The Vocational Training Team (VTT) was picked up from Entebbe Airport and we arrived at Ngora at 02:30 am. The training started later that day. The team was made up of 4 midwives, Gillian Pearce, Claire Carter, Samantha Fleming and Danielle Naughton.

Nursing and Midwifery Training.

Samantha Fleming and Gillian Pearce took the Pre-Training School students and these were taught basic first aid and how to recognise the deteriorating patient.  Basic Life support had been requested by the Medical Superintendent following a maternal death earlier on in the year. We also covered haemorrhage, sepsis, malaria and its impact on eclampsia and cord presentation.

There were 130 students broken up into 5 groups and they were engaged with the training. They were taught about managing a patient who was choking with the use of a training aid so that they could practise the back slaps and the Heimlich Manoeuvre.

Danielle Naughton and Claire Carter taught student midwives newborn life support and infant feeding.  We then all came together to teach obstetric birth emergency skills, we did deteriorating patient, haemorrhage and choking.

Health Professionals.

The training was given to nurses, midwives and other support personnel. It was identified that the theatre cleaners and porters were more aware of where the emergency equipment was located and they were often the second pair of hands. Pharmacists can be a trained nurse. We did adapt our training to meet the level of support we would expect from them, such as providing cardiac compressions.

Master Class

We organised a master class with the aim to train the trainers and give specific training to hospital staff on the use of the defibrillator. We insisted that medical staff needed to be present as this is a piece of kit which could harm staff if incorrectly used. As the hospital had organised a surgical camp at the same time as our visit and had been promised extra surgeons which did not materialise. The decision was made to fund a surgeon so that medical staff could be released to be trained on the use of a defibrillator.

The training was carried out using a training defibrillator. Cardiopulmonary resuscitation was taught and included the Chain of Survival.

Rotary Family Health Day

A Rotary Family Health Day was done in conjunction with the Rotary Club of Ngora. It was held in an outreach area, in a school and church. The health day in addition to the session the VTT did, covered immunisations, HIV testing, antenatal care and cervical screening.

The VTT held a community workshop with Village Health Team Leaders, Parish Elders, Health Centre 1 staff, teachers and community workers. The training sessions covered the recognition of the sick baby and / or woman, infant feeding, kangaroo care, the importance of antenatal care and how to prepare for birth and when they needed to refer to hospital. The team supported menstrual hygiene workshop which was given to people attending the community workshop but also to 120 school children (boys and girls). The entire sessions were covered in Teso and we did have interpreters.

Training

475 people were trained in total, consisting of 210 student nurses and midwives and 265 healthcare professionals, these were from Freda Carr Hospital and a number of surrounding health clinics.

Impact of the Vocational Training Team and the global grant for refurbishing the hospital.

The hospital held for the first time a surgical camp. There were 70 cases being operated on as well as doing the normal hospital work. The theatre had one operating theatre running and 2 minor operating theatres going at the same time. The theatres were going for about 12 hours a day. They were operating on hernias, goitres and lipomas for example.

The wards were full. On the first day, the VTT handed over 30 vials of tranexamic acid and 2 vials were used the same day for a pregnant woman who came in with an abruption both her and the 34 weeks gestation baby survived.

The hospital now has more medical staff than from when Rotary first got involved ( when there was just one junior house doctor) now there is a full time medical physician a part time paediatrician ( 3 days/ week) and normally 2 anaesthetists and that the senior medical officer Dr Willy is a senior  proficient surgeon enabling interns to attend providing additional surgical assistance … and although there may be more challenges ahead I think we’ve left the place in a much healthier place than when we first arrived.

The hospital has been accredited by UNICEF and have received an International Baby Friendly Initiative Award. This is given when a hospital meets certain standards for infant feeding. The staff must be trained and the local community health workers which is part of the training given by the VTT. They have successfully sent home a baby that weighed 800g at birth. This did use a combination of expressed breast milk given via a nasogastric tube or by a spoon.

The staff were aware of the benefits of Tranexamic Acid following the teaching we gave last year. It is recommended by the World Health Organisation but it has not made the list of essential drugs for hospitals. The drug is considerably cheaper than a unit of blood and the government needs to add it to their drugs list.

As a result of the changes between the hospital and the school of nursing, the hospital could not borrow equipment to train the staff. So, the team provided equipment to enable the hospital to set up a skills lab.

The team provided: –

• Cardiopulmonary resuscitation manikin
• Baby Annie which is a neonatal resuscitation doll
• Defibrillator training kit
• Anti-choking training aid
• Ambu-bags and masks for babies and adults
• Medical books had been donated which could be used by interns.
• Doll and pelvis so they could practice different birth manoeuvres.

We also gave pinards, blood pressure machines and stethoscopes and neonatal ambu-bags which were going to be given out via the District Health Office to relevant health centres.

One person has been mentored by one of the members of the VTT. She was a student midwife, and she successfully passed her diploma in midwifery in June 2023. She felt we had mentored her and empowered her to achieve her dreams.

Community workshop

The impact of this was the sharing of knowledge. There were discussions about ensuring that there was a motorbike available to take a woman to hospital. There were discussions about sexual activity during pregnancy and we did discuss alternative positions and the importance of the woman’s consent. The Village Health Team leaders are a valuable source of health information and they do not often get an opportunity to have their knowledge updated or have a forum where they can discuss issues about health that concern them and their community.

Overall the team felt that staff morale was high. The hospital was busy. The hospital has successfully been allowed to join the programme for training junior doctors.

Vocational Training Team

The team worked well together and were highly adaptable for the challenges that did occur at short notice.

The Rotarian Team Leader (Gillian) and Claire made a presentation to the Rotary Club of Kampala Central following the completion of the project. This included a YouTube Video https://www.youtube.com/watch?v=nwsU3yPggxc of the training team from last year.

Claire commented “I’ve learned a lot over our visits and it’s been a pleasure getting to know the staff and lead by example, to support the teams at Freda Carr.”