Professional Documents
Culture Documents
Master Report NEMMRH
Master Report NEMMRH
Glan Clwyd
- Ethiopia
Link
Since 2006 the YGC link has been encouragement of the visiting team.
undertaking fundraising for NEMM hospital
and has been privileged to contribute in
GLAN CLWYD - ETHIOPIA LINK | Nov 2018 Visit Report 2
Visiting Team
A group of 13 visited in a period of two weeks so was split into 2
teams, one for each week.
Week 1 Team:
Nick Waterfield Consultant Cardiologist
Shona Hollins-Davies ICU Sister
Claire Morton Consultant Ophthalmic Surgeon
(almost all) of Week 1 Team. From left to right: Samad, Nick, Shona, Clare,
Samad Ansari Ophthalmic Surgery Trainee Jenny and Brian, with the Wachemo University bus in the background
Brian Davies ICU Nurse carrying the Wachemo slogan ‘let your light shine in the society’
Clare Williams Senior Echocardiographer
Jenny Davies ICU Nurse
Week 2 Team:
Alan Owens Informatics Specialist
David Morris ‘Moz’ Biomedical Engineer
Duncan Cameron Consultant Paediatrician
Tom O’Driscoll Consultant in Emergency Medicine
Dr Richard Barrie General Practitioner
*Dr Janet Cameron General Practitioner
*joining team but independently funded
Week 2 team. From left to right: Alan, Tom, Moz, Richard, Janet and Duncan
Team Objectives
The YGC – Hossana link is now in its 12th year knowledge and experiences is also a very IT: design/planning of telemedicine and
and for successive visits consideration is important part of the link work. electronic clinical systems
given to experience and feedback from Primary Care CPD project support and
recent previous visits and the work done In Nov 2018, the link targeted provision of development.
through the year in the link committee the following activities as the formal Reviewing joint working with NEMMH
meetings. objectives for visit: senior staff, reviewing recent project
spending and progress, and discussing
Collaboration with the senior staff at Providing training and teaching in future directions for the link.
NEMMH, in particular Dr Ayano, and Dr ophthalmology for health officers,
Ashebo is crucial and directed by them we medical students and doctors Monitoring of progress on these objectives
aim to target specific ‘gap specialties’ where Cardiology and echocardiography included using attendance logs, feedback,
the local provision is not as strong and to training/joint work participation in post course tests, continuous
target specific needs or difficulties faced in Providing a BASIC-DHS course (acute assessment, learner skills assessment, and
essential support service areas. Our projects care) for nurses project development reviews.
are small-scale but adopt a ‘train-the Providing a BASIC-DHS course for
trainers’ approach and look to sustainably doctors In addition, the team hoped to develop and
equip local staff to improve their clinical Providing teaching for clinical students extend the existing relationship, sharing both
services for the benefit of their local from Wachemo University the best wishes and friendship of colleagues
population. Undertaking paediatrics training/joint in North Wales with our Ethiopian hosts. We
work looked also to learn some more about recent
Whilst we predominantly aim to benefit the Reviewing provision of Emergency developments in Hosanna town and the
health officers, nurses, doctors and students Medicine services and potential for wider region and their impact on the hospital
in Hossana Hospital and Health Centres, support and staff.
realising a benefit to NHS practice in Wales Providing Medical engineering
when staff return home to share their new training/support
GLAN CLWYD - ETHIOPIA LINK | Nov 2018 Visit Report 3
20,194
one of the busiest maternity units in
Ethiopia.
Emergency Department attendances per year
Paediatric Ward Extension
162,462
The current emergency outpatients
department at Hosanna hospital is very
cramped with very limited facilities. There has Outpatient attendances per year
been a programme funded by the Federal
Ministry of Health to provide Ethiopian
hospitals with upgraded Emergency facilities
1,506,733
Hadiya Zone (NEMHH Catchment area) Population
and the hospital has begun construction of a
large new 2 story Emergency Department at FOR MORE INFORMATION
the very front of the hospital. We were told
that it will be ready in April, though there was https://en-
no work being undertaken there during our gb.facebook.com/WachemoUniversity2008/
A significant extension is being built on the
stay. Certainly the hospital is dealing with an https://www.facebook.com/Nigist-Eleni-
roof of the operating theatres, at one end of
increasing number of emergencies and Mohammed-Memorial-Referral-Hospital-
the Paediatric ward. This will be used as a
trauma cases and it is crucial for the hospital 230899684152100/
sleeping area for mothers who have infants
to plan how it will operate the Emergency
on the neonatal unit. At present, these
department carefully to make best use of the
mothers sleep on mattresses in the corridor
GLAN CLWYD - ETHIOPIA LINK | Nov 2018 Visit Report 4
Transcutaneous Bilirubinometer
As in the UK neonatal jaundice is common in of bilirubin and this makes managing
Ethiopia and can be treated if necessary, with neonatal jaundice particularly difficult.
phototherapy. However very high levels of
bilirubin can cause neurological damage, a Clinicians at Hossana have had to rely on
condition called kernicterus. The neonatal clinical appearance to decide on which
unit in Hossana has no access to blood levels neonates to treat with phototherapy.
Cardiology Teaching
Nick Waterfield Consultant Cardiologist
Clare Williams Senior Echocardiographer
As before, I was struck by the range and severity of the conditions we (As a side comment, I would be very keen to make a month long stay in
met, often in young people, and we learnt as much from our visit as I Hossana a regular commitment for the cardiology registrar rotation:
hope our Ethiopian colleagues learnt from us. they would learn so much and see conditions now confined to the text
books in the UK, as well as having much to give.)
Once again I was impressed by the dedication and skill of the doctors
we worked with, and their commitment to teaching and learning. We
renewed a friendship that has lasted the years, with exchanges of
emails, ideas and images.
When not on the ward I also undertook formal teaching of the 1st year
clinical medical students (37 in total, about 12 female). Feedback from
previous visits in 2016 and 2017 had been that more specialist
cardiology training and ECG interpretation would be very welcome. I
taught on common cardiac conditions and ECG interpretation, with a
test at the end of the week and encouraging feedback. I also taught the
30 junior doctors in hypertension, hypertensive emergencies and heart
rhythm problems.
Claire Morton Ophthalmic Consultant We hope to keep in touch with Dr Sara and
Samad Ansari Welsh Ophthalmic Trainee the hospital management team and to offer
further support to the eye clinic with the
The ophthalmology teaching was Arclights have been designed for resource possibility of a further teaching week for
undertaken between 5th and 9th November limited countries and at the end of the week students next year.
and was given to both 3rd year student Health we were able to donate one to each of the
Officers and 3rd year Medical students. All the medical students. ACTIVITIES
students are based at Wachemo University,
Hossana and receive their clinical teaching in We were also able to give a session on Teaching
NEMH hospital. fundoscopy to 7 interns who also received an
Arclight. They need to be able to recognise
The programme was designed to cover the papilloedema and see the retinal changes of
basics of techniques of eye examination and diabetes and hypertension. Evaluation of the
also to teach about eye conditions likely to teaching was obtained by distributing forms
be encountered in Ethiopia. We used with the weeks teaching subjects marked on
PowerPoint presentations with many and space to write comments and give scores
photographs for most of the didactic for each session out of 5 according to interest
teaching. To try and display ophthalmic and usefulness. The results were most
photographs clearly the room had to be encouraging with most students writing
darkened with newspapers stuck over the positive comments such as excellent, nice,
windows. A battery projector was our back interesting and giving high scores. One Claire and Samad with student health officers.
up in case of power cuts and we also brought commented on good interaction. There were Attendance at the classes was quite variable
a small microphone to ensure we were heard a few instructive negative comments such as but averaged (from 4 days register) 13 for
at the back of the class. it was “too speedy” and one commented on health officers and 26 for medical students
the problem with understanding. Whilst all
To teach anatomy we had photos and a large students can speak English they are not use
model eye. We then tested the students’ to our naturally faster way of speaking and Training
knowledge with a competition to see which our accents.
half of the class (Fire or Water) was the
fastest to label the parts of the eye drawn on At the end of the week a short test was given
white boards at the front of the class. to all the students. Papers were marked and
prizes e.g. books were given to the highest
Encouraging the students to answer scorers in each group with all students
questions was not easy and to break the ice receiving at least a torch or flash drive
we tossed a soft toy welsh dragon into the containing the weeks talks. This occasioned
group, asking the student who caught it to many photographs and clapping and a joyful
hazard a guess. Another approach to secure end to the weeks teaching.
student participation was to divide the
groups into 4 well known premiership In between teaching we were able to join the Samad with Dr. Sara using the slit lamp in
football teams e.g. Manchester City and to ophthalmologist Dr Sara Abebaw in the eye the eye clinic. Here the slit lamp was being
ask them to prepare short talks on measuring clinic. Dr Sara has been in Hossana for about used with the aid of a battery torch for
visual acuity, testing pupils, eye movement a year. She trained In Addis and is an illumination as the light source on the slit
and visual fields testing. They all rose very experienced small incision cataract surgeon. lamp was faulty. This was subsequently fixed
well to the challenge! The week after our visit she and a visiting by David Morris, biomedical engineer.
Ophthalmologist were due to carry out 300
Fundoscopy was taught by asking for cataract operations over just 1 week. This The clinic ophthalmoscope was also broken
volunteers to have their pupils dilated and was with the support of a US charity the but we were pleased to be able to donate a
then teaching the technique using Arclight Himalayan Eye Project. rechargeable ophthalmoscope and
mini ophthalmoscopes. These mini retinoscope together with a collection of new
ophthalmoscopes are solar powered, or USB Dr Sara pointed out that currently they do and second-hand text books, children’s sight
charged and have an LED light source. The not have the equipment to perform biometry testing kit, posters for the clinic rooms and a
Arclights also have a 4X magnifying loupe and must insert a standard intraocular lens. It bag of second-hand spectacles.
which can be used to examine the external is hoped that at the time of the charity
eye. This technique was also demonstrated.
GLAN CLWYD - ETHIOPIA LINK | Nov 2018 Visit Report 7
BASICS–DHS Course
Shona Hollins-Davies ICU sister
Tom O’Driscoll Consultant in Emergency Medicine
so were pleased to
Brian, Shona, and Jenny preparing to deliver a session on the BASICS-DHS donate to him a hardback
Course for nurses
GLAN CLWYD - ETHIOPIA LINK | Nov 2018 Visit Report 8
Biomedical Engineering
Moz. (David Morris) Biomedical Engineer
As my first-time visiting Ethiopia or reasonable number of tools and test
doing anything like this, I was unsure as to equipment. Biniam was intelligent,
what I’d be doing when I was out there, and professional and very committed to
how best to help. I’d made contact with the development of the department.
Biniam Seifu the Biomedical Engineer at Mokenen Seyfu was equally keen to learn
Hosanna and he was particularly interested and enthusiastic and was very Biomedical Engineering department perhaps
in what parts I could bring out. After hard working. Abiy Geletu had been there needs to be given a parts budget and a
discussions with the team it was decided my the longest of the three and therefore was procurement department – or even one
best course of action however was to do a the most experienced, although his person – who looks after how to buy stuff at
proper assessment of the genuine background was more electrical than the cheapest price would make a massive
requirements for spares. electronic. Overall, a good team of difference.
engineers.
By the time we arrived the week 1 team had
We took a look at the main hospital water
passed on that several pieces of equipment
pump which was not working. It had been
were priorities for repair and I’d brought out
overheating but we found discarded a
some parts for these. The first day was spent
cowling which had been left off. The cowling
repairing a slit lamp for the ophthalmology
ensured proper cooling, so we managed to
department and a large ultrasound machine
reattach it and get the pump working again.
which had been donated by Glan Clwyd, both
of which are now in full working order.
Informatics
a key problem emerged that the patient at the hospital with data cables being laid in
identification number was missing in the the hospital grounds.
Alan Owens IM&T / Logistics Specialist data entry. As a result, Berhan (HIMS) could
not link the departments activity to an
individual patient.
Before I had arrived in Hossana Ethiopia, I
had already met with Dr Ayano Shanko; the After discussions, we worked on updating
hospital’s Chief Executive on his visit to the excel workbooks, and re-deployed them
Wales. I heard about the some of the plan’s into the departments starting with the
he and Degele Desta; the Head of Laboratory. That evening we also worked
Informatics and IT at Wachemo University late into the night on data structure,
had been forming for the future. I had also standardization and formatting. This is still a
been sent a project plan by Degele laying out work in progress, but Berhan was picking it
their vision of a hospital network and digital up fast.
transformation at the hospital.
During my time in Hossana I also spent a lot
In particular they were giving a lot of of time working on fixing or refreshing their
consideration to an Electronic Clinical computer hardware. I worked on laptops,
New network infrastructure being laid
System and to capturing hospital activity desktops, projectors and printers. Just about
accurately. Berhan Shibeshi, the Health every computer I worked on was heavily Dr Ayano invited me with him to tour the
Management Information System (HIMS) infested with some really bad viruses, Wachemo University campus to understand
manager had been directed by Dr. Ayano to trojans, and worms, and a few keyloggers the developments taking place there. I was
start collecting electronic data from ten too. Unreliable internet and frequent power able to visit their proposed data centre and
departments within the hospital. So once out cuts made the job more difficult, but I was server room and we had some useful
in Hosanna, with Berhan we decided to look able to update and clean the computers and discussions about network development
at their data management and patient flows in particular three computers in the steps and whilst trying to see if a microwave
together. laboratory and two in the eye department data connection between the hospital and
University would be possible, we also spent
some time accessing rooftops!
During the second week we gave lectures for Recommendations for future medical Emergency and Acute Medicine
year 3 and year 4 medical students. The student teaching:
lectures were held on four afternoons, and On request from Dr Eshetu, Tom also
covered the following topics: Clarify numbers likely to attend, and provided teaching for the medical
which doctor is responsible for the department grand round on sepsis and joined
The Ethiopian vaccination programme medical students the medical ward round. Later on in the week
Coma Request a set location for locations there was also an opportunity to provide
Trauma management – primary and Always have teaching material ready in teaching on the use of ultrasound to guide
secondary survey the event of power failure or computer vascular access.
Neonatal resuscitation malfunction (useful topics: neonatal
resuscitation, trauma scenarios) with Similarly, on request Tom provided teaching
Paediatric respiratory conditions
dry marker pens and board wipers to the surgical department on the use of the
Shock and its management
Tape and black heavy duty bin bags for eFAST (extended Focused Assessment with
Epilepsy in childhood.
covering windows Sonography in Trauma). With no immediate
Whilst lectures on these topics could be given access to CT in the hospital the use of
by a number of the specialists in NEM ultrasound scans in this setting remains a
hospital, we felt that a fresh and different valuable tool to assess for the presence of
approach by visiting clinicians is still helpful. treatable life-threatening abnormalities in
trauma patients.
The lectures were held in four different
classrooms in the hospital campus and it was
clear that demand for teaching space has
increased at the hospital. Two of the
classrooms were rather crowded; attendance
varied between 35 and 55 students. The
students seemed reasonably competent but
were generally cautious about interactive
sessions. However, feedback was positive
and indicated the topics covered were Paediatrics
relevant and helpful.
Duncan undertook ward rounds with Dr
35 WHO pocket handbooks of paediatrics Lamesginew, Paediatric specialist at
were distributed and much appreciated. Hosanna in the general paediatric ward, the
These are excellent books for covering high dependency unit and the neonatal
hospital paediatrics in such a setting. intensive care unit. These gave the Tom also met with Dr Gelaw Hailemariam,
opportunity to discuss the best management an Emergency Medicine physician from
of different clinical situations and is essential Jimma University in Southern Ethiopia who
for gaining some understanding of how was visiting Hosanna. Dr Gelaw was able to
things work in Hossana. update on developments in Emergency
Medicine (EM) in Ethiopia, including the very
The wards remain very busy, and as a result welcome development of residency
there is a high risk of patients acquiring programmes in the specialty. Previously EM
nosocomial infections. Ward rounds are very physicians like Dr Gelaw have had to train
crowded with medical students and health abroad but although there are very few at
officers and the note-keeping can sometimes present EM physicians are beginning to
be cursory. However, observation charts are qualify from the Ethiopian residency
used fairly well. Duncan has written to Dr programme and hopefully in time the new
Lamesginew with thanks for hospitality, and Emergency Department may help to attract
with some observations on practice. an EM specialist for Hosanna.
GLAN CLWYD - ETHIOPIA LINK | Nov 2018 Visit Report 11
The Primary Care link has been in operation project which seeks to
for 3 years now and has been focused on the encourage involvement in
delivery of Continuing Professional meetings every two weeks.
Development for health officers working in
the 3 health centres in Hossana as well as As a result on the November
further afield in the region. (Hadiya Zone) visit Richard and Janet visited
and engaged with key staff in
Recently there have been a number of the health centres in Hossana Richard and Janet with Demelesh, CPD project coordinator.
developments in respect of primary care in to understand how best to
Additionally considered was supporting via
Ethiopia that have an impact on the link support their needs in the future and in the
the primary care link the positioning of
primary care CPD project. The Federal context of the PACK programme.
Hossana and the Hadiya zone to be a
Ministry of Health (FMOH) in Ethiopia have Communication with staff in the health
potential pilot site for the upcoming PACK
adopted the PACK (Practical Approach to centres in Ethiopia had been difficult
programme.
Care Kit) programme, a collaboration throughout the year and so it was good to re-
between South Africa and BMJ learning. This establish contact and to confirm that key A meal was hosted by Richard and Janet
is an algorithmic approach to management facets of the CPD project were still in place inviting staff from the health centres and this
of illness, with a book provided for health and functioning. gave opportunity for more informal
workers to guide management of symptoms. discussion and feedback. It was heartening to
Having been adopted by the FMOH, training Richard and Janet had some excellent further
see that the CPD project was continuing to
courses are starting for it very shortly; with discussion with the CPD project coordinator
deliver for the staff and that there was still a
the anticipation that it will be rolled out Demelesh about the future of the project. It
very strong desire for ongoing engagement
throughout Ethiopia. was felt that as it was still delivering quality
and expansion of the CPD project and
CPD that it should continue at least until the
material.
The Pack project involves weekly meetings rollout of the PACK programme was further
for a short period, and then meetings every advanced. Some challenge was also put in to In line with the objectives for the visit
three months for top up learning. However ensure continued recording of attendances friendships were affirmed and collaborative
both the PACK approach and CPD schedule and topics delivered as a means of ongoing work undertaken on the next steps for the
would be slightly different from the link CPD assessment of impact. primary care link.
Summary
Tom O’Driscoll Link Chair
The visit to Hossana this year was again an we have in common as powerful advocates in the hospital medical and nursing faculty.
amazing experience for the NHS staff for improving patient care and served as They did however feel that they would value
involved and a real privilege to be a part of. excellent ambassadors for NHS Wales. On continued support with the course as the
the review of the visit activity presented addition of outside faculty lent the courses
Many of the challenges the hospital faces above I can be confident that the team an additional standing and improved the
sound familiar – matching resources to objectives were met and undoubtedly, we uptake of the training on offer.
increasing demand and rising expectation, have learnt a great deal more than we could
staff shortages, academic and training have expected too. Similarly, it was clear that the very practical
ambitions, equipment and IT issues. Many and direct help afforded by visiting
more challenges however are very unfamiliar It was evident that the teaching and training colleagues from both Biomedical
including extremes of need, and shortages of from all visiting staff was highly valued and Engineering and Informatics in repairing and
water, power and medication. the approach of targeting gap areas was servicing equipment was incredibly well
successful. It was very gratifying to see that received by the hospital staff and had
In teaching and working alongside colleagues the BASICS DHS courses were being run immediate benefit to clinical work at the
in Ethiopia facing the challenges together, efficiently and that the competencies to hospital.
the team visiting demonstrated how much deliver the skills taught are certainly present
GLAN CLWYD - ETHIOPIA LINK | Nov 2018 Visit Report 12
Future directions
As a link group we will be considering our We will also need to consider the hospital
More Info
next objectives jointly with our NEMMH and request for support with their waste
senior colleagues and reviewing them management very carefully to assess how
against the link aims of supporting with best we can help with this.
infrastructure, equipment and education.
The Primary Care CPD project is at an
Ongoing support with teaching and training interesting juncture with Federal
in gap specialties, and support for the programmes emerging that may impact on
BASICS DHS training has been very how this is best delivered in future, and
successful and would be useful to continue. colleagues from the primary care link are
The development of a new Emergency following events closely to inform the next
Department is an exciting prospect for steps.
Hosanna and the link will wish to consider
how best we can play a role in supporting What is clear from our visit however is that
this. There is also a related need in the there is a strong commitment to the
development of an Orthopaedics and development of the hospital, university and
Trauma service and there may well be a role primary care and the YGC link is extremely @Ethiopia_L1nk
for Orthopaedic equipment donations to be proud and determined to continue to play a
made at subsequent visits. Likewise the need small role in supporting this ongoing
to ensure ongoing support for Critical Care development.
and Anaesthetic work following up on work www.glanclwyd-hossana.org.uk
done on previous visits and projects. Once again, I would like to thank Dr Ayano
and his staff at NEMMH for their generosity
Some of the infrastructure needs at the with their time and support, the Welsh
hospital such as the IT developments are Government Wales for Africa grant scheme
large and complex and already being for supporting the visit project and of course,
undertaken at pace with the University but all of the fundraisers and generous
certainly for the link there is scope for future contributors to the link work throughout the
joint working with expertise from informatics year. Diolch yn Fawr!
colleagues in NHS Wales on how to most
efficiently make use of their developments.