PART 1: BSSH COSECSA Hand Surgery Course, BSSH AO Alliance ...€¦ · PART 1: BSSH/AOAF Hand Surgery Course for COSECSA, Blantyre 23rd - 24th September Malawi and Course Locations

PART 1: BSSH COSECSA Hand Surgery Course,

BSSH AO Alliance Hand Trauma Course and IFSHT

BAHT Therapy Courses, Malawi

September 2019

PAR

T 1:

BSS

H C

OSE

CSA

Han

d Su

rger

y C

ours

e, B

SSH

AO

Alli

ance

Han

d Tr

aum

a C

ours

e an

d IF

SHT

BA

HT

Ther

apy

Cou

rses

, Mal

awi

1

PART 1: BSSH COSECSA Hand Surgery Course, BSSH AO Alliance Hand Trauma Course and IFSHT BAHT Therapy Courses, Malawi September 2019

Background Over the past decade members of the BSSH Overseas committee have worked jointly with international surgical communities towards improving management of hand conditions through delivering training courses in lower to middle income countries across Africa. The primary objective is to advance education, training, standards, research & practice in surgical care in these regions. Each tailored to the specific needs of the local health care context. Since the first successful collaboration between BSSH and AO Alliance in Malawi in 2015, the work in this country has evolved and strengthened year on year. Currently BSSH is invited to run a course for surgeons in training and physiotherapists from COSECSA countries at Queen Elizabeth Central Hospital, Blantyre and a separate course for Orthopaedic clinical officers in Mangochi, Malawi with focus on clinical areas that WHO considered as essential.

Delegate Feedback Quotes “The course has been well tailored to the requirements on the ground. It will help me in assessing hand injuries.” “Very useful for trainees at my level. The hand examination on Point!” “Well organised and very relevant content” “Perfect !!!!”

*Names changed

to protect privacy

PAR

T 1:

BSS

H C

OSE

CSA

Han

d Su

rger

y C

ours

e, B

SSH

AO

Alli

ance

Han

d Tr

aum

a C

ours

e an

d IF

SHT

BA

HT

Ther

apy

Cou

rses

, Mal

awi

2

PART 1: BSSH/AOAF Hand Surgery Course for COSECSA, Blantyre

23rd - 24th September

Malawi and Course Locations Malawi situated in southeast Africa has a population of 18 million. Eighty five percent of the population living in rural areas with limited access to healthcare. Although the 9th poorest country in the world, it has plenty of natural richness and beauty including Lake Malawi, Africa’s third largest lake, known by locals as the “lake of stars.” Despite limited resources and funds, healthcare is free in the government hospitals. Life expectancy is approximately 51 years and infant mortality 48/1000 live births. There is approximately 1 doctor per 65,000 population. Clinical officers in district hospitals undertake majority of the workload. There are 19 trained specialist surgeons spread over four central hospitals across the country. Eleven are Orthopaedic Surgeons (one of whom is a Hand Surgeon), three are Plastic surgeons and the rest are General surgeons. The Queen Elizabeth Central Hospital founded in 1958, is a recognised centre of excellence located in Blantyre, receiving referrals from a wide geographical area. Hence, it is a natural course location for doctors.

PAR

T 1:

BSS

H C

OSE

CSA

Han

d Su

rger

y C

ours

e, B

SSH

AO

Alli

ance

Han

d Tr

aum

a C

ours

e an

d IF

SHT

BA

HT

Ther

apy

Cou

rses

, Mal

awi

3

Faculty & Local Partnership The instructional course sponsored by BSSH was jointly organised by Nick Sheppard, consultant Plastic surgeon, Jonathan Jones, consultant Orthopaedic surgeon, and Tilinde Chokotho, Malawian consultant Plastic surgeon. The faculty was composed of the above-named surgeons in addition to Martin Wood, consultant Orthopaedic surgeon, Jeremy Stanton, consultant Orthopaedic surgeon, Shan Shan Jing, Plastic Surgery trainee as well as senior therapists: Sarah Mee, Debbie Stanton, and Zoe Clift from the UK. The course was supported by Linda Chokotho, a local Orthopaedic Hand Surgeon, Noha Nyamulani from COSECSA, Whitney Bartlett, the Country Coordinator for COSECSA and Emma Brighton from BSSH. The hand therapists ran a parallel BAHT course. The objective was to provide doctors and other healthcare professionals with guidelines for the management of hand conditions. Financial support was given to delegates travelling from outside Malawi towards their expenses.

Delegates Twenty- two delegates attended the course including two from Tanzania. The Malawian delegates also travelled far and wide from four major medical centres across the country. All were doctors at various stages of their training. The majority attendees were males and five were females. A significant proportion was either in the first or second year of training.

PAR

T 1:

BSS

H C

OSE

CSA

Han

d Su

rger

y C

ours

e, B

SSH

AO

Alli

ance

Han

d Tr

aum

a C

ours

e an

d IF

SHT

BA

HT

Ther

apy

Cou

rses

, Mal

awi

4

Course Structure The course was spread over 2 days. The format featured a pre- and post-course test to assess and consolidate the delegates’ core knowledge, a series of interactive lectures, small group and practical sessions, and unique to this year, advanced sessions for subspecialty interests. The doctors and therapists from the parallel course were integrated for the practical sessions this year. This gave the therapists

22

9

2

9

2

Total

Kamuzu

Cen

tral,…

Muhimbili…

Queen Eliz

abeth

…

Malamulo, M

alawi

Origin

98

21

2

1st year 2nd year 3rd year 4th year 5th year

Year of Residency

PAR

T 1:

BSS

H C

OSE

CSA

Han

d Su

rger

y C

ours

e, B

SSH

AO

Alli

ance

Han

d Tr

aum

a C

ours

e an

d IF

SHT

BA

HT

Ther

apy

Cou

rses

, Mal

awi

5

opportunity to observe/perform tendon repairs and doctors the opportunity to learn more about splinting from their colleagues. Core Lectures Functional hand anatomy Assessment and management of the injured hand Burns in the hand Tendon injuries Hand fractures Nerve injuries including brachial plexus

Small group sessions Hand and wrist fractures LA techniques Wound incisions XR assessments Clinical case discussions

Practical sessions Splinting Tendon repairs Advanced Content Congenital hand surgery Carpal fractures & dislocations Tendon reconstruction Brachial plexus injury

Prizes were awarded for the best tendon repair, the best post-course exam score, and the delegate who demonstrated the greatest improvement between pre- and post-test test scores. As expected, the more senior trainees scored the highest in both the pre- and post-exams and also improved the most over the course period by 15% in their marks. Delegates were also invited to join in the Webinar programme via the zoom platform for further interest.

PAR

T 1:

BSS

H C

OSE

CSA

Han

d Su

rger

y C

ours

e, B

SSH

AO

Alli

ance

Han

d Tr

aum

a C

ours

e an

d IF

SHT

BA

HT

Ther

apy

Cou

rses

, Mal

awi

10

Delegate Feedbacks Delegate feedback was overwhelmingly positive. All rated the entire course “Very good” or “Excellent”. The most popular sessions with the highest ratings were XR assessment of the hand, clinical case discussions and hand examination on Day 1; and upper limb burns, carpal fracture and dislocation and wrist fractures on Day 2. The integrated practical sessions were very well received. They provided the perfect platform for network opportunities. Majority of the delegates had asked for an extension in the duration of course. A few had hoped for live demonstrations on patient in real time.

5 5 5 5 5 5 5 5 5 5 5

4.74.8

4.94.8 4.8 4.8

54.9

4.8 4.8 4.8

HAND…

RADIOLOGY

HAND…

BURNS IN THE…

LA TECHNIQUES

WOUND…

XR…

CLINIC

AL…

CLINIC

AL…

ASSESSIN

G…

OVERALL…

Day 1 Hand Surgery Workshop for COSECSA Feedback Scores, Blantyre

Median MeanKeys 5 Excellent, 4 Very good, 3 Good, 2 Fair, 1 Poor

PAR

T 1:

BSS

H C

OSE

CSA

Han

d Su

rger

y C

ours

e, B

SSH

AO

Alli

ance

Han

d Tr

aum

a C

ours

e an

d IF

SHT

BA

HT

Ther

apy

Cou

rses

, Mal

awi

11

Useful Course Comments

• This is a very important training course that is obviously going to enhance our surgical skills: in the future we will benefit more if USB drives containing lectures are provided for retention purposes

• The course has been well tailored to the requirements on the ground. It will help me in assessing hand injuries.

• Practical sessions on the wards or AE on real patients will be more helpful • Well organised and very relevant content • More time for advanced optional sessions • Needs more detailed revision of anatomy • Carpal fractures were great more of that please • Increase the number of days for the course. The material is a lot for only 2 days. • Increase the number of small group sessions