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  • Caroline Homer

    Posted on 25th January 2015 by Global Health Gateway in

    Professor Caroline Homer is a midwife and academic who is currently the Project Director for a midwife education project in Papua New Guinea.

    GHG: What was your first engagement in a global health setting?
    My work has almost always been committed to improving maternal health.

    When I finished my midwifery education I worked in Malawi for a while, which was an amazing experience. I realised very quickly there that I knew nothing and the midwives knew everything. They essentially re-taught me midwifery, I don’t think that I gave much back in that experience, but it taught me a lot, and put me in good stead for the future and taught me about braveness and courage. An experience such as this was very humbling, and I said to the matron when I left ‘I’ve learnt more than I’ve taught anybody here’. I worked in a hospital that had approximately 2,500 births/year with very few midwives, probably about six. Those midwives were highly skilled and worked under incredibly difficult circumstances. I had and still have enormous admiration for the work they did.

    GHG: Tell us about your approach to maternal health needs globally
    I am strongly committed to building capacity in global maternal health. Most of our roles within global health should be around capacity building, helping countries get themselves sorted and taking a step back as they move forward themselves. We must never take over – we must always walk alongside, respectfully and positively.

    There’s so much to do and maternal health is critical to every country around the world. Addressing the MDGs 4, 5 and 6 (maternal health, child health and HIV) are part of this. Sustainability Development Goals are goals proposed as a result of the RIO+20 processes. They core aim to eradicate poverty and are going to be much more generic, rather than a vertical approach to health, of which the MDGs have received some criticism for being. Those countries who have done really well in achieving the MDG 5 are often because they have focused on training midwives and improving midwifery services. All countries also obviously need a functioning health care system and resources around them. Midwives, as part of this type of package can be incredibly cost effective.

    GHG: Tell us about your involvement in Papua New Guinea
    Papua New Guinea is an example of a neighbour whose maternal and child health mortality rates are unacceptably high. Only 53% of live births are attended by a skilled health professional (see these statistics, and more in the Countdown to 2015 ‘Building a Future for Women and Children’ Report). UTS and AusAID is currently working to strengthen midwifery with WHO PNG and the PNG National Department of Health. The Maternal and Child Health Initiative aims to strengthen midwifery by supporting education, regulation and association. These three critical elements are what the International Confederation of Midwives calls the pillars to improving midwifery and then maternal and child health. Education is obviously key (without this, you won’t obviously have skill or capacity), regulation is important for quality and sustainability (accreditation, registration, continuing professional development) and having a strong and vibrant midwifery association will also build capacity (having a strong foundational association for midwives to have a sense of pride, identity, gain support and understand and engage with the bigger picture issues). The wider social determinants of health have implications as well, which, to be addressed. These of course require political will.

    GHG: What are some tips you have for others interested in working in maternal health globally?
    As a midwife, everyone can make a contribution, not necessarily by working somewhere else, but we still have a responsibility to be engaged in global issues. We can do this, whether it be through lobbying our own government in terms of aid or even just staying informed.

    The key to working globally is to always be humble and remember that you’ve got a lot to learn. Always work alongside local counterparts, building capacity and confidence in others. Genuinely working with people is really important and working towards making yourself redundant is a true measure of success.

    Learning about the world is an important part of being a midwife, whether you will ever work internationally or not. I strongly recommend going to the Congresses of the ICM as a great way to learn more. The ICM Congresses are wonderful exchanges of clinical practice, stories, wisdom and progress. It’s a sobering experience in which there you gain great perspective and meet wonderful people. The ICM Congress in June 2014 is in Prague and has the theme ‘Midwives: Improving Women’s Health Globally’. The other important event coming up is the Women Delivery Conference. Women Deliver is an advocacy organisation aiming to improve the health and well-being of girls and women that has it’s 3rd Global Conference in Kuala Lumpar in May, 2013.

    Caroline Homer is the Professor of Midwifery, the Associate Dean (International and Development) in the Faculty of Health and the Director of the Centre for Midwifery, Child and Family Health at UTS. She is also the Associate Head of the World Health Collaborating Centre for Nursing, Midwifery and Health Development at UTS.  Interview compiled by Sophie McEniry thanks to the conversation with Caroline Homer at UTS, Sydney.