Helping Babies Survive



Sinds 2018 organiseert de EGCH trainingen voor AIGT i.o. en andere geinteresseerden in HBB in binnen en buitenland. Deze worden geleid door Jeanine Punt, AIGT en kinderarts en Janet Lewis, verloskundige. Beiden hebben hiervoor de mastertraining van de AAP gevolgd. Sinds kort is Peggy van der Lans, AIGT, gynaecoloog aan de opleidingsgroep toegevoegd. 
Totaal zijn en al 36 gegadigden getraind in HBB in NL door de EGCH.

Wereldwijd sterven er per jaar 2,6 miljoen pasgeborenen en worden er geschat net zoveel kinderen doodgeboren.Deze sterfte vindt voornamelijk in de zogenaamde LRS’S (low resource settings) plaats.De 3 grootste goed te voorkomen oorzaken van neonatale sterfte zijn complicaties tijdens de geboorte, complicaties door een premature bevalling, en infecties van de pasgeborene.Het op de juiste manier zorgen voor het kind in de eerste levensminuut met nadruk op het helpen met ademen binnen die minuut (zo nodig beademen met masker en ballon) en zodoende zuurstofgebrek te voorkomen, skin-to-skin techniek te promoten direct na de geboorte , de navelstreng niet meteen doorknippen, promotie van borstvoeding, helpt om deze oorzaken weg te reduceren. Al deze eigenlijk zeer simpele technieken worden onderwezen in de trainingen Helping Babies Survive waarvan Helping Babies Breathe (HBB) het begin is. Dit zijn trainingen ontwikkeld door de WHO en de AAP. Het is een evidence based, hands-on programma. Dit programma wordt ondersteund door vele global partners zoals USAID,Save the Children, Laerdal Global health.
Uit onderzoek is gebleken dat het toepassen van deze trainingen door verloskundigen, vroedvrouwen, mensen die bij de bevalling aanwezig zijn in deze LRS’s al kan leiden tot 47% minder sterfte onder pasgeborenen en tot 24% minder dood geborenen.   
Hiernaast is er ook cursus serie ontwikkeld die gericht is maternal health genaamd HMS (Helping Mothers Survive).

In november 2019 is in het kader van de nadruk op sustainability waarbij uiteindelijk de getrainde zelf een trainer wordt en zodoende de trainingen zich als een olievlek zich kunnen verspreiden, een bezoek gebracht aan Sierra Leone, Masanga Hospital en Lion Heart Hospital in Yele waarvan u hieronder het aangepaste rapport kan lezen.  


Report HBB training Sierra Leone 
Dr. Peggy van der Lans, MD obs/gynae, MDGHTM, instructor of tropical doctors, trained in HBB by Master Trainers J.Punt, J.Lewis
Dr. Angelique Veenstra, MD obs/gynae, trained in HBB by Master Trainers J.Punt, J.Lewis
Dr. Rosa Roemers, MD, resident in GHTM, trained in HBB by Master Trainers J.Punt, J.Lewis
Dr. Jeanine Punt, MD pediatrics, MDGHTM, Master Trainer HBB,

have travelled to Sierra Leone, Masanga Hospital with the assignment to 1)explore the needs and possibilities for organizing trainings in HBB/HBS with emphasis on implementation and sustainability on request of Masanga Hospital.
2)additionaly train the mentioned above 3 newly certified HBB trainers to become facilitators in the field.
F.e. Rosa will start her internship GHTM in Masanga in 6 months. 

Too often, HBB courses are organized in the lrc’s but no follow up is guaranteed and so the knowledge and skills are lost very quickly. Additionally facilitators/master trainers who were trained in HBB in a high resource country without experience in training in lrc’s have not been prepared enough to facilitate trainings in lrc’s.

INTRODUCTION
Sierra Leone is a West-African country bordering Liberia to the south and Guinea to the north and east. The capital Freetown is located on the Atlantic coast. The country is 71 740 km2 and is divided in 14 administrative districts. The country is still recovering after the civil war between 1991 and 2002. Life expectancy at birth is 49 years, infant mortality and maternal mortality remain high at 89 per 1000 live births and 857 per 100 000 live births, respectively. Masanga Hospital is one of the 13 district hospitals in Sl. 

Masanga Hospital in Tonkolili District in Sierra Leone was initiated by the government in the sixties as a leprosarium. The running of the hospital was delegated to the seventh day Adventist Church and with help from international experts the hospital started to provide high quality care to the poorest outcast at the most rural place on earth. The hospital had a high reputation and was well known in West-Africa for its effort for leprosy patients. The hospital was ruined by the rebels during the civil war (1991 - 2002). Association Friends of Masanga (AFOM) started in 2006 to rehabilitate Masanga Hospital. The focus was not only on leprosy patients but for the whole population. After the reopening, the project developed in a quick tempo.
Today the hospital has well-run operation facilities, 6 wards and a outpatient department. The hospital is run by local staff supported by 2 employed Dutch tropical doctors. During our visit  the new maternity ward and labour room was opened, funded by AFAS, enabling the pregnant ladies to be separated from the mothers with their newborns. Per year 500 deliveries are done in the hospital. 500.000 people are dependent on this hospital.

The MOHS  has a collaboration with CapaCare, a non-profit humanitarian organization dedicated to medical education and training in developing countries) initiated a Surgical Training Program (STP) for Community Health Officers (CHOs) and Medical Doctors (MDs) in Sierra Leone. The aim of the surgical training program is to increase the level of surgically skilled health staff at district hospitals in Sierra Leone. The goal of this program is to train, each for two years + one year housemanship MDs or CHOs for the country’s district hospitals, to be able to handle the most common surgical and obstetrical emergencies that without treatment would lead to disability or death. All theoretical training of the STP students takes place in Masanga Hospital in addition to the first 6 months of the practical training. After six months the students are sent to other NGO hospitals all over the country to gain further practical training and experience in obstetrics and surgery. After succesful completion of the rotations and passing of the oral and written exam the students enter a one year housemanship period (six months obstetrics and six months surgery) in the governmental hospitals in Freetown. The people enrolling in this training after a serious selection are usually junior med doctors and SHO’s. These trainees and SACHO’s ( surgical assistant clinical health officers) are not very skilled in pediatrics but do have to attend births during their rotations and in their later profession. 

 Primary Training Center
1. Masanga Hospital 
Partner Hospitals
2.     Magbenteh, Makeni 
3.     Holy Spirit, Makeni 
4.     St John of God, Lunsar 
5.     Kamakwie Weslian Hospital 
6.     Lion Hearth Medical Center, Yele
7.     Gundama Refferal Center, Bo
8.     Serabu Catholic Hospital
9.     Aberdeen Womens Center, Freetown 
Housemanship Hospitals
10. Canaught University Hospital, Freetown
11. PCMH Maternity Hospital, Freetown 

In the very near future there will be a bachelor training initiated by the MOHS and partners.

There will be 3 types of training: pediatrics ( provided by German Doctors e.V. , a charitable organization), internal medicine, surgery/obs/gynae (provided by CapaCare) during a 2 year in practice training. Besides the training of SACHO’s in Masanga, there also is a nursing college, educating nurses upto RN level. 

The HBS module was not yet introduced in Masanga. There is clearly a need of HBS skills both for the nurses and the SACHO trainees.  This was expressed by the local SACHO trainer in Masanga; Dr. Erik Wehrens, MDGHTM, one of the 2 tropical doctors, Dr. Jan-Henk Dubbink , the other Dutch tropical doctor ( also trained by EGCH in HBB)  and the director of the nursing college, Amara Forna.
 

EXECUTION
 
Because of a recent serious Lassa fever outbreak which costed the life of local health staff but also the a much loved and highly appreciated Dutch tropical doctor Dr Wouter Nolet, the project in Masanga has been on a standstill since November for about 2 months so there was a slight delay in finding out all we want to know and arranging all we wanted to achieve. Also the trainings we wanted to provide turned out a bit different from what we expected but we were able to organize 2 adapted half day trainings in HBB provider course for all the SACHO’s and 2 midwifes.

The first day was initiated by Jeanine and so she could train her 3 companions. Since because of the mentioned unexpected circumstances it was decided to split up and also go to Lion Heart Medical Centre Yele.  Peggy and Angelique finished the training in Masanga. The next day they organized the other half day training. Focus of these HBB trainings was what to do when not breathing and the technique of ventilation. This clearly was highly needed. All the 13 participants passed the exam. Dr. Jan-Henk Dubbink had ordered 2 neonatalie sets and a flipchart . These were delivered for repeat trainings in the future.Certificates in Masanga 

Implementation:
 
During our visit in Masanga: 
*we inspected all the equipment for birth and resuscitation,  cleaned and reorganized it. 
*An inventory list was made and one of the STP’s was made responsible for maintainance and cleaning.  
*We made recommendation for the new set up of the new maternity ward and labour ward and operation theatre with focus on possibilities for a good preparation for birth, a hygienic and safe situation for tools needed for the birth, resuscitation within the golden minute.
*Action Plan Posters were pinned down. Cleaning Posters were provided and pinned down. 

Rosa and Jeanine travelled to Lion Heart Medical Centre Yele and organized a HBB provider course for 9 nurses. So there were 3 facilitators providing the training. One of them was the local tropical doctor Dr. Geerte den Hollander who in 2018 was trained by Jeanine as a HBB facilitator and in this way also received a refreshment of the training. The complete HBB training was provided and 7 out of 9 passed the exam as a provider.The Yele hospital already was well equipped with training material brought by Dr. Geerte after a previous order made by me.During the visit stay there was the opportunity to witness a birth and see how HBB was put into practice and give feedback on this.  Furthermore during the stay a 360 degrees VR film was recorded. After processing in collaboration with WARP, a company originated from the Technical University Delft, the Netherlands, the material this will be used as an interactive E-learning film on HBB .  Certificates in Yele HBB course in Yele   

FUTURE PLANS/ sustainability
 
Peggy and Angelique are part of the ZGT HOSPITAL group In Almelo, NL. Peggy is an instructor of the tropical doctors in NL in her hospital. ZGT has an alliance with Masanga Hospital/CapaCare to train the tropical doctors (MDGHTM) during their internship abroad. She will ensure that all the tropical doctors who will go to Masanga will have received a HBB training before they go to Masanga in order to guarantee the quality of skills and knowledge there. As part of their training they will have to organize trainings and cooperations with other health facilities such as the PHU’s (public health units) surrounding Masanga or the nursing college. Rosa, the MD trainee in GHTM will organize the trainings of the nurses in Masanga once she will work there in 6 months ,only after a solid baseline measurement of neonatal mortality/morbidity and will collect data 3 months after her trainings. 

The Expert Group Global Child Health (EGCH), regularly organizing HBB (HBS) and ETAT (emergency triage and treatment, WHO) trainings, and the KIT (Royal Tropical Institute) have agreed upon that those trainings must be an obligatory training for all the trainees in GHTM . At the moment EGCH is negotiating with KIT and TROIE ( Society for MDGHTM) how to finance these trainings since the trainees in GHTM are not funded by the government (the only exception for all the medical specialities!) for their training.  

                                                                           
Jeanine Punt
The Hague, 20 February 2020                                                      




 



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