COURSE REPORT

ZIMBABWE

6th – 10th October 2014

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.

http://www.ndorms.ox.ac.uk/cool.php

1 | P a g e

PTC

COURSE

ZIMBABWE

6 – 10 October 2014

2 | P a g e

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

3 | P a g e

1) Executive Summary

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

course in Zimbabwe which was conducted from the 6th to the 10th of October 2014.

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

during this wonderful training 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.

Inspired by Steve Jobs’ words “it’s best to do it best the first time” this PTC training

was done with the best of desire and hard work by all those involved and the result

was a humbling success story by novices in the field of PTC training thanks to all

who made this possible.

Course numbers and gender

ratios

Performance

Pre-test mark Post-test

mark

Day 1&2 Trainers: 3 [M: 2 /F: 1]

Trainees: 12 [M: 5 / F: 7]

lowest: 40%

highest: 90%

lowest: 60%

highest: 100%

Day 3

T0T:

Trainers : 3

Trainees: 7 [M: 2 / F: 5]

Day 4&5 Trainers: 9

Trainees: 16 [M: 8 / F: 8]

lowest: 23%

highest: 83%

lowest: 66%

highest: 96%

Total Trainees: 28 [M: 13 / F: 15]

4 | P a g e

2) Purpose of the Training

The purpose of this inaugural locally coordinated PTC course was to empower

health professionals at various levels in their carriers and diverse capacity

institutions at different levels of care for the trauma patient to manage trauma

patients confidently and knowledgeably 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 Grace Zvokowomba who is the Secretary for the

department of Surgery University of Zimbabwe College of Health Sciences where

the course was hosted and Mr Joel Mugota the chief technician in the department.

5 | P a g e

Ms Grace Zvokowomba

(right) and Dr Josephat

Chiripanyanga (left) having

a lighter moment as they

fill in data on the excel

spreadsheets.

From the UK, Annette Clark, Dr Caroline Grange and Dr Noel Peter, 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 a registra in

cardiothoracics surgery with the invaluable guidance provided by Dr Farai

Madzimbamuto consultant anaesthetist and Dr Max Gova Consultant Orthopaedic

Surgeon.

Dr Farai Madzimbamuto Dr Max Gova

6 | P a g e

4) Course Instructors

There were four course instructors who had been earmarked for this training but

unfortunately one of them couldn’t participate in the training as she was not

feeling well.

This left a team of three instructors who worked tirelessly to make this course a

success. The instructors were Dr Josephat Chiripanyanga (team leader), Dr

Tasimbanashe Masamha, and Nurse Anaesthetist Rutendo Dimba. All the three

instructors are based at Parirenyatwa Hospital the largest health institution in the

country where Dr Josephat is a registra, Dr Masamha works in the accident and

emergency department as a Casualty Officer and Sr Rutendo is a Nurse

anaesthetist.

The trainers

were trained in February by a team of trainers from the United Kingdom which

came to Harare in February 2014 led by Dr Caroline Grange.

Tasimba Joe

Rutendo

7 | P a g e

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 goat

which we used as a guinea pig.

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

three 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.

The activities during the training literary followed the guidelines in the PTC

instructors manual which will be outlined on the specific days.

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

data collected during the training.

6) Day 1 & 2

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

Twelve participants attended the PTC Course 7 females and 5 males. Five of the

participants were doctors and six were nurses and one was an ambulance

technician.

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

questionnaire to feel in.

8 | P a g e

The participants in the back row from left to right were Spencer, Agnes, Pauline, Nyasha, Edith, Kudzi,

Billy, Patel, Thandi, Lionel and in front is Andrew.

The 12th participant is not in the picture as she was delayed.

After the questionnaire and the MCQs a

discussion of the local trauma perspective was

held, and then the following lectures were

delivered ABCDE of Trauma and Primary

survey by Tasimba, Airway and Breathing by

Rutendo, Circulation and Shock by Tasimba.

This was followed by the skills station where

the simple airway was done by Rutendo,

surgical airway by Tasimba (see picture to the

left) the cervical spine and Logroll by Tasimba

and Chest drains by Joe.

After the lunch break Joe delivered the

following lectures Secondary Survey and Chest Trauma which were interspaced by

demonstration scenarios.

The day was concluded by Rutendo with an overview and summary.

Day 2 was kick started by Tasimba with a lecture on Head and Spinal Trauma,

followed by Abdominal and Limb trauma by Rutendo then Trauma in Pregnancy

and Children by Joe.

9 | P a g e

This was followed by a tea break (see

picture).

After the tea break Joe delivered a

lecture on burns followed by the

following workshops;

Analgesia done by Rutendo,

Transportation by Tasimba,

Paediatrics by Joe and Neurological

assessment by Rutendo.

After the lunch break Tasimba gave a

lecture on Disaster management which was followed by Demonstration Scenarios,

Post course MCQs and questionnaire and a Summary and evaluation by Joe.

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

LOWEST MARK HIGHEST MARK PRE-COURSE 40% 90% POST-COURSE 60% 100%

7) Instructors Course

The instructors’ course saw the training of a total of 7 new trainers, 5

females and 2 males by the original 3 instructors. Four of these trainers were

doctors and 3 were nurses.

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

with essentially no changes.

10 | P a g e

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.

Standing from left to right: Nyasha, Thandi, Lionel and Patel Sitting: Pauline, Ndaizivei and Kudzi.

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.

Patel Teaches Lionel how to Paper concord made by Lionel’s paper concord Lionel’s paper concord flies as Make a paper concord. Lionel takes off Patel and Thandi watch

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.

11 | P a g e

8) Day 4 & 5

Six of the seven newly trained trainers were available to conduct the training on

day 4 and 5 under the supervision of the original three trainers. A total of 16

participants attended the training this includes one of the trainees from day 1 and

2 who had not performed well. The other participant who had not done too well

couldn’t make it for this training. There were 8 male and 8 female participants. Of

note is there were 5 ambulance technicians in this group, 5 doctors, 5 nurses and 1

Health promotion officer. This group was generally less knowledgeable than the 1st

group.

Course content was maintained as per PTC manual although at times there was

need to explain basic medical terminology as some of the participants were not

well versed with some terms.

These are some of the participants in the 2nd PTC course.

One of the new

instructors, Thandi

teaching how to put a

chest drain at a skills

station.

12 | P a g e

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

LOWEST MARK HIGHEST MARK PRE-COURSE 23% 83% POST-COURSE 66% 96%

Even though the knowledge base was low this group improved remarkably thanks

to the hard work exhibited by the new trainers. One of the participants who had

performed poorly in the pre-test course didn’t come back after breakfast on his 1st

day.

Of concern is that only 1 participant from both groups had ever attended a trauma

course before.

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. 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.

A goat carcase was used for the chest drain and advanced airway practical

sessions.

13 | P a g e

10) Conclusion

To conclude, this inaugural locally coordinated PTC course was quite successful and

surpassed the organisers’ anticipation. A total of 28 participants were trained, 15

females and 13 males of these 7 were trained to be instructors 5 females and 2

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.

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

for the demonstration scenarios.

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 was to start doing trainings in other towns and

provinces and spread the gospel of PTC to the whole nation. It was also agreed

that PTC be 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 funding. This course was

funded by PTC in retrospect after the submission of all the receipts. This poses a

major challenge for future courses as most of the costs incurred needed a down

payment. My suggestion is if the funding could be made available in advance after

a budget has been presented to PTC then the receipts can be sent after the

training has ended. This will make the running of PTC technically easier. We are

also 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.

Thank You

God Bless

front pg course report ZimbabwePTC Post Course Report for Zimbabwe October 2014.pdfPTCCOURSEZIMBABWETable of Contents1) Executive Summary2) Purpose of the Training3) Key Staff4) Course Instructors5) Activities6) Day 1 & 27) Instructors Course8) Day 4 & 59) Equipment10) Conclusion