The concept of a Pacific Society emerged in 1993 in Suva, Fiji by a group of reproductive health professionals who met at an educational meeting organized by the Fiji School of Medicine and the Royal Australian and New Zealand College of Obstetricians and Gynecological (RANZCOG).  Their vision was to establish a Society that fosters continuing medical education and ongoing support for reproductive, maternal and newborn health among Pacific health professionals. The Society would support various forms of capacity building, partnerships, conferences, meetings and networking.  The name South Pacific Regional Obstetrics and Gynaecology Society (SPROGS) was given at that time. RANZCOG through the commitment of Professor Brian Spurret supported the initiative and made it possible for the Secretariat to be located at the College House in Melbourne during its early development.
1995 – The first inaugural meeting of the Society was held in Port Vila, Vanuatu. A structured executive committee was established to run the affairs of the Society. Dr Wame Baravilala (Fiji) was elected the first President. He was the Dean of the Fiji School of Medicine and Head of Obstetrics and Gynaecology.
1997 – At the biennial meeting in Apia, Samoa the name changed to Pacific Society for Reproductive Health (PSRH), a change put forward by country members to reflect the inclusiveness of country membership.  The term “Reproductive Health” in the Society name also broadens the core business of the Society so that other health professionals become members including midwives, nurses, non-O&G doctors, researchers and academics.
Thereafter, PSRH conferences have been held every two years, preceded by a series of technical skills building workshops on specific topics to respond to the needs of both doctors and midwives. Locations of biennial conferences are listed below:
1999 – Suva, Fiji. The Secretariat was moved to Fiji School of Medicine.
2001 – Madang, Papua New Guinea
2003 – Nadi, Fiji. The Secretariat moved to the Secretariat of the Pacific Community, SPC
2005 – Nadi, Fiji
In April 2006 the Secretariat moved to the Pacific Women’s Health Research & Development Unit which was set up by Dr Alec Ekeroma. The Unit was under the auspices of the University of Auckland and the Counties Manukau District Health Board, New Zealand. The PSRH became registered for the first time as a Charitable Trust with the NZ Charities commission in August 2008 when Salausa Dr John Ah Ching was President and Dr Ekeroma was instrumental in realising that move. The Secretariat was moved to Aiono Dr Alec Ekeroma’s private practice at 525 Remuera Rd, Remuera, Auckland in 2012 as the University no longer had office space for the Trust.
2007 –  Apia, Samoa
2009 – New Zealand hosted (Auckland)
2011 – Solomon Islands hosted (Honiara)
2013 – Samoa hosted (Apia)
2015 – Fiji hosted (Suva)
2017 – Port Vila, Vanuatu
2019 – Port Moresby, Papua New Guinea
 
PSRH Presidents
1995-1999:    Dr Wame Baravilala (First president, Fiji)
1999-2001:    Dr Emosi Puni (Samoa)
2001-2003    Prof Glen Mola (PNG)
2003-2007:      Dr Rufina Latu (Fiji)
2007-2011:    John Ah Ching (Samoa)
2011-2015:    Dr Alec Ekeroma (NZ)
2015-2017:    Ms Kathleen Gapirongo (Sol)
2017-current:    Dr Pushpa Nusair (Fiji)
 
PSRH has gained new heights in the last 25 years of development. It is the only Society in the Pacific whose membership includes doctors, midwives and nurses. It has a unique organization that engages both doctors and midwives in maternal and reproductive health, and has maintained its relevance in the Pacific.

• Its biennial conferences have been successfully conducted in the last 20 years
• It has conducted numerous up-skilling training activities for health professionals, inclusive of midwifery and specialist doctors
• Expended its membership for building a stronger Society
• Engaged new partners for joint efforts towards common goals
• Developed stronger links with UNFPA, who has the global mandate for reproductive health
• Conducted various types of capacity building in collaboration with RANZCOG and other partners
• Reaffirmed its commitment for a regional initiative and moving together to shape the direction of Reproductive Health in the Pacific.

As PSRH enters its 25th year, we salute the dedicated members of the Secretariat and Board for keeping the organizational affairs afloat.  Appreciation goes to RANZCOG who contributed significantly in the early development of PSRH and continues to assist. We also thank the members across the Pacific, NZ and Australia for your dedication and support; and to the professional partners and donors for believing and trusting in the work that PSRH does.
The future of PSRH depends on a strong Secretariat, an effective Board and dedicated members and partners to work jointly in supporting organizational growth and development.
 

Dr Pushpa Nusair
Pacific Greetings to our Readers of the PSRH newsletter.
Through this issue of the PSRH newsletter, I am honoured to highlight a number of important PSRH events, on behalf of the Board. First and foremost, I am delighted to share with you that plans are on-track for the 2019 PSRH Biennial Meeting scheduled to take place in Port Moresby in July next year. I was privileged to have visited the O&G Society of PNG a few weeks ago and held discussions with the local organizing committee under the capable hands of Dr Mary Bagita, President of the O&G Society. One of the amazing things I found was the joint collaborative efforts by both the O&G Society and the Midwifery Society in planning next PSRH conference. The launch of the 13th PSRH Meeting was held in Port Moresby on 11th September 2018. The launch was successfully organized by the local committee.
The biennial conference is a major activity of the Society, a unique occasion that allows members and maternal and reproductive health professionals to network, share experience, debate, discuss and agreeing to actions.  This is a meeting not be missed and I encourage you to start planning your mission to Port Moresby ahead of time. The committee reassured me that intending visitors and participants need not be overly concerned about security issues in Port Moresby. We will be taken care of by our local counterparts.
Following the election of the new Board at the last biennial BGM in Port Vila in July 2017, the Board has been kept busy discussing issues on emails and skype. The membership of the Board includes both doctors and midwives and this is particularly important, noting the complementary roles of the two professions when it comes to maternal and newborn care in Pacific settings. In August this year, we held a face to face meeting in Nadi, Fiji which coincided with the conduct of a number of PSRH workshops and the Fiji O&G Society annual symposium.
In February 2018, I was invited by RANZCOG President Dr Steve Robson to hold a meeting in Melbourne. Much to my delight, it was a meeting that led to the establishment of stronger professional ties between RANZCOG and PSRH. An MOU was signed between the two organisations to seal the partnership and to allow for more functional engagements and collaboration that can strategically lead to improved maternal and newborn care in the Pacific.
We do remember that the PSRH conference in 2017 in Vanuatu called for a focus on prevention and management of cervical cancer in the Pacific. Related to this agenda, I was privileged to participate at the Cervical Cancer Meeting in Samoa in May this year. This was a high level meeting organized by the government of Samoa whose invitation extended to international and regional speakers and participation. At this meeting, I facilitated a discussion on developing a Regional Pacific Policy on Cervical Cancer Screening, Management and Prevention.  The discussion was positive and well received but we need to keep the momentum for policy dialogue and even moving towards initial steps for action. At the upcoming PSRH conference in Port Moresby, we will need to revisit this agenda and aim to arrive at some action plans at regional and national levels. We are banking on our partners to assist us with resources, both technically and financially. I call on you all to start taking a thorough country analysis about this subject before the next PSRH conference. Country voices are important in the discussion of what is feasible and what is not for the management and prevention of cancer of cervix.
Urogynecology is often a forgotten topic in health services for women. In Pacific settings, it is often not talked about. Nevertheless, this year PSRH has engaged Dr Jackie Smallbridge to carry out a feasibility study for urogynecology services in Fiji. Results will be shared and if services can be strengthened in Fiji, it is possible to model in other Pacific Island countries.
PSRH worked with Fiji O&G Society to deliver a series of pre-conference workshops. With support of the PSRH Secretariat, Board members and Partners namely RANZCOG, Ministry of Health (Fiji), Fiji National University, UNFPA, SPC and RACs. We organized and successfully ran six workshops. The six workshops were:
 

• PEMNeT Workshop:  focusing on maternal and neonatal safety

• Research Workshop:  focusing on Fiji obstetric audit

• Family Planning Workshop: focusing on Key to SDGs

• Colposcopy Workshop:  focusing on standardizing care to prevent cervical cancer

• Palliative Care Workshop: focusing on giving life to days rather than days to life

• Professional Development Workshop: focusing on leadership and safety in health practice

 
Details of these workshops can be accessed from the PSRH website. The success of these workshops is attributed to the PSRH Secretariat, resource persons, Board members and partners. It was also encouraging to have Board members co-facilitating the workshops. PSRH intends to hold similar preconference workshops at the PSRH Meeting in Port Moresby.

The PSRH Focal Points (FPs) in each participating Pacific Island country act as eyes and ears for PSRH at country level. Therefore, PSRH regards their roles as critically important to providing relevant information to the Secretariat, especially in sharing PSRH-supported maternal and newborn activities at country level. Focal Points also contribute to collating country news articles that can be featured in the PRSH quarterly newsletter. This way, we are connected across the Pacific Ocean and made aware of important events taking place in the countries.
 
The current FPs were appointed at the last PSRH Biennial General Meeting in Vanuatu (July 17, purely on voluntary basis. The PSRH Executive has decreed that the FPs roles are:
 

• To liaise between PSRH Executive and appropriate authorities in countries on matters relating to PSRH.
• To coordinate functions and activities of PSRH at country level.
• To feed relevant country information and updates to Executive, and coordinate country contribution to the PSRH newsletter
• To facilitate the implementation of PSRH Action Plans agreed to at each biennial meeting.
• To facilitate membership drive among RH professionals and advocates.
• To communicate & hold regular PSRH meeting (at least 2-3 times a year) with local PSRH members in respective countries.
• To facilitate selection of country delegates to attend the PSRH biennial meeting in line with the official procedures of each country.
• To coordinate fund-raising activities to support country delegation to BGM meetings.
• To prepare a country presentation for each BGM meeting, as appropriate and to lead the country delegation

For list of Country Focal Points, please visit PSRH website:  www.psrh.org

During 2018, a number of workshops and meetings have been delivered in many of the Pacific Island Countries. These include PEMNeT, Family Planning, Ultrasound, Colposcopy and Research in Reproductive Health. More workshops are being are planned for delivery. Workshops are funded by the Royal Australasian College of Surgeons Pacific Islands Programme, Secretariat of the Pacific Commission (SPC) and United Nations Population Fund. PSRH would like to acknowledge our funders and partners who have supported the delivery of these workshops.  A list of workshops completed and being planned appears in the table below.
 
The second edition of the PEMNET Manual and Guideline is under review and this work has been led by Professor Alec Ekeroma and Dr Sharron Bolitho. The review is needed so that the manual remains relevant for Pacific island settings. The new edition will be launched as soon as it is ready.

Professor Aiono Dr Alec Ekeroma and the team have continued their regional work on Cervical Cancer screening, prevention and treatment that started in Samoa in May this year. The meeting which was held recently (Sep) in Sydney.
A call was made by WHO and meeting partners to eliminate cervical cancer in the region. There was general agreement to build on the Sydney call for action and discussions are already underway among a number of collaborating groups including PSRH, RANZCOG, Victoria Screening Lab and the Universities of Otago and Victoria.  It is possible to eliminate cervical cancer in Pacific Islands if joint efforts are sustained and national buy-in is secured. Pacific nations need to be in the driver’s seat in this agenda to prevent unnecessary deaths in young mothers across the region. Comprehensive interventions are needed including HPV vaccination, screening and early detection, and robust treatment programs. To facilitate the drive, actions for research, political will and activism are needed in this area.

During the FOGS week, the PSRH hosted a regional symposium at the Grand Pacific Hotel in Suva, Fiji. The function was officiated by Hon. Rosy Akbar, Minister for Medical and Health Services in Fiji. Minister Akbar deliberated on the continued need for advocacy on sexual and reproductive health including a focus on cervical cancer prevention, screening and treatment in the Pacific. She also emphasized on the role of multisectoral collaboration and networking among organisations and partners in jointly responding to major health challenges. She highlighted that the PSRH Symposium is an example of regional collaboration to generate discussions, mobilize capacity building, negotiate for resources and strengthen health program development. The function was supported by UNFPA Pacific Sub-regional office, Ministry of Health and Medical Services Fiji and the Secretariat of the Pacific Commission.

The annual scientific meeting of the Fiji Society of Obstetricians and Gynaecologists (FOGS) took place on 27th-29th August 2018. Six workshops were delivered in the lead up to this meeting.

The Chief Guest was Professor Alec Ekeroma and the key note address was given by Professor Rajat Gyaneshwar. Both have been key influential agents in the on-going development of PSRH. Other international speakers included Dr Roy Watson from RANZCOG, Ireen Manuel from PSRH, Dr Tapa Fidow from Samoa and the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) President, Dr Angela Makris who was able to offer clinical advice on the difficult clinical cases via video conference.
The main resolutions from the FOGS 2018 were:

1. Critical Incident Protocol:  there is a need to develop standard protocols to facilitate reviews of critical obstetric incidents such as maternal and perinatal deaths. This tool helps to review case by case events and facilitates positive learning among team members, and eventually leads to improved care and prevention of unnecessary deaths.  A workshop is planned for February 2019 to further address maternal death reviews.
2. New partners such as the SOMANZ network offer an additional avenue for discussing complex clinical obstetric cases with Pacific specialists.
3. Increasing numbers of Fetal Anomalies was raised as a common cause of early neonatal deaths. The meeting advocated for diligence in preconception Folic Acid administration to prevent such events.

The FOGS annual general meeting was also held where it elected a new and younger membership of FOGS Executives. Nevertheless, they will need mentoring and development in during their term of 2 years.  The team plans to hold regular quarterly meetings, initiate a membership drive, conduct workshops on Critical Incident Protocol, Intrapartum Care, Perineal Care, Gynecology and Subfertility; sourcing assistance from PSRH, RANZCOG and the Fiji Midwifery Society.
 
The FOGS meeting ended on a high note. Dr Nitik Ram of CWM Hospital in Suva Fiji had his first phase of research published in The Pacific Journal of Reproductive Health, an independent publication of the Pacific Society for Reproductive Health (PSRH) Charitable Trust and administered by the Pacific Women’s Health Research Unit of the University of Auckland. The Journal began publishing in 2015 as a means to increase research evidence from the Pacific region in collaboration with Pacific-rim countries. PSRH has been working with researchers in the Pacific region to help develop research and audit capabilities and drive research in the workplace.
 
We are very proud of Dr Nitik Ram, pictured here (second from the left) with a number of PSRH founders. We hope more young doctors will follow his footsteps. You can read Dr Ram’s research findings at:
https://pacificjournalreproductivehealth.org/…/issue/current

The 13th Biennial General Meeting (BGM) for PSRH is being planned to take place at The Stanley Hotel, Port Moresby in Papua New Guinea (PNG).  The dates are confirmed for 6-11 July 2019 and hundreds of health professionals are expected to attend. The PNG LOC is chaired by Dr. Mary Bagita, currently the President of the PNG O&G Society. The local organisation is being jointly coordinated with the PNG Midwifery Society.
The theme for the conference is “Pacific Experience for Pacific Solutions in Reproductive Health.” Prior to the conference a number of technical workshops will be conducted in parallel sessions organised by the Local Team in consultation with visiting experts. Details of the workshops will be posted in the PSRH website by January 2019.

The Secretariat’s role in contributing to regional oversight, advocacy work and up skilling of clinicians has been crucial. The CEO, Mrs Ireen Manuel represented PSRH at the recent UNFPA meeting held in Nadi Fiji in September.
The workshop discussed issues related to health workforce development for Reproductive, Maternal, Newborn, Adolescent and Child in the Pacific. PSRH shared its work in the Pacific on how it is contributing to this agenda. Together with other RMNCAH partners and stakeholders, we anticipate that PSRH’s role in capacity development is of critical importance to further strengthen RMNCAH services in the Pacific. A number of NGOs and other partners were present at this meeting to support the UNFPA workshop. PSRH is keen to collaborate with UNFPA in this area and continues to collaborate with other RMNCAH colleagues at regional and national levels so that our efforts and initiatives are appropriately aligned and harmonized, and respond to local needs.

by Christine Jackson, Midwifery Technical Advisor
The first ever Graduate Diploma students of Midwifery in Vanuatu completed the studies in June 2017. This has been a great achievement for the government in training their own midwives and taking ownership in future capacity building in maternal and newborn health. Fifteen trained midwives are now deployed and working in rural hospitals and health facilities.
 
The 15 students were selected from all provinces in Vanuatu, many in remote rural settings. Therefore the students have already been exposed to the challenges of maternal and newborn care, and have dealt with many maternal complications while working in rural health facilities.  It has been a rewarding experience for tutors and facilitators to build capacity on experienced health workers. Ms Christine Jackson (NZ) played a major role in supporting the local team in steering the course and providing technical guidance and assistance to achieve this level of qualification.
 
The application of midwifery skills and knowledge in Primary Health care is pivotal to improving community health, especially maternal and newborn care. Midwifery functions as a key component of the health system and facilitates improved basic care when well integrated in primary healthcare settings. The health of a community is profoundly dependent on the health of the mother and her family. To ensure informed healthy reproductive choices birth spacing is essential. Access to quality, and appropriate antenatal care and removing the “three delays” for seeking safe delivery, ensures quality care in pregnancy and delivery.
 
Six months following the graduation of the first batch of midwifery students, a second cohort of 15 students were recruited to take the same Graduate Diploma of Midwifery. This is in line with national plans of government to train enough midwives so that every health centre has a trained midwife and therefore the capacity to provide quality maternal and newborn care at primary level.
 
The 15 midwifery students have just completed a two-week course on Pacific Maternal & Neonatal Emergency Training. PEMNeT (including Early Essential newborn care, EENC) with funds from Australian government sourced to the Ministry of Health and administered by Vanuatu College of Nursing Education (VCNE). The course aims to upskill midwifery students in emergency obstetric and neonatal care, a core component of their formal 18month training programme.  The workshops allowed the students to interact with other primary health providers so that they learn team work with other categories of health professionals and maximize joint efforts in addressing maternal and newborn health. The ultimate result is to have competent graduate midwives who can provide quality reproductive and maternal-newborn services throughout the six provinces of Vanuatu.

Three male midwifery students come from remote rural areas who have a combined nursing experience for over twenty years. Using acquired critical knowledge they will play an important role in the necessary changes required to improve maternal and newborn outcomes, by implementing safe, respectful and expert midwifery care. These 3 men along with other male midwives will be pivotal in changing the attitudes in a male dominated society, to ensure all women have access to maternal reproductive health.
 
The midwifery students are exposed to both clinical and managerial topics that highlight the importance of the midwife who contributes to reviewing and the development of health policies at local and national levels. On completion of the Graduate Diploma the students will return to their provinces and take up multi-skill midwifery role in health centres and hospitals.