Researchers from CMNH have delivered their newly developed Extended Comprehensive Obstetric and Newborn Care course to a group of 26 anaesthetists and obstetric resident doctors in Kenya. It was delivered over five days in Moi Teaching and Referral Hospital in Eldoret.
Feedback from staff was equally positive in Kenya, and in Nigeria where the course has previously been delivered, indicating that it meets a widespread need for training and support in this area of care.
The hands-on interactive training takes the form of a journey through evidence-based operative obstetric care, starting with training on appropriate decision making, informed consent, preparation for surgery, safe theatre practice, and managing anaesthesia and surgery in both straightforward and complex cases. It then covers assisted vaginal delivery, caesarean section and third and fourth degree tear detection and repair. The course concludes with teaching about care after surgery and counselling of the patient for the future. Teams of participants are then encouraged to formulate achievable action plans geared to improving safe practice in their facilities. CMNH staff provide ongoing mentorship support to assist with the realisation of these plans.
Anaesthetists and surgeons study together for much of the course but also benefit from specialised training sessions for issues unique to each speciality.
This training package is extremely timely. The publication of the African Surgical Outcomes study last week highlights a fifty fold increased mortality for women delivering by caesarean in Africa compared to developed nations. It identified perioperative haemorrhage and anaesthetic complications as factors independently associated with maternal mortality. Therefore, the introduction of this new advanced surgical and anaesthetic peri-operative skills training course, with an emphasis on team work and safe practice, is key to tackling the skill gap that is in part responsible for this burden of excess mortality.
Dr Helen Allott, Senior Technical Officer, CMNH:
"Caesarean section is the most frequently performed major surgical procedure. Its frequency belies that fact caesarean surgery is often complex and difficult, yet in many low resource settings it is performed by junior medical staff with minimal training or supervision. Likewise, inherently risky caesarean anaesthesia is generally undertaken by non-physician anaesthetists working in inadequately resourced circumstances. Equipping both surgeons and anaesthetists with the requisite knowledge and skill to provide safe surgical and anaesthetic care is essential if post-surgical outcomes are to be improved.
Whilst a five-day course alone cannot solve all the problems contributing to the excess mortality and morbidity associated with operative obstetric delivery, it can form the basis for a comprehensive programme of support and mentorship and foster a spirit of evidence-based multidisciplinary team work and co-operation that together can improve the quality of care for women and babies, leading to significantly improved outcomes."
Feedback from participants:
- “The training has been of tremendous help. It will really help in improving my skills in obstetrics practice and also help in reducing maternal morbidity and mortality in Nigeria”
- “It will really go a long way in improving my patient management and my overall contribution to health care delivery. I would like that this training is done all over the country as this will help to improve our health indices for this country”