Emergency triage assessment and treatment course: Kenya, Dec 2009

Report on ETAT+ held at KMTC Nairobi 9-13 and 16-20 November 2009

Purpose: The Ministry of Medical Services has requested that the Ministry’s Paediatric Protocols be taught as part of the appropriate programmes at KMTC. The letter of request stating this goal led to discussion between KMTC and KEMRI personnel. These courses became joint efforts between the two organisations in conjunction with MoMS. KMTC’s Project Implementation Unit (PIU) and KEMRI representatives worked closely to set up the course. KMTC provided venue and lunches as well as transportation and appropriate lodging fees for faculty from their campuses across the country. The 23 campuses with schools of nursing and 16 with schools of clinical medicine all sent lecturers to participate in the courses. A particular request from KMTC was to hold larger than normal classes to allow greater numbers of lecturers to participate and KEMRI met this request but with commitment to maintain participant:faculty ratios less than 8:1. KEMRI supplied textual and printed materials, training equipment and insructors as well as teas with snacks.

Venue: KMTC Nursing School Assembly Hall and HMS Auditorium for plenary sessions and Skills Laboratory for practical sessions

Dates: Two courses were held; 9-13 November and 16-20 November

Course Directors: 9-13 Nov. Dr. Teresa Alwar
16-20 Nov. Rebecca Mwengi and Jalemba Aluvaala

Course Coordinators: KEMRI: Dr. Bill Bevins assisted by Judy Ng’ang’a and Jason Kiruja
KMTC: Florence Maina with assistance from Lucy Kuria, Joseph Bwogo and Rosemary Andendo and others.

Logistics: Organisation went relatively smoothly. A series of pre-course meetings were held with KMTC Deputy Director of Academic Affairs and heads of departments. Pre-course reading materials were assembled by KEMRI and distributed by PIU across Kenya. Materials were delivered at least the requisite 4 weeks in advance. Due to shuffling among participants a few received materials later than two weeks before the course.  The course opened both sessions with Dr. Grace Irimu giving a history of the Ministries’ Paediatric Protocols and ETAT+ with encouragement to use the material to update teaching and practice of paediatrics rather than view the course from an implementation strategy; the material presented is based on sound paediatrics with an evidence base designed and proven in Kenya. The hospital patient file and mortality audit and inspection was performed at Mbagathi District Hospital. This facility is more like the hospitals with which the various MTCs are associated. These visits were orchestrated with the assistance of the paediatrician at Mbagathi, Dr. Loice Mutai.  A separate report will detail the site visit and summarise inspection findings. The feedback sessions were organised to discuss how to conduct inspection and reflection on the audit process using the protocols and a group discussion led by Dr. Ngwiri the first week and Dr. Aluvaala the second week on how these courses should impact the lecturers. This is discussed further in a separate section.

Venue: The venues worked well. The Assembly Hall worked well and has good acoustics. 7/10 days were held there with the last 3/10 days held in HMS auditorium due to scheduling conflicts. Because of the size of the classes five breakout groups were organised for the practical sessions. These were scattered reasonably closely to the plenary session rooms. Access was opened between the Nursing school and Skills Laboratory to reduce walking times. The participants had many questions and there was a tendency for especially practical sessions to go overtime but largely the schedule was adhered to. 

Transportation: The reasons for close adherence to time to allow the course material to be well covered was explained initially. Through the week adherence to schedule improved in regards to participant timeliness. Transportation from lodging in the morning was often cited as challenging. Transportation to and from Mbagathi DH was provided by KMTC buses.

Meals: Meals were served at the KMTC kitchen in KNH and were well received. The walking distance made keeping to time more challenging. Water was provided by KMTC during the days. Teas and snacks were provided by KEMRI using the services of Comcare Café who were very good about keeping to requested times.

Sponsors: KMTC and KEMRI shared costs of the course as described in the opening. KEMRI’s contributions will be detailed in a separate document. MoMS greatly assisted in the impetus for the trainings and with release and letters of release for the clinicians who serve as ETAT+ faculty. Faculty were released from other duties from government hospitals, KNH education and paediatric staff, KMTC lecturers and UoN post-graduate registrars in Paediatrics.

Facilitation of courses: 9-13 November, Full Instructors:
    Dr. Teresa Alwar (post-graduate UoN)
    Dr. John Wachira (post-graduate UoN)
    Dr. Thomas Ngwiri (MoMS, Paediatrician Embu Provincial Hospital)
    Dr. Bernard Awuonda (MoMS, Paediatrician, Voi District Hospital)
    Dr. James Gitau (MoMS, Paediatrician, Garissa District Hospital)
Instructor candidates:
    Dr. John Ngugi (MoMS, Paediatrician, Karatina District Hospital)
    Mr. Jason Kiruja (KRN, KNH)
    Ms. Carol Ouma (KRN, KNH)
    Ms. Caroline Malingu (KRN, KNH)
    Ms. Linda Chemtai (RCO, KNH)
    Dr. Prisca Amolo (post-graduate UoN)
In the evaluation of the ICs at the end of the first course Kiruja and Amolo were advanced to full instructor status.
16-20 November, Full Instructors:
    Mrs. Rebeccah Mwengi (KRN, KMTC Kitui)
    Dr. Jalemba Aluvaala (MoMS, Nyahururu District Hospital)
    Mr. Jason Kiruja (KRN, KNH)
    Dr. Brian Mauga (post-graduate, UoN)
    Dr. Bill Kigathi (post-graduate, UoN)
    Dr. Grace Nalwa (post-graduate, UoN)
Instructor candidates:
    Ms. Carol Ouma (KRN, KNH)
    Ms. Caroline Malingu (KRN, KNH)
    Ms. Linda Chemtai (RCO, KNH)
    Mr. Eliud Okello (KRN, KNH)
    Dr. Abdisalam Maalim (post-graduate, UoN)
In the evaluation of the ICs at the end of the second course Chemtai and Maalim were advanced to full instructor status.

Discussion Session re: Way Forward with Basic Paediatric Protocols/ETAT+:
Discussion was held with all participants and faculty on the 4th day of each course after the visit to Mbagathi District Hospital. Common themes emerged in both weeks and considerations are herein discussed together from both courses.
It was acknowledged that many stakeholder consider ETAT+ important and as a contributor to meeting MDG. MoMS, KPA, WHO (KCO), UoN, Moi University and MTRH all agree that implementing the material should be given priority. KMTC is collaborating as well with these two courses for lecturers. KMTC is vital to ensure that health care workers in Kenya acquire these skills in pre-service training. KMTC lecturers are teachers and so are familiar with concepts of adult education that are built into the ETAT+ delivery. Modern teaching methods are being embraced including e-learning and skills laboratories. There is also the extensive and nationwide presence which can allow for potential rapid scaling up of dissemination of the Basic Paediatric Protocols. It was agreed these are more updating of information and skills than implementation of new material allowing for speedier scaling up than a re-write of curriculum. It was recognised that how the material is presented in ETAT+ is unique and contributes to retention of knowledge, skills and attitudes.
ETAT+ challenges some old practices and trainers must be willing to adapt to new evidence and current best practice guidelines with the continuous challenge of life long learning as new data emerges. ETAT+ is hands on and requires trainers to spend bedside time teaching but also practicing. We must all be spending time in the hospital training for the market.
It was pointed out that the lecturers do not always feel welcome in the hospitals where their facilities are located due to regulations in those hospitals and the existing institutional policies between the Ministries and other government institutions.
It was also pointed out that the regulatory bodies may have policies in place differing from KMTC policies making changes in teaching difficult. It was recommended that the Chief Nursing and Chief Clinical Officer and the representative governing boards be involved in discussions with KMTC for this need.

Conclusions:
The overall performance of both groups of lecturers was very good with a very high pass rate. Five people in each class, or a total of ten overall, were identified as Instructor Potential, which makes them eligible for consideration for invitation to the Generic Instructor Course. The GIC is the UK standard needed to become a recognised Instructor Candidate. The IC is then eligible to become a full instructor for ETAT+ after observation in two full ETAT+ courses.
Four IC were advanced to full instructor status during these two courses.

16 December 2009

Dr. Bill Bevins

Training of Traditional Birth Attendants, Pakistan

(Click on pages below to enlarge)

Rose Charities Vietnam 2009-2010: Report and Planning Schedule

For the full report  on *.pdf ... click here

2009 Annual Report-Descriptive: S.ASIA

ROSE CHARITIES 2009 ANNUAL REPORT - DESCRIPTIVE

SOUTH ASIA SECTION

Introduction.

Rose Charities International has had another productive year in S.Asia With one or two exceptions most of the projects and initiatives have either expanded or maintained their 2008 levels of operation.

Activities and projects are divided geographically.


SRI LANKA

The CIDA funding program came to an end mid 2009 and as no new funding had been offered (the CIDA grant was for post-tsunami reconstruction and hence not part of a continuing program), many of the original elements had to be run-down or discontinued. The main casualty was the counseling program but the others, namely Sports for Peace, and Education were significantly reduced pending restructure.

Earlier in the year Sports for Peace particularly had achieved some notable successes with two of its participants being selected for the national team.  Rose Charities has established communication with the Sport for Peace Foundation Monacco  www.peace-sport.org/  who have expressed interest in the progam and kindly invited Rose Charities to send a representative to their annual conference.

In October 2009 a major European Philanthropic Organization awarded substantial 3 year a grant for  ‘Young Woman and Child Education’  The planned program extends from ECCE/D  (Early Childhood Care and Education / Development ) through to women targeted higher education. Elements of sporting activities are also included and special needs children also. Young women are targeted through direct grants as well as women’s group activities at community level as well as targeted vocational training  Pre-program activities started December 2009 with view to full commencement January 2010..

In order to assist in monitoring this and other Sri Lanka programs and to create a ‘think-tank’, advisory steering, and fund-raising function a Rose Charities Canada, Sri Lanka Projects Sub-committee was formed.

Other programs (additional to the grant program) which continue include…
The University/College support program (formerly UniversiTea) which runs in conjunction with the Education Generation Organization (www.educationgeneration.org) and has now assisted around 80 students, some of whom have now successfully graduated in several disciplines and have obtained jobs

The Rose Charities Sri Lanka Microcredit program. This, very successful program is monitored and assisted by the RoseMicroCredit Committee of Rose Charities Canada which runs its own fund raising program as well as website. www.RoseMicroCredit.org  Around 1000 persons have now been assisted in individual or shared micro-credit initiatives of all types.

Eye Clinic.  A small eye clinic was founded, with aim initially to provide simple examination and advice,  but gradually to expand to refraction and glasses preparation services, more complicate medical treatments and possibly eventually cataract treatment. Speed of progress will depend on resources and ability to integrate into the current health systems

‘K-2-K (Kid to Kid), formerly ‘Edu-twin’ program.  This program designed to twin children  and families in industrialized countries with those needing schooling assistance in Sri Lanka . Several donors have already started contributing. However before the formal inauguration of this program there had been at least one generous individual sponsorship which effectively piloted the program


PAKISTAN.

Rose Charities continues to support Frontier Primary Health Care (FPHC) Pakistan through the Hillman Medical Education Fund  www.srpc.ca/Pakistanproject.html    or  www.hmef.blogspot.com   This program is a Pakistani non-governmental organization (NGO), providing primary health care services to more than 150,000 people in the Charsadda, Mardan and Swabi districts of Northwestern Frontier Province. The Hillman support has helped to train women village health assistants in midwifery.


NEPAL.

The RIC-Rose  www.roserehab.org  drug-alcohol rehabilitation and anti trafficking program suffered some contraction during 2009 which lead to a dormant planning and reassessment phase at the end of the year.  Whether the program will be redeveloped is currently unclear.

Rose Charities New Zealand, which has major focus in ophthalmology,  however commenced support  for the Lumbini Eye Institutes program in training village female community eye workers  www.lei.org.np/communout.html  to screed for eye disease. Early detection of conditions such as glaucoma or trachoma is essential to prevent blindness.

Rose Charities New Zealand www.rose-charities.org also sponsored a visit by Dr Basant Raj Sharma - current Vice President of Rose Charities Intenational and Senior Ophthalmologist (and founder of several of their programs) at Lumbini Eye Institute to Visit New Zealand.

AMDA-Canada / Rose Charities Canada report on disaster activities Oct-Nov 2009

In October and November 2009 multiple natural disasters struck in a number of part of the world. These included

1) Typhoon induced floods in the Philippines - extreme
2) Typhoon induced floods in the Hue area, Vietnam - severe
3) Typhoon induced floods in Cambodia - serious
4) Major earthquake in Sumatra
5) Tsunami in Samoa (and Tonga) - extreme

AMDA Canada is a relatively small Chapter of AMDA International.  Its role is to support AMDA HQ efforts in disaster relief and/or seek to help directly where possible with or without the assistance of other organizations.  AMDA Canada is the recipient of the local Vancouver Rose Charities resource raising efforts relating to international humanitarian disasters.

The organizers of AMDA Canada are aware that they are generally , on their own, not able to help with immediate relief to counties where there is no field involvement. However its linkage with other organizations often means that it has direct links to areas where the disaster may have stuck. In this there were connections to the Hue area in Vietnam (though the Rose Charities Sia Blind Center project), to Cambodia, (via AMDA Cambodia links ) and also through New Zealand (though AMDA and Rose Charities New Zealand) to Samoa.   It was thus considered that focus of assistance for AMDA Canada should be in these areas and to the other disasters  (Sumatra, Philippines) by giving support if possible to AMDA HQ efforts.  Emergency funds were duly forwarded and a specific concert fundraiser for Vietnam relief organized in Vancouver where there is a big expatriate Vietnamese community.

Very strong links with NZ (New Zealand), the main aid-activity country for Samoa coupled with considerable post tsunami experience of AMDA Canada gleaned following the 2004 Asia tsunami in Kalmunai, Sri Lanka and Acheh,  made our organization aware that while direct relief is initially needed, very soon after, there is a considerable need for both support materials (medications etc as local supplies tend to run out) and also for traumatic stress counseling.  AMDA Canada, AMDA NZ and Rose Charities both have small networks of counselors experienced in this area and it was ascertained that  Ms Liese Groot Alberts would be able to go.  Contact had been made with a local Samoan grassroots organization (Women for Business Development  - WIBDI) through the Christchurch Branch of Rose Charities NZ and Ms Adi their Director was from that moment on, hugely helpful in providing all information as to what was needed, where it was needed and in forwarding updates.   AMDA HQ provided its usual speedy and substantial response to the request to send medical materials.  Within hours two coordinators had been dispatched from Japan to liaise with AMDA NZ who started immediately looking into obtaining the required medications / drugs for transport to Apia, Samoa. It was noteworthy that AMDA NZ was able to obtain the drugs over the weekend when these events were happening.

The AMDA team consisting of  Ms Lisa Groot-Alberts, Mr Nithian and another AMDA HQ coordinator and many thousands of dollars worth of drugs and medications traveled from Auckland to Apia together.  On arrival they immediately went into action coordinated by Ms Adi of WBD.  Drugs and medications were distributed  and Ms Alberts both carried out  multiple workshops to train local relief workers in post traumatic stress management as well as directly assisting those who had borne significant loss. The team worked tirelessly and were able to achieve a huge amount in a relatively shot time.

The main coordinating relief agencies in Samoa were the NZ Govt Relief Agency and Oxfam NZ. It is notable that almost as soon as the need for post-traumatic counseling had been identified AMDA had flown in a highly experienced international expert (Ms Groot-Alberts) and this was commented on very favorably.  Oxfam NZ has since engaged Ms Groot-Alberts to return to Samoa to continue and expand her work.

Throughout all the disasters of October 2009, AMDA Canada was able to contribute to all in varying degrees either through supply of funds or coordinating other assistance.  This came about almost entirely from maintaining good networking links as well as enjoying (and appreciating) rapid and excellent communication response from AMDA HQ.   The organizers of AMDA Canada believe strongly in the AMDA philosophy of ‘open-door-cooperation’ with any and all groups who are working for the same goals of assistance within the coordinates of a purely humanitarian focus.   Responses to these recent disasters proved yet again that such an open policy of   ‘Sogo Fugo’ spirit  is able to achieve considerably more than that of maintaining closed ‘territorial’  organizational barriers.


Will Grut MD.  Vice Chairman AMDA Canada
Nov 2009

Rose Charities Malaysia 2009 end year report

Rose Charities Malaysia Annual Report 2009

1)  We carried out another Orang Asli ( natives ) community project involving over 350 families in Simpang Pulai ,Perak   recently . Rose distributed food,beverages etc to the families .Also ,our medical team screened the children for   de-worming and the adults on general health screening . This community based welfare project was jointly   co-ordinated by the lions clubs from perak,the district health office ,the health ministry ,the penang senior citizens    association members and Rose volunteers . It was a very meaningful and significant project in terms of combined   team spirits and efforts by various service groups participating in the event .

2) .Another health expo jointly with the state family planning ,women and development ministry  was carried out at the   Bukit Berapit community centre in Bukit Mertajam district across the mainland from penang . We screened over 1,000   people during the two day event showcasing various health screening tests for the public .

3).Over 1,000 women from all walks of life participated in the National Seniors Line Dance Carnival held at the Han   Chiang school hall , a joint project with the senior citizens and supported by Rose .   This programme is aimed at fostering and encouraging women 's involvment and participation in healthy lifestyle

exercises.

4) 29th Nov.2009 the Governor of Penang and his consort will lead over 600 participants from   all walks of life including the handicapped ,the blind ,the deaf ,people with special abilities and the orphans from  various charitable homes, on the CHARITY WALK WITH TYT ( TYT stands for His Excellency the Governor ) down  memory lane at the lower loop of the Botanic Garden in Penang .    The event, jointly organised  by Rose and the Senior Citizens with the support from the Penang State Government,    is to raise funds for the State Government's very poor programme under the "Partners Against Poverty "    Programme . ( Rose is a partner of the State Council on  Poverty  ) Participant taking part will pay $l0 malaysian towards the cost of pack snack food, a souvenir T shirt, a goodie bag (consisting various sample health and other products ) and morning breakfast cereal from Nestle . On top of that,each participant is entitled to a lucky draw...  comprising of 5 top prizes of complimentary air tickets  to medan,bali,phuket ,subang and acheh plus several other prizes.

On the Coming events for next year ....2010 .. we are going to kick start the new year with a big bang ....the launching  on oour new premises at the State Government's caring society complex in western road next to the Governor's    Residency .

   

On 12 and 13 Dec 2009 ,Rose is organising the biggest health Expo in Penang  at the International sports arena showcasing over 60 health care providers and their products together with free  health screening tests provided by Gribbles and the fedeal and state health departments involved in the two day  event .   The State Consumer minister Abdul Malik will launch the event  involving over 50,000 people during the two day health expo . This is the 3rd year we are involved in  the joint project with the state government and the private sector .

Rose Charities Madagascar - New school

Cheryl-Anne writes "Our school has grown yet again. We now have 199 students, 11 teachers and 3 support staff (not all are full time). Bina and the Mahatsara Parent's Association have built another school building as well as a smaller building (both located on the hill above the first school building)."