Caring for refugee women in Europe – a new way to think about a crisis

By Gabrielle Bourke on 25 March 2019 Midwives

Have you ever thought about the origins of the word ‘crisis’ in our English language?  We use it to describe something terrible, an intractable calamity of some kind.


But in Greek – the source of our English word – it means something different, and this point was made to be by Greek academics working on a new way to care for refugee mothers across Europe, at the Oramma conference in Brussels on 28 February.


We all remember the photographs and the headlines, as more than a million refugees from the Middle East and North Africa made the perilous journey across the Mediterranean in 2015, creating a ‘migrant crisis’, as we termed it. Every day we were confronted in the media with the desperation of people fleeing Syria, Eritrea, Iraq and other war torn countries. You may have felt very powerless looking at those images, especially of children.


But the word crisis in Greek isn't what we conceive it to be in English. It means an event that requires thought, introspection, a creative response. Instead of the stasis that ‘crisis’ can lead us to, the Greek people see a call to action. And that’s the origin of the pan-European Oramma project.


The Oramma project is funded by the European Union Health Programme and in short, is about finding a way to provide better maternity care for refugee women. It had three sites: Greece, the UK and the Netherlands and this was key to finding out what works when refugees make their journeys across the European continent into different health systems with different cultural attitudes towards pregnancy, birth and motherhood (and migrants). For the EU, the project was an example of midwives’ leadership across Europe to uphold human rights and pan-European values.


The conference in Brussels brought together the researchers, and research partners to show what the team has developed and the implications for European health systems who want to ensure all mothers and babies have a safe journey to motherhood . It was chaired by the RCM’s own Mervi Jokinen, who is the President of the European Midwives Association.


The Oramma researchers based in the UK, the Netherlands and in Greece looked at the evidence base for the best interventions for improving care for pregnant refugees. They then developed a new approach to care and ran pilots in the three countries, from the refugee camps of Greece, to Dutch community clinics, to the big teaching hospitals of our NHS.


The new approach sees refugee mothers not as a problem, but as potential, just like any other mothers. It harnesses the power of multidisciplinary teams to wrap around the women, to care for her clinical but also very real, social needs. And this care is in the community, using peer supporters as advocate and friends to the women, helping them navigate their new homes, in sometimes unfriendly, confusing countries.


At the conference, we heard from peer supporter Marfat Saeed, who had volunteered in the pilot in the UK. She spoke of her pride in being able to help women, who, just like she had done herself ten years earlier, moved to the UK with no support. “I was so happy to help... I remember what it is was like for me when I arrived in the UK... I knew I could help her and build her confidence. And I built my confidence too.”


Midwives reported their satisfaction in being able to care for women knowing that social workers, doctors and others were working in collaboration with her, as a team. And most importantly, the women themselves reported huge satisfaction with their care. The peer supporters were there for them, a listening ear, a trusted friend. Healthcare systems were easier to navigate, and they felt those caring for them could address all their needs, not just the ones that were organisationally convenient.


The Oramma project has created a training package for midwives and other professionals to learn the Oramma approach.  It instils in clinicians the need to see these women not just as a homogenous group, but as individuals with competing priorities in their lives. The pilots show us that women’s basic needs like shelter, nutrition and personal safety must be obtained before women are able to engage with health services.  Prof Hora Soltani, from Sheffield Hallam University, outlined the huge impact of stress on pregnant migrant woman. “Unless the social conditions women are living in are addressed, we won’t improve their overall maternity outcomes or experience.”


For the UK, the lessons are huge. Refugee women will benefit from community peer supporters, who can help them settle-in to life here and engage with the NHS. Creating barriers to access – like charges for care – only increases health inequality and creates poorer clinical outcomes for mothers and babies. We maximise the contribution of midwives by creating a team of professionals who can care for the woman holistically. We see some of this thinking is in the NHS already, with specialist teams caring for vulnerable migrant women across the UK.


There are familiar challenges to the Oramma concept of care. Burnout, capacity and the decimation of other wrap-around services – like housing or mental health – can make the model harder to implement. And peer supporters need support too – and the conference had a good discussion on the role of volunteers in healthcare, and finding a balance between community advocates and paid clinicians each with their own strengths and weaknesses. We also heard the familiar refrain about training across disciplines. We expect different disciplines to collaborate in the field… but where in their training are they taught to do that? The Oramma training is deliberately multi-professional for this reason.


It was inspiring to see Prof Soltani stand alongside Prof Victoria Vivilaki from West Attica University and Prof Maria van den Muijsenbergh from Radboud University demonstrating what a collaboration looks like when we take a Greek approach to a European crisis: a new way of thinking, together.