Outcome measures

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The ultimate outcome measurement for the Newborn Care Course project would of course be a reduction in neonatal mortality in the areas where we work.  There are so many confounding factors in any clean data that is actually collected that it is almost impossible to prove that one intervention like this has any statistically significant effect on neonatal mortality.  But our funders always ask for outcome measures.  This year in Cameroon we changed the feedback form a bit, bringing it more into line with the template suggested by the UK’s Royal College of Paediatrics and Child Health.  This has allowed us to measure pre- and post- course confidence in the main areas identified by WHO as contributing to newborn deaths.  Here are the results from last month’s course:

 

The challenge now, of course, is to keep that confidence up going forwards.

 

Di Pikin no don die 

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This is what we are aiming for!

It was noticeable that when Cameroonian candidates were role-playing a scenario, for example giving the baby to the mother after a successful resuscitation, they would speak to her in Pidgin English (sometimes called Kamtok in Cameroon).

One of the candidates used the sentence above.  It means ‘the baby hasn’t died’.

It is a reminder that neonatal mortality in Cameroon is still 10 times that in the UK, and that the aim of teaching the Newborn Care Course is to reduce it.

 

 

 

 

 

 

48 of the 49 candidates who took part successfully completed the course in April 2019.  That’s 48 more skilled birth attendants and nearly 20 trained or partially trained instructors (not all those who did the GIC last year managed to get to these courses to do their supervised teaching) who will continue to cascade the learning.  That’s good news for many thousands of babies in Cameroon in the years to come.

Traffic light comprehension

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With some French and some English speakers (and some hard to understand UK accents) we wanted to be sure that learners could hear and understand everything they were being taught.   Jarlath initiated his ‘traffic light system’, whereby everyone was given a piece of paper with a red light drawn on it.  They were asked to hold up the red light if they couldn’t hear or understand what was being said.  It works well with learners who are too polite to say they don’t follow.

 

 

We are very lucky to have such senior instructors involved with NICHE.  Their breadth of experience is humbling for those of us still hanging on their coat tails, they can adapt their teaching style to any situation, they are supremely patient with the learners and they never, ever, pass up an opportunity to pass on skills and knowledge – even if the only flat space available is a windowsill a few floors up (thank goodness it’s only a manikin).

The Newborn Care Course has reached a variety of health workers

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On the NCCs at the end of April in Cameroon, altogether we had candidates from 6 of Cameroon’s 10 Regions. Participants came from a variety of work places, some small local health centres, some bigger hospitals. There were nurses, midwives, doctors and a paediatric surgeon taking part. There were English and French speakers. The workshops and small group teaching gave participants the chance to share their experiences, and discuss specific problems that they face at work.  This is important in a health environment where doctors and midwives and nurses do not usually share training experiences.

Paediatric surgeon, George, practises resuscitating a baby
Midwife, Julia, studies her course manual. Julia did particularly well on the course and is responsible for training other midwives in her health facility in Douala. NICHE left one of the manikins donated by the BMA with her so that she can continue to cascade what she learnt to others.

Civil unrest affects healthcare in Cameroon

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Jarlath at breakfast with Grace, Ernestine and Margaret, instructors from Bamenda

Because of the civil unrest in Cameroon, some participants from the North West and South West Regions, which are the worst affected by violence, had difficulty travelling.  There are weekly ‘ghost towns and ‘lock downs’ in these regions, when no shops or schools are open and there is no public transport.

Nurses and doctors are forced to sleep on the floor in the hospital at these times. Pregnant women have difficulty reaching hospitals and health centres.  Three instructors from Bamenda NW Region, where we ran the first course in 2014, managed to get to Yaounde to teach.

Instructors and trustees raising money for NICHE in Berlin

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We’ve been running in Berlin this weekend, raising money for NICHE International and raising the profile a bit:

One of NICHE’s senior instructors with her “magic sticks” which apparently make her run faster or more safely or something. Anyway, they worked.

 

 

 

You can still sponsor us!

https://www.justgiving.com/fundraising/joannabruce-jones

https://www.justgiving.com/fundraising/julia-thomson9

https://www.justgiving.com/fundraising/seb-palmer99

The baby who won’t live long

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Cameroonian doctors and nurses were entirely responsible for the teaching on the course on this occasion. They rose to the challenge; time keeping being the only aspect which needs a bit of work still.  Stella, one of the younger teachers, gave an inspirational talk on ‘The baby who won’t live long’, which is one of the most challenging lectures on the course.

Hard for us to teach too, as many of the babies who fall into this category in Cameroon such as those with spina bifida or congenital heart disease, can be offered so much more in the UK.  The reality is that the Cameroonian instructors do have a better idea of how to make these babies comfortable and also have more experience of having to do this than the UK instructors.  It is yet another area where the UK instructors learn from our Cameroonian counterparts.

Stella teaching on the baby who won’t live long

Trainers undeterred by building works

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Jarlath and Alison have been in Yaounde, Cameroon to support Cameroonian Instructors who were teaching on their first or second courses following their training as Newborn Care Instructors.

The courses were being run in the Cameroon Baptist Convention Resource Centre, in Mvan a suburb of Yaoundé.   This is a new centre, and building was still taking place on the site.  There was a big room for teaching on the 3rd floor, as well as a dining room and accommodation on site.

Teachers had to contend with hammering from the builders, tropical thunderstorms and the odd powercut, but were undeterred.

View from the teaching room as storm clouds gather
Building works next to the teaching room

 

Sustainability, here we come!

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Julia recently spoke at a national conference on “The challenge of sustainability” in newborn care training.  NICHE International’s vision of the Holy Grail of sustainability is in the slide below:

There is much written on skills decay over time and the lack of sustainability in the model of flying outside instructors to a country for a week to teach resuscitation skills and expect attitudes and habits to change as a result. That is why we concentrate on training local instructors and have developed our 10-step path to sustainability (see under sustainability section of the website).  That is also why we are so excited about the course currently running in Yaounde, Cameroon.

These workshops and lectures are being delivered by people we trained as instructors last year:

Mentoring in Yaounde, Cameroon

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This is Alison and Jarlath, busy in Cameroon mentoring 12 local instructors through their instructor candidate newborn care courses. We use the UK model for training instructors. They first have to do a two day very intense instructor training course known as the generic instructor course (GIC). Then they have to teach on 2 newborn care courses but are supervised during that time by a more senior instructor. At the end of this they are fully fledged newborn care course instructors. It is quite demanding training, the same as the UK advanced life support instructors go through, but is one of the best short instructor training courses available. The NICHE instructors are on site this week to complete the training of the 12 local instructors who did their generic instructor course this time last year. As a team, we are very heartened by this step. It is step 8 in our sustainability plan and means that we can remove ourselves from Cameroon for a few years. Step 9 and 10 will take place when the trained local instructors have done enough courses to start training as instructor trainers themselves. We hope to be invited back for that stage in two or three years time.