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Background Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF. Methods Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison gro cup and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies. Conclusion Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

Bien qu’une intercompréhension entre les locuteurs du français à travers le monde soit possible grâce aux nombreuses conventions prescrites, l’efficacité de leur communication peut toutefois être compromise à cause de la présence de mots et d’expressions propres à un pays ou à une région. En effet, le français est susceptible de variations synchroniques et diachroniques, étant donné les variations culturelles, sociales, économiques et politiques à l’intérieur d’un même pays et entre les pays ou les régions partageant cette langue. Ces mots et locutions, qui peuvent faire partie du vocabulaire de certains locuteurs, réfèrent alors à des réalités spécifiques de leurs pays ou de leurs régions. En outre, ces expressions ont souvent une telle opacité sémantique que les locuteurs étrangers à celles-ci risquent d’être déroutés et ne seront pas en mesure d’en comprendre le sens (Klett, 2013, p. 60). À titre d’exemple, dans une situation où un locuteur francophone de la Belgique communique avec un locuteur francophone du Canada, il est possible qu’il y ait une incompréhension des expressions utilisées de part et d’autre. De même, cette incompréhension peut s’instaurer entre locuteurs d’un même pays. Cela suggère que le vocabulaire de ces locuteurs diffère par des facteurs individuels, c’està-dire des facteurs sociolinguistiques, qui ont un effet sur leur usage et leur compréhension des expressions. C’est sur cette incompréhension que nous nous penchons dans cette étude. Étant donné la panoplie d’expressions existantes, nous avons restreint notre champ de recherche en ne nous intéressant qu’à quelques locutions anatomiques1 contenant le mot « tête » dans les canadianismes, telles que « être une tête carrée » et « avoir des yeux tout le tour de la tête ».

Background: Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.Methods: Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison group and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results: All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

OBJECTIVES: This article aims to uncover health inequities related not only to living in a linguistic minority, but also to being an immigrant and living in a new environment with a cultural background different from that of the host community. METHODS: This qualitative study presents the personal experiences of many Francophone immigrants in relation to services and health care in Sudbury and their perception about the quality and accessibility of these services and health care. Seventy-two (72) respondents aged between 18 and 65 years (45 men and 27 women) participated in this research through individual interviews and focus groups. RESULTS: The results show, among other things, that being immigrant and Francophone limits access to health services, affects the quality of these services and hinders being well supported when encountering health problems. Thus some individuals are not even able to give informed consent when making important decisions about their own health. CONCLUSION: The article makes recommendations that would allow access to better services and health care for immigrants, and would contribute to improving the health of the Canadian population of which they are an integral part.

OBJECTIVES: This article aims to uncover health inequities related not only to living in a linguistic minority, but also to being an immigrant and living in a new environment with a cultural background different from that of the host community. METHODS: This qualitative study presents the personal experiences of many Francophone immigrants in relation to services and health care in Sudbury and their perception about the quality and accessibility of these services and health care. Seventy-two (72) respondents aged between 18 and 65 years (45 men and 27 women) participated in this research through individual interviews and focus groups. RESULTS: The results show, among other things, that being immigrant and Francophone limits access to health services, affects the quality of these services and hinders being well supported when encountering health problems. Thus some individuals are not even able to give informed consent when making important decisions about their own health. CONCLUSION: The article makes recommendations that would allow access to better services and health care for immigrants, and would contribute to improving the health of the Canadian population of which they are an integral part.