Dear BCA community. My local (Adelaide) BCA students will know me as the Biostatistics Postgraduate Program Coordinator at The University of Adelaide but others may have encountered me as a past coordinator of DES. I have a special interest in perinatal randomised controlled trials and am a current investigator on a NH&MRC project grant on technologies for the monitoring of fetal heart rate during high-risk labours, with the intention of reducing the number of unnecessary emergency caesareans. This work has involved productive collaboration with clinicians and midwives at the Women’s and Children’s hospital in Adelaide who introduced me to the amazing 2h Project, a grass-roots Australian-based development and advocacy organisation.
In Nov/Dec in 2017, my medical colleagues volunteered their time and expertise to support the ‘safe arrivals’ pilot project which aims to reduce the appalling maternal and neonatal mortality and morbidity in Cambodia through a sustainable model of care.
The last 15 years of their work has focused on the training of traditional birth attendants and midwives, but a lack of engagement with the local hospital in made it difficult for them to understand how high-risk women were being managed by the local referral hospital.
I was invited to join the first trip of medical doctors which included leading obstetricians, gynaecologists, a specialist anaesthetist and junior doctor. I became fully immersed in all aspects of the 2h project, visiting local health care centres in villages, experiencing many functions of the maternity ward at the referral hospital, understanding how and what data they were routinely collecting and helping to identify differences in knowledge/practice – but even more importantly, identifying feasible priorities to target in the local context, discussing strategies on how best to do this and helping to create relevant seminars on the basis of our daily experience to deliver to hospital staff – mostly prepared the night before!
I came to Cambodia with a lot of ideas that quickly became irrelevant but I ended up learning so much more about the power of working closely on every aspect of a project with a team of compassionate and infinitely knowledgeable and adaptable professionals who continue to inspire me, the importance of a deep understanding the local context (including its history), creating respectful, reciprocal relationships of trust with Cambodian colleagues and understanding that tough decisions not to intervene on current practice that differs from ours are going to be more beneficial in the longer term when coupled with education on why we believe our practices are important.
As a statistician in a third world context, I understood that one of the most beneficial and important contributions I could make was to raise awareness of the power of their locally routinely collected data - where typically there is no time, money or expertise to consider anything beyond day to day operations. I found examples in third world countries where powerful simple studies led to targeted funding of important initiatives, and considered how this might work for a compression garment they had introduced us to that had already saved lives of women with post-partum haemorrhages in Cambodia.
My longer-term goals are to continue to learn all I can about maternity care, locally and in Cambodia with the help of my inspiring medical colleagues, to support the referral hospital in Cambodia to take simple steps to understand whether seminal papers on evidence-based practice (predominantly in first world countries) are relevant in their context and to document aspects of their practice that could benefit from an evidence base to support targeted funding from Cambodian health authorities.
Finally, I been overwhelmed by the support of my biostatistics students and colleagues who had never imagined that their skills could be useful in a context such as this. I too failed to see this not so very long ago but now my eyes are open to the possibilities and I am determined to spread the word that this can be a reality for those who wish to take this path.