From the Field

The latest MNH trip was a great start to the second FOHG Maternal and Neonatal Health program that has commenced in Nagekeo district in Flores.   The team consisted of 2 Australians, one Indonesian midwife who was one of the clinical leaders from the 2009 MNH program in Ende and two Indonesian educator/interpreters.   
The program was designed to cater for the absence of a hospital in this district.  

The program started in Mbay with a two day workshop where the Australian team leaders taught the first module on managing postpartum hemorrhage and neonatal resuscitation followed by a day of educational principles including the use of skills stations, a new concept for the six local midwives who had been chosen as the clinical leaders in Nagekeo district.   On the third day, our new team moved to Puskesmas Danga in Mbay to teach the MNH module to midwives from Mbay and the local area.   Day 4 saw the team move to Puskesmas Boawae in the highlands, one and a half hours drive from Mbay to teach the module to another group of local midwives.  The last day took us to Puskesmas Nangororo on the south coast of Flores where our local clinical leaders taught the module with minimal input from the Australians.

There were many highlights.   Being able to include a local trainer from the previous MNH program in Ende and a local interpreter in the FOHG team was exciting evidence of the worth of this train-the-trainer model of up skilling knowledge and clinical skills in remote areas of developing countries.   The six local trainers were enthusiastic and took on board the new teaching style with alacrity.  They had excellent support from the local health department.   Also of interest was a report from Ende about a huge increase in the confidence of the midwives to advocate for their patients insisting on using current evidence-based practice in the delivery suite in RSUD Ende to the point of refusing to carry out instructions from their doctors if old treatment regimens were ordered, a significant cultural shift.
News of financial support for the whole one year MNH program in Nagekeo District by Give Hope Not Flowers capped off an excellent week.

August 2010 trip report

A team of 5 flew to Denpasar on August 9. After staying overnight, the team flew to Kupang where the group went to the University for a planning meeting. Two of the team stayed overnight in Kupang for further discussions about setting up a new scabies eradication program whilst the rest of the team hit the road to Kefamenanu.     All along the way, flags for the celebration of Indonesia’s Independence Day on August 17th fluttered in the breeze.

An excellent week had been planned at Kefamenanu Hospital.  The patients had been triaged well and a wide variety of cases brought in for surgery.  49 operations were performed by the team with local doctors being given ample opportunities to refine their surgical skills, expertly supervised by FOHG doctors.   As usual, the elective surgery was punctuated by emergencies including a 50 year old man who required a laparotomy for dead bowel.  By the time the team left on the 17th, he was well on his way to a full recovery - yet another example of the toughness of the West Timorese people.

One highlight of the week was being joined by  the Dean of the Medical Faculty of Nusa Cendana University (UNDANA)  joining us for 2 days to see what learning experiences were available for his medical students as well as doing some operating.   He was amazed and delighted with the 3 tiered teaching program.  Five medical students, 4 young women and 1 young man, from UNDANA, supervised by their Lecturer, had a wonderful week rotating around spending a day with each member of the FOHG team. Our volunteer Recovery Nurse was outstanding in teaching them basic clinical skills and empathy for their patients. The babies born by Caesarean Section were particular favorites. 

The young doctors from the Puskesmas (Community Health Centres) also had many learning opportunities which included teaching them dermatology and general medicine in the Outpatient Clinic as well as demonstrating anatomy and basic surgical skills in the Operating Theatres.  

The enthusiasm and inquiring attitudes of the medical students and the continuous presence of the junior doctors over this week indicates the outstanding success of this model of working in partnership with our in-country health care colleagues in a general district hospital- based education program. 

Overall, this was a very successful trip with further refinement of the collaboration between the UNDANA Medical Faculty, District General Hospital Kefamenanu, junior medical staff from the Puskesmas and FOHG.