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.

Service au Sahel held a two-day training in neonatal resuscitation at the Provincial Hospital in Moussoro. The course was held on November 12 and 13 and 16 medical staff from the hospital were trained.

The program teaches skills in caring for neonates with a focus on those babies who have difficulties in breathing after birth. The participants improved their practical skills in basic life support, working on clinical scenarios in small groups. Implementation of a set of simple measures like bag and mask ventilation has been shown to reduce early neonatal mortality up to 50% in the low resource setting.

Of the 16 medical staff trained, five were from the Maternity department of the hospital.

The training on neonatal resuscitation is the second collaboration Service au Sahel has had at the hospital in Moussoro. The first was a dental training in November 2019.