HELPING BABIES BREATHE AND HELPING BABIES SURVIVE WORKSHOPS LAOS PDR, JANUARY, FEBRUARY 2018 January 24, 2018 Dr. Rita Dahlke and Dr. Janice Heard met with Dr. Khamphay at Champassak Provincial Hospital during the week we were there taking care of Meuang Kang School business.(january 22-27) We wanted to be sure there was scheduled time for us in the first week of February to teach HBB and HBS. Dr. Khamphay took us to meet an old friend of mine, Dr. Soudsada, MD, MS, who is now the Deputy Head of Medical Administration of the Champassak Provincial hospital. She speaks excellent English, having done her Master s in the USA, and was very helpful to us, ensuring a room was available and that nurses and doctors would be available for teaching February 5, 6. We were also briefly introduced to her superior, Dr. Bounsai. We gave Dr. Khamphay a list of items he might be able to find in the hospital for the workshop (empty antibiotics vials, Vitamin K, eye drops), which he gathered for us. Dr. Sensapert requested that two of his staff be able to join us for the two days of workshop in February, and we were delighted to have them come. We paid for their rooms for the nights they stayed in Pakse. January 27, 2018 Flew to Vientiane for the CME January 29,30 2018 CME in Vientiane for the Family Medicine graduates
Dr. Rita Dahlke, Dr. Janice Heard and Dr. Phetnoulad presented HBB on the first day and HBS on the second day to 16 FM graduates (IM, ER FM, NICU, PEDS). The skill level of the family medicine graduates was quite good, so we were able to get through the HBB course fully, in spite of a late start. Because we were short of time, we made a few modifications: Dr. Phetnoulad read out the pretest MCQ, we had them do d fewer practices of the basic steps, and we had the doctors test each other on the basic skill OSCE. Dr. Phetnoulad tested OSCE B with our help. Most of the pretest scores were already a full pass, so we did not do the MCQ as a post test, just discussed the problematic questions. HBS course was late in starting (Dr. Phetnoulad had a sick child and had to drive in from Marie Teresa) and this was our first full run through in Laos language. Fortunately, on of the FM grads, Dr. Somphet Soukhaphouvong (Female, at Marie Teresa) had good English so was able to fill in for Dr. Phetnoulad, so we got through the material. We grouped some items for practices differently from the way the flip chart presents it, and we did less practice with the dolls. Once again we did the pretest as a group. The results were actually surprisingly poor, so they all took the post- test after the course and the scores were excellent. We stressed the course was more education for the parents, and had them practice giving each other take home information. There was good interest in HBB, but the HBS course appeared to be too basic for this group of doctors. Many indicated they had taken the WHO Essential Newborn Care, which is similar in content although presented differently. We felt this course would be more interesting to nurses and midwives. We did feel that the information presented was relevant and important for the doctors to know and be aware of, but the workshop could be modified and consolidated for the more experienced and medically advanced learner. We also identified a number of things we could do differently-our first run through was very educational to us as teachers! Thanks to Allan Davis who entered all the names into the computer at the CME and in Vientiane Province for us a tough task when all the names are unfamiliar!!
February 1,2, 2018 CME in Vientiane Province Rita, Allan Davis (Rotary) and Janice were driven to Marie Teresa Provincial Hospital, near PhonHong and met with Dr. Phetnoulad who took us to a nearby Health Centre where we taught 11 people. It was mainly nurses and a dentist, a pharmacist and 2 doctors. When we queried why the dentist and pharmacist were taking the course, we were informed that at the health centre, there was often only one nurse and either the dentist or the pharmacist on site. They felt it would be beneficial for them to learn HBB so they could help at a delivery. We delivered the course outside on a porch, so the non-technology format of flipchart, workbooks, and simulator dolls was a perfect modality! We went down the road to a restaurant on the banks of the river Nam Ngam, and bought noodle soup for the group. We stayed overnight in a small resort - Leokhampaseurth Resort- that Janice has stayed in before, just down the road from the hospital. Dr. Phetnoulad took us to restaurant for supper and we had a delicious feast of 4 kinds of Nam Ngam fish. February 2nd we taught at the nursing school located beside Marie Teresa hospital. Dr. Phetnoulad teaches there as a volunteer on a weekly basis. We taught 10 third year nursing students who self identified as midwives It was obvious they had
done some deliveries as they had confidence in what they were doing. They were thrilled to have the opportunity to learn Bag-mask resuscitation skills. We realized we need to develop more scenarios for these more advanced learners and we need to find a way to present heart rate abnormalities in a better way future work! We presented Dr. Phetnoulad with a 16G USB, loaded with both courses, and a U of Calgary pin, pen and lanyard. He was most appreciative. February 3, 4 We returned to Pakse and organized our materials for the next week of teaching. Dr. Sendpasert kindly acted as our coordinator with the district hospitals, so we knew we were expected the next week. February 5, 2018 Champassak Provincial Hospital Dr. Khamphay and Dr. Soudsada organized a large conference room and we had 24 learners for two days. This included doctors, 6 doctors who identified themselves as FM1 residents (?), medical assistants, and nurses. One doctor and one nurse came fro Don Kong at Dr. Sensapert s request. One doctor was an anaesthetist who indicated he attended many deliveries in the hospital. Most of the group works at the provincial hospital in obstetrics or paediatrics.
We taught, with the help of Dr. Sousada and Dr. Khamphay, HBB the first day. The Deputy director of the hospital came and made opening remarks which Dr. Soudsada translated. Dr. Heard made a few comments thanking the hospital for accommodating the workshop and allowing their staff to come. Once again we did the pre-test as a group, and managed to get through OSCE A before lunch. With this large group, we had to rely on the doctors and nurses examining one another to get through everyone. The skill level for the basic resuscitation of the newborn was quite good, so we were not worried about doing the testing this way. After lunch we spent a lot of time practicing bag-mask resuscitation. They did OSCE B with Dr. Rita, Dr. Khamphay and Dr. Heard examining the individuals. February 6, 2018 We presented HBS this day, with Dr. Khamphay reading the flipchart and Dr. Rita and Dr. Janice demonstrating. Interestingly, at 1130 am, Dr. Soudsada asked if the Deputy Director could come in and present the certificates and make closing remarks, as he would not be available later in the day. The ceremony transpired, and we went back to teaching. We found there was good discussion amongst the staff around the HBS materials. There are obviously different things being done by different people, and it was good for them to come to agreement about how they should care for the newborns in the hours after birth. We polled the group and found only a couple had done the WHO ECEN course, so some of this information was new for most of them. This workshop is less hands on, but the discussion is helpful. We presented Dr. Khamphay with a 16G USB, loaded with both HBB and HBS courses, and a U of Calgary pin, pen and lanyard. He was very appreciative. We left HBS flipcharts, workbooks, posters for the hospital and also gave bag- mask, suction and flipcharts to the doctor and nurse from Don Kong to take to Dr. Sendpasert. We also gave the Deputy Head a U of Calgary and a Canada pin.
February 7, 2018 Don Thalat District Hospital, Dr. Inpone Mr. Som drove us to Don Thalat where we were welcomed by Dr. Inpone. He had gathered 12 nurses, midwives, and medical assistants from his hospital and nearby Health Centres to take HBB. He proved to be a dynamic teacher who made the day easy for us, and educational for his staff. We left supplies for him and for the health centres as well. Dr. Inpone took us to lunch at a nearby restaurant, and graciously paid for us! We realized once again how important it was to have an enthusiastic and knowledgeable teacher! We were able to finish the whole course easily in one day, and the learners had questions answered, did lots of practice, and seemed very satisfied. February 8, 2018 Paksong District Hospital, Dr. Aii Douangta Once again Mr. Som drove us to Paksong. The road was under construction so it took a longer time to get there than usual, so a large group was waiting patiently when we arrived. There were 26 doctors, nurses, midwives, assistant doctors, all from the Paksong District hospital or nearby health centres. Some of the group did not return after lunch, and we were informed they had emergency surgery to attend to. Dr. Douangta acted as teacher and translator. Fortunately, he has done this course a number of times so is quite familiar with the materials. Once he realized he knew the workshop, he was more comfortable. Mr. Som, our English-speaking driver, was co-opted to help with translation when Dr. Douangta was unable to ask us questions adequately. ( As an aside, Mr. Som wrote the MCQ after listening and helping all day and scored 22/25!!!) This worked for the most part. He still left most of the main delivery to us, while translating, but he was able to generate discussion and answer questions. It took quite a while to get through the pre test, but many people did quite well on it so there was already a level of expertise there. We discussed the problematic questions at the end. It would appear there are two or three questions that are poorly translated, so these will need revision. Again, because of the large number of learners, we had them do many practices, and had them test each other on the basic skills, while the three of us tested the more advanced OSCE B skills. We handed out certificates and gifts to Dr. Douangta at the end. We left him some HBS materials, and promised to return to teach that course next year. He had seen the materials I had sent them ahead of time, and he indicated he thought the HBS course would be very good for his staff-especially the nurses and midwives. Dr. Douangta also paid for our lunch that day! What a wonderful progression!
February 9, 2018 Although we had planned to return to Paksong, Dr. Douangta indicated it was not possible for his staff to have two days in a row of workshops, so on Friday, February 9, Dr. Dahlke and Dr. Heard spent hours cleaning, itemizing and packing the teaching materials to be stored at the Pakse hotel. Attached is an itemized list of supplies in Pakse. LESSONS LEARNED, FOOD FOR THOUGHT, AND TO DOS First, a huge note of thanks to all of the clubs in Rotary District 5080, whom Allan Davis represented, for their generous funding of the CME and of the Meuang Kang School project. Without their help, we would not have been able to run the CME in Vientiane. Allan was a great ambassador for the club, and a wonderful travel companion. We again want to emphasize that: A knowledgeable, medically trained translator is essential for the adequate teaching of HBB and HBS. We believe this applies to all our teaching when in Laos!****
1) Ideal workshop size is 12-16 people. Beyond that number, it is very difficult to adequately assess all the learners. We were fortunate this year in having enough Neonatalie dolls to accommodate the learners, but that may not be the case in years to come because we have given dolls to some of the sites. It is difficult to engage the learners with more than 16 people in the room. We suggest a maximum of three people per doll. 2) We had a huge amount of equipment to transport across the country, which incurred extra costs and was difficult. Fortunately we had an extra set of hands for one flight it would have been difficult for two of us to manage. We need to consider transport of equipment when planning our teaching next year. 3) HBB and HBS should ideally be incorporated in medical school, nursing, midwifery and FM residency curriculum at UHS. Helping Babies Breathe suggestions/to do: 1) Pre -test questions identified that need to be revised- Dr. Inpone has offered to help with that. 2) HBB has a 2 nd edition-it will need to be translated. There are a couple of changes but most of the course is the same. Dr. Phetnoulad indicated he would be willing to do it. 3) With larger groups we need to modify the presentation and testing to be able to cover all the material and assess everyone properly. 4) We would like to use less paper -photocopy less. We presented digital copies of the workshop materials to all the doctors who helped us so they can use them on a projector in the future. There is still very much a need for paper flipcharts and posters in case there is no electricity! Successful changes this year included: a) Reading the pre-test to the group all at once saved time. b) Having the learners test each other on the basic skills that require speaking and understanding the language (OSCE A) c) Not doing the MCQ post -test if most learners did well on the pretest-just review the problem questions; d) Streamlining the day depending on the pre test results e) Combining OSCE B and bag-mask suction evaluations. f) Laminating the pre-test/post-test to be read by the instructor, and copies of the OSCE A and B. We do not need one for each participant. g) We found the participant this year were almost all involved in maternalnewborn care as opposed to other years when administrators and others who would never use the skills took the workshop. This made the workshop
run better as there was a basic level of knowledge and a great level of interest by all participants because it was relevant information for them to learn. Helping Babies survive suggestions for workshop delivery 1) Run through the entire flow chart at the beginning 2) Demonstrate the first 90 minutes at the onset of the course 3) Get a copy of the forms they currently use for after birth care 4) Make a list of scenarios for practice 5) Highlight the HBS flipchart for reading in Laos language. Some of it is repetitious and can be excluded. Dr. Janice Heard and Dr. Rita Dahlke