midwifery in Cambodia? That's what I'm here to find out and also to identify any further possibilities for the RCM to continue our partnership with CMA in the future.

I'm fortunately to have lived in Cambodia in the 1990s and to have worked in Cambodian Refugee Camps in Thailand in the 1980s so the culture and language are familiar to me although, on my return after 15 years in 2013, my Khmer was a bit rusty and Phnom Penh (the capital city) had changed beyond recognition.  Costa Coffee, KFC and wifi - a whole new world!

With Margaret and Barb, both UK midwives with whom I worked in Cambodian Refugee Camps in the 1980s and who are still living here in Cambodia, supporting Khmer people.  So precious to reconnect

On this trip I'm re-visiting the places we've had programme activities in the past 4 years: Phnom Penh, Prey Veng and Kampot.  These were places the CMA wanted grow their branches but co-incidentally I used to live in Prey Veng from 1994-1996 so it's been great to reconnect with friends (western and Khmer) and see old haunts.

I've been here for 5 days and so far I've met the CMA in Phnom Penh, attended the annual conference of the Cambodian Obstetric and Gynaecologists Society (who want to develop their association in a similar way as they've been so impressed with the midwives!) and conducted a three-day field visit to Prey Veng to interview the local branch of the CMA and visit the provincial hospital and MCH clinic. This week I'll be visiting various stakeholders in Phnom Penh and making a day-trip to Kampot before holding a workshop with the CMA's executive members at the weekend.

Reunited with Lida (left) and Chea Ath (right): Vice president and President of the CMA - and bringing a bit of Uganda to Cambodia!

I hope to blog more as the trip progresses but perhaps I'll just share some quotes from the interviews I've conducted so far.  Let's hear it from the midwives themselves:

'Everyone now knows about the CMA and others want to learn from us.  Since the RCM's twinning project we've more than doubled our membership and we're going to increase our membership fees so that we have more resources to provide services to our members.  We now have Facebook groups for our executive committee and our branch leaders and we have a new branch in Mondulkiri (an underserved region). We feel proud of our activities and when we do them we want to share them on Facebook so that the RCM will feel proud of us too'

(Mrs. Chea Ath, CMA President).

'Here in Prey Veng we've seen a lot of change since the RCM workshop in 2013. Previously not all local midwives clearly understood about the role of the CMA.  Now our branch membership has increased from around 150 members in 2013 to 286 today. In 2013-2014 there were 14 maternal deaths in our province.  This has been rapidly decreasing and, to date, there have been no maternal deaths this year. Now we have multidisciplinary training every three months and midwives know how to use Magnesium Sulphate for pre-eclampsia and compression garments for post-partum haemorrhage. These save lives.  These changes are due to the efforts of many different organisations and programmes, but the RCM's twinning programme with the CMA has raised the profile of midwives in the province and has given them more encouragement to change themselves' .

 (Mrs. Samrith Sotheavy, Branch Leader of Prey Veng CMA Local Branch). 

With the lead midwife at Prey Veng Provincial Hospital and Barb Soung, who helped to establish the CMA in the 1990s and has been supporting midwifery in Cambodia in various ways for the past 20 years

'I am a midwife.  I need to be a member of the midwives association.  It's important to discuss things together.  It's our role. We feel we can ask our branch leader for support if we have problems.  After the RCM workshop I encouraged my colleagues to join the CMA.  Now all of our midwives in this clinic are  members of the CMA. The CMA provides insurance if our members get seriously ill or die. This is very important for us. In the future I hope the local branch will organise more learning and provide opportunities for the midwives to share their experiences and problems together'.

(Mrs. Cho Pahnita, Assistant Lead Midwife at Prey Veng Provincial MCH Clinic)