Aliwal North: South Africa

PTC COURSE REPORT: 5-6 DECEMBER 2012: JOE GQABI DISTRICT - ALIWAL NORTH: SOUTH AFRICA.

Purpose of the visit

As part of the Mthatha Hospital Complex initiative for in reach-outreach programme to the Eastern Cape Province District Hospitals for 2012 -13, the Department of Surgery, Walter Sisulu University and the Primary Trauma Care - Africa region organised a 2 Day PTC course for the 5th and 6th December, 2012 at Joe Gqabi District in Aliwal North.

Executive summary

Aliwal North; an Eastern Cape Province boarder municipality; is located where the busy national highway N6 meets R58. The R58 connects the eastern parts of South Africa to another busy national highway N1 which runs from Johannesburg to Cape Town. The hospital is 55 bedded, recently upgraded with a bigger casualty to cope with trauma victims. Patients involved with Motor Vehicle Accidents, assaults and other trauma conditions from this part of South Africa with an estimated population of 350,000 people come first to this hospital for stabilisation prior to referral to other health facilities for definitive management.

Key staff involved in planning and co-ordinating

Dr Rafique Surtie; Medical Director Aliwal North Hospital approached PTC Africa Committee; organised sponsorship for this CPD accredited, 2 day PTC course for Joe Gqabi District Health providers from the Africa Health Placements - Rural Doctors Support Program (AHP-RDSP). Indeed RDSP paid for the instructors and participant’s travelling and accommodation (except those provided for by the district / the province/departments) Venue and Catering. Dr Surtie in collaboration with PTC – Africa region and Walter Sisulu University PTC Instructors together with the Joe Gqabi District Health team planned and organized the training. Ms Hluma Xakaza the AHP-RDSP Practice Manager was particularly instrumental in the detailed planning, co-coordinating, execution and providing all financial and secretarial work for the course.

Professional aspects of the visit

The Mthatha Hospital Complex has organised an in reach/outreach support programme to all its catchment area districts hospitals based on the PTC principles to ensure all patients referred to the complex are referred in a stable condition. It has put in place compulsory PTC training to all district doctors including Joe Gqabi. Walter Sisulu University is likewise establishing a trauma surveillance registry; telemedicine facilities as well as ongoing carrier development for both undergraduate and postgraduate students has earmarked Aliwal North as one hub for such activities. During the visit to Aliwal North, the instructors had a hospital tour, did ward rounds and had clinical consultatory exchange of ideas.

Professor Dhaffala reviewing a neurosurgical patient admitted at Aliwal North Hospital

Course participants

NAME MP/REG NUMBER 1. Mr Cawe B 14702930 2. Dr Nqeto A MP 0701378 3. Sr Menong VR 12592598 4. Dr Hardie JL MP 0684635 5. Dr Walsh M MP 0503665 6. Dr Dlima A MP 0648922 7. Dr Kaunda N MP 0464341 8. Mrs Q. Nyangintsimbi 9. Dr Eziohuru TN MP 0691887 10. Sr Menemene N 15230154 11. Mrs Tubela JV 12092623 12. Dr Amor BD MP 0649112 13. Mr S Du Preez 1034820 14. Sr XO Gqalaqa 15. Dr Rafiq Surtie MP 0424757 16. Ms Z Xamsane 14391304

Course instructors

1. Professor Adupa Dhaffala: Professor & Head Department of Surgery: Walter Sisulu University 2. Dr Howard Kingu: Consultant General Surgeon & Senior Lecturer: Walter Sisulu University 3. Dr Jayakrishnan Radhakrishnan: Consultant General Surgeon: Nelson Mandela Academic Hospital

Details of activities

Lecture session

Lecture session Subsidiary activities:

Visit to Aliwal North Hospital

Ms. Ndabula: District Manager (Human Resource Development & Management Admin Staff): officially opening the course and welcoming participants and instructors.

Contents of the Primary Trauma Care course

2 DAY PTC COURSE PROGRAMME 5th & 6th Dec 2012

TIME TOPIC INSTRUCTOR 8.30 OPENING 9.00 15 minutes Introduction Prof Dhaffala 9.15 30 minutes Local trauma perspective and MCQ 9.45 30 minutes ABCDE of Trauma and Primary survey Mr Kingu 10.15 45 minutes Airway and Breathing Mr Jay 11.00 15 minutes BREAK 10.15 45 minutes Circulation and Shock Mr Kingu 12.00 80 minutes Skill stations Airway Mr Jay Cervical spine Mr Kingu Chest drains Prof Dhaffala 13.20 40 minutes LUNCH BREAK 14.00 30 minutes Secondary survey Mr Kingu 14.30 15 minutes Demonstration Scenario Kingu/Jay 14.45 60 minutes Scenarios All 15.45 15 minutes BREAK

16.00 30 minutes Chest injuries Mr Jay 16.30 15 minutes Overview and summary Prof Dhaffala DAY 2 9.00 30 minutes Head and Spinal injuries Prof Dhaffala 9.30 30 minutes Abdominal and Limb injuries Mr Kingu 10.00 30 minutes Paediatrics and Obstetrics Mr Jay 10.30 15 minutes BREAK 10.45 30 minutes Burns Mr Kingu 11.15 80 minutes Workshops Analgesia Mr Kingu Transportation Mr Jay Paediatrics Mr Jay Neurological assessment Prof Dhaffala 12.35 55 minutes LUNCH BREAK 13.30 30 minutes Disaster management Mr.Kingu 14.00 30 minutes Demonstration scenarios All 14.30 60 minutes Scenarios All 15.30 15 minutes BREAK 15.45 15 minutes Multiple choice paper Mr Kingu 16.00 15 minutes Summary and evaluation Mr.Kingu 16.15 15 minutes Certificates and close Prof Dhaffala

Eager and attentive participants

Skill station: Cervical spine

Skill station: Chest Drain

Skill station: Airway

Demonstration scenario: Instructors

Execution of scenarios: participants

Participant giving feedback.

PTC COURSE EVALUATION ALIWAL NORTH 5-6 DECEMBER 2012 Please say how useful you found each section. Choose from 1 – 5

Very poor Poor Average Good Very good DAY 1 1 2 3 4 5 Local trauma perspective 1 8 7

The ABCDE of trauma and Primary 7 9 Survey Airway and breathing 7 9

Circulation and shock 10 8

Skill stations 1 10 5

Secondary survey 1 6 10

Demonstration scenario by instructors 9 7

Scenarios practice 9 8

Chest injuries 1 7 8

DAY 2 Head and spinal trauma 2 7 8

Abdominal and limb trauma 2 8 7

Trauma in children and pregnancy 4 7 6

Burns 2 7 8

Workshops 8 8

Disaster management 2 8 7

Scenarios practice day 2 1 8 5

Multiple choice questionnaire 8 7

What was the best part of the course? Scenarios (9), Trauma ABCDE (5), Interaction & practical to our circumstances, Integration of theory & practise, Simplicity & Approach of the PTC course, Refreshed resuscitation knowledge, and Friendly instructors.

What would you change? More practical skill sessions e.g. venous access (2), Course should be done in more than 2 days (2), train doctors & nurses in their institutions, more teaching on trauma in children & pregnancy, more manikins for intubation practise, add burns assessment chart

NOTE:

1. Figures in brackets and those shown in cells is the number of participants giving such a feedback 2. All the participants were confident to expect improvement in trauma care at Aliwal North Hospital in the future after this PTC course.

Summary of multiple choice questionnaire scores before and after the course

120

100

60 pre-test percentage post-test 40

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 parcipants

Observations and recommendations for future visits in your speciality and suggestions as to how such visits could be modified to contribute further to the projects objectives

All medical practitioners working in South Africa are required by the Health Professional Council of South Africa (HPCSA) to participate yearly in CPD accredited activities to earn the minimum required CPD points to retain their registration. While practitioners working near cities would easily attend CPD accredited activities in their cities, Joe Gqabi District doctors work far from any city offering such activities. The Joe Gqabi District PTC training visit being a CPD accredited course served dual purpose for these rural participants namely improvement of their resuscitation knowledge and skills as well retaining their registration. Attending a CPD accredited PTC course near their working place served as a great incentive for attendance. While the rest of the PTC courses planned by the Mthatha Hospital Complex initiative for in reach-outreach programme to the Eastern Cape Province District Hospitals for 2012 -13 will be conducted at the Walter Sisulu University Mthatha Campus, it seems logical to plan future visits to Aliwal North to fulfill this dual purpose as well as train local instructors.

Acknowledgments

RDSP paid for the instructors & participant’s travelling & accommodation (except those provided for by the district / the province/departments) Venue and Catering. RDSP also provided all the stationary used as well as paying for printing of the PTC manuals and certificates. Aliwal North Hospital, EMS Joe Gqabi District, Walter Sisulu University and PTC Africa provided all the equipment used in teaching the course.

Sent to 1. The Primary Trauma Care Head Office, 2. A copy to all participating instructors, 3. A copy to [email protected]. 4. A copy must be sent to the course co-coordinator who organized the Primary Trauma Care programme in that country

5. The organization funding it.