70% of the learners this time were students with no clinical experience yet. 89% were nurses and midwives or students of those professions. NICHE collects feedback on increased confidence levels in certain skills taught on the Neonatal Care Course. Research has shown that health professionals with confidence are more likely to “have a go” at things they have learnt about and, with this attitude and an appropriate level of supervision, will come increasing competence over time.

The increase in confidence in all 5 areas is obvious from the charts. These are the most important factors in preventing deaths within the first month of life. We have put more emphasis on the recognition and management of unwell – potentially septic – babies in the new rendition of the Neonatal Care Course. It is nice to see people feeling a little more confident about this cohort and the premature babies, but it looks like this is an important topic that we need to support the learners with going forwards. The resuscitation trainers should be proud of the shift in confidence figures after they had taught the skills. 70% of the learners on this occasion were student nurses which may explain the low level of confidence in all skills prior to the course.

People enjoyed the food and refreshments and commented that they help with the learning: “The refreshments were available and this gave us energy to concentrate”

One person commented that they would like them earlier in the day “to improve on candidates attention”. Lots of people asked for more time for the course as it was hard to fit all the learning in.

One person commented “I liked the fact that mentors from all over the world shared their experience” although others asked the native English speakers to slow down: “I suggest that while teaching us you are more audible and slow in speech because we are not used of the UK accent”.

There were lots of comments on the importance of the hands on aspect of the training and how they think that everyone should get this training because it saves lives: “I wish all nurses and midwives are trained in this course as it is very important and enriched”

Overall, it looks like the courses hit the spot:

“I loved every bit of the course because I really lacked confidence but now, I can’t wait to put my learning into practice.”

Today is the penultimate day of NICHE International’s Uganda visit and the penultimate day of the 3 Neonatal Care Courses. Everyone has worked incredibly hard and been made to feel very welcome. Here are a few photos of Bwindi’s instructors in action:

The red-tailed monkey is a species of guenon native to central Africa. Other common names include the black-cheeked white-nosed monkey and the red-tailed guenon. Their home range extends throughout the Central African Republic and the Congo, with southern Sudan as the northern boundary and northern Zambia as the southern limit (https://neprimateconservancy.org/red-tailed-monkey/):

There are quite a few bold members of the troupe that is based in the trees around the hospital. They steal food from the hospital canteen and anything bright and interesting they find lying around. One of the instructors’ bathroom was raided on an earlier visit of ours to Bwindi, soap eaten and pink, shiny razor seen lying in bits in the forest the other side of the fence!

UK instructors getting excited about monkeys watching the course intently through the window is probably the equivalent of Ugandans getting excited about seeing a squirrel in a UK garden. All part of the experience!

The team is teaching 72 hospital staff and nursing students over the next 10 days. They are teaching an overhauled course which we hope will lead to even more effective learning. Fingers crossed that the timings on day 2 work out OK!

A team of instructors from UK and Cameroon are currently in the air, flying from Entebbe to Bwindi to meet up with six Ugandan instructors (trained by NICHE last year) for three back-to-back NCCs for staff and students at the hospital and adjoining nursing school. Pictures eagerly awaited!

The Neonatal Care Course was originally written by Maternal & Childhealth Advocacy International and https://www.alsg.org/ and has stood the test of time well. Before NICHE International was set up, some of us were volunteers with MCAI and taught the course in Gambia in 2014 as well as Cameroon in 2015.

The Strengthening Emergency Care (SEC) committee of ALSG keeps an eye on the course content and provides the educational governance for the course and we have certainly added things to it over the years as a result of changes in World Health Organisation policy, relevant new clinical studies or feedback from the learners. We have kept it as practical as possible and ensured that it is easy for local instructors to teach in their turn.

Educationally though, it was in need of a bit of a revamp. It was very lecture heavy with no e-learning site in a world where most healthcare professionals in the world now have access to the internet at least intermittently during their working week. Alistair, Cath and Julia have been restructuring and updating the course for the past few months and on 4th and 5th January, trustees, instructors, friends and interested parties gathered together in Calderdale Hospital to put the new course to the test.

The weekend got off to a great start with lots of very enthusiastic learners and the timings working out better than we had feared. But then it snowed. This is not really a problem we have in Uganda and Cameroon (although we have had courses threatened in Liberia by heavy rains making the red laterite soil roads impassable). All trains to and from Halifax were cancelled because of a fallen tree, no bus replacement services were allowed to run and emergency services were busy rescuing people from their cars overnight all around Halifax. So we reluctantly did the sensible thing and cancelled day 2.

“Two deliveries today with some issues breathing and just with positioning, the babies picked up and are presently on S2SMC [Skin to Skin Mother Care] thanks for the knowledge from Neonatal care work shop“

This is a quote from one of the healthcare workers Grace and her team trained last week in Bamenda. They were a group from Life Abundance Primary Care Staff who are healthcare practitioners working in remote, hard to reach areas of Cameroon.

The Neonatal Care Course normally has a limit of 24 per course but Grace was asked to teach 42 at once! Experienced people working in very difficult circumstances in anglophone Cameroon at the moment, desperate to learn.

The Cameroonian faculty still delivered effective training for this group, opting to miss out the final exam and the oxygen concentrator session “since they have no oxygen and no concentrator”. The group work sessions were a bit crowded but the instructors stayed late to ensure everyone got a go at the simulations.

An amazing feat to have run the course with almost double the number of learners as usual, and credit to Grace and the other instructors for being so adaptable for the good of the babies these people will go on to help. Feedback like that quoted above empowers the team (and us at NICHE International) to continue with the programme.

NICHE International’s programme manager Grace is now the Maternal and Child
Health Services supervisor for Cameroon Baptist Convention Health Services, our
partner in Cameroon.

In this capacity she has been visiting various health centres to look at their newborn
care facilities and offer support if necessary.

Bonaberi is a district of Douala with a rapidly growing population and severe poverty.
Internally displaced people from the Cameroonian regions where there is civil unrest
have moved to Bonaberi and added to this problem.

In the health centre she visited in Bonaberi, she found a range of difficulties. On
reviewing neonatal deaths, she recognised the need for training particularly in
resuscitation of the newborn.

Grace and other instructors trained by NICHE International have just finished running
a training course in Douala and 5 staff from the Bonaberi Health Centre have
attended it to improve their skills.

Grace and her colleagues are now experienced Neonatal Care Course Instructors.
They can assess need and respond with appropriate training.