Report for International Relations Committee From Mothers of Africa Visit to Liberia February 2013

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1 Report for International Relations Committee From Mothers of Africa Visit to Liberia February 2013 Title of project: Liberian Association of nurse anaesthetists (LANA) annual conference: No mother should die whilst giving life Location(s): Phebe Hospital, Bong County, Liberia. Local co-ordinator(s) overseas: Mr Wilmot Fassah (Head of Phebe anaesthesia training program), Mr Garrison Kerwillian (President of Liberian Association of Nurse Anaesthetists), Mr Gogoe Augustine (Secretary of LANA and trainer at Phebe anaesthesia training program). The Liberian Association of Nurse Anaesthetists requested support from Mothers of Africa and the AAGBI IRC for a national conference to be held in February There were 4 areas that they wished to focus on: Unfortunately one week before the planned visit to Liberia it became apparent that no conference had been arranged by LANA. The local co-ordinators had indicated a positive response regarding the conference but the LANA president Mr Garrison Kerwillian and LANA secretary Mr Gogoe Augustine had not circulated any information about the conference to any of the LANA members. Many of the LANA members knew about the conference having been copied into s from Dr Sheraton between LANA and herself. As a result of the miscommunication the number of new delegates at the conference was significantly reduced (we had planned 24). There were 21 nurse anaesthetists in attendance plus 6 Liberian teachers who delivered the training alongside the UK faculty. Of the 21 delegates there were 15 (71%) of the delegates who had attended the previous SAFE Obstetric anaesthesia course. All of the instructors had attended the previous course and the train the trainers course. The aims and outcomes of the visit: Aim Run a SAFE Obstetric anaesthesia course for 24 candidates using Liberian instructors mentored by UK trainers. Outcome SAFE Obstetric anaesthesia course completed for 21 candidates using 4 Liberian instructors mentored by UK trainers. Follow up on the AAGBI SAFE Obstetric anaesthesia course by collecting data from logbooks provided at the Feb 2012 pilot. Due to the short notice in arranging the conference no candidates provided logbooks that had been provided in the 2012 SAFE Obstetric anaesthesia course. The importance of these logbooks was re-iterated 1

2 Liberian instructors who underwent the SAFE obstetric anaesthesia training the trainer course to run another half day Lifebox course for any anaesthetists requiring an update or for those who were not able to attend the previous course in Feb Setting standards of Good Clinical Practice for advertising the training program for anaesthesia and critical care clinicians. A survey conducted at the AAGBI IRC sponsored LANA conference in 2012 (report previously submitted to IRC) showed that anaesthetists from: 50% of hospitals felt they had inadequate monitoring in the context of ongoing / further support from AAGBI. The 4 Liberian instructors paired with the UK team to deliver the SAFE Obstetric anaesthesia course together. One UK anaesthetist (myself) had to travel to Ghana and one UK anaesthetist was unwell and unable to deliver his training sessions. A Uk Obstetrician stepped in to support the Liberian trainer. The Lifebox training was given by a UK team member in combination with one of the Liberian team. Only 20 of the 40 Lifebox pulse oximeters could be distributed because of the smaller geographical range from which the candidates came. The remaining 20 will be distributed by the team going to Liberia in July facilitated by the MoHSW. The draft Good Clinical Practice for nurse anaesthetists has been circulated to the president and secretary of LANA who are considering it. It has also been shared with the Liberian Medical and Dental Council (LMDC) to consider in regard to nurse anaesthesia registration processes. Nurse anaesthetists are registered with the Liberian Nursing and Midwifery Council regarding their nursing skills. The LMDC has still not reviewed training facilities or the training program at Phebe to consider it for registration of the nurse anaesthesia training. LANA leadership appears to be in disarray. The Critical Care training program was advertised at the LANA conference. Candidates that scored highly and performed well in the skills and appeared supportive of colleagues were encouraged to apply. Since the conference 3 nurse anaesthetists have been selected to undergo the further training being led by MoHSW. 3 oximeter logbooks were collected. It was re-iterated that ongoing support was reliant on feedback. The feedback that was received was positive. 45% of hospitals were lacking anaesthesia machines 32% of hospitals were lacking other anaesthesia equipment Lack of pulse oximetry was noted in 45% of hospitals (Lifebox donated 18 2

3 oximeters at the conference after this data was collected) Since then one has broken and one has been stolen. Lifebox logbooks from the 2012 conference could also be collected on behalf of the charity Lifebox. Feb 12 (n=44) Feb 13 (n=21) Pre MCQ mark (%) Mean Pre MCQ mark (%) Median Post MCQ mark (%) Mean Post MCQ mark (%) Median n=20 (20 n=8 (7 candidates) candidates) Pre skills (out of 10) Mean Pre skills (out of 10) Median Post skills (out of 10) Mean Post skills (out of 10) Median Collect feedback and data regarding impact of SAFE Obstetric anaesthesia course on knowledge and skills. Table 1: Pre and Post course MCQ marks and skills Statistically significant improvement in knowledge and skills demonstrated by the candidates (Table 1) with results comparable to Feb General Feedback Comments in 2013: I firstly want to congratulate you all for taking off your time to impact knowledge in us. I will appreciate if this program be spread to other counties in Liberia. Please try to establish a treatment protocol for antenatal haemorrhage and a machine checklist that is in order. I will like this conference to be every year Need information sharing via e mail to members of the Liberia anaesthetist team to be prepared next time My suggestion is that in subsequent times other theatre team members be incorporated as well as mid-wives so that some of those collaborative works can be well understood and put into practice by all. Especially the WHO checklist and then obstetric emergencies on the ward. I really appreciate the team for the knowledge impacted to us in order to improve our skills and knowledge in anaesthesia. I wish to extend my thanks to this team that came to impact knowledge to us. I hope this visit will not be the end. I will suggest that you continue to help us with this training and add more on critical care. Appreciate a continuous education as such this sort of training biannually. Please continue your good work in order to promote good anaesthetic health care delivery Thanks for your efforts and that will be happy if you can get some of the intraosseus machines for us. I would highly appreciate this training will continue every 6 months I am so grateful to your team for giving us knowledge. I learnt a lot and going home to share with my friends. I suggest the team increase the days. I will suggest that you people also tell our doctors about the WHO checklist. Let them take it serious in order to meet our goal of good patient care. I am grateful for this training. It has increased my knowledge in the future care of obstetric patients. I suggest this training be carried out every year. I suggest a very big thank you to all members of the team and please come again. 3

4 Yes, let this be a continued activity to improve our skills and ability in practice of our profession. May some back up of teaching aid be supplied as all may not be able to go through the disc given. This knowledge gained will be practiced during my study. Hope you continue to come. I recommend the return of Cerys and Helen. Other institutions should be contacted and this course be introduced in the South East region of Liberia, where limited health workers are limited. I just want to say thanks you so much for the training. You continue to remember us in Liberia. Table 2: General Feedback on SAFE Obstetric anaesthesia course Question Mean score (max =10) Median score (max =10) Was the course enjoyable? 9.8 (9.7) 10 (10) Did it improve your knowledge? 9.7 (9.6) 10 (10) Do you think it will improve your clinical ability? 9.7 (9.7) 10 (10) Was it relevant to your day to day work? 9.8 (9.7) 10 (10) Do you think what you have learnt will improve the care you give patients? Would it be a useful course to run in your hospital? 9.9 (9.8) 10 (10) 9.7 (9.8) 10 (10) Table 3:Usefulness scores on sessions in SAFE Obsteric anaesthesia course (1 = not useful, 10 = extremely useful) 1 = Lecture on airway and general anaesthesia 2 = Airway breakout sessions 3 = General anaesthesia breakout sessions 4 = Spinal anaesthesia breakout sessions 5 = Lecture on critical care and resuscitation 6 = Critical care breakout sessions 7 = Lecture on pre-eclampsia and eclampsia 8 = Pre-eclampsia and eclampsia breakout sessions 9 = Lecture on Haemorrhage 10 = Haemmorrhage breakout session 11 = Lecture on obstetric emergencies 12 = Obstetric emergencies breakout session Session number Mean score (max =10) Median score (max =10) (9.3) 10 (9) (9.4) 10 (10) (9.3) 9 (10) (9.4) 10 (10) (9.3) 10 (10) (9.3) 9 (9) (9.6) 10 (10) (9.6) 10 (10) (9.5) 10 (10) (9.3) 10 (9.5) (9.7) 9 (10) (9.4) 10 (10) 4

5 Statistical analysis MCQs: There were 15 candidates for whom there is data both pre and post. The scores increased for 13 candidates and were the same for 2 candidates. The mean increase in score was 4.8. Using the Wilcoxon test, the p-value is Skills: There were 8 candidates for whom there is data both pre and post. The scores increased for all 8 candidates. The mean increase in score was 4.1. Using the Wilcoxon test, the p-value is This data clearly demonstrates a maintenance of high standards with Liberian faculty working alongside UK faculty. The Liberian faculty team consisted of: 1. Mr Gogoe Augustine 2. Mr Aaron Sonah 3. Mr Wilmot Fassah 4. Mr Sumo Gayflower The Uk Faculty team consisted of: Ms Lorna McAtee (ODA supporting Admin and data collection) 1. Dr Alison Carling (previous lead on SAFE Obstetric anaesthesia course in Liberia) 2. Dr Richard Venn (Consultant anaesthetics and critical care, potential long term volunteer) 3. Dr Cerys Richards (Advanced trainee in Obstetric anaesthesia) 4. Dr Helen Jewitt (Consultant in anaesthesia, special interest in medical education) 5. Dr Iljaz Hodzovic (Consultant anaesthetist with an interest in airway equipment) Unwell 6. Dr Tei Sheraton (Consultant anaesthetist RGH, Lead for MOA Liberia project and chair of trustees MOA) travelled to Ghana so could not teach on course. Dr Clare Lipetz (Consultant in Sexual Health and trained in obstetrics and Gynaecology)and funded by Wales4Africa stepped in to replace Dr Hodzovic. Also Dr Carling stepped in. Dr Antoinette Johnson (Liberian doctor interested in training in anaesthesia) observed and played a supporting role, as did Dr Olivier Hagon (Consultant Anaesthetist from Swiss Development Agency). Future plans for SAFE Obstetric anaesthesia in Liberia Run subsequent courses with less input from Uk faculty. 5