COURSE REPORT

ZIMBABWE

2nd – 6th March 2015

Report Presented by: Dr Josephat Chiripanyanga

COSECSA Oxford Orthopaedic Link (COOL)This Primary Trauma Care course is part of a project funded through the HealthPartnership Scheme, which is funded by the UK Department for InternationalDevelopment (DFID) for the benefit of the UK and partner country health sectors andmanaged by the Tropical Health Education Trust (THET). The project is called theCOSECSA Oxford Orthopaedic Link (COOL). More information is available atwww.ndorms.ox.ac.uk/cool.php.

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PTC

COURSE

ZIMBABWE

2 – 6 March 2015

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Table of Contents

1. Executive Summary

2. Purpose of the Training

3. Key Staff

4. Course Instructors

5. Activities

6. Day 1 & 2

7. Instructor Course

8. Day 4 & 5

9. Equipment

10. Conclusion

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1) Executive Summary

This is a Post PTC Course narrative report for the second locally organized PTC

course in Zimbabwe which was conducted from the 2nd to the 6th of March 2015.

The purpose of this report is to give feedback on all the events that transpired

during this first training session of 2015 i.e. key staff involved in planning and

coordinating the course, course instructors, course participants, instructors course

instructors and participants, content taught, multiple choice questions summary,

equipment used and conclusion.

2) Purpose of the Training

The training sought to increase the confidence levels of both the instructors’ and

participants in managing trauma patients. We also sought to empower health

professionals at various levels in their careers with the knowledge and skills to save

life and to preserve limbs.

3) Key Staff

The key staff involved in the planning and coordination of this PTC course from the

Zimbabwean side are Dr Farai Madzimbamuto, Dr Max Gova, Dr Josephat

Chiripanyanga and Ms Shale J. Kasambira who is one of the Secretaries for the

Department of Health Profession Education, University of Zimbabwe College of

Health Sciences where the course was hosted and Mr Joel Mugota the chief

technician in the department of surgery.

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Dr Farai Madzimbamuto

Consultant Anaesthetist

Lecturer University of Zimbabwe Department of Anaesthesia and

Intensive Care

Dr Max Gova

Consultant Trauma and Orthopaedics

Lecturer University of Zimbabwe Department of Orthopaedics

Dr Josephat Chiripanyanga

Registrar Cardiothoracics

From the UK, Annette Clark, Mr Charles Clayton and Grace Le were of invaluable

help in the organising and running of this course.

The compilation of this report was done by Dr Josephat Chiripanyanga and Dr

Kudzai Kanyepi with the invaluable guidance provided by Dr Farai Madzimbamuto

and Dr Max Gova.

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4) Course Instructors

There were eight course instructors who had been earmarked for this training and

fortunately all of them found time in their busy schedules to instruct the course.

The instructors were Dr Josephat Chiripanyanga (team leader), Dr Thandiwe

Munaiwa, Dr Kudzai Kanyepi, Dr Abdur-Rehman Shaukatali Patel, Nurse

Anaesthetist Rutendo Dimba, Nurse Nyasha Masvosva, Nurse Pauline Matongo,

Nurse Ndaizivei Garufu. Most of the instructors are based at Parirenyatwa Hospital

the largest health institution in the country handling the most trauma admissions.

The majority of these trainers were trained in our first locally ran PTC instructor

course in October 2014.

Dr Joe Chiripanyanga Registrar Cardiothoracics Parirenyatwa

Rutendo Dimba Nurse anaesthetist Parirenyatwa

Dr Kudzai Kanyepi Senior House Officer Accident & emergency Parirenyatwa

Ndaizivei Garufu Nurse in Orthopedic ward, Parirenytwa

Thandiwe Munaiwa Senior House officer Accident & Emergency Parirenyatwa

Patel Senior House officer Orthopedics Harare Hospital

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5) Activities

The activities of this PTC course started prior to the course itself with a series of

preparatory and planning meetings hosted by Dr Madzimbamuto attended by Dr

Gova and Dr Chiripanyanga.

Part of the pre-course activities involved the purchase and preparation of the goats

which we used as demonstration aides.

The final pre-course activity was on the Friday prior to the training when all the

eight trainers met and checked all the equipment, practiced practical sessions and

scenarios and also lecture delivering. This is when the final topic allocation was

done. Two different teams of 4 instructors each were setup, each team to run its

training course concurrently.

The activities during the training followed the guidelines in the PTC instructor’s

manual which will be outlined on the specific days. However to accommodate 2

sessions we had to adjust the timetable so as to allow both teams access to the

skills room at different times.

Post course activities were mainly hovering around the final aggregation of the

data collected during the training.

Pauline Matongo Theatre Nurse Parirenytwa

Nyasha Masvosva Accident & Emergency Nurse Parirenyatwa

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6) Day 1 & 2

Day 1 started with a welcome note and introductions by Joe and Dr Gova.

Forty one participants attended the PTC Course on the first two days. Two sessions

were run concurrently with 4 instructors in each session. The instructors in team 1

were Pauline, Josephat, Ndaizivei and Patel; team 2 instructors were Thandiwe,

Kudzai, Rutendo and Nyasha.

In total there were 15 female and 26 male participants in the two teams combined.

After the introductions, the participants were given the pre-course test and

questionnaire to fill in.

After the questionnaire and the MCQs a discussion of the local trauma perspective

was held, and then the lectures were delivered in both sessions according to the

timetable set out in the PTC manual.

After the break Team 1 proceeded to do the skills stations; airway management,

surgical airway, chest drain and c-spine & logroll stations.

Ndaizivei showing participants

in Team 1 airway

management techniques

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Team 2 however proceeded with lectures as we only had one skills room. The

following lectures were delivered Secondary Survey and Chest Trauma and a

demonstration scenario was done.

Participants in team 2 listening to a lecture. (From left to right, Coscar, Hosea, Tinashe and Fortune.

Behind Anja, Mobby, Naison (partially obscured) and Ellen)

Patel showing

participants in team 1

how to insert a chest

drain

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The Lunch break for both teams was at the same time. After lunch Team 1 went on

to do the lectures as per schedule while team 2 did the skills stations.

Rutendo showing airway management to Anna and Yemurai

Soon after both teams mangaged to run a few scenarios before concluding the

day.

Joe lunga (patient),

Macdonald, Doreen,

Coscar

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Day 2 was kick started by an address by Mr Charles Clayton.

Day 2 involved both teams giving lectures on Head and Spinal Trauma, followed by

Abdominal and Limb trauma, Trauma in Pregnancy and Children.

Nyasha giving a lecture

in Trauma In pregnancy

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Day 2 activities proceeded relatively unchanged from the PTC manual outline.

All the topics were covered comprehensively and interactively by both teams. Post

course MCQs and questionnaire and a Summary and evaluation were concluded by

Joe and Rutendo.

The Summary of the MCQs is shown in the table below.

LOWEST MARK HIGHEST MARK PRE-COURSE 33,3% 96,7% POST-COURSE 46,7% 100%

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7) Instructors Course

The instructors’ course saw the training of a total of 13 new trainers, 3 females and

10 males by the original 8 instructors.

The instructors’ course content simply followed the PTC instructors’ manual with

essentially no changes.

After the filling in of the pre-course questionnaire, the following topics were

covered how adults learn, how to ask questions, getting feedback. The new

instructors to be were also taught how to give a lecture, lead a discussion group,

run a scenario and how to teach a skill.

In the afternoon the students were asked to do practical sessions in the form of

giving a Lecture, lead a discussion group, teach a skill and run a scenario.

The post course questionnaires were completed and the instructors’ course was

concluded by planning for the last 2days of the training and allocation of topics to

the new instructors.

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8) Day 4 & 5

10 newly trained trainers were available to conduct the training on day 4 and 5

under the supervision of the original eight trainers. A total of 29 participants

attended the training this includes one of the trainees from day 1 and 2 who had

not performed well. There were 12 male and 17 female participants.

Course content was maintained as per PTC manual however the timetable was

changed to allow the two teams to use the skills stations at different times.

One of the new instructors, Tafadzwa giving a lecture while Thandi and Kudzai look on, and John one of

the participants.

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Demonstration scenarios in pictures on Day 4& 5

Above Sanjay (obscured) runs a scenario assisted by Nyasha.

Below Anja runs a scenario with Rutendo looking on

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The Summary of the MCQs is shown in the table below.

LOWEST MARK HIGHEST MARK PRE-COURSE 33.3% 86.7% POST-COURSE 63.3% 96.7%

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9) Equipment

Most of the equipment used for this training was left by the UK instructors team

which came in February 2014 led by Dr Grange. The equipment included

2manikins, a digital projector and a kit box.

From the Department of Surgery we were loaned a flat screen tv which we were

able to use for one of the teams and project slides via an HDMI cable.

Dr Farai Madzimbamuto provided his Laryngoscopy blades and Joe provided his

cervical collar. The rest of the smaller items e.g. cannulas, IV lines, oral airways

were sourced from the hospital.

All the documents were printed locally.

Four goat carcasses was used for the chest drain and advanced airway practical

sessions.

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10) Conclusion To conclude, this second locally coordinated PTC course was very successful and

surpassed the organisers’ anticipation. A total of 69 participants were trained, 32

females and 38 males of these 13 were trained to be instructors 3 females and 10

males.

Participants enjoyed and learnt a lot from the PTC course and some actually vowed

to go and initiate training their colleagues back at their hospitals, under the

leadership of the local PTC team.

The commonest negative feedback was that there wasn’t enough time especially

for the practical sessions.

There are now twenty trainers in the local team who have done both the ToT and

have trained others. There are four other who have done the ToT only. After the

training a committee was set up to be headed by Dr Farai Madzimbamuto and Dr

Max Gova, with Dr Josephat Chiripanyanga, Dr Tasimba Masama, Sr Rutendo

Dimba, Dr Kudzi Kanyepi, Dr Patel, Dr Thandi Munaiwa, Sr Nyasha Masvosva and Sr

Pauline Matongo as committee members.

The way forward for PTC Zimbabwe remains as to start doing trainings in other

towns and provinces and spread the gospel of PTC to the whole nation. As

previously planned PTC is now housed under the department of Health

Professionals education headed by Dr Madzimbamuto’s office.

The main obstacle for the future of PTC in Zimbabwe is still funding and time for

the trainers and trainees. This course was funded by PTC in retrospect after the

submission of all the receipts. We are still exploring other avenues of funding

locally.

Finally the course content, material and methodology of PTC is second only to

none and it should be spread to the four corners of the world and should be the

backbone of management of a trauma patient in any situation. We look forward to

receiving the revised training manuals.

Thank You

God Bless