safer anaesthesia from - aagbi paeds benin, november 2016 dr savini wijesingha safer anaesthesia...

SAFEPaedsBenin,November2016 DrSaviniWijesingha

SaferAnaesthesiaFromEducation

SAFEPaedsCotonou,BeninNovember2016

AssociationofAnaesthetistsofGreatBritainandIrelandInpartnershipwithMercyShips

ReportcompiledbyDrSaviniWijesingha


ExecutiveSummary TheSAFE(SaferAnaesthesiaFromEducation)PaediatricsCourseaimstoimprovethedeliveryofpaediatricanaesthesiainlow-resourcecountries.Theprovisionofpaediatricsurgicalservicesinlow-resourcecountriesisoftentheremitofageneralsurgeonandanurseanaesthetist.Itisestimatedthat85%ofchildreninlow-resourcecountrieswillrequiresurgerybeforetheageoffifteen,andtheresponsibilityofananaesthetistcoverstheneedtoprovideanaesthesiaforemergencyprocedures,electiveoperations,resuscitationandpainmanagement. TheSAFEPaedscoursewasdevisedbyDrIsabeauWalkerandDrMichelleWhite,fortheAssociationofAnaesthetistsofGreatBritainandIreland(AAGBI)andtheWorldFederationofSocietiesofAnaesthesiologists(WFSA).Sinceitsinceptionin2014,ithasbeenruninanumberofcountriesinsub-SaharanAfrica. ThisSAFEPaedscoursewasruninBeninandconductedinpartnershipbetweenMercyShipsandtheAAGB,IandthecoursewasruninFrench.PreviousFrench-languageSAFEPaedscourseshavebeenundertakeninMadagascarbyMercyShips.TheAfricaMercyiscurrentlydockedinCotonou,Benin;anditwasthefirsttimeSAFEPaedshadruninBenin(SAFEObshadoccurredSept2016).. TheSAFEPaedsCourseDirectorwasDrSaviniWijesingha,aUKanaesthetictrainee.ShewassupportedbyProfessorEugeneZoumonou,professorofanaesthesiainCotonou,astheleadlocalcontact,andDrMichelleWhite,DeputyChiefMedicalOfficer,MercyShips Thefacultycomprisedofonefourconsultantanaesthetists,twoanaestheticregistrarsandonepaediatricregistrar.AllthefacilitatorscamefromtheUK,baroneSwissconsultantwhohastaughtonpreviousSAFEpaedscourseswithMercyShips.Fourlocalinterpretersprovidedexcellentassistancethroughout,howeverthetwofluentFrench-speakingfacultytaughtwithouttranslation. Thiscoursedifferedslightlytopreviouscourses.Theinformationwastaughtovertwodaysratherthanthree,followedbyadayof‘TrainingofTrainers’andthenasecondtwodaycourse.ThetimetableandtopicswerechoseninconsultationbetweenDrMichelleWhite(MercyShips)andProfessorEugeneZoumonou(ProfessorofAnesthesia,Benin). Atotalof19anaesthetistsattendedthefirsttwo-daycourseand30attendedthesecond.TherewereninecandidatesfortheTraintheTrainers.MostofthedelegatescamefromBenin,howeverthreetravelledfromBurkinaFaso. ClinicalskillsandknowledgeweretestedviaMCQsandskillsstationsbeforeandafterthecourse.Thecourseitselfwasamixtureofshortlectures,workshopsandscenariotutorials. TherewasexcellentfeedbackfromthedelegatesandgoodimprovementintheirMCQandskillstests.


Acknowledgements OursincerethanksgoestoMercyShips,withoutwhom,thecoursecouldnothaverun.Recruitmentofdelegates,logisticsandorganisationwerehandledbymedicalcapacitybuildingprojectmanagersKrissyCloseandAbbyWatrous.TheyweresupportedbyJoanKotze,medicalcapacityprogrammesassistant,andKirstieRandall,MedicalCapacityBuildingDirector. WeareverygratefultoDrMichelleWhite,MercyShipsDeputyChiefMedicalOfficer,forherinvolvementandguidanceofthiscourse,aswellherongoingsupportfortheSAFEinitiative. ManythankstotheAssociationofAnaesthetistofGreatBritainandIreland(AAGBI)fortheirsupportandfinancialcontributiontothecostofourflights. OurthankstoProfessorEugeneZoumonouforhisinvolvementinthecourse. Thefacultyandinterpretersworkedextremelyhardovertheweekandfunctionedverywellasateam.Forthesecondcourse,thisincludedfacilitatorsfromBeninandBurkinaFasowhoworkedalongsidetheEuropeanteam. Finally,ourgratefulthankstothedelegatesfortheirattendanceandenthusiasm.


Background BeninisaFrancophonecountryinWestAfricaandsharesborderswithTogoandNigeria,BurkinaFasoandNIger.Thepopulationis10million.Theunder-fivemortalityrateis85.3per1,000livebirths.43%ofthepopulationareunder15yearsofageandthemedianageinthecountryis18.Malariaaccountsforthemostdeathsinchildrenunderfiveyears. Asof2015,therewere35membersoftheBeninSocietyofPhysicianAnaesthetists,withafurther34doctorsenrolledonthefour-yeartrainingcourse.Thiscomprisesofdoctorsfromaroundtheregion,notjustBenin.Thereareapproximately250anaestheticofficers,whodelivermostoftheanaestheticsinthecountry.Therewasananaestheticofficertrainingschool,butfundingforthiswasunfortunatelysuspendedafewyearsago. MercyShipsarrivedinCotonouinOctober2016.Thecharityprovideshealthcare,surgicalinterventionandfollow-upfromthehospitalship.Itaddition,thereisasignificanteducationprogramme,withtheaimofimprovinghealthcaredeliveryinthehostcountryandensuringsustainability.


TheNovember2016SAFEPaedsCourse ThiscoursewasheldattheHotelduPort,Cotonou.Alargeair-conditionedconferenceroomwasusedforlecturesandtwoconcurrentworkshops,andafurthertwoworkshopswereheldoutside.Thehotelprovidedfoodandrefreshmentsduringbreaks.Thefacultyalsostayedhere. TheSAFEPaediatricscoursehaspreviouslybeenrunoverthreedays.Thiscoursewasshortenedtotwodays,attherequestofthelocalanaesthesiaschool.Thepermittedconcisedeliveryofinformationrelevanttothelocalpopulationandalsoallowedustoteachtwocoursesinthesameweek,therebyincreasingthenumberofcandidatesabletoattend.Therewerenineteencandidatesonthefirstcourseandthirtyonthesecondcourse.ThecoursefollowedthesameformataspreviousSAFEcourses,withamixtureoflectures,skillssessions,groupdiscussionsandscenarios.Sinceneonatalresuscitationwasnottaughttheskillstest–neonatalresuscitationwasreplacedbyoneonmanagementofafit,whichwaswrittenbyDrMichelleWhite.TheBeninanesthetistswillbegivenneonatalteachingatanothertimebyMercyShips.Monday20thNov Tuesday21stNov Wednesday23rd

NovThursday24thNov Friday25thNov

Pre-courseassessments

Recognitionandassessmentofthesickchild

Givingalecture Pre-courseassessments

Recognitionandassessmentofthesickchild

Basicprinciples Resuscitation Teachingaskillsstation

Basicprinciples Resuscitation

Airway Thesicklaparotomy

Leadingadiscussion

Airway Thesicklaparotomy

Painassessmentandmanagement

Traumainchildren Leadingascenario Painassessmentandmanagement

Traumainchildren

Burns Logisticalconsiderationsandobstacles

Burns

Post-courseassessments

Facultymeeting Facultymeeting Facultymeeting Facultymeeting Facultymeeting

ATrainTheTrainerscoursewasheldonthethirdofthefivedays.Therewereninecandidatesonthiscourse,includingthreefromBurkinaFaso.ThesedelegatesthenhelpedthevisitingfacultytoteachonthesecondSAFEPaedscourse.Allparticipantsreceivedacertificate,aUSBstickwithcoursematerialsandacopyoftheSAFEPaediatricandObstetricAnaesthesiaPocketHandbook(Frenchtranslation).


TheSAFETeamTeachingfaculty:DrColmLanigan ConsultantAnaesthetist LondonDrAlanaKirkwood ConsultantPaediatricAnaesthetist LeedsDrKateHolmes ConsultantAnaesthetist PlymouthDrAlexPolet ConsultantAnaesthetist Geneva(retired)DrAndrewMullett SpecialistTrainee7inPaediatrics BristolDrLesleyMilne SpecialistTrainee3inAnaesthetics BristolDrSaviniWijesingha SpecialistTrainee6inAnaesthetics EdinburghInterpreters:DrQuenumSeidjolo

ZoulihaSalami

KegnonhouBarnetSergie

PierreDjossa


Monitoring,EvaluationandResultsThecoursewaswarmlyandenthusiasticallyreceivedbythedelegates.Pre-andpost-coursetestingdemonstratedveryencouragingresults.

MCQPre

MCQPost

firstcourse 22.5 27.8

64.4% 79.9% 2nd

course 21.5 27.6 61.4% 78.7%

BLS pre post Intubation pre post

1stcourse 4.7 8.8 1stcourse 5.4 7.8 2nd

course 3.6 8.6 2ndcourse 5.9 7.7

Seizure Trauma

1stcourse 6.5 7.9 1stcourse 3.75 8.5 2nd

course 6.9 7.9 2ndcourse 4 7.8

Alldelegatesrankedthecourseveryhighlyintheirevaluations,givingmainlyscoresof10/10forthequantitativepartoftheevaluations.Whenaskedwhatwerethethreemostimportantthingstheylearned,themainfocuswasonlearningaboutmanagementofchildrenwithtrauma,theABCDEapproach,dealingwithburnsinchildren,estimatingchildren’sweightandcalculatingcorrectmedicationdosesforchildren.


SummaryTheSAFEPaediatricscourseheldinCotonou,Benin,inNovember2016resultedinthetrainingofforty-ninedelegates.Thecoursereceivedexcellentfeedbackfromtheparticipants.Therewasmarkedimprovementinfourkeyareasofanaestheticmanagement,asdemonstratedbythepre-andpost-skillscoursetesting,andtheMCQresultsdemonstratedanincreasedlevelofknowledge.NinecandidatesattendedTrainTheTrainersandhelpedteachthesecondofthetwocourses.Thetrainingoflocalinstructors,alongwithMercyShips’ongoingworkinBeninandsubsequenthostcountries,willhopefullypermitasustainableandlong-termsystemofpaediatricanaestheticeducationinWestAfrica,therebyreducingchildmortalityintheregion.


References:WHOBeninStatisicalProfile:http://www.who.int/maternal_child_adolescent/epidemiology/profiles/neonatal_child/ben.pdf?ua=1Benin:NeonatalandChildHealthProfilehttp://www.who.int/maternal_child_adolescent/epidemiology/profiles/neonatal_child/ben.pdf?ua=1

safer anaesthesia from - aagbi paeds benin, november 2016 dr savini wijesingha safer anaesthesia...

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