The midwife program started by Dr. Robert Skankey in 2011 has completely changed the maternal and infant mortality rate among nomads in Niger. In 2011 one in five women in Niger had a lifetime risk of death in childbirth. In 2015 our matrons have assisted at over 300 births with no maternal deaths and no deaths of children born alive. Our matrons and major at the clinic have successfully dealt with breech births, post partum hemorrhages and delivered healthy triplets. They consult each other and now four of our former trainees are helping us teach the new ones. The most exciting new development is the turning over the program (with our continued oversight from afar) to the local staff. From the beginning Achicha has been an important assistant to Dr. Bob. She learned to speak English and as a registered nurse in Niger, helped him treat patients in the clinic. She then learned how to teach his mid-wife program. He has passed on not only his knowledge, but almost more important, his philosophy of kindness and respect for his patients and preventive care. Achicha, after six years of working with him has solidly adopted this philosophy. So after this most recent training he decided she was ready to follow up on her own as director of the program. This allows for the program to continue, even if we Americans are not able to come. Bob at 84 is not so sure he will return and I a full 15 years younger am never too sure either, especially as the terrorists keep rearing their ugly heads. Our goal has always to move toward local management. They will continue to report to us, but do the follow up missions on their own. In three months Achicha and Sidi will visit the new trainees in their camps evaluate their work to date and report to us. They will also determine if and when follow up training is warranted.