CONTINUING EDUCATION FOR HEALTH WORKERS
There is little point having access to antivenoms if the doctors and health workers who need to be able to administer it in an emergency situation, lack the proper education and vocational training to be able to adequately assess, diagnose and treat patients who have been bitten by venomous snakes.
It is a sad fact that globally many health systems are unable to provide for the continuing medical education needs of their staff. In some cases rural health workers may not have received even basic ongoing training in subjects such as cardiopulmonary resuscitation, or trauma care, and with very few exceptions, ongoing practical training in the management of bites and stings by venomous animals is non-existant.
GSI personnel have been actively involved in delivering training in snakebite treatment to rural communities in Papua New Guinea and Cambodia, and the GSI plans to adapt this approach to develop a learning platform for health workers in Africa over the next 2 years.
PAPUA NEW GUINEA
GSI CEO David Williams, and GSI Director Dr Simon Jensen have both worked on snakebite projects in Papua New Guinea for more than a decade. In 2004 they set out to develop a National Training Course in the treatment and management of the bites and stings of venomous snakes and other toxic animals, after recognising that many health workers lacked the basic clinical skills.to adequately manage these emergencies. The philosophy behind the course was that the then declining prognosis of snakebite patients could be reversed if key issues, including health worker and community education and training, were addressed with situationally relevant education and training.
The inaugural National Snakebite Management Course was conducted at the UPNG School of Medicine and Health Sciences in Port Moresby in September 2004. Taught by a volunteer faculty of physicians and snakebite specialists from Australia and PNG the course was aimed at rural Health Extension Officers (HEO’s), Community Health Workers (CHW’s) and Nursing Officers (NO’s), as well as hospital-based doctors and NO’s. Annual courses have been conducted in Port Moresby and Madang, and the program expanded to Alotau and Popondetta in 2007. A one day Intensive Care Management of Snakebite Patients Course was started in 2007 to cater to the training and education needs of emergency and intensive care doctors at Port Moresby General Hospital.
Today the course is operated through the newly established Charles Campbell Toxinology Centre (CCTC) based in the School of Medicine and Health Sciences at the University of Papua New Guinea. In 2010 the Australian government lent support to the program by funding the purchase of life support training manikins, and providing financial support to meet course needs until the end of 2012.
Since it began, the teaching faculty has undergone a distinct shift, with fewer expatriate volunteers running the training in favour of an increasing number of well-trained Papua New Guinean doctors, and the aim is to eventually localise the entire program. Smaller training courses that concentrate on core skills, such as Basic Life Support are also now being run at District level in southern PNG.
In 2008, the Cambodian government sought assistance from the WHO Western Pacific Regional Office to undertake a detailed investigation of snakebite problems in rural areas, and to recommend a new course of action to address the problem.
- READ MORE: Snapshot: Cambodia
One of the outcomes of this process was the establishment in August 2009, of a national training course in snake bite treatment for doctors and health workers. Designed and rolled out by GSI CEO David Williams, and GSI director Dr Simon Jensen, the course, which runs over three days is comprised of a comprehensive curriculum that teaches all aspects of the assessment, diagnosis, primary treatment and ongoing medical care and rehabilitation of snake bite victims.
At the Calmette Hospital in Phnom Penh, the course was taught first to 12 National Master Trainers who were senior specialists from National Hospitals. These doctors in turn are now responsible for teaching the course content to their colleagues and students, and will take the leadership role in the transition to making the Cambodian Snake Bite Treatment Course a wholly localised initiative that will be taught around the country.
Further training courses were then staged in Siem Reap, where 30 doctors from Provincial Referral Hospitals around the country were introduced to the curriculum over three days. These doctors will assist the primary Master Trainers in teaching the course to their colleagues in their respective provinces.
A shortened 1 day course in first aid, assessment, resuscitation, referral and transport was also designed and trialled with a group of 34 rural health centre staff. This basic course which comprises 6 lectures and some practical sessions was designed for nationwide implementation to improve the ability of primary healthworkers to recognise severe snake bite cases, stabilise the patients, and then safely refer then onwards for treatment in a larger Provincial or National level hospital.
In 2011 GSI began developing the curriculum for a primary snakebite treatment training course for sub-Saharan African health professionals. The aim is to develop this course both as a web-based, self-directed learning resource that will be accessible via the GSI website, and to also produce country-specific training packages that can be taught face-to-face by GSI-trained medical educators. The GSI is currently looking for assistance from software designers to help with the development of the web-based resources, and the aim is to launch this new training initiative in 2013.