Supervised instructors in full swing at Cameroon Neonatal Care Courses

Newly trained NCC instructors teaching their first course

It is always a great moment as an instructor trainer to watch someone you have just trained stand up and deliver a lecture, facilitate a workshop or teach a skill in the way that the Resus Council’s Generic Instructor Course (GIC) suggests. In the UK, we don’t often have the privilege of seeing this beautiful transition from student to teacher as people disperse after a GIC and teach on their provider courses at a different time. Because of the financial and environmental cost of NICHE volunteers travelling long distances to the countries where we are active, we now attach 2 NCCs to the end of every GIC to complete the new instructors’ training. And the rewards for the exhausted team of trainers are immense.

Keen midwives and nurses being trained in newborn care on the NCC currently going on in Yaoundé

These 16 healthcare professionals are learning about the care of the newborn infant in the first 28 days of life. (There should have been 4 more but it was too dangerous for them to travel down from Bamenda in the North West region of Cameroon which still has a significant amount of civil unrest). The learners are also providing the new instructors with the means to complete their training as instructors as each newly trained instructor has to teach on 2 NCCs, supervised by more senior instructors, in order to be fully fledged instructors themselves.

The NICHE team of 4 has been working very hard this week to deliver a GIC and these 2 NCCs. They started the week by running a one day instructor update for the established NCC faculty in Cameroon who have been courageously continuing the project throughout their country’s period of civil unrest and the pandemic.

You can read more about our first Instructor Development Day below.

“I am sending them out to blow their trumpets”

3rd Cameroonian GIC completed and the first 2 local GIC instructors have begun their training

This is what our programme manager for newborn training in Cameroon said today, as we were coming to the end of their successful “train the trainers” course.

Dr Ferenc Sari, European Resuscitation Council educator, and our educator on this week’s GIC course in Cameroon, has been impressed by the progress of the participants over the 2 days. We are privileged to be able to witness and support their first teaching experience which will occur when they teach on Neonatal Care Courses later in the week.

A GIC candidate taking Alison through a resuscitation scenario
GIC candidates discussing peer-to-peer learning

The Learning Conversation in Cameroon

The circle of trust

The learning conversation is a term used in adult education, and is a skill required for giving feedback to learners on their performance. A well-managed learning conversation should leave learners feeling “relieved, valued and clear about their next steps”. It is not an easy skill to master, and requires practice.

In Cameroon this week, NICHE instructors have spent a day refreshing the skills of newly qualified local Neonatal Care Course instructors. The learning conversation was one of the skills we spent time on together. During these sessions we sat in a circle with the candidates, sometimes know as “circle of trust”. This was a new concept to them, but they embraced the principles. The exercise emphasised the importance of trust, particularly as we all come from such different cultures and backgrounds.

Instructor Development Day, yaounde

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.

En route to Cameroon after being grounded for 2 years!

Skelleftea Airport in north Sweden

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.

Ferenc’s journey is probably the longest

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).

Back to cameroon later this month

Julia’s been packing up teaching equipment again

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.

It’s official! skin to skin care saves lives

https://www.nejm.org/doi/full/10.1056/NEJMoa2026486 takes you to the full text of this 2021 publication from WHO comparing survival data of low birth weight infants nursed skin to skin from birth with a cohort who only received a couple of hours a day of skin to skin care. The trial had to be cut short because the babies in the control group (couple of hours a day) had a significantly higher risk of dying than the babies in the intervention group (around 17 hours a day skin to skin).

Keeping babies warm workshop, Neonatal Care Course, Mutengene, Cameroon. June 2021

Grace gathered 9 of the trained instructors in Cameroon this month for a Neonatal Care Course which trained 36 more healthcare workers in the care of the newborn baby in the first 28 days of life. Quite a feat in a country battling with Covid and political unrest. Immensely rewarding for NICHE volunteers and trustees to see the programme up and running without much direction from us. Julia did try to “drop in” to some of the sessions via zoom on day 2 but the internet connection was so bad that, in the end, she gave up and let the Cameroonian faculty get on with it themselves. There’s only so much one can do remotely.

Today is International women’s day

Dr Alison Earley

It’s a day for dressing up in much of the world, a day to celebrate the work women do to make the world go round, a day of empowerment. The picture here is of Cameroonian women on International Women’s Day in 2018, learning how to resuscitate babies dressed in their International Women’s Day material that they make into powerfully beautiful dresses every year. We should make more of it in the UK really.

There are many achievements to celebrate on International Women’s Day, but we mustn’t forget that in resource poor areas of the world, maternal mortality (death related to pregnancy and childbirth) is still 5 – 10 times higher than in richer countries.

Many mothers still give birth in unclean or unsafe places, and without skilled help or adequate facilities.   This has a direct result on the survival of their babies; two of the leading causes of neonatal mortality are infection and intra-partum related events.

Education for healthcare workers and sustainable improvements in maternal and newborn care are the key to improving this situation.   NICHE International has a mission to improve the care of newborn babies, by the training we give and by supporting nurses, doctors and midwives to maintain their skills and improve the care they give to mothers and babies.

Training (predominantly female) nurses and midwives to be instructors on the Neonatal Care Course (NCC) empowers them to “Choose to Challenge” and make changes to their own healthcare systems from the bottom up.

Zooming to Cameroon

Local Cameroonian instructors, who are now organising their own Newborn Care Courses, ran an NCC last week in Yaoundé, Cameroon.  Some NICHE Instructors joined them for parts of the course via zoom from UK, to try out the technology and assess the feasibility of remote training.

We were able, remotely, to:

1. Demonstrate how to run a simulation (this was management of a baby having fits).  NICHE Instructors from their homes in London and N. Ireland did this on zoom at the request of Cameroonian Instructors who watched.

2. Deliver one of the lectures on the NCC course via zoom

3. Join the faculty meetings in Cameroon at the end of each day.

4. Join the candidates for certificate presentation at the end of the course.

This was a useful exercise as we are thinking about the practicalities of training online, in particular delivering ‘Instructor Development Days’ for Cameroonian NCC Instructors, which before the pandemic, we had hoped to be able to do in person in November.

There are some technological improvements to make, but generally it was successful.

It was a pleasure to see our Cameroonian colleagues, who keep going despite pandemic and political difficulties.

Some comments from candidates on the course:

  • The training was an impacting one with lots of skills and knowledge acquired.  I could have wish that all health personnel around the world be train if possible to augment care of neonates.
  • I am confident now that I can take care of a newborn very well as compare to what i was doing in my station, especially resuscitating asphyxiated babies immediately after delivery.

Universal health coverage (UHC)

“Universal Health Coverage (UHC) means that all people can access quality essential health services, without having to suffer financial hardship to pay for health care.”  Says the World Bank which teamed up with WHO in 2017 to monitor progress with this target. https://www.worldbank.org/en/topic/health/publication/universal-health-coverage-study-series

“Each year, close to 100 million people are being pushed into extreme poverty because of health expenses, and 800 million spend more than ten percent of their household budgets on health care. Achieving UHC is not just about better health outcomes. The overarching goal of the Sustainable Development Goals (SDGs)–ending extreme poverty–will remain out of reach without UHC.” [World Bank]

Achieving UHC is one of the targets the nations of the world set when adopting the Sustainable Development Goals in 2015 but, despite this, at least half the world’s population has to pay for some or all essential health services.  People in the poorest countries are the worst affected.

Colleagues in Cameroon, who have been trained by NICHE International to teach a Neonatal Care Course, recently taught this course in Yaoundé.  An important part of the course is the teaching of skin to skin mother care, also called kangaroo care.  This has many advantages and is advocated by WHO as a way of promoting the healthy survival of babies.

Premature baby being kept warm sustainably

Candidates on the course recognised these advantages -see comment below from one candidate.

  • I must comment I learnt a lot on demonstration of S2SMC (skin to skin mothercare) which i thought i could do it but just realised I was far below standard.  This training is so empowering.  Keep up.

However, a problem that became clear during the course, is that one of the hospitals in Yaoundé asks parents for payment whenever a baby is nursed in an incubator.  The hospital management is therefore unwilling for their nurses to introduce skin to skin mother care, as when a baby is nursed with his/her mother, the hospital does not get this payment.  This is despite the fact that skin to skin care is usually better and safer than incubator care, particularly in poorer countries.

There is still much to do to advocate for safe basic healthcare for newborn babies.

Read more on UHC at:

https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)