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MC01 - Life Saving Skills & Essential Obstetric Care

Maximum Number of Participants = 32

Background of the Course
In 2006, the Liverpool School of Tropical Medicine (LSTM) and the Royal College of Obstetricians and Gynaecologists (RCOG) developed a standardised 3-day “skills and drills” training package in Life Saving Skills – Essential Obstetric Care.  The training package is based on the WHO Manual: Integrated management for Pregnancy and Childbirth and has been developed in collaboration with the Department of Making Pregnancy Safer, WHO and in consultation with a wide group of experts from a multidisciplinary background (including midwives, obstetricians, paediatricians, public health specialists and anaesthetists) with extensive practical experience of maternal and newborn health in resource poor areas as well as educational methods.

“I really enjoyed the course, thanks. The practical sessions were really useful. All the consultants/midwives were very good at explaining things and approachable enough to ask lots of questions. (2011)

Programme Introduction
At least 80% of all maternal deaths result from five complications that are well understood and can be readily treated: (1) haemorrhage, (2) sepsis, (3) eclampsia, (4) complications of abortion and (5) obstructed labour.  We know how to prevent these deaths – there are existing effective medical and surgical interventions that are relatively inexpensive.

“Overall the course was extremely useful. The course facilitators were fantastic – very knowledgeable, realistic and encouraging. I now feel much more confident in management of obstetric emergencies and overall feel the course was well worth doing" (2011)

To reduce maternal mortality it is important that all women have access to maternal health care services, particularly skilled attendance at birth and timely access to Essential (or Emergency) Obstetric Care (EOC) when an obstetric complication occurs.  Two levels of EOC can be distinguished BEOC and CEOC:

Basic Essential Obstetric Care (BEOC) – 7 signal functions:

1. Parenteral Antibiotics
2. Parenteral oxytocics
3. Parenteral anti-convulsants
4. Manual removal of a retained placenta
5. Removal of retained products of conception by Manual Vacuum Aspiration
6. Assisted vaginal delivery (vacuum extraction)
7. Resuscitation of the newborn (using bag and mask)

Comprehensive Essential Obstetric Care (CEOC) – 9 signal functions:

1. All 7 BEOC functions (above)
2. Caesarean Section
3. Blood Transfusion

This training package has been enthusiastically embraced by health care providers across the world, demonstrably increasing knowledge and skills, improving teamwork and encourages uptake of evidence based clinical practice, reducing morbidity and case fatality rates - Dr Nynke van den Broek, Head of LSTM’s Maternal & Newborn Health Unit.

Who Should Attend
This course is suitable for Health Care Providers such as nurses, midwives, clinical officers, medical assistants, doctors, obstetricians and Skilled Birth Attendants.  A Skills Birth Attendant (SBA) is defined as a health provider who has at least the minimum knowledge and skills to manage normal childbirth and provide basic (first line) emergency obstetric care.  This course would be especially useful for health care providers who may be going to work overseas in a resource poor area.

A Complete Learning Package
The training is delivered using a mixture of interactive continuing medical education techniques which include lectures, scenario teaching, skills teaching, demonstrations and workshops.  The structure and method of delivery strongly encourages evidence-based practice through sharing of good clinical practice and dialogue between participants and facilitators.

• Communication, triage and referral
• Resuscitation of mother and newborn
• Shock and the unconscious patient
• Severe pre-Eclampsia and Eclampsia
• Haemorrhage
• Obstructed Labour
• Sepsis
• Assisted Delivery
• Other Common Obstetric Emergencies
• Complications of Abortion
• Early Newborn Care

In addition, there are sections on specific surgical skills including:

• How to deal with a difficult Caesarean Section
• Conduct a perineal repair
• Manual vacuum aspiration
• Venous cut down
• B-Lynch suture

Dr Charles Anawo Ameh, MBBS, MPH, DRH, FWACS (ObGYN), FICS

Appointment: Clinical lecturer in Sexual and Reproductive Health at LSTM
Areas of interest: Safe Motherhood, quality care best practice, ethnic minority groups, confidential enquiries, development of guidelines and protocols

Background

• About 15 years professional experience working in sexual and reproductive health in Africa, including 10 years of work at post-graduate level
• Undergraduate medical training at Ahmadu Bello University, Zaria, Nigeria 1989-1997 and post-graduate medical training in Obstetrics and Gynaecology at Ahmadu Bello University, Zaria, Nigeria 2000-2006. Post-graduate diploma in Reproductive Health for Developing countries at the Liverpool School of Tropical Medicine, Liverpool 2006. Masters in Public Health at University of Liverpool 2008
• Experience in improving reproductive health services, especially capacity building in Africa (Emergency Obstetric Care, Life Saving Skills, Family planning, audit methods in Safe Motherhood)
• Experience in providing technical support to safe motherhood programmes in developing countries (Assessment of existing health care provision systems to meet minimum UN standards for Maternal and Neonatal health, development of strategic plans for maternal health, )

Teaching
Charles has extensive experience in teaching of undergraduate, post-graduate medical students and nurse midwives. He currently lectures on the Masters in International Sexual and Reproductive Health, Current Clinical Challenges in Tropical Medicine TROP 938, Diploma in Tropical Nursing, Diploma in Tropical Medicine and hygiene and Diploma for reproductive health in developing countries. Charles also convenes TROP 926: Sexual Health and Human sexuality module.

Research
Charles leads the MNH’s unit research on effectiveness of skills and drills training for the reduction of Maternal and Newborn Care in sub-Saharan Africa. Quality improvement for women with severe pre-eclampsia/eclampsia, audit and feedback methods for reducing morbidity and mortality from post partum haemorrhage.

Students
Charles mentors students on the Diploma in Reproductive Health (DRH) and MTID and MISRH courses

Current projects

• Making it Happen Programme, Sierra Leone, Kenya and Zimbabwe
• European Commission Sexual and Reproductive Health programme for Somaliland
• DFID PRRINN Northern Nigeria maternal child and newborn health programme

Completed (selected) projects

• WHO guidelines for the use of Misoprostol in Obstetrics and Gynaecology
• DFID Essential Health Services, Kenya
• DFID Health System strengthening Programme, Somaliland
• Assessment of a new proposed WHO classification of Maternal deaths. ( September 2008)
• DFID PATHS technical brief 2007: Strengthening Supply Side Components of the Safe Motherhood Programme
• Analysis of maternal death reviews/audits in between Kenya December 2006-January 2007.
• Literature review on Maternal health of Black and Ethnic Minority women in the UK. September 2006
• Rotary International 3-H (Hunger, Humanity and HIV/AIDS) field project in Reproductive Health, Kaduna State, Nigeria

Other relevant expertise, professional memberships etc

• Membership of Society of Obstetricians and Gynaecology of Nigeria (SOGON)
• Nigeria Medical Association
• Nigeria Cancer Society
• Fellow West African College of Surgeons
• Fellow International College of Surgeons
• Associate Fellow of the Royal College of Obstetricians and Gynaecologists
• Member of RCOG International Office steering committee for RCOG IO life saving  skills-Essential Obstetric Care and Newborn Care courses.