Peter McEwan
Consultant neonatologist
Lira report for Poole Africa link re visit 14 October – 28th October 2017
Formal teaching
I prepared some slides for a talk given on the second Thursday of our trip to the third year students at Lira University. The same material was given as a tutorial to smaller groups who had training at the nearby antenatal clinic and maternity unit at Aboke (?”Oboke”). I spoke on neonatal delivery-related issues, (birth injury, also Apgar and highlighting babies who require extra care following delivery), and the expected progress after normal delivery (weight loss, and monitoring of that).
Informal teaching
On most mornings and some of the afternoons, groups or four or five nursing students from the other facility in the town were at the neonatal unit, and seemed to appreciate teaching (various topics – recognition of the sick infant, baby resuscitation, jaundice, how to put CPAP on). At various timeswhen I was either by myself, or with others (two Americans – one neonatal consultant , one NICU nurse both there on first three days of my trip) I was using the scenarios unfolding in NICU (sick baby newly arrived there on Wednesday morning) to try and give some education to Caroline (clinical officer) and Catherine (neonatal nurse).
I was unsure whether Caroline was very receptive to suggestions about the babies we were looking after, but on one or two occasions I can remember, she definitely seemed to want my input (stopping anticonvulsants for example). I feel that Caroline is quite at home making adjustments to care for babies as part of the ward round, and also looking after babies brought for consultations to NICU after discharge. I don’t think that she feels she can make proactive plans for babies in labour ward who then go on to require admission to NICU.
Delivery and set up of CPAP
CPAP (continuous positive airway pressure) machine was provided for us to take by Dorchester Hospital, who had purchased it as part of commitment to South Sudanese Hospital, but subsequently not been able to deliver it, because of war there.
Taking the machine out of the box in UK had revealed there to be not much actual componentry. Components were: the stand, a humidifier, a vessel for attachment of expiratory limb tubing (about two litres) and the cables for providing temperature monitoring at either end of the inspiratory tubing, and lots of disposables (tubing, hats, chambers for humidifier and soft silicone CPAP nasal masks).
Having set all up in Uganda, there was then a patient who needed to be nursed on CPAP straight away. This worked well, and on each occasion when he was put back on CAP I was able to show others how to do this. Unfortunately the nasal mask was tied too tightly into the bonnet on one occasion, resulting in a loss of the babies airway, and the baby died. This was apparent at the end of week one, and by the middle of the second week, after having tried and failed to get nasal prongs (as opposed to masks), I used other tubing available since the week before (not brought by us but by the Americans) in order to give a circuit which both worked and was less hazardous in being set up by those with less experience.
Manikin teaching on PROMPT course – years three and four University students
As part of PROMPT, each of six groups who completed the session had training on newborn life support as per the PROMPT manual
Attempt to get neonatal unit chart working better
I showed the current documentation for drugs and fluids to the hospital administrator for records (?exact title – nice man called Paul) because of what I feel is a deficiency in the writing of fluids and drugs. Boxes under column headings which are times of day are filled opposite the drug name(written by Carolinein the left hand column) by the nurse giving the drug or fluid if the drug was given at that time. Hence the whole document is just record, not prescription (the same document in UK serves both purposes). The Ugandan system seems to be that the long-hand writing for that day includes a “plan” paragraph at the end (this is in the continuation notes) which gives frequency of administration of drug and fluid information to the nurse looking after the baby.
Also the same fluid or drug could be charted twice - once in row number one and once in row four, and dated the same, and this would give the impression that the drug or fluid was meant to be given under the old regimen, and the new regimen at the same time.
Solution: needs to look like UK drug chart, but with the modification for Ugandan simplicity that each new day gets a new box in which all drugs and fluids get prescribed afresh but with times of administration all “boxed-in” as intended dose times.
Tis plan was left with Paul.
Team working, movement of team etc
Arnold was very good driver and mechanic and general fetcher and carrier of all stuff (printing, money, phone card etc).
Slightly alarming trip South at end for four of us, and near miss of flight for two (Will and Shona).
All team working very good, got on well with Americans (email at end). Unsure what their plans are for further visit, but seems they spend four weeks every year in Uganda, three in Kampala and one in Lira, so would be good to co-ordinate.
Dianne (Peace Corps) very useful at making contact with her class group (year three, I think) and also provided opportunity for three of us (me, Julie and Kate) to visit Aboke.
Suggestions for further visits
Could do more with teaching Lira University students if had more access to student curriculum for delivering pre-prepared lectures. Having seen feedback forms it appears that some students rely heavily on pre-prepared material for lectures, and my impression is that some of the time the “weaker” students just don’t understand English so well. Having never really done much “prep” for sessions because of slightly “ad-hoc” nature of teaching, I now feel that this is a weakness.