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The paediatric ward

Murals on the children’s ward, Bwindi Community Hospital

Dr Cath Harrison:

 A visit to the paediatric ward today – an amazing set up with the ward being divided up into separate areas to allow patients needing frequent observations and management to be near the nursing station.

There is a kitchen at the end of the ward where families are taught by nursing staff the importance of nutrition and how to make nutritionally balanced meals.

There is an indoor play area and outdoor space as well for children.

We saw a variety of conditions – orbital cellulitis secondary to trauma (fall from a tree), pneumonia and malaria.

The pride was apparent in the quality of care the staff provided and the clinical space was so clean and tidy.

A good demonstration of teamworking to improve the quality of care provided to children and their families.

Uganda Nursing School, Bwindi

Bwindi nursing school is co-located with the hospital and was built in 2013

UK consultant neonatologist, Dr Cath Harrison, is part of the team in Bwindi this year and has written a couple of blog posts for the NICHE website:

During preparations for the GIC course, we were fortunate to have a visit to the Bwindi Community Hospital School of Nursing. This was set up in 2013 initially with 100 students. Now 10 years later there are 400 students. The course is 2-3 years long with students graduating with a Diploma in Nursing.

The school is about 3 minutes’ walk from the hospital entrance and is a self-contained facility with communal spaces, lecture theatres, library and on-site accommodation for the students. There is even a football pitch and the women’s team won a national competition last year!

The nursing school has improved nursing staffing for the hospital, with the best students being offered posts at BCH, thereby maintaining workforce and sustainable care provision.

Back in Bwindi

We’re back in Bwindi Community Hospital for the first Generic Instructor Course (GIC) to be run here, followed by 2 x Neonatal Care Courses (NCC) where we will be supervising the newly trained instructors as they facilitate their first 2 courses.

Dr Scott Kellerman, founder of Bwindi Community Hospital with Julia and Kirstie

U.S missionaries Dr. Scott and his wife Carol Kellerman started the hospital in 2003 when it was a simple outreach clinic under a tree for the Batwa people, who had been evicted from Bwindi Impenetrable forest when it was turned into a mountain gorilla sanctuary. That small clinic is now a fully-fledged hospital with 155 beds, which also houses the Uganda Nursing School and Uganda College of Health Sciences Bwindi.

The close proximity of the Impenetrable Forest makes it a beautiful place to come and teach.

Instructors Jo B-J and Grace waiting to go to the hospital this morning to set up the teaching rooms. Uganda is quite a bit cooler than Cameroon!
Jo L had to wait for someone else to finish using her bathroom this morning
Such a beautiful place to work
Street scene outside the hospital

Tomorrow we start work properly – 2 full days of instructor training for the 12 candidates chosen this time last year during the first 2 NCCs we ran here. There is a lot of enthusiasm from all involved and we are looking forward to getting going.

Our 5 Year Anniversary!

Five years of NICHE International

Report from the lead trustee, Dr Alison Earley

Our charity was established because too many babies in low-income countries die in their first month of life.  We wanted to reduce this by delivering training in neonatal care, and to make changes that would be owned and sustained by the healthcare workers we trained.

So, after 5 years, how are we doing?

Where have we worked?  

We have run Neonatal Care Courses in Cameroon, Liberia and Uganda.  Following each course, selected candidates undertake a ‘train the trainers’ Generic Instructor Course (GIC), so that they can train local colleagues.  GIC courses have been taught in Cameroon and Liberia, and the first one will take place in Uganda in February 2023.

How many health care workers have been trained? 

More than 300.  Candidates have come from 7 of Cameroon’s 10 Regions, from two districts in Liberia (one remote), and from districts in South West Uganda.  The learners have been nurses, midwives, nursing assistants, clinical officers, general practitioner doctors, anaesthetists, paediatricians and a paediatric surgeon.  Our courses have also been observed by public health doctors, a professor of paediatrics and nursing school tutors.

Knowledge assessment and feedback

Each course concludes with a multiple choice and practical assessment.  The pass rate is high, 80%. Nearly all candidates pass these, but occasionally someone doesn’t meet the required standard, and we try to offer a place on another course. 

Feedback has generally been very positive.  Some learners would like a longer course, in particular to practise learning from scenarios, which is a new concept to many.  Accordingly, we are planning to add a further half day to the 2 day Neonatal Care Course when we teach it in Uganda in February 2023.

Demonstrating that this training is being incorporated into participants’ daily practice, and that skills are retained is challenging.  We have collected anecdotal evidence, and have asked the course graduates to keep records of babies resuscitated at birth, and to fill in questionnaires about their confidence in various aspects of practice.  While there is some data from these, we have not yet overcome the difficulties of proving that what is learnt is retained and used.

What about sustainability? 

There are more than 25 health workers in Cameroon who have completed the Generic Instructors Course (GIC) and who are now gaining experience in teaching their own courses, without the need for international instructors to come from UK.  Despite the Covid 19 pandemic, they have run five courses successfully. One of these was in the remote Far North Region of Cameroon, where health facilities are scarce and the perinatal mortality is high.

We are confident that this success will be repeated in Uganda, where 12 candidates have been chosen for the first GIC which will take place in Feb 2023.  In Liberia, several sessions of neonatal resuscitation training have been carried out locally by nurses who attended the NICHE courses.  The University of Buea in Cameroon has asked for a course for its final year medical students.

We see maintaining the skills and enthusiasm of local Instructors as critical to the goal of making lasting improvements in neonatal care and to that end we have developed a novel Instructor Development Day course which we ran for the first time in 2022 in Cameroon.

Partnerships and friends

We have been delighted to establish partnerships – working closely and sharing expertise and knowledge with the following:

  • ALSG (Advanced Life Support Group), an educational charity
  • 2 NICHE trustees are on the Strengthening Emergency Care committee of ALSG.
  • Child Health Matters, a charity supporting health care in Uganda
  • Bwindi Community Hospital, South West Uganda
  • MCAI (Maternal and Childhealth Advocacy International), developers of the Neonatal Care Course and of neonatal clinician training in Liberia
  • Cameroon Baptist Convention Health Services, which contributes to health care in Cameroon.

In addition, we owe much to the huge amount of enthusiasm, guidance and friendship from local ‘champions’ in each country, who are passionate in taking the training forward, and with whom we are planning the next steps.

Governance

The charity is run by the six founder trustees on a voluntary basis.  Between us, we have experience working for teaching and medical charities in Cameroon, Liberia and other resource poor countries, in project management, post-graduate teaching, IT and business. We also have two co-opted members, who lend their expertise to trustee meetings. They are Irish paediatrician Dr Jarlath O’Donohoe, and Cameroonian senior neonatal nurse, Mrs Grace Ndze.

We have established a regularly reviewed safeguarding policy and code of conduct to which all trustees and volunteers adhere.

Fundraising

It has been a huge challenge to fund the delivery of our courses over the past 5 years, and our sincere thanks go to our supporters:

  • The British Medical Association
  • The Batchworth Trust
  • St Mary’s Church, Amersham
  • Calderdale and Huddersfield RCM
  • Souter Charitable Trust
  • Ashworth Trust
  • The many individuals who have raised funds through sponsored and other activities, or who have donated via our website or Just Giving.

Not forgetting our UK and international volunteers, who give their time free of charge to deliver courses for NICHE.

All funds raised go directly to NICHE projects.  We have no premises and no paid staff. 

In the next 5 years we would like to:

  1. Support local health care professionals in the areas where we work, not only in teaching the Neonatal Care Course, but also in training their own Instructors.  This means finding local experts in adult education to lead the Generic Instructor Courses.
  2. Provide robust evidence that attending courses improves practice.
  3. Work on reducing skills decay within the cohort of trained healthcare professionals.
  4. Continue to develop the online work and mentoring programme to help GIC Instructor candidates prepare for their courses.  This is being piloted currently in Uganda.
  5. Reach out and offer courses to more health sectors, such as medical schools, nursing schools and government institutions.
  6. Work towards a more globally representative senior instructor team which allows suitably trained healthcare professionals to share practices across their own continent.  Our Cameroonian colleague accompanying us to Uganda already confers credibility on the international instructor team.
  7. Withdraw from countries where we have helped to build a fully functional faculty able to run courses and train instructors, and begin the process again in new countries.  Remote support for fully functioning faculties is likely to continue for a while.

In conclusion:  NICHE International is in good health.   Over the past five years, instructors and candidates have learned much from one another.  We look forward to more years of working with our partners and local ‘champions’, developing training in neonatal care and cascading skills and knowledge to healthcare workers in poorly resourced areas of the world.  We look forward to continuing our collaborative and sustainable work on ensuring fewer babies die in the first month of life. 

AE & AG  2023

Remote support of the GIC candidates in Bwindi

12 candidates for instructor training were selected at the first Neonatal Care Courses that were run in Bwindi in February 2022. They were supposed to be trained in November 2022 but the Ebola outbreak (in a different part of the country) put pay to NICHE International’s travel plans and we had to disappoint the group by postponing the training.

We have been doing some preliminary pre-course training with the candidates via a Zoom link. The Pocket Guide to Teaching for Clinical Instructors is the manual for the internationally taught and recognised Generic Instructor Course. Our educator, Jo Lawrence, arranged for some to be sent to Bwindi and the candidates have been busy reading about the “Set, Environment, Dialogue and Closure” structure of all teaching modalities.

Last week, the “Green group” of four each presented their prepared 5 minute lectures for Grace and I, their group mentors. The tropical rain was hammering down on Bwindi’s tin roof and the temperate wind was howling around my house in the UK. Only Cameroon’s weather sat quietly and listened to our four enthusiastic learners teaching us about hypoglycaemic fits, neonatal resuscitation and the risks of being born too early.

This is exciting and ground breaking work. The Advanced Life Support Group started to run “remotely enhanced” GICs during the pandemic in the UK but we are not aware of anyone else doing pre-course GIC training with overseas instructors. Our Cameroonian colleague, Grace, was instrumental in driving this forwards as she pointed out that the ethos of the GIC is new to many African healthcare workers and it takes time to get used to the GIC educational theories and practices.

There is a nurse training school based at Bwindi Community Hospital. Some of the GIC candidates are nurse tutors in the training school.

All systems go for Uganda again!

The Ebola outbreak in Uganda has been declared “over” and the team is busy preparing for the postponed return trip to Bwindi Community Hospital to teach one Generic Instructor Course and two Neonatal Care Courses. We will be training 12 new instructors and then supervising them while they facilitate the NCCs for 48 learners.

Watch Dr Birungi talking about the work done at Bwindi Community Hospital back in 2013. 10 years later, Dr Birungi is still overseeing nearly all of the projects mentioned here.

Sad news

Hildegarde (left) was a paediatrician and one of NICHE’s NCC instructors in Cameroon

We were deeply saddened this week to learn of the sudden death of a young paediatric colleague in Yaoundé, Cameroon. Hildegarde was won of the first Neonatal Course instructors to be trained by NICHE and was one of the team who recently travelled to the far north of the country to teach the first 2 Neonatal Care Courses to health professionals there. She was an enthusiastic trainer and passionate about improving the care of newborn babies in her country.

Our deepest condolences to her family and friends as they prepare to attend her funeral tomorrow. She will be sorely missed.

NICHE team in Bristol, UK

L to R: Cath, Alistair, baby manikin, Jo, Jo, Julia

A NICHE team was supposed to be in Uganda at the moment, running the first Generic Instructor Course. The trip has been postponed because of an Ebola outbreak. Jo B-J, head of resuscitation services at Bristol and never one to miss a trick, persuaded 4 of us to go to Bristol instead to teach on the GIC her department was running. It was a great course, well run as always with lots of learning at every level.

Impromptu meeting to discuss Jo, the educator’s, plans for remotely supporting the Ugandan GIC instructors prior to a rescheduled visit

It was good to meet the new members of the instructor team face to face. Jo is an experienced educator with the Resuscitation Council and Cath is a neonatal consultant with overseas experience who instructs on a variety of neonatal and paediatric life support courses as well as the generic instructor course. I am very much looking forward to working with both of them at Bwindi – hopefully in February 2023.

A fine team to be part of

First Neonatal Care Course in the Far North Region of Cameroon

Dr Alison Earley

B marks Maroua, the main city in the far north region of Cameroon, a 36 hour journey by bus from Yaoundé

The Far North Region of Cameroon is at the Northern tip of the country, between Nigeria and Chad. Its capital is Maroua, which lies to the East of the Mandara mountains.

Pictures from the Mandara mountains

This is where Cameroonian Instructors are currently teaching the Neonatal Care course. Two of the instructors did their instructor training in Yaoundé in April this year, when NICHE International volunteers visited to facilitate the course. Other instructors are more experienced and have taught on several Neonatal Care Courses before.

Faculty member, Felicia, ready for action at Maroua CBCHS health facility


The perinatal mortality is particularly high in this remote region, and the course is much needed. The instructors travelled for 36 hours from Yaoundé, Cameroon’s capital, to reach Maroua where they are training healthcare workers in the Cameroon Baptist Convention Health Services facility. The majority of the health care workers in the Region are French speaking, and the course manual has been translated into French for them.

Felicia in action, training nurses and midwives in neonatal resuscitation

They shared their past frustrations and said this course will help them to save many lives

Grace on the learners’ feedback after course number 1 last night

Empowering local healthcare staff

Mme Ngome Vivian, recently trained NCC instructor, returned to her health facility and delivered training on the oxygen concentrator

The Neonatal Care Course is a short, stand alone course on the care of the newborn baby in the first 28 days of life but the ripple effects of the training are far-reaching. NICHE believes that training local instructors leads to this sort of – hopefully long lasting – empowerment. Many oxygen concentrators are abandoned or broken because they are poorly maintained or not fully understood. Here, Vivian is teaching staff at Nkoabang Baptist Health Centre how to look after this vital piece of equipment.

Nkoabang Baptist Health Centre, 15 miles outside of Yaoundé, Cameroon

The transcript below is Vivian’s WhatsApp message to Grace in Cameroon, delighted that a baby’s oxygen saturations came up so demonstrably after she had overhauled the concentrator and got it working again:

[5:00 pm, 25/05/2022] NDZE GRACE BONGBAN: Greetings to everyone in the house above is my first presentation on oxygen concentrator to the staff body in Nkoabang Baptist health center infact i really thank Ma Grace and Daddy Justin Fombe for the knowledge I have rescued a patient’s life today we had a patient whose saturation stood at 88 just from cleaning changing distilled water, positioning and ventilation saturation is now 91 dear colleagues let’s pass this knowledge to safe lives on another positive note i emphasized on the need for a projector and we bought one to facilitate teaching
[5:00 pm, 25/05/2022] NDZE GRACE BONGBAN: Also did a presentation to MCH Staff today on convulsion and there was a lot of learning
[5:00 pm, 25/05/2022] NDZE GRACE BONGBAN: We keep on putting our knowledge into practice and results will be visible