Dhangadi - Day 3

Day 3 - Seti Zonal hospital training agenda:

The third day training session comprised of SBA trainees practising the skills themselves and cross-checking the same with the checklists for each task. A trainee would read the step by step tasks as per checklists and another trainee would do it. In the process, a trainer would cross-check both. All the tasks done on day 1 and day 2 were practised in teams in several stations on day3.

observations: 

In Newborn resuscitation, trainees used the upright bag mask provided by Laerdal to practice resuscitatation on Neo Natalie. Though trainees could get feedback on their resuscitation by seeing the chest of the baby go up and down, the effectiveness with which they carried out the pumping was unable to be evaluated as the baby needs 40 equally spaced pumping in 1 min manually. Neither the trainees were doing 40 pumping nor the trainers could evaluate.

PPIUCD insertion: 

During this 3 day training, only few people were trained on PPIUCD as it is a fairly new skill for SBA and it in undergoing the process of integration in the curriculum. however, the trainers used Mama-U which was very beneficial in learning the skill effectively as the model has the provision to open and check of the trainee had placed the implant accurately. With one or two tries, most new trainees were able to improve their skills greatly.

About  PPIUCD and other family planning techniques: 

The head trainer Sunita elaborated on the various techniques available for family planning and why some are better than the others. She explained the disadvantages of PPIUCD in terms of low adoption due to inconvenience to mothers after placement and other reasons beside its safety and advantages. Also, she told that many of the mothers are restoring to arm contraceptive implant technique.

Chat with Seti hospital Director, Dr.Ganesh Singh: The director gave valuable insights on the need for a better training simulator/model for trainees to learn C-section on model before actual execution. He showed the current jugaad(quick and dirty prototype) that the hospital staff had made for people to practice c-section, however it was far from being close to reality. He expressed the need for having multiple muscle, tissue and skin layers on the model to reach trainees not to damage the uterus when making incisions. He also backed up telling how the trend for c-section is increasing in seti hospital and elsewhere with increasing demand from patients and surgeons decision making to avoid risk in deliveries. 

Pls note- Seti Zonal hospital has c-section elective days on two days a week with 10-15 cases/day apart from emergency c-section cases on all days. Also with increasing awareness among public for institutional deliveries, the share of c-sections is only bound to increase in future. All these reinstate the need for an accurate training model for trainees to practice.

Day3 - AN - feedback session:

The afternoon was spent in sharing feedback on how training was conducted and what improvements that the trainers and trainees wanted in models. Various  feedback was shared on all the training models and simulators.

Day 3 - Clinical site visit:
After the feedback session, the team split up and visited the clinical site, Labour ward and room where normal deliveries take place in Dhangadi. We got an opportunity to observe a normal delivery in the labour room. We observed all the steps that the health care providers follow in Dhangadi. Also, we identified the various people involved , their roles during a delivery.