The First Training Visit 2008

St Mary’s Hospital, Isle of Wight (UK)-Juba Teaching Hospital, Southern Sudan Link

 

Report on the First Training Visit of Senior Healthcare Professionals from St Mary’s Hospital,Isle of Wight, UK to Juba Teaching Hospital, Southern Sudan

October 2008

 

Registered Charity No. 1123754
Patron : Baroness Cox of Queensbury
Contents Page

Introduction 3
Activities during the visit: 3
• Surgery 3
• Midwifery 4
• Mental Health 5
• Education 5
• Strategic 5
Observations and Impressions: 6
• Surgery 6
• Midwifery 7
• Mental Health 8
• Education 10
• Strategic 10
Recommendations 11
Acknowledgements 12
Appendix 1 – Postgraduate Education & Training for Doctors 13
Appendix 2 – Clinical Tutor job description 16
Appendix 3 – Teaching Room 17
Appendix 4 – Nursing/Midwifery Training 18

Introduction
“The healthcare situation in Southern Sudan is dire and your support will help to make a very important contribution at this critical time.”
Caroline Cox (2008)
The St Mary’s Hospital-Juba Teaching Hospital Link has been set up specifically to help South Sudanese healthcare professionals to develop their skills, thereby building capacity and developing self-sufficiency. The key activity is to arrange for experienced trainers to go to Juba Teaching Hospital and undertake intensive training. The programme has already started with a fact-finding visit in March 2008, followed by this the first training visit in October 2008. Clinical attachments have also been undertaken by 2 Southampton medical students and 2 junior doctors.
Our aim is to send around 20 trainers per year for periods of 3-4 weeks each across the whole spectrum of healthcare. These trainers are not paid and many volunteers are willing to use their annual leave. Hence fundraising is needed but only for travel and accommodation. Accommodation is relatively expensive in Southern Sudan but we are currently working with the Ministry of Health (Government of Southern Sudan) with a view to collaborating to build a 6 bedded bungalow for use by visiting trainers.
It is also hoped that further links can be made with other hospitals in Southern Sudan so that this or similar programmes can be rolled out across the Region.
Visit to Juba 6-25 October 2008
This was the first visit by senior trainers and the team consisted of :
Tim Walsh, Consultant Surgeon
Jane Salih, Consultant Psychiatrist
France-Marie Reed, Midwife
Zorina Walsh, Educationalist

Accommodation was kindly provided by the Ministry of Health (GOSS).

Activities during the visit

Since this was the first training visit time was necessarily spent gathering information and organising programmes. Thereafter, the following teaching activities were undertaken:

• Surgery – Tim Walsh
(a) A course on Applied Physiology for doctors in training. This ran over 6 afternoons and covered topics including – cardiovascular physiology, respiratory, renal, acid-base balance, gastrointestinal, liver and biliary tract, endocrine, energy/nutrition and the physiology of the nervous system. It was directed towards surgical applications but was appropriate for postgraduate doctors in all specialties.
(b) A course in The Management of Trauma for doctors in training. This ran over 5 afternoons and covered topics including – initial assessment, airway management, breathing, chest injuries, shock, abdominal trauma, head injuries, spinal injuries, musculo-skeletal trauma, burns and trauma in children.
(c) The doctors are particularly busy during the mornings and it was not possible to free
them up during this time for formal teaching. This however provided the opportunity to attend ward rounds, outpatient clinics and operating lists and the undertaking of bedside and some operative teaching . These sessions were an excellent means of gaining an understanding of the issues involved in practising surgery in Southern Sudan and hopefully provided some positive influence on that practice.

• Midwifery – France Reed
a)Initial discussions with senior staff in an effort to assess training needs and priorities
b)An intensive 3 day workshop for midwives. The contents of this workshop were
determined in conjunction with Janet Michael (Director of Nursing and Midwifery) and Jemelia Sake(Registered Midwife).

Day 1. Antepartum care including : taking a history, blood pressure, testing urine, palpating
abdomens and auscultating fetal hearts. Documentation of findings was stressed.

Day 2. Intrapartum care
Revision of mechanism of labour, normal progress, documentation on partograph
Third stage of labour
Degrees of perineal tears, suturing
Taking a baby at delivery

Day 3. Obstetric emergencies
Antepartum haemorrhage
Pre-eclampsia
Shoulder dystocia
Post partum haemorrhage
Resuscitating a baby
Documentation of all the above

c)The rest of the time was spent working on the maternity ward.
d)FR also appeared on the local radio station. This was a live phone-in and she answered questions from the public mainly about maternal and fetal mortality. This was a useful health promotion platform.
• Mental Health – Jane Salih

This was very much a fact finding visit as there was no prior knowledge of facilities for Mental Health, either in Juba or South Sudan. Teaching of ward nurses was limited due to language
problems. The nurses did not speak English and were general nurses, either certificated or student. Limited patient discussion was possible. Some joint clinical assessments together with the medical assistants and physicians were undertaken as was the teaching of medical assistant students.
Lectures were given on:
General concepts of mental health and mental disorder
Disorders of mood
Schizophrenia and other psychoses
Perinatal psychiatry
Psychopharmacology
Anxiety and other neuroses, post traumatic stress disorder
History taking and mental state examination

Role play of common conditions
Hand outs were provided including the Royal College of Psychiatrist’s information sheets on the above.

A fact finding visit to the Juba prison, containing male and
female wings for severe Mental Illness

• Education – Zorina Walsh
(a) Review of the facilities for postgraduate education at Juba Teaching Hospital. This included the requirements for a teaching room and the facilities provided by the Resource Centre.
(b) Review of the structure and organisation of postgraduate medical/nursing/midwifery education and training. This included how the Link could help in re-starting nursing and midwifery training, the possibility of local postgraduate training programmes for doctors, the supervision of training at Juba Teaching Hospital and how the culture of education and training could be promoted.

• Strategic : Three of the team (TW,ZW,FR) met with the Director General, Nursing &
Midwifery (Janet Michael), the Medical Adviser for the Joint Donor Fund (Bengt Herring) and the Deputy Medical Director for JTH (Dr Thomas ) on the 8th October 2008 and subsequently with the Undersecretary of State of Health (Dr Monywiir Arop Kuol) on the 24th October 2008. All 4 members of the team also attended a meeting with Dr Yatta Lugor( Director of Curative Services, Janet Michael and Dr Olivia Lomoro (Director General Research, Planning and Health System Development). JS and ZW had a meeting with Dr Lomoro on the 9th October 2008. FR had a meeting with Janet Michael and Jemelia Sake, Registered Midwife and Dr Mergani, Consultant in O & G on the 7th October 2008. FR also had a meeting with a UK trained midwife (Magda) who works for the UNFPA on the 23rd October 2008.

At these meetings a broad range of issues was discussed including the development of postgraduate training and education in medicine, nursing and midwifery, infection control, supply of basic medical equipment to Juba Teaching Hospital, the need to develop specialties such as Mental Health, Anaesthetics and Microbiology and the possible development of Clinical Tutors in hospitals to promote education and educational supervision. We also discussed issues around developing the Link, what we could do to help to improve skills training and the feasibility of building a 4-6 bedded bungalow to accommodate trainers in partnership with MoH (GOSS). These were very positive meetings and led to definitive proposals (see below).

Observations & Impressions

• Surgery :
a) Course in Applied Physiology. This course was attended by approximately 20 doctors each day. Feedback was generally good. Out of a total of 35 responses the overall assessment was Excellent in 23 and Good in 11.

Comments clearly indicated a desire for more teaching. There was also a desire for Powerpoint presentations plus handouts. The course was aimed at the level of a postgraduate doctor in training who is considering taking the postgraduate examinations. Basic knowledge of attendees varied considerably but many clearly had the potential to progress in postgraduate training. About half of the doctors attended most sessions but there was also a significant number who only attended a few. Punctuality was poor. Much of this relates to them having other commitments but the development of education does require an understanding of time management and the concept of dedicated educational time.

b) Course in Trauma Management. The attendance, feedback and comments regarding this course were essentially the same as those for the course in Applied Physiology.

One issue that inevitably arose during the trauma course was the severe limitation on resources, equipment and personnel which exist at Juba Teaching Hospital compared with Western style hospitals. These deficiencies did require some modification of teaching content but it was also clear that the priorities were not for complex, expensive items such as ventilators or CT scanners. There needs to be a consistent supply of basic equipment such as a sucker and oxygen and the reliable ability to do simple investigations such as haemoglobin, cross-match and chest x-ray promptly. However, the most important priority is to develop skills in the management of the critically ill patient. Airway management is especially vulnerable and we would strongly recommend the training of some medically qualified anaesthetists at Juba Teaching Hospital.

c) The Wards, Outpatients & Theatres
The surgical wards are fairly basic but clean and tidy. There are a large number of patients, many of whom have had road traffic accidents or gunshot wounds. Notwithstanding the comments above, I was impressed by the positive outcome of those trauma patients who were admitted to the surgical wards. Many patients had open wounds and open fractures and I was informed that the incidence of wound infection is high. There is a relative lack of handwashing facilities on the wards. Possibly control of infection is an area for skill development, especially with the appointment of a Microbiologist.

The Outpatient Department at Juba Teaching Hospital is the main point of entry to the hospital. It functions as a combination of Accident and Emergency and Primary Care. Patients who come with elective surgical conditions are referred to the Surgical Referral Outpatient Clinic and similarly for Gynaecology, Paediatrics and Medicine. To all these clinics patients appear to arrive at the beginning of the morning and just wait. This leads to a feeling of chaos which does gradually evaporate as the day wears on and patients get seen. The junior doctors do get good practical experience in these clinics. They are supervised, especially in the elective clinics and diagnostic skills appeared generally good. The operating theatres have recently been renovated by means of a Turkish grant and appear totally fit for purpose. Surgery is of a good standard with good learning opportunities for the trainees but there are very few trained specialists. Again, anaesthetics is a vulnerable area. Most anaesthesia seems to be undertaken by Ketamine or spinal anaesthesia.

In general these clinical areas provide good educational opportunities and a possible area of focus for the Link.

• Midwifery

The visitors found the staffing structure of Maternity and exact qualifications of members of staff somewhat confusing. There are 2 Registered Midwives at JTH. The rest of the staff are “certificated” nurse/midwives who appear to have varying levels of training, ranging from 6 months to a year. There are also some newly qualified community midwives who had had a slightly different training and were working at JTH to consolidate their skills prior to working in outlying villages.

In the villages there are Traditional Birth Attendants (TBA’s) who have little or no formal training and rely upon skills passed on to them from other TBA’s.

The nurse/midwives in general speak very little English and communicate with the patients in Arabic. The Registered midwives and Community midwives have good English skills.

A number of practices were observed that would not be recommended in a UK hospital, for example, fundal pushing at the second stage of labour, not waiting for the head to restitute before delivery and not feeding the babies within one hour of birth. There is a very good rate of breast feeding but a high mortality rate in children under 5.

Placentas are given to the attendants to take home but they are invariably flushed down the lavatories. We saw the consequences of this during our visit because the drains became blocked.

Pathology is restricted at JTH. No complex tests can be undertaken and often even simple tests have to be undertaken elsewhere at a cost to the patient. Families commonly have to look for blood donors. There are sonic-aids but often no gel .
One tragedy observed was the death of a 23 year old woman and her twins. She was delivered at 34 weeks because she was pre-eclamptic but this developed into eclampsia. An attempt was made to repatriate her to Uganda because of the lack of any form of intensive care at JTH but unfortunately she died prior to transfer.

• Mental Health

Mental Health care is understandably under-provided for in South Sudan. There is no mental health legislation and as yet no mental health strategy.

The Psychiatric ward is at the far end of Juba Teaching Hospital. This Ward 11 also houses the beds for sleeping sickness patients. The inpatients’ bedrooms are cell like. There are 3 to 4 single units with minimal or no furniture, lockable but often broken doors and a high window opening inside.
Less ill patients share open rooms with beds. There are no communal rooms other than toilet and shower facilities. Relatives supply basic care and food. The hospital currently has no food supply provision for patients without relatives.

a) Medical staffing
There are 2 experienced Medical assistants who are held in high regard by patients, families and nurses.
The senior is George Nazario who did a 3 year general nurse training followed by a 2 year diploma in sciences and public health. He completed a 3 year specialist training in psychiatry at the Tigani al-Mahdi Mental hospital in Khartoum. He and his colleague perform all the functions of medically trained psychiatrists in the UK. A third Medical assistant is responsible for patients with sleeping sickness.

b) Psychiatric Office
There is one small office for the medical assistants and the councillor. Clinic patients and their families are seen in this room. They wait outside on the veranda and self refer or are referred on from general wards and out-patients. There is one general trained nurse and no secretary.
Clinical records are minimal. The patients and their families have great respect for the staff.

c) Treatments
Disturbed patients receive a rapid tranquillisation by intra muscular injection. Families help to restrain the patients and are generally responsible for care. Physical examination and observations are not routinely performed. Medication supply is limited to chlorpromazine, an antihistamine and diazepam. Many patients also need treatment for malaria. Electro-convulsive treatment is no longer used as it would be unmodified without an anaesthetic .

d)Prison Psychiatry
Juba prison covers the state of Central Equatoria. Psychiatric patients are located in the Lunatic wing. Patients are not criminal and not subject to criminal legislation. The family apply to a magistrate for a committal order on grounds of insanity and public and personal safety. The male wing houses 22 or more patients. The wing when necessary takes in young teenage males developing psychosis who on occasion stay for several years. There are no beds nor other furniture nor evidence of activities. Bathroom facilities are minimal. It is staffed by prison guards
Very disturbed patients may be managed in shackles and chains. There are 2 clinical assistants who administer medication and the prison has several councillors. George Nazario visits several mornings a week and works with dedication in extremely basic conditions. A gruel is provided with the morning medicines and there is a mid day meal. There is a chapel and family visits occur. Medication is supplied from Khartoum but the supply is not constant. Unlike the hospital an atypical anti psychotic is available. Physical health is poor including malnutrition, dysentery and malaria.

The female prison is adjoining and has a more family atmosphere with several young children playing. There were 6 females classed as non criminal lunatics in locked cell -like bunkers.

The Governor General of the prison was in full agreement with the health professionals that the mentally ill should not be located in prison and should be managed in a modern unit by skilled health professionals.

e) Training
Currently there are no medically qualified doctors working in Psychiatry in Juba. It would help if mental health training modules are included in both undergraduate and postgraduate nurse
training. The medical assistant students are a very able group and several of them wish to specialise in mental health. A training and career structure needs to be agreed. Similarly the health assistants who work with them in remote areas will benefit from mental health modules in their shorter training. The strength and cohesiveness of the families has a very positive effect on care and
recovery. Doctors in general would benefit from more knowledge of acute mental illnesses as patients are often located on general wards and include failed suicide attempts. Overseas trainers would be more effective if they have a grasp of basic Arabic.

• Education
Review of facilities:
• Juba Teaching Hospital has a well equipped Resource Room with 6 computers linked to the internet and a fairly well stocked library. This room is managed from Tombe Francis and was supported through USAID Capacity Project.
• The hospital is in need of a dedicated education/training room and the Old Laboratory was identified as being very suitable. ZW wrote a proposal to equip this room and it was sent to USAID and to Dr Dario Kuron Lado, Director General of JTH. (See Appendix 3)

Review of structure:
• Medical – there is no defined career path for doctors in Southern Sudan. They qualify, generally in Khartoum, and are then sent out to the teaching hospitals for their one year House Officer posts. Following this they are sent out into the districts to practice single-handed, lacking knowledge and certainly experience . This is very daunting for these young trainee doctors. All the doctors we spoke to wanted to develop their careers and training but considered the only opportunity would be either to go to Khartoum or overseas. The opportunities available for this are very extremely limited.
• There are only very occasional postgraduate training sessions being held. There needs to be regular teaching with “protected time” away from the wards and theatres. In addition, there should be bedside teaching and training in audit and research.
• Nursing/Midwifery – again, there is no defined career path for nurses at present. Most of the nurses and midwives are certificated with only very few who are Registered. MoH (GOSS)policy is to develop the training of Registered nurses and midwives but at the moment the Schools of Nursing and Midwifery (formerly located in Khartoum) are not admitting students. At present there only 2nd and 3rd year nursing students at JTH and the 3rd year students are often in charge of the wards.

• Strategic:
The visit allowed wide-ranging discussions with the staff at Juba Teaching Hospital and officials at the Ministry of Health (GOSS), mainly on educational issues. These included discussions about educational facilities and supervision, nursing and midwifery training, postgraduate medical education, the underdeveloped specialties, particularly Mental Health and Anaesthetics and supply of equipment. The findings of the visiting team are described above. There was good general agreement. Indeed, it should be recognised that the impressions and recommendations presented in this report are largely those expressed to us by the staff in Juba Teaching Hospital.

We also discussed the possibility of building a bungalow to house visiting trainers from Link and possibly others. This would save money in the longer term as accommodation is very expensive in Juba and the Link has already collected £25,000 (UK pounds) specifically towards the building of such accommodation. We looked at various sites, including land which had kindly been offered by His Grace the Archbishop and land owned by the ACROSS Charity. Although both these generous offers were suitable as sites they were a significant distance from the hospital. The preferred option is to build on the site of the doctors accommodation just opposite Juba Teaching Hospital, where land is available. MoH (GOSS) expressed willingness to develop this accommodation in partnership with the Link. The requirements for the Link are simply a 4 bedroom bungalow although Juba Teaching Hospital will probably need more accommodation in the future. It has therefore been agreed that we will get designs for a 4-6 bedded unit which could be erected as a single unit but also with the flexibility to extend it up either upwards or to the sides.

Recommendations:

Education in General
• Equip a dedicated teaching/seminar room with Powerpoint, blinds, etc.(Appendix 3)
• The concepts of dedicated training time, time management, multi-professional team working and communication skills do need further development and in the opinion of the visitors would enhance both the culture of education and patient care.
• The training of skills is paramount and a culture of education needs to be developed both at JTH and also the other tertiary centres of Wau and Malakal.
• Courses need more detailed planning in advance of a visit. Visiting trainers should transmit details of their courses with sufficient time for JTH to organise and advertise. In general they should be Powerpoint presentations with handouts and directed to specific groups who are either released for the sessions or available for the course outside times of main commitments. Courses should be open to others outside JTH.
Medical Education
• There is a need to develop a structured programme of postgraduate education and training for doctors, especially in the major specialties. This will be difficult initially in view of the limited numbers of specialists but can be done by utilising some local and some overseas training. A suggested structure is attached as Appendix 1.
• We would recommend the appointment of a Clinical Tutor at JTH. An outline job description is enclosed as an appendix 2
• The development of specialties outside the established ones of medicine, surgery paediatrics and obstetrics/gynaecology needs serious consideration. We found mental health and anaesthetics to be particularly deficient. How these services are delivered and hence how training is provided needs urgent attention.
• We would recommend the appointment of 2 medically qualified anaesthetists who should be given appropriate training. Apart from their anaesthetic role they should also have commitments to the development of resuscitation and airway management of critically ill patients in the Outpatient Department.
• We welcome the appointment of a Microbiologist who should also undertake responsibility for control of hospital infection.

Nursing/Midwifery Education
• Nursing and midwifery training requires the appointment of qualified tutors. The Link can provide nursing and midwifery support (See Appendix 4). We will also see if it is possible to identify tutors who may be willing to spend a year at JTH to get the Nursing and Midwifery schools restarted. We understand there is a detailed curriculum developed by the African Medical Research and Education Foundation.
• Nurses/midwives must be encouraged to use the new hand-held notes and to document all procedures.
• There is a need for the teaching of English to be developed, especially as part of the nursing curriculum.
Other Issues
• Equipment at JTH is limited but the major priority should be to ensure continuity of supply of basic equipment rather than more advanced equipment, such as CT scanners, ventilators and dialysis machines. Advanced equipment should only be procured once there are the skills to use it. Lack of consistency of supply of basic items such as essential drugs, gel for sonic-aids in Maternity, x-ray film, etc. remains a major and correctable problem.
• Malnutrition as an exacerbating factor to disease in patients, especially children, is clearly recognised. There is also a need to address the problem of in-patients who have no available relatives and hence no immediate supply of food.
• There should be a placental pit for the safe disposal of placentas
• The new maternity theatre needs to be opened as soon as possible as patients are currently being transferred from one building to another whilst in labour
• The development of accommodation at JTH for visiting trainers would make an enormous difference, both to the St Mary’s Hospital,I.W.—Juba Teaching Hospital Link and also to overall training capacity at JTH.

 

 

Acknowledgements : Our heartfelt thanks to the Government of Southern Sudan (GOSS) and to Juba Teaching Hospital for their continued support and hospitality. We would also like to thank the many donors to the charity on the Isle of Wight and in the UK.

Appendix 1

Postgraduate Education and Training for Doctors in Southern Sudan (Initial observations from the St Mary’s Hospital,Isle of Wight-Juba Teaching Hospital Link)

Postgraduate education and training for doctors in Southern Sudan at present appears to be virtually non-existent. Trainee doctors are dependent upon their own initiative for developing their careers and believe that any training programme or career development occurs either in Khartoum or in another country. This is unacceptable and steps are required to develop a local training structure or one which maximally utilises local educational opportunities. This would have enormous advantages in attracting doctors to Southern Sudan and would lead to progressive improvement in clinical care.

The lack of resources and limited numbers of skilled trainers will almost certainly necessitate such postgraduate training to be developed gradually but as a first step I would suggest that there is a need to institute firstly a body to oversee the development and quality of training and secondly a body to validate the training and qualifications obtained.

In practical terms could I put forward the following suggestions for discussion?

1. The development of a College of Physicians and Surgeons. I believe this should be a semi-independent organisation, not Government controlled but where GOSS (MoH) has representation at the highest level (i.e. on Council). It would develop training programmes in all the medical specialties, oversee training and ensure quality, both of training/education and also ?service. This body would conduct examinations in due course and although comparable to such colleges in other countries would be adapted to the needs of Southern Sudan.

The South Sudan College of Physicians and Surgeons (SSCPS) would look after all doctors in training including House Officers, develop a curriculum in each specialty, review training posts to ensure that they provide both adequate experience and education, determine rotations necessary for a broad training in the specialty, develop assessment methods and register rotations.

2. A South Sudan General Medical/Dental Council (SSGMDC), whose role would be to validate and certificate doctors, dentists and specialists. This body would need to be run predominantly by doctors but in my opinion should be a statutory Government body.

Details of training programmes need to be developed by the College of Physicians and Surgeons. Some trainees will apply for training in Khartoum as at present. The severe limitations on numbers of experienced senior doctors will mean that the numbers of trainees on South Sudanese structured programmes will initially be small and some training will need to be done outside Southern Sudan. However, there is a wealth of clinical experience and training opportunities available. With proper organisation and a commitment to training by local Consultants a significant proportion of a significant number of programmes could be delivered in Southern Sudan. These programmes will gradually produce, increasing the numbers of specialists and in time allow full programmes to be delivered in Southern Sudan.
An example of a training programme in Internal Medicine which could be started almost immediately is as follows:

 

 

 

 

Subject to passing (but as numbers increase there may need to be competition)


Part II Examination – either locally developed by SSCPS or an equivalent overseas exam.
Specialist status would depend upon undertaking this programme satisfactorily and passing the appropriate exams. The awarding of Specialist Status would be by the SSGMDC.

Costs: The above proposal would require some set-up costs for a South Sudan College of Physicians and Surgeons and for a General Medical and Dental Council but these costs would be minimal and only required in the initial stages.

Overseas training is comparatively expensive but as long as steps are taken to ensure that the right trainees are funded and that trainees return to Southern Sudan it is likely to be a very cost-effective way of developing the pool of specialists in the country. As the numbers of specialists increases so can training be taken over locally.
Tim Walsh,MS,FRCS, Hon FCPS (Bangladesh)
Consultant Surgeon (Retired)/Juba Project Lead

Appendix 2
JOB DESCRIPTION
(Please note this job description originates from a UK hospital and details may need modification for JTH)

1. Job Details

Title: Clinical Tutor or Director of Medical Education
Remuneration: 3 sessions per week
Responsible to: Director General or Medical Director
Location: Juba Teaching Hospital
2. Job Purpose
 Provide educational leadership for all involved in medical education and help raise the profile of medical education in the hospital
 Oversee the Continual Professional Development of all trainee medical staff
 To identify and ensure that the educational and pastoral needs of all trainee doctors in the hospital are being addressed

3. Key Result Areas
 Write an Annual Business Plan for Medical Education and request funds as appropriate
 Liaise with other educational leaders to develop multiprofessional learning
 Provide training for Educational Supervisors and Consultants for their educational role
 To ensure that non-training grade doctors or medical assistants receive the necessary education, support and careers advice
 To inform the development of a Knowledge Management strategy with regard to the doctors needs for library services, e-learning and Information Technology

4. Principle communication and working relationships
 Medical Director
 Human Resources
 Senior Nursing Management

Personal Development
Tenure: Normally for 3 years, subject to annual appraisal of the key result areas by the Medical Director or Director General

Appendix 3
St Mary’s Hospital, I.W. – Juba Teaching Hospital Link

Proposal for a Teaching Room at Juba Teaching Hospital

The visiting team feel it is essential to have a dedicated room for teaching. The Old Laboratory appears not to be used anymore and would be eminently suitable. It was used during the visit by our midwife who undertook a 3 day workshop and by the surgeon for trauma management training. The room would hold approximately 25 people comfortable and is light and airy and easily accessible.

It is suggested by keeping this room dedicated for teaching purposes nurse training could be undertaken in the mornings and each specialty in medicine could have an afternoon for junior doctor training. Specialties should agree amongst themselves which afternoons they would have for training. This would free up the main conference room for important meetings.
The following requirements would be essential :
Replace broken glass in the door
Put up blinds or curtains
Ceiling mounted data projector
Chairs
Table
Flip chart and paper and pens
Air conditioning
The costs of equipping this room need further discussion. However, it is possible that a data projector could be brought by the visiting team in March 2009. Although it is not essential for it to be ceiling mounted it is much safer and there is less wear and tear on the machine. The bulbs and replacement items for this piece of equipment are extremely costly so the less it is moved around the better.
ZW applied to USAID through the Capacity Project to see if funding was available but this was unfortunately rejected due to lack of funds.
Zorina Walsh
Education Lead
17th October 2008
Appendix 4
St Mary’s Hospital, Isle of Wight-Juba Teaching Hospital Link

Proposed Outline Plan for Nursing/Midwifery Training

Main Issues:
• The skills demonstrated by Certificated Nurses and midwives(e.g. baseline observations and delivery technique) are variable and generally weak.
• Weak communication skills in English
• Non-function of the School of Nursing at JTH
• The policy of GOSS (MoH) emphasises the training of Registered Nurses and Midwives
Proposals:
1. Training of Registered Nurses/Midwives:
The Schools of Nursing and Midwifery at Juba Teaching hospital need to be reopened and to a standard that can train Registered nurses and midwives. The key requirement is to appoint 1-2 appropriately skilled and experienced Tutors to lead each of these schools. We will make enquiries as to the possibility of finding such individuals – possibly through The Tropical Health Education Trust or Voluntary Services Overseas.

The Link can also help by providing specific training modules and on the job skills training to students.

2. Certificated Nurses and Midwives:
These nurses and midwives will continue to provide much of the frontline care of patients for the foreseeable future and may wish to progress to Registration. The Link can help with the training, especially of basic skills and competencies –for example:

a) A basic nursing course. This would teach basic competencies such as :
Observations, recognition of sick patients and simple ward procedures. There would also be assessment tools and subject to satisfactory completion a certificate of attendance would be issued. The course to be approximately 12 x 1 hourly sessions and could occur twice a year.
b) A more advanced course (to be developed).

3. There is also a need to promote English language teaching as part of the Nursing and Midwifery studies.

Tim Walsh,BSc,MS,FRCS,Hon FCPS (Bangladesh)
17th November 2008

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