SMP - Catriona Connelly

Scotland Malawi Anaesthesia

Dr Catriona Connolly, Consultant Anaesthetist Ninewells Hospital, Dundee

Outline of talk

What we have done Challenges Future plans Recommendations

Scotland Malawi Anaesthesia- summary

Refresher courses in anaesthesia and resuscitation Textbooks on each subject donated to every delegate Equipment donations

Total attendees so far:

93 Anaesthetic Clinical Officers (ACOs)

12 midwives, 12 Intensive Care/HDU Nurses

2 paediatric and one surgical Registrar

1 obstetric clinical officer

7 Malawian ACOs trained as trainers

Training in Anaesthesia- UK/Malawi

UK- Anaesthetists are doctors. Approx 8,000 in the UK Post graduate training programme of at least 7 years

Malawi – 4 physician anaesthetists in the country Clinical Officers: 3 year training programme as clinical officers 18 months training in anaesthesia Independent practitioners- max 2/3 in a dept but usually 1-2

NO POST GRADUATE EDUCATION PROGRAMME

Getting Started: July 05- Feb 06

Association of Anaesthetists of GB and Ireland Obstetric Anaesthetists Association World Federation of the Societies of Anaesthesiology

Paul Fenton Cyril Goddia

Request from Malawi: Refresher course obstetric anaesthesia, paediatric anaesthesia, trauma

management Advanced life support courses in UK

Inaugural course: Planning Feb-Oct 2006

Course design and key topics Textbooks and course materials Donated out-of-date disposables/Hardware

All delegates invited by local co-ordinator 16 Clinical Officers from all over Malawi 3 midwives, 2 nurses Pamela Johnston, Jo Thorp, Manchula Navaratnam One week Mixture of lectures, workshops, M&M, scenarios

Reflections on first course:

Lessons learnt: ACOs dedication, resilience, enthusiasm, resourcefulness Local co-ordinator workload Course Accommodation Feedback

Training The Trainers one-day course for developing countries- Royal College of Obstetrics and Gynaecology/ Liverpool School of

Tropical MedicineBritish Association for Immediate Care, Scotland (BASICs Scotland)

Refresher course structured to enable training and supervision of new trainers

Planning for sustainability

Proposal:

3 separate 3-day courses running concurrently-obstetric anaesthesia and trauma -paediatric anaesthesia and trauma -intensive care medicine

Run each set of courses three times

New Malawian instructors will attend one course then teach, under supervision, on two courses in the same subject

Plan for multiple crossover courses

3 day course ( obs/paeds/ICU)

DAY OFF/ Train The Trainers (TOTT)

3 day course (obs/paeds/ICU)

DAY off

3 day course ( obs/paeds/ICU)

Challenges

Books/Equipment Shipment of course materials Accommodation for delivery of the courses Funding Delegate expenses Course Co-ordination Faculty

Feedback

Requests for repeat courses /slides and handouts Specific points about the course content ( ECT, acute pain)

Two weeks is too long Sunday work not popular

Autumn 2008 course

Reorganised and delivered in 6 days

3 ACO instructors from 2007 on faculty

3 new ACO instructors attended TOTT and were supervised teaching on two courses

Key challenges raised by ACOs:

Facilitation of CPD by Malawi Ministry of Health (medical council introduced CPD but await funding from ministry)

David Corner/Jean Kerr- Meeting October 2009 for all interested

Internet access ( lessons from the GP twinning project?)

Intergovernmental collaboration: Support at Malawi Ministry of Health in procuringessential drugs( including oxygen) and equipment (??links with international health partners UK)

Supporting ACOs to run refresher courses themselves Multi-disciplinary courses

Co-ordinate future courses (all specialties)

-Scottish Clinical Advisory Board

-Local Malawian co-ordinator

-Scottish co-ordinator

Future Plans and Challenges

International Effort

NGOs - Unifem / White Ribbon AllianceManagement of maternal and paed emergencies Irish MOET Norwegian Paediatric anaesthesia ALSO Scotland Child Health Advocacy International Emergency Trauma And Triage English Refresher course

Within Scotland All medical specialties Nursing-Bell College Medical school collaborations NHS Tayside

Recommendations

Scottish Clinical Advisory Board (first mooted in 2006/7) Scottish and Malawian Co-ordinators Liaison at government level

Listen to the front line workers

Thank-you for your attention

Acknowledgements

Cyril Goddia Faculty members, their families

and colleagues Eric Borgstein Dept of O&G QEH Logima International, Fife( Donation of 100 sets of theatre

scrubs 2007 and 2008) Avian graphics Dundee( banners and stationery) Synermed Abbott Pharmaceuticals Fresenius Kabi

Scottish Government Humanitarian Health Fund

Scottish Society of Anaesthetists Royal College of Anaesthetists Association of Anaesthetists of

GB and Ireland Scottish Intensive Care Society Obstetric Anaesthetists

Association Advanced Life Support Group,

Manchester Local fundraisers-

runs/cycles/ceilidh/charity ball Forth Valley NHS Trust NHS Tayside

Scottish Faculty

Brian Carlin Paul Currant Colin Donald Hilary Edgcombe Chris Hawkesworth Jacqui Howes Drew Inglis Pamela Johnston Barry Klaassen Richard Price Caroline McQuillan

Rose McRobert Sam Moultrie Vince Price Michaela Salvadore Susan Somerville Steve Stott Jo Thorp Lyn Walton Nigel Webster Wayne Wrathall