Influencing midwifery education - internationally

International consultancy in developing countries is not uncommon especially within in the field of health care and professional practice. Large universities, Non-government organisations and global agencies are all commonly found within this environment (Stubbs 2003) whereas small teams of practitioners and academics have less experience in this arena. This paper focuses on a personal journey to influence the strengthening of midwifery in India. The literature available is often on two levels, that of the broad overview or the very personal account (Stubbs 2003, Woods 2004), which do not give much instruction for primary interactivities. International working requires new ways of thinking as many of us are not used to working with political figures in political systems which are complex, unfamiliar and often frustrating. Consideration of many interconnecting factors is required for a successful outcome. Attention to four key areas of a complex jigsaw is required before embarking on this new territory of working practice. 1. Personal - critical evaluation2. Political system which includes a country analysis3. Professional4. PeoplePersonal - critical evaluation: The need to understand the new role and how personal attributes may increase or decrease the effectiveness of the relationships (MacClean 2000). MacClean outlines the need for self awareness as our belief and value system will be very different to those we are asked to work with. Personal motivation needs exploring in depth as this could cause a barrier in that we have an agenda which is not compatible with working internationally. Clearly working in partnership requires skills which we may not have or we have not considered. We could, by not valuing or respecting those we are working with, cause the project to fail. Personal experience has shown that the need for flexibility is paramount, as the need to adapt to systems which we find oppressive or legalistic. Transcultural awareness enables working on the positive aspects (Papadopoulos 2006) and lays the foundation for the more difficult issues. Professional understanding and ways of working may also pose different issues which need to be addressed from within rather than imposing a solution from outside the system and because they are not the same does not make them wrong. Political system: Understanding the politics of the country helps to identify any possible barriers to success. This includes researching the country’s population, geography, financial system and the area from which the identified problem is embedded. Gaining as much insight into these will save time in the long term but remember you will only get what has been presented in the media and there will be issues which are not apparent through this type of preparation. Talking to others, who have worked in the country, will help, but caution should be used when forming assumptions and preconceived ideas, as later experience could prove these wrong. Knowing yourself is therefore very important as you can identify the potential of this happening prior to any misunderstanding and addressing the issues before any barriers occur.Professional: Look at all factors which influence the solution to the problem but always consider what is expressed by users of the system, those giving care and the policy makers. This list may appear to be in reverse but policy makers are political people looking for possible short term gain whilst users require long term sustainability. Any solution should be sustainable, which requires time and commitment, as many countries have tried to change the ways they are providing care but are left without support too quickly to see the changes through and they fail. Importing western ideas to other countries is not always the best solution, as the systems are often incompatible and other problems arise, which were not there previously. People: We are working on a personal level with politicians, partners and client groups. Our understanding of all these areas will enable us to understand and therefore problem solve the situation ( Foss 2004). Women do not access antenatal care as in this country and for the same reasons. They need to know what they are going to get out of it but there is evidence to show that women who access other types of health care are more likely to access maternity care (Pallikadavath et al 2004). The status of women is a major consideration as it pervades all aspects of our interactions as well as access to maternity care which is often dictated by a senior member of the famil