International

Nurse Training in Malawi

Dr Melita Gordon
BSG International Project Funding

The first phase of this project was to bring Rose Malamba to the UK to train in TNT, which has now been accomplished I attach the report of her visit, plus a report of the training she has subsequently delivered in Malawi.

BSG Funded Educational Project Report

Project title:

TRAINING OF LABORATORY SCIENTISTS AND HISTOPATHOLOGISTS IN THE HANDLING AND INTERPRETATION OF GASTROINTESTINAL AND LIVER BIOPSIES IN NIGERIA

Gastroenterology practice is gaining grounds as a clinical entity in Nigeria with specialists in endoscopy practice increasing. Also, the huge burden of viral hepatitis in Nigeria highlights the need for quality liver pathology to support the service. Consequent upon these, there is a leap in the volume of GI and liver biopsies from these invasive procedures. Thus there is need for quality handling and reporting of such expensive tiny pieces of tissue which hold a lot of useful information.

In order to address the gap emanating from the clinical practice of gastroenterology and laboratory input, there is a need to train both the technical staff and histopathologists to meet these challenges. This training workshop, therefore, provided a rare opportunity to build capacity in GI pathology.

Course Activities

The training was delivered as a 2-in-1 practical hands-on workshops which ran in parallel over a five-day period to 20 scientists and 25 pathologists invited from institutions with endoscopy and liver biopsy practice across the country between 9 to 13 September 2013 at the Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital, Lagos, Nigeria.

The technical aspect was facilitated by Mr Peter Jackson (retried Chief Biomedical Scientist, Leeds) and he taught the 20 participants on -

  • Correct handling and orientation of specimen
  • Maximizing use of slides by showing them how to make the necessary three levels on a slide and putting biopsies from multiple sites, e.g. a colonoscopic series, on one block
  • Special stains for GI and liver biopsies
  • Quality staining and quality assurance

The GI and liver biopsies interpretation sessions were facilitated by Dr Olorunda Rotimi (consultant GI histopathologist, Leeds Teaching Hospitals) using a combination of glass and scanned virtual slides to teach the 25 participants on -

  • Approach to GI and liver biopsy interpretations
  • Clinical uses of special stains in GI and liver biopsies
  • Report writing – what to include and use of template

A joint meeting with clinicians from two gastroenterology centres in Lagos with 4 gastroenterologists and one GI surgeon was held on the 5th day highlighting the:

  • values of regular clinicopathological meetings
  • what the clinician expects from pathology report and what the pathologist expects from the clinician.

General comments:

The training was a well received as can be seen from the feedback. The success of the project was encapsulated in what transpired at the opening session when one of the scientists said the aim of getting them to put 3 levels on one slide was an impossible task. However, by the 3rd day, the same scientist produced such a slide! The hunger for knowledge by the participants was insatiable and they all stated that more of such should be done regularly and made available for many more of their colleagues.

Dr Olorunda Rotimi
November 2013.

Bangladesh Endoscopy Training Project Report

Visit by Dr Mesbah Rahman, Dr Dafydd Richards, Dr Umakant Dave, Mark Hillier and Sianed Dafydd.

We selected Bangladesh as our project venue as it is one of the poorest countries amongst the booming economies of Asia (ranked 161 to 183 in world ranking in various parameters by the UN and WHO). One of the members in our team has connection with Bangladesh which helped to set up vital links.

Prior to our visit, we conducted a postal survey of ERCP services in Bangladesh. This work has been accepted for a poster presentation at the "World Congress of gastroenterology- Gastro2013". A five member team visited Bangladesh for two weeks (January-February 2013). We conducted two days of seminars covering advances in gastroenterology/endoscopy in venues across the country along with local speakers and delivered keynote lectures in the Bangladesh Gastroenterology Society (BGS) annual conference. We conducted the first ever full day of live ERCP workshop (video link between Dhaka Medical College hospital and BGS conference venue) in Bangladesh. We also conducted the first ERCP/Endoscopy Assistants' hand-on workshop and the first ever hands-on ERCP workshop using models and accessories for ERCPists. We collected feedback from all the events we conducted and it was rated very good or excellent in almost all parameters.

In addition to a successful first visit to Bangladesh, there have been other achievements. We have already established a good relationship with BGS office-bearers and have continued discussions on future developments. Two consultant gastroenterologists (key partners from Bangladesh) attended the BSG annual conference in Glasgow and spent 2 weeks in Wales as clinical observers. Student exchange is being established between the College of Medicine, Swansea and Dhaka Medical College. We have established a charity to continue the project named GASTROENTEROLOGY TRAINING ACADEMY (registered with charity commission, UK; registration no: 1150282 http://www.charitycommission.gov.uk/find-charities/) and are organising fund raising events. We have participated in two live TV chat shows on Bangla TV to raise awareness about developments in endoscopy and this project. Two Bangladeshi gastroenterologists have joined the BSG as overseas members and another sixteen are in the process. We have provided some input to BGS in the development of draft guidelines on minimum quality standards in endoscopy. A draft proposal on a Bangladesh endoscopy training centre is being developed.

Cook Medical ® and Olympus ® supported the project. We thank BSG and hope BSG will continue to support this project.

Photograph showing travel arrangement from hospital to hospital (left to right: Mark Hillier (endoscopy nurse), Umakant Dave (consultant Gastroenterologist), Sianed Dafydd (radiology nurse), Dafydd Richards (consultant radiologist), Mesbah Rahman (consultant gastroenterologist) and Dr Rahman (BGS representative)).

Kamazu Central Hospital, Malawi - June Update

Visit by Dr Mark Hendrickse(MH) Consultant Gastroenterologist, Blackpool Teaching Hospitals NHS Foundation Trust

Previous visits by BSG member Dr Mark Hendrickse (MH) and other colleagues had established an endoscopy training Programme at Kamuzu central Hospital (see previous report on visit in Feb 2013 below). Basic skills and enhanced refresher courses have been run with MH as a visiting trainer. Gift Mulima was also formally assessed as being fully independent in diagnostic gastroscopy with experience in dilatation, stenting and variceal ligation. He has recently completed a formal Training the gastroscopy trainer course in Blantyre as well as an ex vivo therapy course. It was recognised that in order for the endoscopy service to expand, there is a requirement to develop further trainees to become independent endoscopists and potential trainers. Further trainees also required a basic skills course.

BSG Sponsored Endoscopy Training at Kamazu Central Hospital - Malawi

Endoscopy Training at Kamazu Central Hospital (KCH) Endoscopy Unit - Lilongwe-Blackpool Endoscopy Link 25th February – March 1st 2013.

Visit by Dr Mark Hendrickse(MH) Consultant Gastroenterologist, Blackpool Teaching Hospitals NHS Foundation Trust

Background

Lilongwe is the largest city and capital of Malawi. Kamuzu Central Hospital(KCH) is the main government funded tertiary referral hospital, with an estimated number of beds varying from 600 – 1000 beds. Upper GI bleeding from portal hypertension complicating schistosomiasis and oesophageal cancer are major causes of morbidity and mortality hence the need to have a comprehensive endoscopy service. Through links with the Mersey school of Endoscopy and the Liverpool Malawi Welcome trust previous visits to KCH endoscopy unit in 2011 and 2012 by MH, Dr Paul O'Toole (POT) and colleagues initially involved a basic skills in gastroscopy course for surgical registrars, assessment of endoscopy nurse practice / training and decontamination, and subsequent follow up of trainee endoscopist / endoscopy nurse training evaluation. Recommendations on endoscopy unit expansion, decontamination requirements and support in nurse training were also made. After visits to the Blantyre endoscopy unit and participation in endoscopy nurse training programme in 2011, Rachel Jiya (RJ) and colleagues produced a comprehensive report detailing suggested developments / improvements required in the KCH unit. This has been forwarded to The Matron and the Hospital director at KCH.

Aims of current visit:

  1. To assess endoscopy training requirements of current trainees
  2. To provide small group teaching with all surgical trainees on:
    1. management of upper GI bleeding with particular emphasis on Variceal bleeding (including use of sengstaken tube)
    2. endoscopic therapy particularly variceal banding, oesophageal dilatation and stenting
  3. Review endoscopy training for surgical trainees committed to GI surgery
  4. Provide a refresher / enhanced skills course for those with endoscopy experience
  5. Basic skills course for those with no or very limited endoscopy experience
  6. Evaluate more experienced endoscopist (GM), and run a training the gastroscopy trainer course
  7. Set up meetings with Hospital director, Matron and Head of Department to take forward recommendations from previous visits / report by RJ and colleagues
  8. Assess current endoscopy unit equipment / facilities and future requirement

A full report of the visit may be downloaded below:

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