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Report from Lira 2019

Report from Lira 2019

Antoinette McAulay

Background

This training visit to Lira took place between September 21st to October 5th 2019; the first of two consecutive visits. The team consisted of 5 members, two of whom were new to Poole Africa Link: Sarah Currell, Emily Deary, Sally Loven, Melanie Pritchard and myself.

The team taught the advanced midwifery students at Lira University, and to doctors, clinical medical officer students, nursing students at Lira Regional Referral Hospital (LRRH).

Logistics

Flight and transport to and from Lira went smoothly again this year. We had the services of our usual driver who was always prompt and helpful. There was however a serious incident en route back to a team visit to Murchison Park at the weekend, involving a back injury to one of the team members. This is currently being investigated by the Poole Africa Link Trustees committee.

The team stayed at the Kanberra Hotel where they were welcomed by the staff and had a comfortable stay. No team members had any illnesses during the trip. A new hotel manager (Moses) was extremely helpful.

University

We were delighted to see that the new University hospital is now staffed and in use (Medicine, Surgery, Paediatrics and Maternity departments). The Out-patient department is fully operational, but there is not currently a paediatric clinic. This is likely to start shortly.

Currently the hospital is perceived as an expensive option which is limiting the number of patients attending. Most wards had 3-5 patients. General surgery is now being carried out. The maternity wing is also fully functional with a steady stream of antenatal patients. The wards are bright and clean, and are using the Poole Hospital curtains that we transferred last year. There are still nursing staff shortages, but appropriate medical staffing. The nursing staff are organised and focussed on excellent care. Observation charts are completed and the new prescription charts are in use. Pathology services remain limited.

The children’s ward has 4 rooms set aside of Neonatal care with new incubators, but as yet no respiratory support equipment such as CPAP. There were no neonatal patients during our stay, but apparently a few term babies have been admitted.

There are new building works starting to accommodate new courses, including Batchelor degree- level nursing and Masters level midwifery. The medical school plans are not imminent (around 2 years away).

We were delighted to have the opportunity to meet Jo Acen (Head of Nursing and Midwifery) and Anna Grace (Lecturer in midwifery) on our first morning. Following pre visit plans, we drew up the team teaching program for the two weeks, involving approximately a day a week for each year of the midwifery students. Joy encouraged some of the tutors to join us for teaching sessions which occurred for our first afternoon of neonatal resuscitation teaching. The number of tutors has been expanded. In particular some of the 4th year students from last year, who excelled have been appointed as assistant tutors. The timetable mainly ran to the agreed program, but sometimes due to communication problems, other lecturers arrived to teach during our allotted sessions or students did not arrive for 8am lectures.

We were made to feel very welcome by staff, and were invited for an evening out with a number of the lecturers on the last evening. Some of the team met Professor Jasper briefly who also welcomed our team.

Lira Regional Referral Hospital

We spent approximately half out teaching time this year at Lira referral hospital. We were again welcomed by Dr Odu, the hospital director and also by the Principal Senior Nursing Officer Judith; who were both extremely helpful. We were allocated the Grand Round slot on our second week with good attendance

The infrastructure of the hospital has been improved with new covered walk-ways. The Feeding centre, paediatric ward and maternity unit are still in need of renovation, and building work on the new maternity unit is in progress.

Medical and senior nursing staffing remains poor. During the second week, there was no junior medical staff as the new interns were on strike in regards to their working program.

Paediatrics at LRRH

The paediatric wards were extremely busy during our two weeks, in particular with cases of sepsis, pneumonia, malaria and sickle cell crises. I was pleased to see that many patients were having temperatures taken prior to the ward round but there were no available charts to plot these on, so they were recorded in the notes. The notes were better completed and I noted dated and timed entries. Oxygen saturations were also used to guide starting and stopping oxygen treatment, which was being used more appropriately than previously. Observations during blood transfusions were also noted but not consistently

There were visits by two of the University consultants: Dr Nelson and Dr Nyeko once a week (which they do on a voluntary basis). Dr Williams the senior paediatric consultant visited on several occasions to see the sickest patients. In the first week there was a very keen Intern. Throughout the whole fortnight most of the work was done by a volunteer doctor doing a pre-intern attachment and a staff paediatrician Dr Betty. The two senior paediatric nurses remained the same. As previously no University students were attached for clinical experience during our stay, but there were 5 clinical attachment students and numerous diploma/certificate course nursing students. There was much opportunity for clinical teaching on the children’s ward with all staff groups

Achievements

  1. Facilitation of a successful team visit allowing all team members skills to be productively utilised with excellent team relationships.
  2. Alongside the Team, maintaining and developing relationships with the University and LRRH.
  3. Neonatal resuscitation to all year groups
  4. Assessment and Management of the Sick Child teaching and scenarios
  5. Lectures on various paediatric topics including Triage, Respiratory conditions, and Diabetes
  6. Ward paediatric teaching to clinical medical officer students including history taking and clinical examination of a child
  7. Delivery of basic equipment including ambu-bags, oxygen masks, BNFs to University and LRRH wards

Suggestions for next visit

Teaching

  • Yearly update on neonatal, paediatric and adult resuscitation
  • Lecture and scenario teaching on all relevant aspects of paediatrics
  • ETAT course
  • Clinical supervision of students on the paediatric areas of LRRH and University hospital when appropriate
  • Training Lira lecturers in providing resuscitation training as a more long-term plan
  • Future involvement as needed with students from new courses

Equipment

  • Thermometers, watches, mini-sats to aid teaching and practice
  • Spacers
  • Blood glucose strips (must be in date)
  • Syringe drivers

(Plus see list from Dr Nyeko)