Advanced obstetric training programme and continued strengthening of the emergency care system at Brikama Major Health Centre
Despite the Strengthening Emergency Care project, and other initiatives over the last 10 years, maternal mortality rates remain high and inaccurately reported, particularly in rural as compared to urban areas of the country. In addition, there is a recognized paucity of skilled obstetric practitioners in the Gambia, especially in rural areas.
In response to this situation, and after the successful implementation of a similar task-shifting project in Liberia, in August 2014, the MOHSW, MCAI and ALSG initiated a pilot Advanced Obstetric Training Programme for junior doctors and senior midwives at Brikama Major Health Centre. As part of this programme there was a need also to continue to strengthen the systems in Brikama MHC to enable and support effective training and service delivery.
The one year advanced obstetric training programme commenced in October 2014 and over the following year, 3 international obstetricians from MCAI were involved in providing almost continuous senior obstetric cover for Brikama MHC and training to the first two obstetric trainees (1 junior doctor and 1 senior midwife). With the support of the MOHSW a further 4 trainees (1 senior midwife and 3 junior doctors) began the training in November, 2015 and are currently working at Brikama, with a continuous supervisory and training presence provided by senior obstetric MCAI volunteers enhanced by the two previous trainees, a senior Gambian general surgeon from Kuntaur who is also benefiting from the training, and a Cuban gynaecologist.
Dr Alice Clack, MCAI consultant obstetrician, treating a pregnant woman on the maternity ward
The Brikama Obstetric Project: a description and interim analysis
Maternal and neonatal mortality remains a major problem in The Gambia, particularly in rural areas where there are few skilled practitioners able to provide advanced maternity and neonatal care.
In August 2014, MCAI and ALSG initiated the Brikama Obstetric Project, an intervention consisting of an advanced obstetric training programme in which 3 international obstetricians provided almost continuous senior obstetric cover for Brikama Major Health Centre (BMHC) while training 6 obstetric trainees (4 junior doctors and 2 senior midwives) over 2 years. Health system strengthening to improve the service delivery of obstetric care was also a major component of the project, particularly given the poor condition of BMHC and the lack of essential medicines and equipment.
The first year demonstrated that it was possible to train over this time period doctors and senior midwives to a level where they can provide high quality Comprehensive Emergency Obstetric Care (CEmOC). The second-year of the Project finishes at the end of October 2016 but as yet, has no further funding to continue after this time and will have to stop unless further substantial funding can be secured.
Pictured above is the EgAr Vacuum Device, developed in Bansang Hospital in 2012 by Arfang Faye, a trainee on the MCAI Advanced Obstetric Training Programme. Arfang has presented this innovative device to WHO (Geneva)- November 2013, Health Research Conference The Gambia - 2014 and WAHO (Ouagadougou) - July 2015
Click here to read an informative poster used for a presentation given by Dr Gemma Sheridan, one of our current medical charity workers in The Gambia, at the RCOG National Trainess Conference. The aim was to showcase MCAI's work and to interest junior doctors in obstetrics and gynaecology, to join MCAI or other organisations working overseas. Dr Sheridan focused on the non clinical experience she had gained as this is not so easy in the UK