Life in Action

To make this post more fun, there will be some quizes for the readers.

I have got some of the pictures of my BEMONC (Basic Emergency Obstetrical and Newborn Care) students/trainees in action.

Students attending lectures. The training is really intensive-8:30am to 5:30/6:30pm for 18 days, First 8 days of lectures, skills demonstration and role play, then 10 days of practical on labour ward, antenatal clinic and post natal care.

Role playing.

Quiz: What are they doing here?

They are doing an “Energizer”! Since the training program is developed by JHPIEGHO (Johns Hopkins Program for International Education in Gynecology and Obstetrics), it follows very closely a western model including doing energizers- but in a very Ethiopian way. Sometimes a student will tell a funny joke or the instructor will lead everybody to perform some of their traditional synchronous moves which I find very interesting to copy myself.

Infection prevention and sterile technique are definitely something they need to work on. But how can you do a good job if this is all the gear of protection available? Some students said in their health centres, there were no sterile gloves, not to say sterile drapes and autoclaves…Not much is offered for the health workers to protect them from blood transmitted infection like hepatitis or HIV.

Much emphasis is put on disinfection of equipment with 0.5% chlorine solution, washing in soapy water in a bucket and scrubbing with a toothbrush, then rinse in clean water (but often tap water here is very muddy) and air dry.

Quiz: What do you think this is?

An innovative sponge anatomical model to practice suturing of perineal lacerations! Now you see all the female genital parts??

Quiz: What anatomical structure is this?

Come on, isn’t that obvious? With some imagination, you will see a uterus and it’s a model for practicing repair of cervical tears. See the line of stitches.

Newborn resuscitation- you can tell easily some of these health workers have never seen or laid their hands on an ambu bag!

Quiz: What are we doing in the dark?

In order to simulate close to real life situation, the power was out during class time as usual. So a good buddy spontaneously took out her mobile phone to act as a light source in order for her classmate to finish manual vacuum aspiration of retained products of gestation.

Quiz: Time for mid-term exam. How many students do you think make a pass on first attempt? (BTW 85% or above is their passing score. The reason why they set the passing mark so high is  these health workers  are out there by themselves saving lives, so they want to ensure all the BEMONC trainees  are competent and up to standard)

7 out of 14 passed (ie 50%) To my surprise, the instructors were very pleased saying this was amongst the best batch they had ever taught. Usually less than 25% passed on first attempt. Nobody passed on pre-course evaluation which was using the same questionnaire. I am happy to see everyone passed on the re-sit examination 10 days after.

More to follow .

Time to Do Some Work

It’s high time  for me to write about what I am doing here in Ethiopia. It’s a bit complicated to explain, but  I will try my best.

My volunteer placement is involved with the  BEMONC training of the health workers, midwives, nurses and birth attendants in the peripheral health centres. (BEMONC= Basic Emergency Obstetric and Newborn Care. At this primary level of care, it is now aimed to train the health workers to provide the following services: 1. assisted vaginal delivery- vacuum extraction 2. manual removal of placenta 3. management of postpartum hemorrhage 4. management of eclampsia 5. management of sepsis 6. manual vacuum aspiration 7. newborn  care and resuscitation but they do not have the services of the secondary referral centre of having blood transfusion and Caesarean section).

Often these health centres are staffed with health workers with very minimal medical training or very young and junior midwife totally on their own without much supplies, equipment and supervision. There is no doctors there.  They are often in very remote and isolated rural areas where the nearest referral hospital is  hours  if not days away.

In order to decrease maternal and  neonatal mortality in Ethiopia,  several partners and NGOs – the Federal Ministry of Health, UNICEF, JHPIEGO and Ethiopian Midwife Association have started an intensive 3-week  BEMONC training program aiming to train 2000 health workers in the periphery to provide better delivery service in the rural areas ( 500 health workers in the Amhara region where I station)

So my job has two  roles:

1. I am working as a facilitator at the BEMONC training program at the Felege Hiwot Hospital (NB. I am not a trainer. Since we encourage long  term development and skills transfer, all the teaching and training is done by the Ethiopian midwives. My role is to facilitate, giving  technical feedback and comments especially during skills practice sessions)

I had a student who had to travel 5 days to come from his village on the mountains to Felege Hiwot Hospital in Bahir Dar. He had to walk 3 days by foot before he hit the main road and then a 2 day road trip.

2. Another duty of mine is to develop an after BEMONC training program for monitoring, evaluation and support of these trainees after they return back to the isolated working environment . This  is to ensure they can get the support to practice and sustain the newly acquired skills and knowledge in the real life situation. For this job, I am basically sitting in the Amhara Regional Health Bureau reviewing literature, national and international standards and guidelines to develop  assessment tools for this purpose and writing up proposals.

So I am kind of a “government official” too haha! since my local “employer” is the Amhara Regional Health Bureau (To make things more complicated- my position is funded by UNICEF- so my desk is inside the UNICEF office)