Dr Rob Daniels - Bringing telemedicine to ENT patients in rural Kibuye, Rwanda
In Rwanda there is a critical shortage of ENT (ear, nose and throat) specialists, and most patients have to travel up to 2 days to the capital city, Kigali, for assessment as the level of ENT skills and knowledge in primary care is low.
On this trip we installed telemedicine equipment and trained primary care staff at the first of four planned sites in each of the provinces.
Each province will ultimately get a laptop and otoscope, and will be linked with a senior registrar or consultant in the capital to triage electronic advice requests, review images and provide case conferencing for patients in the community.
When we arrived at our site in the Western province we found that, although the district hospital serves over 1 million people and there is a high prevalence of middle ear disease in the area, it was completely lacking basic equipment such as otoscopes and ophthalmoscopes. Fortunately, we had a spare that we were able to leave behind.
Over the course of the trip, we taught over 40 doctors and nurses, giving lectures to the medical and nursing teams on common primary care ear conditions, red flags and management tips.
Our experience in Rwanda has also translated into innovative ideas for improving care closer to home.
As a result of this experience, we are now bidding for funds to purchase similar equipment for practices in East Devon to run an otology advice service. If successful, this would have significant benefits for isolated populations such as the highlands and islands, and would reduce demand for face-to-face appointments and waiting times.
Dr Michelle Mohajer - Bridging the gap in maternal healthcare in Kathmandu, Nepal
In rural Nepal, only 55% of women receive any antenatal care, and only 32% have skilled assistance during childbirth. The figures are even lower in the most remote Himalayan areas, where neonatal mortality rate has not significantly improved in the last 10 years.
Frontline healthcare staff in these areas are professionally isolated, so periodic additional skills training is extremely important.
Our training course is delivered in partnership with the charity PHASE (Practical Help Achieving Self-Empowerment), which works to reduced poverty on a sustainable basis in Himalayan mountain villages through education and livelihoods for local people.
PHASE training programmes produce a pool of highly skilled health workers who provide leadership in remote public healthcare centres.
In 2017, we delivered a one-week training to a cohort of 50 Auxiliary Nurse Midwives(ANMs), which will impact an estimated 90,000 patient contacts in these remote areas.
The course covered haemorrhage, twins, breech delivery, shoulder dystocia, pre-eclampsia and eclampsia, maternal and neonatal resuscitation, and perineal repair, with a focus on emergencies.
ANMs completed a pre- and post-course assessment, which demonstrated their significant skills and knowledge improvement by the end of the week.
We anticipate returning to Nepal in 2018 to work towards a Train the Trainers course, which would remove any communication/language issues and ensure long-term sustainability.
Dr Emily Clark - Improving neo-natal survival in Velondriake, Madagascar
The remote coastal communities in southwest Madagascar are among the poorest, most under-served parts of the country. The neonatal mortality rate here is 17/1000 live births; 12% is due to birth asphyxia. These neonatal deaths account for 40% of under-5 mortality. Ending preventable deaths of newborns and children under 5 by 2030 is a key target of the Sustainable Development Goals.
Health care in this area is provided by small governmental primary healthcare centres staffed by one nurse or midwife, with few diagnostic and treatment options.
Helping Babies Breathe (HBB) is a training programme that provides health workers with the skills to resuscitate babies who do not breathe at birth. It has been designed by the American Academy of Paediatrics specifically for use in low-resource settings. Approximately one in ten newborns needs a simple but lifesaving intervention at birth, such as stimulation and ventilation.
In 2016, with the support of the Ministry of Health, and the marine conservation NGO, Blue Ventures, who have well-established infrastructure in this remote area, we delivered HBB training and provided essential equipment to the health workers in six remote governmental primary healthcare facilities. It was the first time they had had access to essential equipment, such as a bag-valve mask and manual suction, or received practical training on neonatal resuscitation.
Ten months later, in 2017, we returned to assess health workers’ knowledge and competency in practical skills, provide refresher training, and train the new health workers in the area.
We also took the opportunity to learn from local health workers and to improve and adapt the training to the local context. Refresher training proved extremely valuable and we are now working with local NGOs and the regional Ministry of Health to develop a sustainable solution for ongoing training and support.