Pilot Curriculum Malawi
17th-20th May 2011
Day 1
Tuesday 17th May
Time
9.009.30
10.0011.00
11.0011.15
11.1512.45
12.451.30
1.303.00
3.003.15
3.155.00
Topic
Clinical officers as advanced leaders
Method
Discussion
Leader
Paul O’Hare
1. Epidemiology
Traditional birth attendants, rationale for change,
current data on place of delivery, major causes of
maternal death and neonatal death
Epidemiology
seminar
Chisale Mhango
2 Right place, right time?
Low birthweight and perinatal loss: what is the
evidence? Should there be more guidance on place
of care?
Group
discussion
Siobhan Quenby
3 Pathway of care: transfer between healthcare
localities
Transfers in utero, time intervals for decision-making,
transport, reception, operative intervention
Break
Group
exercise
Paul O’Hare
1. Active monitoring: is the partogram being used?
An audit and evidence from inquiries into maternal
deaths
Presentation
Discussion
Siobhan Quenby
2. Active monitoring: what is the evidence that it
helps? If it works, why is it not happening? Evidence
from significant event reviews in Malawi
Review of evidence, discussion of benefit of change
Lunch
Seminar
Discussion
Francis Kamwendo
Siobhan Quenby
Acting on the partogram information: what should be
happening?
Simulations of prolonged labour, breech, forceps,
vacuum extraction, ruptured uterus. Managing and
leading teams, drills based on local settings
Break
Practical
session
Francis Kamwendo
Siobhan Quenby
Acting on the partogram information: what should be
happening?
Simulations of prolonged labour, breech, forceps,
vacuum extraction, ruptured uterus. Managing and
leading teams, drills based on local settings
Practical
session
Francis Kamwendo
Siobhan Quenby
Place of delivery: where do women deliver and why?
Relevance of place of delivery to incidence of infection
and to PPH
Active monitoring and active intervention prevents
ruptured uterus
Day 2
Wednesday 18th May
Time
9.0010.00
10.0011.00
11.0011.15
11.1512.00
12.0012.45
12.451.30
1.303.00
3.003.15
3.155.00
Topic
Neonatal resuscitation
What about the baby? What are the major causes of
neonatal death and disability in Malawi?
1. Why neonatal resuscitation is important; principles
of good neonatal care
Wider team-working; adoption of evidence-based
practice; hypothermia, kangaroo mother care,
breastfeeding
Method
Group
discussion
Leader
Doug Simkiss
Seminar
Doug Simkiss
2. Serious maternal and neonatal infections in the
local context
Appropriate antibiotics on local inventory? What to do
when these not available
Break
Group
discussion
Francis Kamwendo
Doug Simkiss
1. Collecting the data on HIV infection and acting on it
Checking HIV status of pregnant women, offering
counselling and contact tracing
Seminar
Francis Kamwendo
Chisale Mhango
2. The implications of being HIV positive for
preventing puerperal sepsis
Seminar
Chisale Mhango
3. Points of infection in the pathway of care: when
and how are patients put at risk?
Coming from home, birthing blanket/delivery surface,
use of showers, antibacterial measures, handwashing,
asepsis in theatre
4. Management of sick neonates
Signs and symptoms; appropriate interventions, local
settings
Lunch
Group
discussion
Siobhan Quenby
Chisale Mhango
Seminar
Doug Simkiss
Neonatal resuscitation scenarios
Learning techniques, training others. Bag-and-mask,
Helping Babies Breathe, intubation (trial session)
Break
Practical
session
Doug Simkiss
Neonatal resuscitation scenarios
Learning techniques, training others. Bag-and-mask,
Helping Babies Breathe, intubation (trial session)
Practical
session
Doug Simkiss
Day 3
Thursday 19th May
Time
9.009.30
9.3010.00
10.0010.30
10.3010.45
10.4512.45
Topic
Managing bleeding and blood loss in PPH
Method
Seminar
Leader
Francis Kamwendo
Seminar
Paul O’Hare
Seminar
Discussion
Francis Kamwendo
Seminar
Chisale Mhango
2. Effective intervention post-abortion
Life support and general measures, the manual
vacuum aspirator
Lunch
Seminar
Chisale Mhango
Other active interventions in PPH: what is available?
Repair of lacerations, manual removal of placenta,
repositioning inverted uterus, management of uterine
atony, (uterotonics, bimanual uterine compression,
intra uterine balloon tamponade using condoms,
hysterectomy), auditing, preventing recurrence
Break
Seminar
Siobhan Quenby
Other active interventions in PPH: what is available?
Repair of lacerations, manual removal of placenta,
repositioning inverted uterus, management of uterine
atony, (uterotonics, bimanual uterine compression,
intra uterine balloon tamponade using condoms,
hysterectomy), auditing, preventing recurrence
Seminar
1. Are we giving women a good start
Detecting, preventing and correcting anaemia, steps
to enhance current practice
2. Life support in haemorrhage and fluid loss
Optimal support for the haemorrhaging patient at
clinics, during transfer and on reception at district
hospitals; fluid balance considerations
3. Blood transfusion: have we got enough? If not,
why not?
Evidence from the most recent inventory, current
guidelines for storage and administration of blood,
experience of supporting women with PPH, current
guidelines on blood donation
Break
Abortion
1. The local scene
Legal situation, epidemiological evidence, Malawi
National Health Service Guidelines ch. 6
12.451.30
1.303.00
3.003.15
3.155.00
Practical
session
Practical
session
Siobhan Quenby
Day 4
Friday 20th May
Time
9.009.45
9.4510.15
10.1511.00
11.0011.15
11.1512.45
12.451.30
1.303.00
3.003.15
3.155.00
Topic
Blood pressure
Method
Seminar
1. Managing hypertension in pregnancy and antenatal
care
BP checks of pregnant women, availability of
sphygmomanometers, health education for reporting
signs of pre-eclampsia, time of transfer for raised BP
2. The eclamptic patient and management: local and
Seminar
international practices
3. Magnesium sulphate
Seminar
Evidence of effectiveness, is it administered early
enough – if not, why not? Local guidelines on use of
magnesium sulphate
Break
Leader
Francis Kamwendo
Chisale Mhango
Chisale Mhango
Agenda setting for service improvement
What changes in current patterns of delivery of care
would help to reduce morbidity and mortality?. Audit
as professional tool to improve clinical service and
display leadership, criterion-based audit in Malawi,
confidential enquiries into maternal mortality, the right
culture and attitude
Lunch
Seminar
Paul O’Hare and
Faculty
Simulation training to teach others:
Eclamptic fit and resuscitation of sick infant
Managing and leading teams, drills based on local
settings, prioritising
Break
Seminar
Francis Kamwendo
Siobhan Quenby
Doug Simkiss
Simulation training to teach others:
Eclamptic fit and resuscitation of sick infant
Managing and leading teams, drills based on local
settings, prioritising
Seminar
Practical
session
Practical
session
Francis Kamwendo
Siobhan Quenby
Doug Simkiss