Dr Alison Earley
This is the group of 11 Instructors who attended the first Instructor Development Day that NICHE has run. They came from 5 different Regions in Cameroon, and did their instructor training in 2016 and 2018. They are a mixture of doctors, nurses and midwives. All were keen to refresh and develop their skills as trainers and the course was lively and enjoyed by everyone.
We are delighted to be welcoming Dr Ferenc Sari to the team for this week’s trip to Cameroon. An emergency department doctor and an educator with the European Resuscitation Council, he has lots of experience of living, working and teaching overseas. We were on tenterhooks for his Covid PCR result as he has only recently recovered from the illness but all 4 instructors had negative results yesterday and are now en route to Yaoundé from Sweden, Northern Ireland and the UK.
The team has a heavy week ahead of them. They are facilitating the first ever Instructors Development Day (IDD) as well as a Generic Instructor Course (GIC) followed by two Neonatal Care Courses (NCC).
NICHE Instructors are excited to be returning to Cameroon later this month. We are piloting a specially written Instructors’ Development Day for the faculty members there to support their Continuing Professional Development. This will be followed by a Generic Instructor Course with two of the Cameroonian faculty beginning to train as instructor trainers themselves (see step 9 of the “10-steps to sustainability” plan) and two more Neonatal Care Courses (NCCs).
Over 300 healthcare professionals in Cameroon have been trained in the care of the newborn infant in the first 28 days of life and the team is beginning to see the positive effect on their neonatal mortality figures.
There were 29 feedback forms from the first two NCCs in Uganda. All candidates were frontline healthcare workers and 25 (86%) of them had had previous experience of neonatal resuscitation.
Proving that neonatal mortality is falling as a result of our project is our long-term aim but measuring this outcome is a challenge. 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.
It is more productive to measure shorter term outcomes which are known to correlate positively with an improvement in neonatal survival. We gather feedback from our learners on the usefulness of the course, their prior experience, suggestions for the future etc. but also on their increase in confidence levels in the practice of various skills taught on the course. The template for our feedback forms is based on one promoted by the UK’s Royal College of Paediatrics and Child Health for use on training courses.
Variations in self-confidence are known to influence motivation and tend to predict performance success. The percentage of learners in Bwindi in February feeling “very confident” in keeping babies warm increased from 17% to 100%, in giving breastfeeding advice, an increase from 24% to 100% post-course and in resuscitation skills, 7% to 93% feeling “very confident” after the course. Having the confidence to try and resuscitate an unconscious newborn baby is more likely to lead to a positive outcome than not having the confidence to make the attempt. Our data consistently show an increase in confidence in the essential skills pertaining to neonatal care identified by WHO. See: https://www.nicheinternational.org.uk/day-2-ncc-in-uganda/ for a screenshot of the questionnaires we use.
We are back in Entebbe now after 2 very successful Neonatal Care Courses, full of enthusiasm about returning in November to train the instructors we have identified.
Keeping babies warm is one of the things that reduce neonatal mortality. We promote it strongly throughout the course. It also promotes breastfeeding, reduces the risk of hospital-acquired infection, is important for bonding and leads to faster growth.
When we went to the neonatal unit initially, there were 5 babies (including a set of twins) between 33 and 35 weeks in incubators or being held by their mothers in piles of blankets. The doctor asked for help because none of them were putting on weight. Grace went to work…
All 5 had been discharged by the end of our week in Bwindi, all putting on weight. Well done to the nurses for being early adopters of KMC in Bwindi and for seeing the benefits straight away.
On day 3 of our visit, we noticed these pictures that had been put up in the anteroom to the neonatal unit where the mothers were waiting to see their babies.
On day 5, we did the round with the mothers actually present in the neonatal unit – the remaining 2 babies both skin to skin.
Having 2 of the 4-member team nipping off to the neonatal unit in the middle of the day is not easy on the 2 left behind holding the baby – literally. Jarlath and Kirstie have been doing sterling work covering for our disappearing acts.
At one point, we came back to the lecture theatre to find that Jarlath’s lecture on convulsions had attracted a 16th learner.
A premature baby (probably about 28 weeks gestation) was born on our first day in Bwindi. He weighed 1kg (2.2lbs). The paediatrician had just left the hospital and we were asked to help the young doctor pictured above who was covering the paediatric unit. Grace and Julia have visited daily for the last 5 days and supported the nurses in their excellent care of the tiny little boy who is now off CPAP and in skin to skin care with his mother for much of the day. It is normal for these babies to lose up to 10% of their birthweight and he now weighs 890g but is tolerating his expressed breast milk and I would expect him to start to put on weight from now on. He has had no blood tests, no x-rays and only homemade CPAP to support his breathing. He is a shining example of what good nursing care can do and we have used him throughout the course to illustrate what we teach about supporting preterm babies. These are the lives that can be saved by teaching staff the Neonatal Care Course.
We have been made most welcome here in Uganda for the first 2 Neonatal Care Courses and have been very impressed with the standard of care at Bwindi Community Hospital and the thirst for knowledge amongst the health professionals here.
We have identified 12 potential instructors and aim to return in November to run a Generic Instructor Course and 2 more Neonatal Care Courses. Fund raising over the next few months will be aimed at this next step of the 10 steps to sustainability plan.
My favourite lecture is the one on jaundice – a pet topic of mine. I was challenged today on my statement that congenital malaria can cause jaundice. Actually the challenge was whether the malaria parasites can cross the placenta. Grace – with a lot more experience of congenital malaria than me – came to my rescue. In Cameroon, she is now doing peripheral blood smears for babies born to mothers known to have malaria during delivery and is finding more cases than expected in the neonates being treated for sepsis. This evening, I looked it up.
Here are a few bullet points from the above paper which comes from just east of where I am sitting as I write:
I’ll report back to the learners tomorrow. They do not look for malaria here in babies born to mothers with active malaria but the paper suggests that may be testing is indicated. We all learnt something today.
