Scotland-Malawi Anaesthesia

Overall goals

To Improve surgical outcomes
To improve maternal and neonatal outcomes

Key UK Colleagues and Partners

Scottish Anaesthetists, Obstetricians, midwives, educationalists, theatre and intensive care staff in NHS Tayside.
Clinicians working in England ( Obstetricians, midwives, anaesthetists).
University of Dundee
NHS Tayside
Church of Ireland( for transport of equipment)

International Partners

School of Anaesthesia in Malawi
Mrs Fanny Kachale- Head of reproductive health at the ministry of Health in Malawi Government
Salima DH, Mangochi DH, Machinga DH

Sustainable development goals

• SDG 3 - Good health and well-being

Funding source

Fundraising: easyfundraising, charity balls and sports event, cake sales, personal donations

Grants from:
Scottish Government
The Scottish Society of Anaesthetists
The Scottish Intensive Care Society
The Obstetric Anaesthetists Association
The Association of Anaesthetists of GB and Ireland

Project origin

2005:
Dr Connolly contacted Mr Cyril Goddia- head of the school of anaesthesia in Malawi- to ask what we could do to help. He asked for post-graduate education for anaesthetic clinical officers on the areas of highest mortality- paediatric anaesthesia and trauma, obstetric anaesthesia and trauma, critical care medicine, management of anaesthesia and early post-operative complications, advanced life support.

Evidence of need

1. High surgical mortality
2. High maternal and neonatal mortality
3. No high dependency units within the country- leading to a high frequency of patient transfers to central hospitals for surgery that the district surgeons and anaesthetists were capable of providing, but for which there was no adequate post-operative care.
4. No post-graduate education for anaesthetists
5. No prospect of sustainable post-graduate education

Project areas

Post- graduate health education
Health Service improvements
Implementation of Ministry of Health policy, guidance and protocols

Project activities

2005-2011
All Anaesthetic Clinical Officers( ACOs) working in Malawi attended at least one set of courses on all of the subjects outlined above.
We have trained a team of Malawian in structors to teach all components of all of the courses

Results:
Some ACOs implemented change at their district hospitals.
We assisted in the development of high dependency units in 11 DHs- providing monitoring equipment and nurse education ( developed and delivered by the Malawi project lead). This led to a decrease of 70-80% in mortality from surgery because patients were not being transported to the central hospitals, but were having surgery at their district hospital, and being cared for in the post-operative period by skilled and educated staff withe the required equipment to look after them effectively.

2012-2016
We have focussed on maternal mortality.
We have delivered a multi-disciplinary course, several times, to three district hospitals. The aim is to “flood” the workforce with education and team-training.

The results:
In the first hospital where we delivered the course, there has been a 70% reduction in maternal mortality
In the other hospitals, where not all of the workforce have attended the teaching- there have been decreases in maternal mortality- but not as significant yet.

Staff in all the hospitals have reported improvements in: morale, communication between team members, attitudes of staff to each other and to patients, and a sense of satisfaction at helping women- who would otherwise have died from their condition before our teaching- survive.

Changes

An improvement in surgical survival- we have already proved that our work has achieved this, but the Malawians need support to sustain this. Most of the HDUs that were developed have closed, due to shortage of nursing staff. Some new HDUs have recently been built but there is no infrastructure planned.

An improvement in Maternal morbidity and mortality- the results following our education courses speak for themselves
An improvement in neonatal morbidity and mortality- likewise

A sustained programme of post-graduate education delivered by Malawian health care workers to each other.

Next steps

Applying for grants to fund the work.

Then continuing to roll the courses out through Malawi, as requested by the Malawian Ministry of health and the Safe Motherhood Committee.

Challenges

Yes
1. Funding
Despite the success of the partnership and the request from the Malawian Government for u to roll this education out through the whole country, we have been unsuccessful over the past few years in securing any grants.

2. Per diems
Malawians expect to be paid substantial per diems. We cannot afford to do this, and the SMP and Scottish Govt forbid such payment.
However, reality is that the large NGOs pay substantial "sitting fees", so the Malawians that we are expecting to attend or teach on the course, go off without any notice, to attend meetings where they will receive a large sitting fee. This has had a detrimental effect on the delivery of our courses.

3.Communication between DHs and the project leads
Some staff who have been trained to teach on the course have left to go to college or another job. The local co-ordinators at the DHs have failed to inform us of this- so we have planned courses expecting certain members of staff to teach session and when we have arrived at the hospital have been informed that the individuals concerned are no longer working at the hospital.

4.Shipment of equipment- problems at customs
There seem to be additional unofficial costs applied at customs to get shipments delivered to the hospitals in need.

Mitigating challenges

1. Keep applying for grants and hope that we will eventually be successful

2. Per Diems- I think Malawi Government needs to take a firm stance on this with the large NGOs- but that is unlikely because they do not pay the HCWs very well and te per diems are perceived to be a valid source of income

3.Communication between DHs and the project leads
We plan to train and employ a course co-ordinator whose job will include ensuring details of local faculty in good time before courses.

4. We have recently changed our shipment procedure and now send equipment through charities whose sole purpose is shipment of equipment.

Partnership principles

• strategic
• harmonised
• effective
• respectful
• organised
• responsible
• flexible

Project gains

• leadership
• teamwork
• awareness
• patient
• resilience