The First Basic Medical Training Visit October 2013

Report of Basic Medical Training Programme Visit 7th-19th October 2013

INTRODUCTION:

This was the first training visit for the Basic Medical Training Programme which started in April 2013.  Two modules were delivered – in Mental Health and Acute Trauma Management respectively.  There were approximately 50 recently qualified interns who participated.  The interns were divided into 2 groups.  During the first week one group undertook the Mental Health module, the other the Trauma module.  They then swapped for the second week.  Because of the need to maintain a clinical service some doctors were required to do night duty and the doctors were only available to the course for approximately 5 hours per day.  There was a total of 5 specialist trainers from UK who were ably supported by Zorina Walsh.  In addition to that there was excellent support at a local levelfrom  Dr Francis Oromo, Dr Dario Kuron Lado,Charity Jabe Stanley, the staff of Juba Teaching Hospital and the MOH.  The courses were held in the School of Nursing and the trainers are very grateful for their help and support. We would also like to express our thanks to The Charitable Trust Foundation for contributing financial support for the visit and to Dahabshill UK who kindly provided 50  usb memory sticks onto which all the lectures were downloaded and given as handouts to the participants

Report on the Mental Health Module delivered for the Basic Medical Training Programme in Juba ,October 2013

The trainers were Dr Jane Salih/Newson-Smith, retired Consultant Psychiatrist, Dr Ashok Singh, Consultant Psychiatrist and Dr Shobha Singh, retired Consultant  Psychologist. These trainers developed a week long course, run twice, based on the WHO mental health GAP training programme which deals with mental health, neurological and substance use disorders.  It is primarily aimed at non mental health specialists ,aiming to develop competency in treating the vast majority of these disorders in non specialist settings and closing the GAP between treatments in low and middle income countries with those in high income countries The base course schedule is 35 hours. Our allocated times fell short of this as the doctors needed to return to ward duties for the latter half of morning or afternoon  This meant the whole group of 22 attended the first 2 hours and then the next 2 to 3 hours needed to be delivered to half the group in the morning and then repeated to the other half in the afternoon The course material included 11 modules. We did not include the 4 hour epilepsy module as this will be covered in medicine/ neurology later in the BMT programme.  We expanded teaching on Post Traumatic Stress Disorder and psychological treatments, particularly psycho education.  A lot of time was spent on interview techniques and the doctor patient relationship. Lectures were delivered by PowerPoint. It was possible to adapt the WHO teaching slides to reflect issues in South Sudan, as an emerging nation in a post conflict situation with minimal mental health facilities. Lectures were accompanied by hand outs which needed to be shared.  16 copies of  the WHO mhGAP Intervention Guide  for mental health, neurological and substance use disorders manuals were also shared. All doctors were provided with a usb memory data stick with the lectures, prepared by Zorina Walsh Numbers varied daily with some short attendees. 22 doctors regularly attended the course, run on 2 consecutive weeks The course was well received.  Some doctors had received minimal psychiatric training . They all felt it was relevant to their general professional training They particularly enjoyed the role plays of interview skills in different clinical scenarios usually  in groups of 3, the doctor, the patient and the observer. Some role play was done by volunteers at the front of class Teaching was supplemented by videos from the course which were well received Overall the teaching was successful and the feed back for individual modules and end of course was very positive. No one complained it was too great a contrast with the concurrently running trauma course Many wanted a longer course and availability for more doctors to benefit from the interactive teaching. They all felt much more confident in dealing with mental health patients. They would have liked teaching with real patients and  clinical teaching on the psychiatric unit . Unfortunately it did not prove possible to arrange this. Particularly popular subjects were psychosis, depression, Post Traumatic Stress Disorder, psycho education,  child and adolescent developmental and behavioural disorders They would have liked individual copies of the hand outs and also all to have the manual to keep Pre and post tests were carried out with significant result improvement A few doctors expressed an interest in a career in psychiatry. They were advised to seek advice early on from the Professor of Psychiatry

Report on the Acute Trauma Management  Module delivered for the Basic Medical Training Programme in Juba ,October 2013 The trainers in Trauma were Mr Dominic McCreadie, A&E Consultant and Mr Tim Walsh, retired Consultant Surgeon. The teaching modalities included lectures, demonstrations, practicals, role play and tutorials and concluded with formal assessments. RESULTS: The Feedback Assessments from the Interns was very complimentary and in particular expressed the desire/need for both longer training sessions and more modules and many stated that the training they had received already gave them more confidence with the care of their patients.  A number did state that they felt training should occur on real patients but the purpose of this course was to establish the principles of management of trauma. Practice comes later.  At the end of the course there was a very encouraging 90% pass rate based on attendance, a practical and an MCQ.  Two candidates were awarded a pass with Distinction having achieved 19/20 in the MCQ.

CONCLUSIONS:

1.  Although we are very grateful to the School of Nursing for providing the facilities for this teaching it is hoped that future teaching can be in the nearly completed Postgraduate Medical Centre.  This should allow for educational equipment to be readily available and feel like a home for postgraduate education for the doctors of South Sudan.

2. 25 students per class is a large number for this type of training.  Smaller groups would be better.  If possible not more than 20 per group.

3. We would recommend that trainers, especially for the Trauma module try to familiarise themselves  with the clinical  facilities in which the interns are currently working.  There will always be a difficulty in that doctors in South Sudan need to know about modern treatments but may not always be able to apply these in local circumstances.

4. Although the pass rate for the course was 90% it has to be recognised that the standard required was not particularly demanding.  Most of the interns spoke English reasonably well but there were some concerns that we may be speaking too fast. Punctuality, albeit better than previously, still needs improving.  It is clear that further post graduate training is required for these doctors just as it is in UK and that this training needs to be reinforced in clinical practice.

Update on the St Mary’s Hospital-Juba Link Bungalow.

The 6 members of the visiting team all stayed in the guesthouse situated in the grounds of the Doctors Mess at Juba Teaching Hospital.  We were the first visiting trainers to use this facility.  We would like to thank the House Committee in Juba, the Ministry of Health and particularly Denis Wani Santo, Charity Jabe Stanley and  Dr Louis Danga for making a great effort to make this habitable and comfortable.  In general, the bungalow is ideally situated, the rooms are spacious and comfortable.  Services such as food, laundry etc are all available nearby.  We feel that this will be a great asset to the Link.  1. There is a short “snagging” list which Tim Walsh discussed with  Denis Wani Santo, which are as follows : • A number of internal door locks do not work. • There is a need for more front door keys (in principle there should be 1 front door key available to the occupant of each room plus 2 spares to be held by Charity). • The switch to the air conditioning in the Lounge was not working and the hot water in Room 3 was extremely slow. • A number of strip lights flicker rather  than coming on but this may be related to the variation in voltage of the City electricity. 2. We need a definitive Statement of Account. 3. There needs to be an agreed protocol for  the booking, usage  and management of the rooms in order to ensure that they are used for the intended purpose and that there is some income in order to pay off the debt, to cover running costs and in due course support the training programme.

Authors : Tim Walsh Don McCreadie Jane Salih Ashok Singh Shobha Singh Zorina Walsh

7th  November 2013

 

 

 

 

 

 

 

 

 

 

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