St Mary’s Hospital, Isle of Wight - Juba Teaching Hospital Link
The Link between St Mary’s Hospital (the main base of the Isle of Wight NHS Trust) and Juba Teaching Hospital was established in 2007 and gained charitable status in 2008. The population of South Sudan is 11.7 million and of the Isle of Wight is 140,500.
Aims of the link
To promote understanding of the health needs of South Sudan, and to support the Government of the Republic of South Sudan to improve clinical services through the development of education and training.
The last clinical teaching visits were in late 2013 just before the outbreak of civil unrest. The teaching was the first on the newly developed Basic Medical Training Programme for doctors in the first two years after graduation. Fifty doctors enrolled and were divided into two groups: Trauma and Mental Health which were each taught for a week and repeated the following week for the other group.
The trainers in Trauma were Mr Dominic McCreadie, Emergency Medicine Consultant and Mr Tim Walsh, retired Consultant Surgeon. The teaching modalities included lectures, demonstrations, role play, practicals and tutorials (see Figure 1). The module concluded with formal assessments. Feedback was very complimentary. There was a wish for more modules and longer training sessions. There was a high achievement level based on attendance, a practical and a Multiple Choice Question (MCQ) test. The pass rate was 90% and two passed with distinction.
Figure 1. Don McCreadie teaching resuscitation skills (credit Zorina Walsh)
Dr Shobha Singh, Consultant Psychologist, Dr Ashok Singh, Consultant Psychiatrist and Dr Jane Newson-Smith/Salih, retired Consultant Psychiatrist taught an interactive course based on the World Health Organization (WHO) Mental Health Gap Action Programme course. This aims to provide non-mental health professionals competence in diagnosing and treating most mental health conditions. It is manual based and 25 copies of the manual were used. There is much role play and many videos. The course was well received with excellent participation by the doctors. Many had experienced interrupted training, and undergraduate exposure to psychiatry varied from minimal to significant. Pre and post course MCQ tests demonstrated very good levels of knowledge improvement.
Areas for improvement are the full 2-week course, including other health professionals, better audio-visual equipment and reliable electricity supply. Also the doctors asked for clinical teaching with patients and to meet the local psychiatric team, which had not been possible to organise. A positive outcome was learning general listening and interview skills, and being able to discuss the role of the doctor in difficult situations.
Our impression was that these are promising young doctors and this postgraduate training was extremely important for them. Furthermore we felt this WHO course can offer a lot to healthcare workers in South Sudan and we hope it can be developed there.
Figure 2. Learning mental health interview skills (credit Jane Newson-Smith)
Mrs France Reed, Midwife, joined, as a facilitator, a team based in Belfast, as the Link representative for an Essential Lifesaving Skills Course in Obstetrics in Juba, November 2013. The Course aimed to teach lifesaving skills for mothers and neonates in obstetrics to senior obstetric /midwifery staff. The Course lasted 3 days with fifteen participants. Feedback was very positive and there was a demonstrable gain of skills and knowledge.
Achievements and challenges
The key objectives of the St Mary – Juba link, when it was established in 2008, were to set up and run a Postgraduate Medical Training Programme for doctors and to support the Schools of Nursing/Midwifery, working in conjunction with the Real Medicine Foundation and the World Children’s Fund.
A 5-year plan was commissioned and written for the South Sudan Ministry of Health. In 2012 a 3-day Training the Trainers Course took place in Juba. Mr Tim Walsh led the team with Dr Rich Bregazzi, Medical Educationalist and Dr David Attwood, a Medical Registrar. Eighteen consultants in various specialities participated. A follow up course was run a year later led by Dr Richard Bregazzi with Dr Alison Allan and Dr David Attwood.
The Link raised funds for a bungalow for visiting trainers, which has been built directly opposite the hospital.
Ten training visits have taken place, involving doctors, nurses, midwives, and education specialists.
Communication with Juba partners has not been easy. New developments should improve this.
- Dr Rich Bregazzi, Educationalist, has now been appointed Director of Post Graduate Medical Education and will visit Juba frequently.
- The Minister of Health has proposed establishing the South Sudan College of Physicians and Surgeons in the new Postgraduate Medical Centre in the grounds of Juba Teaching Hospital and Dr Rich Bregazzi has been appointed Dean of the new College.
- High speed internet connectivity is being installed in the new Postgraduate Medical Centre in Juba.
Travel to South Sudan is not considered safe by the Foreign and Commonwealth Office which makes arranging training visits including insurance etc. difficult.
We understand the Ministry has allowed others to use of the Juba Link bungalow which may make accommodation an issue for future visits.
Many of the original UK Link trainers are now retired and the challenge is to recruit more trainers. It is also recognised that Juba Teaching Hospital is the major health training resource in the country and the Isle of Wight has limited resources and professionals to support the training needs. There are now several other UK – South Sudan hospital Links, mainly in Wessex and consideration needs to be given to a consortium approach, i.e. more of a hub and spoke model.
Because of these developments we have already provided support for three South Sudanese doctors and a radiographer to gain UK postgraduate experience. We are currently hopeful that a doctor can come to work at St Mary’s Hospital in a training capacity for 2 years in medicine under the Medical Training Initiative (MTI) which will pay the standard NHS salary. The Link can provide general support and limited financial help - e.g. accommodation and subsistence during the unpaid introductory two-weeks, and ongoing mentorship. We hope that with the difficulties in arranging visits that the MTI can provide a wider opportunity to enhance training in several specialities and locations until regular visits
Dr Dario Kuron Lado. Consultant Surgeon, Chairman of Postgraduate Medical Training Committee. [email protected]
Dr Oromo Francis. Consultant Pathologist, Postgraduate Tutor. [email protected]
Dr Rich Bregazzi Dean of Postgraduate Medical Education, South Sudan [email protected]
Dr Eluzai Hakim. Consultant Physician. Founder Link member, Medical advisor to Link and Vice Chair. [email protected]
Mr Tim Walsh. Founder Link member, Retired Consultant Surgeon, Surgery advisor. [email protected]
Dr Jane Newson-Smith/Salih, Retired Consultant Psychiatrist. Link Chair. [email protected]
Mrs Sandie Paice Nursing advisor. [email protected]
Mrs France Reed, Midwifery advisor. [email protected]
Our newsletter is published on the Link website www.jubalink.org.uk.
Acknowledgement. Thanks to Tim and Zorina Walsh for support in writing this article