Wednesday, 10 August 2016

Contributing to a new movement in anaesthesia care

Laura Macpherson, Grants Officer at THET, shares her impressions following a recent monitoring visit to health partnership projects in Ethiopia, which are funded through the DFID/THET Health Partnership Scheme (HPS).

In June I travelled with my colleague Emily Burn (Evaluation and Learning Coordinator) and two DFID representatives to monitor the progress of seven health partnerships in Ethiopia. We anticipated that a monitoring trip to Ethiopia promised insights into an exciting health context and would allow us to verify some examples of truly successful partnership working.

We were not proved wrong. A highlight for me was our visit to Jimma University Hospital (JUH), which partners with the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the Association of Anaesthetists of Uganda (AAU) to deliver the SAFE Paediatric Anaesthesia in East and Central Africa project. Faced with the reality of extremely basic anaesthetic equipment, very few anaesthetists, a lack of continuing professional development opportunities, only five ICU beds, compounded by a recent increase in road traffic accidents across the country, the senior residents who had received training through this project have been inspired to make a difference and are working against the odds at JUH. As Tirunesh Gemechu, Anaesthesia Resident states:

‘It is very challenging, and it would be much easier for me to go through other departments and specialise in them. There are very few trainers, very limited equipment to practice, and very few consultants with knowledge to pass down.’

Tirunesh Gemechu, Anaesthesia Resident. (Photo: Emily Burn)

They commented that they are noticing a real difference in the way they treat patients on a daily basis, are now much more confident in caring for newborns in particular, and are eager to share their learning with colleagues.

‘The course has filled a major gap I had in paediatric anaesthesia. I am now more confident to practice that. I was able to meet people who can help me get more learning and more experiences and even more rotations outside of Ethiopia. We were trained with international participants so I could learn from them and hopefully learn from them in the future.’ Says Tirunesh.

The project is also contributing to a new movement across the country that is seeing more attention being given to the specialty of anaesthesia, which is clearly much-needed.

The visit has reiterated the value of visiting projects in person. This really allows you to appreciate the numerous and varied benefits to health partnership working that are difficult to capture without discussion. I count myself lucky to have seen first-hand the impact that all of the projects are making across the country.

Thursday, 4 August 2016

A New Generation Takes On Chronic Malnutrition

THET’s Communications Officer, Timur Bekir, traveled to Lusaka, Zambia, to document the activity of two ground breaking training courses in nutrition.  

100 acutely malnourished children. That’s how many cases University Teaching Hospital (UTH) in Lusaka has in the severe acute malnutrition ward at any one time during its peak season. It’s a shocking number for a country edging towards middle income status.

It’s a number that becomes more overwhelming when you’re told that the whole hospital only has four Nutritionists. Just four to deal with the multitude of nutrition related cases such as under-nutrition, diabetes, obesity, renal failure, the list goes on.

Mr Zimba, one of UTH’s valuable Nutritionists, is showing me around the children’s ward. He explains that the peak season is from April to September, this is before harvest time when food stores are low:  

‘Malnutrition is about bad nutrition so there is over nutrition and under nutrition, so on this ward we are dealing with under nutrition. Nutrition intervention is not a remedy but it is a supplement to whatever doctors are doing.’

60% of the population lives below the poverty line and 42% are considered to be in extreme poverty, with much of the population surviving on subsistence farming. Chronic malnutrition, or stunting, is a serious concern in Zambia. With a prevalence of 45% among children under five years of age, substantially higher than the average of 38% for sub-Saharan Africa and the eighth highest prevalence among the 123 countries for which data exist.[1]

Mr Zimba takes me to another ward where the role of the Nutritionist is crucial. At the Renal Unit he explains the tests he does on patients to find out if they are deficient in nutrients or electrolytes or minerals like iron, potassium, sodium. Those tests allow him to see where the deficiencies are, do calculations and know the amount of nutrients needed in the fluid. This is a specialised role but the hospital does not have any specialists in the field of nutrition:

‘Right now in Zambia we do not have Nutritionists who are specialised in treating all these outlying cases, and with only four Nutritionists we are struggling in the field of nutrition.’

THET responded to the lack of Nutritionists and the problem of chronic malnutrition by working in partnership with the University of Zambia (UNZA) to develop the first BSc and MSc in Human Nutrition. This level of teaching in Nutrition has never existed in Zambia before and will go a long way to supporting the Zambian government’s commitment to improving the nutritional situation of its population.

The country’s National Food and Nutrition Strategy and the First 1000 Most Critical Days Programme were launched in 2013.  Central to the Government’s strategy are the objectives to significantly reduce chronic malnutrition in young children and increase investment in nutrition and nutrition-sensitive interventions.  The Government of Zambia acknowledges that achievement of their objectives is constrained by the shortfall of adequately qualified nutritionists and dieticians in Zambia.

Five volunteer lecturers from the UK, east and southern Africa are delivering the programme until UNZA has enough qualified lecturers to run the programme themselves.  Lecturers like Tonderai Matsungo from Zimbabwe:

‘The skills that the students are going to get from the programme are very crucial in terms of improving the quality of care that patients receive at the different health institutions, either government or private. An integral part of any nutrition training, besides the clinical part, is an emphasis on preventing and prevention is the one that covers public health and community aspects of nutrition so that is very important and those components are well covered in the BSc and MSc nutrition programme.’

Lecturer Tonderai Matsungo teaching in class at UTH. (Photo: Timur Bekir)

22 students graduated from the BSc on the 8th of December 2015 and there are nine students currently enrolled in the MSc Programme. Adana has one more year left of training, after which she hopes to go back to her local community and carry on her work as a Nutritionist. But, as she states, if the course wasn’t there she may have chosen a different career path altogether due to the lack of career development:

 ‘If this course was not there, probably I would have been doing other courses in other fields and I’m sure by now I would have gone to do another profession or career. But now that there’s this course I will continue as a nutritionist and I will go back to my province to make sure malnutrition levels are low.’

Adana, BSc Nutrition student. (Photo: Timur Bekir)

Back in the acute ward at UTH a mother is feeding her child, who was brought in with severe malnutrition. Talking to the mother was a stark reminder of how important the role of Nutritionist is, not only to cure nutrition related problems but to improve public knowledge of what good nutrition is. By training a new generation of Nutritionists THET is ensuring that the causes of malnutrition are addressed. Education and training is not a quick fix to health problems, it’s a long-term approach, but one that means a health service, with skilled health workers on the frontline, can offer quality care to patients not just in the short-term but well into the future. 

Mother with under nourished child receiving treatment at UTH. (Photo: Timur Bekir)

[1] UNICEF (2014) State of the World’s Children