On average, women in Australia and New Zealand have high levels of health throughout their life. However, the same cannot be said for our Pacific neighbours. According to the World Health Organization (WHO) at least half of the world’s people are currently unable to obtain essential health services.

RANZCOG’s vision in global health is to contribute to regional efforts to empower the reproductive health workforce to meet the challenges of providing quality care in low-resource and isolated settings through collaboration, partnerships and advocacy. RANZCOG’s commitment includes:

• Educational support
• Provision of resources
• Networking support
• Facilitation of training
• Research
• Continuing professional development (for O&Gs, midwives and other reproductive health workers)

In this series, we will be highlighting the crucial and inspiring work some of our Fellows have undertaken as part of our Global Health Initiative.

John, you worked as Senior Registrar at Groote Schuur Hospital in Cape Town during the 70s. What inspired you to make this move?

It was quite serendipitous as I was working at the Queen Elizabeth Hospital in Adelaide back then; having finished my specialist exams and pondering what to do next. I came across a doctor wandering around the hospital who I took to be a visiting GP and so I took him for a coffee and showed him around. Most of my colleagues in those days were going to the UK for a year or so to gain extra experience in obstetrics and gynaecology but this guy asked if I had ever thought of going to South Africa. I found what he had to say very interesting. ‘Who would I have to ask to secure a position?’ I asked. ‘Me — I’m the Professor and Head of the Department of Obstetrics and Gynaecology’!

Can you tell us a bit more about your experience in South Africa?

Nelson Mandela was still imprisoned in Robben Island at the time and soon after we arrived the African National Congress took to the streets all over South Africa protesting against apartheid. My wife Esther and I were there with our three children under the age of five and we soon became very socially aware. However, the experience at work for me was incredibly exciting, onerous and challenging. Every day provided me with a new lesson. I worked at the Groote Schuur Hospital, which delivered 10,000 births per year; as well as the smaller hospitals for coloured patients; the Midwife Obstetric Units and the Flying Squad; and caring for patients in the shanty towns surrounding Cape Town.

After this, did you think your career would be heavily involved with Global Health initiatives?

I guess I always had a notion that I would respond to the challenge after this life-changing experience. In 1990, I was the Dr Ida Scudder Visiting Professor at the Christian Medical College and Hospital in Vellore, South India. This opened my eyes once again to the incredible challenges my medical colleagues there faced in working with limited resources to deal with life-threatening conditions. This feeling has never left me, and I was excited to return this year to Kerala, South West India, to experience the improvements in maternal and neonatal outcomes they have brought about by giving women equal opportunity to education with a 100% literacy rate in their state.

Between 1995 and 1997 I did short sabbaticals in Rodos, Greece; Istanbul, Turkey; and Penang, Malaysia. I began to appreciate the importance of understanding different cultures and how to go about invoking change with the basic tenet being that gaining people’s trust is fundamental in being able to share experiences. This involves a long-term commitment and once mutual respect and trust is established, the necessary strategies invoking change will fall into place.

I have happily and unwittingly committed 20 years of my life trying to improve the maternal mortality rate (MMR) in Bali, with the first 10 years being a solo effort just to gain trust and the last 10 years being supported by my wonderful multidisciplinary colleagues (junior and senior obstetricians and trainees, midwives, neonatologists and anaesthetists) at the Women’s and Children’s in Adelaide.

Tell us more about your experience in Bali.

I went to Bali on vacation with my family in 1998 at the recommendation of our two daughters who had gone there the year before. I got bored of sitting around the luxury hotel after a few days, so I went to the Sanglah Hospital, the main teaching hospital in Bali, and ‘knocked on the door’. I asked to see the Head of the O&G Department out of sheer curiosity. I was lucky to meet Professor Surya and his associate Professor Kornia who were very welcoming and very committed to improving conditions for their mothers and babies — a very fortuitous meeting for the three of us. I soon learned that the MMR in Bali at that time was 150 maternal deaths per 100,000 births (the rest of Indonesia was 320 per 100,000) – a stark contrast to Australia where in the same year the MMR was 8 per 100,000. They were surprised and pleased when I chose to return the following year as we devised plans to improve the situation. At one point I was going back twice a year to teach and operate.

With time, trust developed. I met up with the Minister of Health, the Australian Consul, the CEO of the Hospital, the President of the Indonesian College of O&G and other stakeholders and we were able to secure AusAID funding to enable maternal-fetal medicine trainees to rotate through Adelaide as part of their training along with incorporating English into their exam process. Our WCH/University of Adelaide initiative of Combined Clinical Meetings was held annually in Bali, where we were able to address, among many other initiatives, the MMR, which fell to 47 per 100,000 births in 2015. Bali was the only Indonesian province to achieve the WHO Millennium Goals. It’s hard not to transcend when you are part of an exceptional collaboration of local and overseas colleagues.

I should take a moment here to recognise that my efforts in Bali has been part of a family commitment: 12 years or so ago my two daughters, Anna Dimond and Eran Svigos, along with some enthusiastic helpers, assisted Brenton Whittaker OAM set up Bali Kids. This orphanage provides acute care for 32 residential children up to Year 12. There is a holistic philosophy that aims for these children to remain within their families after their acute medical/social situation has improved. An in-house medical clinic (named after our daughter Eran who passed away in 2007) along with the dental clinic have a local full-time doctor, dentist and nurse running a two mobile units with 600 patient contacts per month as well as providing education and practical assistance with public health measures to the surrounding villages.

The orphanage has taken up the challenge of looking after HIV-positive women and their children and works hand in hand with a Midwife Obstetric Unit — Bumi Sehat, which is a dedicated unit for very indigent women run by a US Trained Midwife and the CNN 2011 Hero of the Year, Robin Lim.

What was the biggest challenge that you faced in Bali?

Communication. It takes time to resolve communication and cultural differences when English is a second language. Not being embarrassed to try to learn the local language is a major step in gaining respect. It speaks well of you that you take the time to do so. Many of my colleagues from Adelaide have now been accustomed to beginning and ending their presentations in Bahasa, and similarly, our Balinese colleagues work very hard to speak in English, which is equally appreciated.

Another problem that I faced was cultural differences. Indonesians have a very hierarchal educational structure, so interactive teaching by a senior specialist did not work, as their trainees were concerned about the loss of face if they got things wrong. We overcame this by getting our trainees to come along and do the hands-on teaching, which proved to be a master stroke with clear advantages for both groups in terms of learning and team building. This formula has proven so successful that we have introduced it to Malang, in East Java and Professor Gus Dekker from Adelaide convenes a similar program in Surabaya, in East Java.

What advice would you give colleagues wishing to take part in global health initiatives in the future?

Be prepared for a long-term commitment if you wish to make a lasting contribution. By all means take advantage of short term commitments to give you a feel for the challenges involved. They can be exciting and serve as a stimulus for you to look at more long term solutions. But set yourself a long-term commitment in your head so that you can make a significant change, otherwise you’re just putting a Band-Aid on.

Thank you, John.

Working with others, RANZCOG members can offer education, clinical skills, research mentorship, and financial support to improve women’s and family health across the globe. Interested in getting involved? Review our current pathways here.