Resuscitation training

Matt teaching airway management

We had a great time this week on Wednesday (12^th) teaching our ‘Management of the Acutely Unwell Patient’ and Basic Life Support to 18 of the staff here. We have so far only taught it to small groups of 5 or 6 so this was a big change. We were really encouraged as everyone seemed enthusiastic and keen to take part. We had worried about doing the simulation training – giving people a clinical scenario and having them act out in ‘real-time’ what they would do etc.. as this is so different from how they usually learn and have training but they really embraced it and it went very well.

Gillbert teaching some airway skills

 Another of our aims was to identify some people to take over and continue this training and development of essential skills after we leave (next week!). We have found one person, Gillbert, who is really keen and interested, he is an anaesthetic nurse here and part of the resuscitation team as well. He was key in setting up the training day and even organized us all to have a tea break and lunch at the canteen together which also made for a great team-bonding experience! We are hoping one or two others will come forward to help him continue this project and we are feeling more confident of the longer term effects of our teaching during our time here.  We will hopefully have one more day to do the training next week and try and get Gilbert to lead a few of these sessions as well.

Time for tea!

Tea tin the sunshine served with a mandazi (like a fried bread roll)

Back to lectures

Running some simulations

Teaching and practicing basic life support

The gang!

Out of hours

View from the road

Its not all work out here- we are surrounded by amazing natural beauty and make sure we get out and about to enjoy it. We have also made use of the projector we have been using for teaching by creating a home cinema in the evenings!!

Wondering through the local villages

Wondering through the local villages...spot the children!

 

View from the water tower

Sun setting over the lake

 

Home movies!

Guess the film!!

Teaching the basics

Running a scenario with Leonard, Bora, Emmanuel and Julie

One of the projects we have been keen to start and continue here is staff training. Both of us have done individual tutorials and teaching sessions to our different departments – Matt in the ED and me in Internal medicine as well as some lecturing to midwifery students at the local university. 

One of the subjects we have focussed on together has been the ‘Immediate Management of the Acutely Unwell Patient’ which we have adapted from our Advanced and Intermediate Life Support training course we went to in our foundation years. We teach it over a day and have delivered it so far to the chiefs of services – both doctors and nurses. We are running it again next week for the anaesthetic and theatre staff and hope to identify some people to hand it over to in order to continue the training once we have left. 

Matt going through the equipment for the scenarios

We have really enjoyed this aspect of our time here and it has been fun to recreate the simulation training we received in the UK over here. Needless to say the materials aren’t quite the same but we have a mannequin for the simulation scenarios and even some resuscitation models to practice Basic Life Support (BLS) on. It has been great to work more closely with the staff in this way.

In the UK we are fortunate to have this training as a national standard and as a requirement for our employment, however here, not all nurses have had formal training in BLS. Such a basic skill but essential in hospital work, we hope we are leaving a sustainable training model behind so that all clinical staff in Kibogora can become proficient in this.

Airway management

Teaching BLS to Genivieve, Mahdoo and Perrine

Available equipment for the simulation

The life of a rural GP continues

Transport to those further from the hospital

Gatayo with his new clothes

In the past few weeks I have been continuing my visits to the vulnerable elderly around Kibogora with the social care team Console and Etienne. There have been some donations recently through the Kibogora Initiative fund and also from some visiting members of a church in Lancaster that fund raise to keep this elderly programme going. These donations meant that we were able to take gifts of clothes and food. One man received a warm jacket, jumper, t-shirt, socks, and even a smart shirt and tie so he could wear them to church on Sunday. He was so pleased to be receiving these, smiling and thanking us, it made me feel so humble…how many of us have more than one jumper and jacket at home? More than one pair of socks? Yes, me too. I have so much, even here where I thought I had seriously packed light. These visits constantly give me a new perspective and a view into a life I think I finally understand. No one can really imagine these lives. Where you have dirt floors, mud brick houses with gaps in the walls, corrugated iron roofs, maybe you have a toilet maybe you don’t and by toilet I mean hole in the ground with a fence around it. Maybe today you have food, maybe you don’t. 

A new water storage facility

Even in these conditions their smiles are bright, they are so amazed that I am there and asking them how are today. Most tell me they have hip, knee and generalised all over body pain and I’m thinking of course you do! – you sleep on a mattress of woven reeds, you cultivate during the day, you walk up and down these steep hills, you still work and most of you are over 85! Sometimes I diagnose a case of asthma, a chest infection and can help them with antibiotics, analgesia and a salbutamol inhaler (and the steroid inhalers just became available yes!). But most of the time the fact we are actually visiting them and trying to improve the state of their houses, giving them warm clothes and food when we can is the best intervention we can do. 

Building a toilet

The social team can also help with replacing roofs, building toilets and helping with access to water. Currently they are working on re-housing a man and his wife who live close to the lake by a little river whose house floods every time it rains and the river rises. It is currently the short dry season here and it has rained most days including some heavy storms so I can’t imagine what it’s like for them in the wet season.

Singing and praising God

Drinking porridge

Another of the ways the social care programme for the vulnerable elderly helps is by holding an event one morning a month (when they can afford it). Here there is a time of singing and dancing before the pastor reads from the bible and prays. Then cups of porridge (an interesting mix of maize flour, soya, sorghum and sugar) are handed out with a bread roll. This is followed by the social team doing some teaching, this month it was on hygiene – the importance of keeping clothes clean and washing themselves etc. Then a bit more dancing and singing before everyone goes home with a bag containing a kilo of rice, beans, salt and some soap. There were maybe 80 people there, it costs £200 to put on one of these events. £200 to feed all of them while they are there and give them some food to go home with.

Soap, beans, rice, flour

For me it was great to see so many of those that I had seen in their homes and see them looking well. It was a privilege to help serve them and hand out the food and I really hope the programme continues more regularly as they rely more on donations through the Kibogora Initiative. Working with this team has been one of the most eye-opening experiences I have had. It provides me with a good balance from the internal medicine ward work as sometimes you forget the conditions people have come from and the different things going on in their lives which has culminated in their hospital admission.