Take one passionate, determined Australasian Vocational Training Team, add backing from District 9980, throw in a Rotary Foundation global grant, and what do you get?
Mindboggling” progress in Mongolia’s maternal health system – and hundreds of mothers’ and babies’ lives already being saved each year, thanks to a very special delivery: childbirth education.
Above picture: From left, the Mongolian Vocational Training Team in traditional dress: Jo Palmer, Sam Turner, Gary Dennison, Julie Dockrill and Bev Te Huia.
(Left picture): Vocational Training Team member Julie Dockrill, of the Rotary Club of Timaru.
The ground-breaking programme, however, almost didn’t come to pass – Rotary’s involvement in Mongolia was originally intended to centre on a water well project.

Mongolian Maternal Health Project VTT leader Gary Dennison, of the Rotary Club of Waimate, says the initial link to Mongolia was through a friend’s son, a geologist, who was working in the country’s mining industry, and the possibility for an improved fresh water supply for some needy community.

However, after initial scoping, it wasn’t long before he contacted Gary saying such was Mongolia’s challenging geology, finding potable water might prove an expensive – if not impossible – order.

Having lived and worked previously in Mongolia, and recognising the country – which has a population about the same as New Zealand’s but is, geographically, 10 times the size – had high needs in other areas, too, both men set about thinking of an alternative project for Rotary to spearhead.

The geologist’s wife had recently given birth in the United Kingdom, and had a chance meeting in a park with an Australian, who worked in a Mongolian maternity hospital. From that serendipitous encounter, a plan was hatched: to deliver much-needed childbirth education to Mongolian health workers in a bid to stem the country’s tragic infant and maternal mortality rates.

“Going back to Rotary’s key areas of focus, maternal health and infant education seemed to fit best with the needs of Mongolia,” Gary says.
While he couldn’t join the team due to overseas work commitments, Gary oversaw planning of the project’s first phase, which saw a team leader and five Kiwi and Australian midwives – including the Rotary Club of Timaru’s Julie Dockrill – travel to Mongolia in 2013, just four months after the idea was settled upon.

Once there, the team delivered training at three centres throughout the country, and also developed a childbirth education manual, which had been drafted by the Kiwi and Australian midwives, and translated into Mongolian.

“Mongolia had just signed up to the World Health Organisation and UNICEF’s childbirth education agreement, but the Government had no idea what to do about it,” Gary says.

“So our timing in 2013 was absolutely perfect.”

As well as delivering training, the team had another objective on that first visit: to identify the best candidate to travel to New Zealand to experience first-hand the practising of pre and post-natal healthcare in a first world setting.

Mongolian midwife and healthcare manager at Maternity Hospital No. 1 in Ulaanbaatar Amarjargal Luvsandagva was that person, and spent a month in North Otago and South Canterbury last year experiencing the New Zealand maternal health system, both in hospitals and the wider community, as part of phase two of the project.

Gary says, as envisaged, the impact has been far greater than Amarjargal simply learning English and travelling to New Zealand – she’s now regularly attending training seminars and maternal health conferences around the world, including recently at Oxford University, England.

After the 2013 visit, the team knew they had unfinished business in Mongolia, and the decision was made to plan a second trip to deliver further childbirth education and an updated manual, as well as a professional translation, together with a new training module: emergency clinical skills

To put the need into perspective, Gary says, such is the paucity of training in Mongolia, frontline maternal healthcare workers had not previously had any training even in basic resuscitation – education that’s routinely available to the general public in New Zealand.

Phase three VTT became a reality. In late May, Gary, Julie, together with midwives Bev Te Huia, of Hastings, and Sam Turner, president-elect of the Rotary Club of Gisborne (Australia), and Melbourne’s Jo Palmer, travelled to Mongolia to continue their mission to save mothers and babies. With them, they took the revised childbirth manual, the quality of which is such that the Mongolian Ministry of Health has endorsed and adopted it as the nationwide standardised maternal and infant training curriculum.

Over three weeks, with support from Mongolia’s Rotary District 3450, they trained more than 300 maternal healthcare workers.

Delivered in three centres – the capital, Ulaanbaatar, in the country’s centre, Darkhan in the north, and Sainshand down near the Chinese border – training included a three-day childbirth education course and a one-day emergency skills clinic. Along the way, the VTT realised the project was gaining quite a reputation.

“We were a bit blown away by the number of doctors, obstetricians – quite senior doctors – who were at the classes, saying they needed an update,” Gary says.
“And the manual, well that blew them away as well.”

The positive spinoffs from the latest VTT visit were almost immediate. The chief maternity lecturer at Ulaanbaatar University underwent the training in the first week the team arrived in Mongolia. That weekend she was already out sharing her new-found knowledge and skills at a session with 500 students. Instant sustainability, says Gary.

“She was smiling all the way through the course – she said: this is exactly what we need.

“That was a graphic display of how far the project’s impact is spreading, and how quickly. It’s like finger-like tendrils that are going out in all directions, and you can’t even guess as to the total effect it’s having ... it’s the snowball effect in action before your eyes.”

With the help of the project’s influence, the country’s Ministry of Health has made childbirth education compulsory for all Mongolia’s expectant mothers, who must attend a minimum of three classes to qualify for the new Government welfare child support payments programme.

Anecdotally, the feedback the VTT’s received from their Mongolian colleagues, Gary says, has been consistently powerful.
And, it’s not just what’s being taught, but how it’s being conveyed.

“The team delivers very much the interactive, participatory, experiential learning experience. The people in Mongolia weren’t at all used to that – they’re used to being ‘talked at’ in training.

“The front row of glum faces at the start said it all. They actually have an impish sense of humour, so they loved the team’s style. There was a lot of fun and laughter.

“At the end, the comments were all along the lines of: what you have done for our country, our health system, is mindboggling.

“That gave us warm fuzzies – when you leave, you leave knowing you’ve made a difference and left a legacy, and that’s what we join Rotary for.”

Statistically, the data shows, since its inception, the Mongolian Maternal Health Project has made a life-saving difference. Between 2013 and 2015, infant mortality rates dropped 66 percent, while maternal deaths dived more than 70 percent .

In what’s likely to be the “full-stop” to the project, the team is planning a final trip to Mongolia in 2018 to build on the emergency obstetrics and clinical skills training delivered this year, with an emphasis on resuscitation – and saving more lives.

“It’s sure as heck is already making a big difference – the statistics tell the story,” Gary says.