Jo's VSO adventure: May 2012

Saturday, 19 May 2012

Mission NLS complete

The last two weeks have absolutely rocketed past. We have been super busy with our NLS course, running another 3 rounds, and training 80 people in total. The courses seemed to get better and better and it was really lovely to have our local trainers on board, able to translate into Amharic. I’m sure it really improved the understanding of some of the participants who really didn’t speak much English.

I particularly enjoyed working with the local trainers because most of them were young women, and women still have a pretty subservient place within Ethiopian society. There are very few women in positions of power here and the traditional culture is for the wife to serve her husband. Consequently a lot of our female trainers were really apprehensive about the idea of standing up in front of colleagues to give presentations. However with a bit of encouragement and the reassurance that we wouldn’t have asked them to do it if we didn’t think they would do a really good job, they all did us proud and seemed to really relish the opportunity, to make things a bit better where they work. A lot of them seem to have gone back to their hospitals and health centres really motivated to improve things which makes me feel like we’ve achieved our aims.

We have already visited one of the hospitals at their request, and made plans to spend an afternoon there, making sure staff are confident to use the equipment they have that was not covered in the NLS course. The Helping Babies Breathe newborn life support posters which were donated by UNICEF Ethiopia and given out at the first course were proudly displayed in frames on the walls about the newborn resuscitation station just as they should be so some things are working!

The next step will be to ensure all the senior staff have been trained. This was requested by one of our local trainers, who said that she was delighted to have learnt about newborn resuscitation, but had come up against some resistance from senior colleagues at work who still think the best way to resuscitate a baby is to swing it upside down by its feet (seriously!). We’ll need to tread carefully with this one so as not to cause offence and are working with the University to devise a plan.

Finally I’d love to be able to persuade the regional health board that they should fund this training to be run every few months with local staff so that all the health care workers who regularly deliver babies update their skills every couple of years. This might be a long shot be we’ll see what we can do.....

Saturday, 5 May 2012

NLS success

Every now and then I get a day when all the difficulties of volunteering seem worthwhile. This week I’ve had a whole week! It has been brilliant and it’s great to finally feel like you are doing something that might actually make a real long lasting difference.

When Susan and I first started working in the hospitals, one of the things we noticed is the complete lack of confidence most of the nurses and midwives have in resuscitating a baby who does not breathe at birth. This is a really critical part of a midwives job, but our direct observations were that it was done badly or not at all. Partly this is due to inadequate staffing, space and equipment but also it’s due to a lack of awareness and training. More than the basic resuscitation, we also found that the care of the newborn was often really poor. The babies who are admitted to the neonatal unit are frequently hypothermic, and they may not have been fed for hours and hours.

We decided that this was something we had to try and improve, and so since Christmas we have been preparing a newborn life support course for the nurses and midwives working in Harar. We applied to VSO for a grant to fund the project, and spoke to the regional health bureau who asked us to train health centre staff as well as hospital staff, and agreed to ensure that the government institutions have the basic equipment necessary. Then we prepared the course material we wanted to teach, based on UK newborn life support guidelines but also adapted to the WHO/ Ethiopian Paediatric guidelines. As well as basic newborn resuscitation we have includes sessions on ethics and document keeping ( as the quality of note keeping here is generally pretty appalling), and essential newborn care which covers how to support mothers in breast feeding and keeping babies warm amongst other things. Finally we persuaded UNICEF Ethiopia to donate the neonatal resuscitation training equipment in the form of 4 neonatalie complete kits!

The course is happening in 2 stages. The first stage started this week and we had participants from every hospital and health centre attending. We did two days training on the theory and practice of newborn resuscitation and then a final day discussing methods of learning and teaching, and asking our participants to think about how they would take what they have learnt back to their place of work, share it with their colleagues and put it into practice.

The course was really well received and all our feedback was extremely positive. On the 3^rd day we asked our participants in groups to prepare a micro-session explaining and demonstrating a particular aspect of newborn life support, and it was so lovely to see them demonstrating what they had learnt and explaining it to colleagues. The candidates who we thought were strongest we have asked to come back and help as instructors in phase 2, when we hope to train another 60 of their colleagues by running 3 more similar courses but without the third day.

The final part of the plan is to speak to the regional health bureau about setting up an annual professional development programme, where they run similar training regularly throughout the year so that all of the staff here get the chance to update their skills on a regular basis. Even if the final part is not successful we will have around 80 better trained health care staff working in Ethiopia and if they put their new skills into practise that alone will be a year well spent!