26 and 27 November 2024 in Moussoro

Introduction

A medical training event was held by the Health Delegation in Moussoro the 26 and 27 of November. The training was a partnership between the association Service au Sahel and the Ministry of Health, represented by the Health Delegate, Dr. Youssouf Saleh Mahamat.

Maternal and infant deaths are elevated in the Bahr el Gazel province compared to the goals established by the Ministry of Health. For this reason, the association wanted the participants to understand the following things after having taken the training:

1. Understand the Golden Minute and the risk signs for newborns.
2. Recognize a baby that is not doing well and start resuscitation correctly without any delay.
3. Understand what a normal birth is like, as well as moderate and heavy bleeding.
4. Correctly diagnose moderate or severe hemorrhaging and start immediate treatment according to established steps.

The training was primarily given by Drs Michael Schüle and Claudia Wahl. The association also was supported by a volunteer medical team from outside of Chad, composed of two additional doctors and two midwives.

Starting with the knowledge the health professionals already hqd, the training reinforced the steps for emergency treatment. Most of the training time was devoted to practicing established steps, using simulation models and actresses.

Day 1 Moussoro Provincial Hospital

The training was opened on Tuesday 26 November by the Health Delegate. He underlined the need for improved maternal health practices in the province. According to the Delegate, there had been 22 maternal deaths for the current year, or on average 2 per month. According to the audit done by the health delegation, almost half of the cases were due to Postpartum Hemorrhages. Along with this sobering statistic, the Delegate noted that there had been 74 neonatal deaths in the year thus far.

After the opening ceremony, the training focused on postpartum hemorrhaging. First, the trainers discussed a normal delivery and postpartum treatment. After the coffee break, moderate bleeding was taught. After lunch, the training covered severe bleeding. The day finished with a summary of all that had been covered and a time for questions.

All training topics were first presented theoretically and then practices with activities, allowing the participants to put the protocols they learn to practice on simulation models or actresses.

Day 2 Moussoro Urban Health Center #1

The second day focused on neonatal resuscitation, starting with how to evaluate and how to give primary care. The use of a bag valve mask (“Ambu bag”) was practiced. After the coffee break, ventilation and the protocol for resuscitation was practiced. The second day of training finished with a summary of the subjects taught on both days.

A small ceremony was held at the end of the day to give the participants their certificates. The ceremony was attended by both the Health Delegate and the Head Doctor for the District, Dr. Abdraman Hamajouma.

Dur the closing ceremony, Samuel Schoofs, the Secretary General of the association made note of the fact that the training was taught through listening, watching, and doing. The trainers wanted to improve information retention by teaching using multiple sense.

The Health Delegate encouraged all the participants to put the training material in practice in their daily work. He also thanked the association for organizing the training.

Conclusion

A total of 24 people were trained, including 15 from the Provincial Hospital, 7 from Urban Health Center #1 and 2 from Urban Health Center #2. Among the people trained, there were doctors, nurses, midwives, and health technicians.

Many participants noted that they appreciated the practical emphasis that the training used.

Future Possibilities

This was the sixth training that the association Service au Sahel has organized in Moussoro since 2019. Considering the ongoing training needs for healthcare workers in the province, it is possible that future trainings will be organized with the help of the Health Delegation.

15-16 November, 2023 at the Provincial Hospital in Moussoro

Introduction

Service au Sahel organized a training in Moussoro in conjunction with the Representative of the Ministry of Health, Dr Youssouf Saleh Mahamat. The training was given by two volunteer doctors who came from N’Djamena

Since 2019, the association has organized four trainings in Moussoro.

The training was officially started by the Dr. Youssouf, who reminded the participants of the recent history of newborn mortality in Chad, while adding that the causes of newborn deaths are well known. 

He shared that this training was a “great opportunity to help us…improve our skills.”

The hospital administration chose 15 people for the training, including doctors, nurses, and midwives. The participants came from multiple departments: Maternity, Pediatric, Emergency, and Therapeutic Nutrition.

The opening ceremony concluded with a picture of all the participants:

Day 1 Neonatal resuscitation

The first day was taught by Dr. Claudia Wahl with help from Miriam and Dr. Carmen.

The material used came from the program “Helping Babies Breath” from the American Academy of Pediatrics.

The participants were able to practice using an inflatable simulator called NeoNatalie that resembles a newborn baby. 

The first day covered evaluation of a newborn, initial care, ventilation, and resuscitation.

Day 2 Post-partum hemorrhaging

The second day, Dr. Claudia taught on post-partum hemorrhaging.

The leading cause of maternal death is “Severe bleeding after birth also called postpartum haemorrhage”, which “can kill a healthy woman within hours if she is unattended.”

Like the training in June 2022, the “Bleeding After Birth Complete 2.0” program from Helping Mothers Survive, a program of Jhpiego, was used for the training. 

“After birth, the state of the mother and the baby can change quickly. The mother and her baby should be carefully monitored. The first minute after birth is critical to make sure that the baby is breathing normally.”

“Bleeding After Birth Complete 2.0”
Helping Mothers Survive

All during this second day of training, practical activities were done with different “patients” which required analysis and treatment by the training participants.

The training covered normal birth, moderate bleeding, and severe bleeding.

Partogram

At the request of hospital staff, the last part of the training covered how to use a partogram. The trainers showed the hospital staff how to graph labor and delivery. They learned how to recognize danger signs from the partogram and when to take action. 

Conclusion

The second day finished with a closing ceremony. The Representative of the Ministry of Health, Dr Youssouf Saleh Mahamat was present as well as administrators from the hospital. Every participant received a certificate during the ceremony.

In closing, Dr. Youssouf thanked “the association Service au Sahel for everything they have done for Chad in general and in particular for the Bahr el Gazel province.”

Testimonial

A week after the training one of the participants told a trainer how she had put the training material into practice. She said,

“After trying several drugs to stop bleeding, and all other things I could, I compressed the uterus of one woman with my hand for about 15 minutes and the bleeding stopped.”

This testimony shows how simple acts can easily save a life. The association is proud to help improve training and hopes to do another training in the coming year.

January 18 – 19, 2023 at the Provincial Hospital in Moussoro

Introduction

Service au Sahel (SAS) organized training in Moussoro in coordination with the Representative of the Ministry of Health, Dr. Amboulmato Hormo. The training was led by two volunteer doctors who came to Moussoro from N’Djamena.

SAS previously organized postpartum hemorrhage training at the hospital in Moussoro in June 2022, neonatal resuscitation training in November 2021 and dental extraction in October 2019.The training was officially opened by Dr. Hormo along with the Director of the Provincial Hospital, Brahim Mahamat Mahadi. Dr. Hormo underlined the importance of this training at the hospital, because often such trainings are only given at the largest hospitals in the largest cities in Chad.

Day 1 Cardio-Pulmonary Arrest

Day 1 focused on cardio-pulmonary arrest and was taught by Dr. Michael Schüle.

Adult resuscitation typically has a low rate of success due to various complicating factors. Therefore, it is advantageous to prevent cardo-pulmonary arrest before it starts.

Dr. Schüle’s training covered all steps necessary for basic adult resuscitation as well as the steps needed for advanced resuscitation.

He finished by reviewing the material on neonatal resuscitation that had been covered in the previous training in November 2021.Practical exercises were woven throughout the material to help reinforce the information that was being shared.

Day 2 Obstetrical emergencies

Day 2 focused on obstetrical emergencies and was taught by Dr. Claudia Wahl. She discussed how emergencies are rare but are nonetheless potentially mortal for either the mother or the child, or both.

First, she focused on bleeding as a sign of urgency. She covered the various diagnostic actions that need to be done to diagnose the patient.

After the break, she taught about convulsions as a sign of urgency. Eclampsia is always a risk for women with a pregnancy that is more than 22 weeks along.

Finally, the training finished with a review of post-partum hemorrhaging that had been covered in June 2022.Similar to the training from Day 1, practical activities were included in the training so that participants could gain experience responding to different scenarios in the training room.

Conclusion

A total of 16 people were trained, including two doctors, five midwives, four nurses, and three nursing technicians. The 16 healthcare providers who completed the training at the hospital received certificates at the end of the training. In addition, the two doctors who gave the training each received a certificate from the Health Representative recognizing their contribution.

The Representative of the Ministry of Health emphasized in his speech, the need for the hospital staff to put the training into practice. He said that the training will help to save someone’s life. Similarly, Service au Sahel desires to see improved healthcare at the Provincial Hospital and throughout the Province. 

Introduction

Service au Sahel (SAS) organized training in Moussoro in coordination with the Representative of the Ministry of Health, Dr. Amboulmato Hormo. The training was led by two volunteer doctors who came to Moussoro from N’Djamena.

SAS previously organized neonatal resuscitation training at the hospital in Moussoro in November 2021 and dental extraction in October 2019.

Neonatal resuscitation at the Urban Health Center

According to the World Health Organization, “Sub-Saharan Africa had the highest neonatal mortality rate in 2020 at 27 (25–­­32) deaths per 1000 live births.” Chad’s neonatal mortality rate is 32.81 deaths per 1000 live births, which is the 10^th highest in the world according to the World Health Organization’s Global Health Observatory.

The first part of the training was done on 15 June 2022 at the Urban Health Center in Moussoro. 

The morning began with a visit of the Health Center, including the admitting room, the labor room, the delivery room, as well as the laboratory. Then training on neonatal resuscitation was given to six nurses and midwives.

The goal of this part of the training was to prepare the nurses and midwives to better respond to a newborn who was having trouble breathing.

Instruction was given and then the participants were able to practice resuscitation using an inflatable simulator called NeoNatalie that resembles a newborn baby. 

Training at the Moussoro Provincial Hospital

Two days of training, 16-17 June 2022, were given at the Provincial Hospital in Moussoro. Sixteen participants, a combination of doctors, nurses, midwives, and health aides were trained on three subjects: prevention and treatment of postpartum hemorrhage, neonatal resuscitation, and improved charting using the partograph.

Module 1: Prevention and treatment of postpartum hemorrhage

The WHO says that “Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known.” The leading cause of maternal death is “Severe bleeding after birth also called postpartum haemorrhage”, which “can kill a healthy woman within hours if she is unattended.” 

Chad has a maternal mortality rate of 1140 deaths per 100,000 live births, which is the 2^nd highest in the world. The World Health Organization has a Sustainable Development Goal to reduce the global maternal mortality rate to less than 70 deaths per 100,000 live births. 

The “Bleeding After Birth Complete 2.0” program from Helping Mothers Survive, a program of Jhpiego, was used for the training. 

The training showed healthcare providers how to identify the causes of heavy bleeding and manage each one correctly. Charts were used which helped identify the steps to take for routine care and advanced care. Focus was given to rapid response in emergencies, requiring the assistance of other staff members.

Module 2: Refresher course on neonatal resuscitation

A refresher module was given on neonatal resuscitation. Like the training at the Urban Health Center, the training helped the healthcare providers know how to respond to a newborn who was having trouble breathing.

Module 3: Improved charting using the partograph

Médecins sans Frontières defines the partograph as “a tool for monitoring maternal and foetal wellbeing during the active phase of labour, and a decision-making aid when abnormalities are detected. It is designed to be used at any level of care.”

The provincial hospital wanted to improve their use of the partograph in the maternity. Trainees were shown how to chart labor and delivery. They were taught how to recognize the signs for alert and the signs for action. Using a hypothetical scenario, they practiced using the partograph for charting.

Conclusion

With an estimated population of 349,000 people in the Bahr el Gazel, the Provincial Hospital and Urban Health Center are two of the most used healthcare structures in the province.

The 16 healthcare providers who completed the training at the hospital received certificates at the end of the training. In addition, the two doctors who gave the training each received a certificate from the Health Representative recognizing their contribution.

The association Service au Sahel is proud to have helped organize this training to reduce neonatal and maternal mortality in Moussoro and the Bahr el Gazel. Additional training in Moussoro in 2022 will be discussed in collaboration with our local partners.