Project Sachibondu: Where There Is No Doctor (Closed)

Overall goals

To improve the provision of emergency care through a programme of clinical support and education focused on:

• Triage, assessment and emergency treatment of acute conditions
• Recognition of the deteriorating patient
• Basic nursing skills
• Hand washing and hygiene
• Waste management
• Quality improvement and audit

Achieved: So far we believe we have established a trustful relationship with the staff at the Sachibondu hospital, and have set clear expectations of what we can offer within the resources, timeline and framework of our project. We have just completed the first year of the project.

Key UK Colleagues and Partners

Colleagues/Volunteers
NHS Lothian
University of Edinburgh

International Partners

Sachibondu Mission, Northwest Zambia
Orkidstudio, based in Nairobi (Glaswegian organisation)

Sustainable development goals

• SDG 3 - Good health and well-being
• SDG 4 - Quality education

Funding source

Medic One Charity
Laerdal Foundation grant
Volunteer fundraising (min. £500 per traveller)
Colleague fundraising

Project origin

In early 2016 an approach to assist with the design of a rural hospital by Orkidstudio was made. At the time there was a rural health centre in place, Orkdistudio had a vision for a first-level hospital. We felt that a new building alone is unable to fulfil the role of a hospital without support and education and agreed to visit the site under the invitation of the mission management. From this visit we realised that the identification of deteriorating and emergency care patients was limited and should be a priority as the health developed into a hospital. Local staff and management were asked their opinion and gave their support.

Evidence of need

In early 2016 an approach to assist with the design of a rural hospital by Orkidstudio was made. At the time there was a rural health centre in place, Orkdistudio had a vision for a first-level hospital. We felt that a new building alone is unable to fulfil the role of a hospital without support and education and agreed to visit the site under the invitation of the mission management. From this visit we realised that the identification of deteriorating and emergency care patients was limited and should be a priority as the health developed into a hospital. Local staff and management were asked their opinion and gave their support.

Project areas

Workforce development, capacity building, service improvement, education, safety and resilience

Project activities

A baseline visit was completed in May 2016. Since then funding was achieved from the Laerdal Foundation to establish a full project. Two of five visits of 10 days have been completed as part of this project, with 3 further visits before mid-2019. Full results will be available by end 2019.

Changes

It takes a system of emergency health care to save lives. That system has to start somewhere, and building upon specifically designed building infrastructure with a system of audited clinical practice is an innovative method to instigate improvement in health care. We believe that this project has a focused approach to robust and sustainable development, enabling long-term progression of enhanced provision of health services for a population that would otherwise not have access to emergency care. We hope that the design of this project is replicable and will allow GEM to adapt and repeat the process within low resource setting throughout the world.
We believe that in order to create sustainable development of emergency care, local staff must be able to appropriately question their own clinical practices in a way which provides continuous feedback to clinical processes, thereby reducing the morbidity and mortality of the local population. This is a prospective observational study over an initial 2-year period during which GEM hopes to answer the following question: Using innovative infrastructure design and modern technology, can a system of educational interventions, remote clinical support and emergency resuscitation training significantly and sustainably reduce neonatal, child and adult mortality in a rural setting?
The quantitative and qualitative outcome measures are listed below:

1. Hospital data will be gathered, analysed and compared annually (baseline 2015)
2. Staff will complete pre and post education tests to identify short and long term learning, repeated each visit
3. Patient and staff satisfaction questionnaires bi-annually
4. The hospital management will be interviewed
5. Ministry of Health engagement will be monitored
6. The local community will be interviewed to gather opinion in the form of community discussion groups
7. Staff from NHS Lothian will be asked to complete a questionnaire on their experience
8. An annual report will be compiled collating the above points as they become available.

Next steps

Continue to motivate and facilitate the preparations for visits 3 to 5; including volunteers, organisational issues such as travel, accommodation, travel health and safety issues, educational preparation, scenarios and case studies, equipment and further fundraising.

Challenges

Rural Africa has its challenges by the context, low resources and remoteness. One of these was the intensity of the wet season and the poor functioning of the roof of the new hospital. This has now been resolved; however it caused a delay of 12 months in the patients moving into the hospital. This meant the first 2 visits were completed in a make shift health centre/hospital. Time that could have been spent facilitating the use and functioning of the space was therefore not possible, but it will be for the remaining 3 visits. The team managed to complete their planned activities regardless, this kind of adaptability is essential.

Mitigating challenges

Advice on how and where to seek funding for NHS staff backfill.
Wider recognition on the benefits of global citizenship. Hopefully our project evaluating the volunteer experience will assist change.

Partnership principles

• strategic
• harmonised
• effective
• respectful
• organised
• responsible
• flexible

Project gains

• leadership
• teamwork
• clinical
• academic
• patient