Southern Ethiopia - Gwent Health Link

Introduction

The charity “Mothers of Africa” was established in 2005 by anaesthetists in Cardiff to support, through education and training, the delivery of obstetric anaesthesia in countries in Sub Saharan Africa. To date, we have established links with Benin and Toga and members of the charity have visited both countries to run short update courses for post graduate anaesthetic nurses and support local anaesthetists with equipment and drugs. The visit to Southern Ethiopia with the Gwent link was undertaken to explore the possibility of running similar courses there in the future. We thus accompanied the Gwent link between 26th October – 5th November.

What we did

• Assisted Dr Kyle Jacques with teaching on the course for postgraduate Health Officers
• Spent a day in the operating theatres in Hwassa Hospital to observe anaesthetic practice and do some basic interactive teaching with the two anaesthetic nurses. We saw them anaesthetise two patients for gynaecology laparotomy. Later in the evening, we returned to theatre for an emergency ruptured uterus and emergency caesarean section.
• We donated to Hwassa Hospital a new mains operated pulse oximeter and a variety of anaesthetic equipment including: tracheal tubes, laryngeal masks, airways, face masks, Ambu bags, bougies and spinal needles. We also left them some basic anaesthetic textbooks.
• Visited Yirga Alem Hospital, a busy hospital, and joined the anaesthetic nurse and assistant nurse in theatres for a couple of hours, watching them to anaesthetise patients for an ovarian cystectomy and emergency caesarean section. We left them some basic airway equipment and did some teaching and training.
• Visited Dila Hospital which was quiet and appeared rather run down. Spend a short time talking to the lone but very experienced anaesthetic nurse finding out the problems she faced in her practice. Left her with some books and equipment.
• We accompanied members of the Gwent link to two of the Health Centres which they are currently supporting: Yirgacheffe and Wondo Genet. These two centres were in marked contrast. The latter was in a good state of repair, clean, was vibrant with enthusiastic staff and appeared to be popular with members of the local community. In complete contrast, Yirgacheffe was run down, dirty and staff appeared somewhat disinterested. During the day we spent there, we saw very little activity and formed the impression that the centre did not enjoy the confidence of the community.

What we plan for the future

From our observations and after constructive discussions with Drs Ghosh and Yifrou, we have concluded there is a need to support anaesthetic nurses in Southern Ethiopia as they work usually in isolation with little opportunity for update and development. We therefore are planning to return to Hwassa with the Gwent Link towards the end of 2008 and with the local assistance of Dr Yifrou, to run a course open to anaesthetic nurses from Southern Ethiopia. The exact content of the course will need development but will be tailored towards delivering safe anaesthesia within existing resources and develop teaching skills so that the anaesthetic nurses can disseminate their training to support staff in their locality.
Given that many mothers present to secondary care in extremis, it would be extremely valuable to extend the course to include perioperative resuscitation and postoperative high dependency type care.

Conclusions and observations on the work of the Gwent link

We were impressed by the excellent work of the link and by what has clearly already been achieved by the link’s involvement with the region over the years. It was also obvious to us that the link’s work was greatly appreciated by the local health professionals.

The following are some suggestions which might be helpful to future developments:

The midwife’s course was over subscribed and the faculty felt that the numbers inhibited some of the interaction so important to the course. We wonder whether, in the face of similar large numbers, it is worth considering putting on back to back identical courses. Even if this meant shortening the course to accommodate the existing timeframe, the overall content and impact might not be reduced as teaching could be more efficient with smaller numbers. The other advantage might be that health centres would be disadvantaged less, particularly when more than one member was attending from the same centre.

It was clear that the health centres being supported by the Link were quite different in their success. It thus would appear that the less successful ones will require greater support in future if they are to improve. Wondo Genet, for example, is already of a high standard and will probably require less support in the future to maintain high standards.