OBSTETRIC ANAESTHESIA REFRESHER COURSE Kagera region, Tanzania, 24 – 26 January 2018
Maternal death is a huge problem in many African countries, including Tanzania. There are few health centres, even for emergency health care, and patients in remote areas have to travel long distances to reach them. As a result, women with complications in pregnancy and childbirth often arrive in urgent need of medical care. The Tanzanian Ministry of Health is increasing the number of health facilities where mothers can go for help, including emergency Caesarean sections. This has huge implications for the anaesthetic workforce.
This project was initiated by Philbert-John Tegambirwa, an experienced nurse anaesthetist from Bukoba Hospital in the Kagera region, one of the poorest areas of Tanzania. He surveyed health centres and hospitals and identified that a lack of competency in obstetric anaesthesia was likely to be contributing to morbidity and mortality in the Kagera region.
Need for Local Training
In Tanzania, non-physicians provide the majority of anaesthesia services. These are nurse anaesthetists who have received one year’s training and for some it has been more than 30 years since they graduated. They work often in isolation, with limited equipment and drugs, on low pay, without any continuing medical education (CME) and eventually many become demotivated.
Recent efforts to update the knowledge of anaesthetic nurses include SATA, SAFE courses and Government initatives. However nurses in the Kagera region have not been able to attend these courses because of the long distances they would have to travel and lack of funds.
To fill this gap, SAWW agreed to fund a locally orgnanised refresher course for anaesthetic nurses in the Kagera region. The course aimed to improve skills and knowledge and to increase collaboration between these nurses and with the anaesthesia faculty of KCMC Hospital and Bugando Hospital. The course was organised and led by a mainly Tanzanian faculty who knew the specific local challenges involved. Approval for the course was obtained from Society of Anaesthesiologists of Tanzania (SATA).
The main objectives of the 3-day refresher course were to enable nurse anaesthetists to provide safe obstetric anaesthesia in resource limited areas; to deal with common challenges encountered in obstetrics; and to conduct emergency procedures and resuscitation appropriately.
The course included theoretical teaching and two practical days in operating theatres at Bukoba and Kagera hospitals. Teaching methods included simulated scenarios, case study discussions, skill stations, lectures and practice in theatre.
Pre and post course assesment of the nurses’ theoretical knowledge was made with a questionnaire and an on-site follow-up evaluation of the practical impact on anaesthetic practice at their hospitals/ health centres is being undertaken in the coming months.
Feedback from the participants
Participants were enthusiastic about the training and eager to learn. They spontaneously reported that they felt it had improved their knowledge and skills. Also they had learned from the on-site visits about set-up of theatre, equipment and communication. They appreciated the importance of not accepting substandard help from their hospital administration. Participants said they felt less isolated due to increased peer support and support from the senior anaesthetists in two teaching hospitals. This resulted in the creation of a Whatsapp group among participants and teachers on which to share problems and discuss questions related to anaesthesia.
Overall evaluation of the project
Everyone involved in the project, organisers, participants and funders, agreed it had been very successful. Nurses increased their knowledge and skills in relation to practical obstetric anaesthesia. Local teachers and organisers helped to tailor the course to the needs of the anaesthetists of the region and were important mentors. Finally, the open constructive atmosphere during the course contributed significantly to its appreciation. The course helped in forming networks among nurse anaesthetists from Kagera region and between the participants and the teaching faculty.
Challenges remaining include the lack of reliable communications, such as internet, smartphones and computers. This makes communication between organizers and participants difficult, hampering follow up assessments and limiting access to up-to-date knowledge. Many participants return to face difficult working conditions and some may be unable to follow the protocols taught during the refresher course due to lack of adequate anaesthetic equipment, drugs and trained nurses. The course was short and could only cover a limited number of topics.
We hope to raise funding to repeat this course for anaesthetic nurses of the Kagera region who did not attended this one, and to potentially organize further courses in other regions of Tanzania.
Funding for this course was provided by SAWW and Diamedica (UK) Ltd. Each participant received text books that were donated by the AAGBI and a pulse oximeter donated by Lifebox. Participants on the 2018 Kagera region Obstetric Anaesthesia refresher course, Tanzania
Teaching sessions included imulated scenarios to help attendees to practice their skills, decision making, and how to deal with common emergencies.
The course included visits to local hospital operating theatres on days 2 and 3, to put skills inot action.
Dr Mwenzi Kaino, anaesthesiologist from KCMC, was one of the key trainers on the course.
Participants each received a Lifebox pulse oximeter and text books donated by the AAGBI.
Dr Bernard Kenemo, Head of Anaesthesia at Bugando Hosptial, anothe key member of the training faculty, gave important instruction
The class of January 2018 with the teaching faculty on the Obstetric Anaesthesia Refresher Course, Kagera Region, Tanzania,