Providing training in advanced obstetrics including abdominal surgery such as Caesarean section for experienced midwives

MCAI’s Liberian task-shifting project on film

Al Jazeera's, The Cure, features MCAI's Liberian task-shifting project.

Watch the film.

Read Al Jazeera article about the project.

May 2nd 2016  The latest Bulletin of the World Health Organization (WHO) is a special theme edition entitled: The Global strategy for women's, children's and adolescents' health (2016-2030).

 

One of the peer-reviewed published papers in this theme edition reports on the latest progress with the MCAI training programme described below. Here is the formal citation:

Training of midwives in advanced obstetrics in Liberia
Obed Dolo, Alice Clack, Hannah Gibson, Naomi Lewis & David P Southall
http://dx.doi.org/10.2471/BLT.15.160473

Zoomin TV have just made a short film about one of our trainee obstetric clinicians (midwives) in Liberia.

Watch the film

History of project.

In February 2012, MCAI approached the Liberian Ministry of Health and the World Health Organization (WHO), proposing a collaborative partnership to reduce rates of maternal and neonatal mortality in Liberia. One aim was to address the shortfall in doctors by training experienced midwives in advanced obstetrics including abdominal surgery. In October 2012, a formal partnership – including a pilot project training two experienced midwives – was established.

 

In September 2013 – after a debate supported by the ministry of health – the Liberian Medical and Dental Council approved the provisional registration of the first two midwives to train as obstetric clinicians. The midwives’ selection for this pilot study was based on their five to six years’ experience in midwifery, the quality of their work in public health facilities and their performance on an internationally accredited three-day training course in emergency obstetric and neonatal care held in Liberia (see below).

 

Read the latest presentation on this work (December 2016).

 

Read here the Curriculum for Advanced Obstetric Training

 

Read here the weekly classroom based schedule for advanced obstetric training

 

An E Library of > 300 videos, textbooks, manuals and presentations on maternal, neonatal and child healthcare has been developed and in collaboration with the Ministry of Health, UNFPA and WHO is being introduced for continuing medical education throughout Liberia. Read here for contents of this E Library as of March 2017.

 

In a PLOS Medicine blog post on 9th March 2017 (read here), our experience of interactive distance based tutorials between midwives training in advanced obstetrics including surgery (obstetric clinicians) in Liberia and experts in the UK was presented.

 

Such tutorials in combination with apprenticeship-based and direct face-to-face training, is making a particularly valuable contribution to the achievement of safely skilled and knowledgeable obstetric clinicians. Given the paucity of both Liberian doctors and international volunteers willing to work in Liberia, efforts such as this are likely to be increasingly important in supplementing the training for Liberia’s desperately needed future healthcare workers.  

 

One rapidly identified secondary consequence of the tutorials was to improve the trainees’ literacy in reading and writing in a country where basic school education has been interrupted by conflict and extreme poverty.

Senior midwife and trainee obstetric clinician, Lucretia K Koko, is delighted to model our new uniforms for the operating theatre and labour ward at Redemption Hospital, Liberia where she is also the Assistant Supervisor in obstetrics and gynaecology

On 22nd July 2017 in Monrovia, a special meeting was held to commemorate the qualification of the first two obstetric clinicians in Liberia; senior midwives Hannah Gibson and Naomi Lewis.

The meeting was attended by senior dignitaries from the Ministry of Health, World Health Organisation, United Nations Population Fund, Liberian Medical and Dental Council and trainers from three hospitals (CB Dunbar, CH Rennie and Redemption).  Also present were the latest 8 trainee obstetric clinicians (who are about to become interns) and 4 trainees in advanced neonatal hospital care (who started in April 2017).  The meeting was inspiring - see the following for more information:

1. The programme.

2. An article in the Liberian national newspaper.

3. The speech given by the Master Trainer, Dr. Obed Dolo.

 

Hannah and Naomi – our first two obstetric clinician trainees.  Naomi (left) has just performed a Caesarean Section with help from Hannah and an international MCAI obstetrician.

The first two obstetric clinician candidates: Naomi and Hannah together with Dr Obed Dolo (trainer) and Jeremiah Akoi (logistician far right)

Hannah & Naomi undertaking Caesarean Section under the supervision of an MCAI international obstetrician.

Outside CB Dunbar Maternity Hospital in Bong County, during the Ebola outbreak. Standing just outside a cordon protecting visitors from entering the hospital until they have washed their hands in chlorinated water and had their temperatures taken are from left to right Jeremiah Akoi (MCAI logistician), Naomi Lewis then Hannah Gibson (obstetric clinicians in training). On the right is Dr Obed Dolo, consultant obstetrician and the Director of the Hospital. Dr Dolo, with support from MCAI’s obstetricians Johan Creemers and Alice Clack, has been the trainer of the obstetric clinicians (senior midwives).

MCAI newly published textbook being given for free to Yamah Miller, midwife at Phebe Hospital,  by Augustine Laveleh from ACDI Voca.

By ensuring that the hospitals in Liberia had essential drugs, supplies and equipment, including protective clothing, during the Ebola epidemic, we hoped to encourage more health workers to return to work and keep functioning the life-saving work of the public hospitals, which care for more than 90% of the population.

In September 2015, following the results of the training of the first two midwives, permission was given by the Liberian Ministry of Health and Liberian Medical and Dental Council to extend the training for more obstetric clinicians to 7 additional senior midwives and 2 physician assistants (both with extensive experience in midwifery). Apprenticeship based education for these additional 9 trainee obstetric clinicians is now based in 3 Liberian hospitals: Redemption in Monrovia, CH Rennie in Kakata Margibi County and CB Dunbar Hospital in Gbarnga, Bong County.

After consultation with, and funding (100,000USD) from, our partner WHO, these 9 new trainees were appointed in the autumn of 2015 after a rigorous selection procedure held at the headquarters of UNFPA, a new partner to the programme, in Monrovia.  

 

Apprenticeship training is now underway in the 3 hospitals under the supervision of master trainer in obstetrics for Liberia (Dr Obed Dolo) with support from Liberian doctors: Dr Brima Davis, Dr Whesseh, Dr Loa, Dr Johnson, Dr Asinya, Dr Harris, Dr Gorpudolo and Dr Maxime.

 

The 9 new trainees have now completed a Foundation Course in Basic Surgical Skills, Pelvic Anatomy and Ultrasound Scanning for Obstetrics and started their apprenticeship based work at CB Dunbar, CH Rennie and Redemption Hospitals.

 

MCAI's international consultant obstetrician, Dr Maire Casement, is providing invaluable support to the training at CH Rennie Hospital.

 

Our two obstetric trainers Hannah Gibson & Naomi Lewis have been officially appointed by the Liberian Medical and Dental Council as interns.  Hannah started this work at Phebe Hospital in Bong County and is now working in Redemption Hospital.  Naomi was initially working at CB Dunbar to help with training but has now moved to CH Rennie Hospital.

 

To help launch the next stage of the programme, MCAI provided three portable ultrasound scanners.

The first 6 trainee obstetric clinicians receving training materials including logbooks (paper based and electronic) from Master Trainer, Dr Obed Dolo. 

MCAI provided 3 portable ultrasound scanners, (funded by Dr E and Mrs A Southall) to the 3 hospitals providing training. Here we see one of the scanners donated to CB Dunbar Hospital.(from left Jeremiah Aquoi, Dr Davis, Hannah Gibson, Dr Dolo, Naomi Lewis)

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