Jan 24, 2020

THE GYNECOLOGICAL TRAINING OF ANM (MIDWIFE) REPORT

THE GYNECOLOGICAL TRAINING OF ANM (MIDWIFE) REPORT DECEMBER 2019

 Date:    2019 Dec 21st to 24th – First cohort of five ANM and

Dec 25th to 28th - Second cohort of five ANM

Place:   Gajuri Primary Health Centre
Gajuri Rural Municipality
Dhading District, Central Nepal

Participants:
10 AMNs from village health posts and primary health center of Gajuri Rural Municipality

Trainers: Dr. Richa S of Shankarpur Hospital & Dr. Sunita T of Patan Hospital

Implemented by: Himalayan HealthCare

Background
HHC had discussed with the District Health Office in regards to expansion of this training to other rural municipalities in the Dhading District region where HHC has been active since 1992. Gajuri Rural Municipality was selected as the next center for ob-gyne training in 2019-2020 after Ruby Valley RM in 2018-19 after they requested for such training. Gajuri RM also has health posts in remote village sites where HHC has built health posts and also equipped and furnished them after the earthquake devastation of 2015. Helping the midwives with gynecological training was a continuation of our support to this rural municipality as well as improving services to the women patients of the region.

Gajuri Primary Health Centre or PHC where the training was conducted is three hours’ drive from Kathmandu and two hours from the Dhading District HQ of Dhadingbesi and is the center of the region but the participants had to travel for several hours to reach this center from other village sites which are spread out in the region. HHC field health supervisor Phe D and Dhading coordinator Kul M escorted the two ob-gyne specialists as well as a nutritionist and a blood transfusion expert from Patan Hospital as well to Gajuri for the training in two different groups. They all were provided food and stay at a local hotel during the eight days training period.

First Training
21st – 24th December 2019
Ob-gyne facilitator - Dr. Richa S, Shankarpur Hospital, Kathmandu
Participants:
Ranjana S, ANM, Pida HP
Yeshoda U, ANM Kiranchowk
Radha P, Staff Nurse, Gajuri PHC
Amrita Pa, ANM, Gajuri PHC
Amrita Po, ANM, Gajuri PHC

Second Training
25th to 28th Dec 2019
Facilitator - Dr. Sunita T of Patan Hospital
Participants:
Sharada S, ANM, Pida HP
Ambika K, ANM, Gajuri PHC
Anju C, Staff Nurse,  Dolbhanjyang School
Sarita R, ANM, Gajuri, PHC
Rama R, ANM, Pida HP

Topics Covered:
History Taking (present illness, mentrual history, obstetric history, contraceptive history, personal history, occupational history, family history)
Physical Examination (GC fair, conscious or unconscious,  vitals,  PILCCOD, breast & chest examination, cardiovascular, per abdomen, per speculum, per vaginal examination
Types of Discharge (Physical and pathological)
Sexually Transmitted Diseases (STD)
Disfunctional Uterine Bleeding (DUB)

Total 18 patients were asked to b subjects for the training.

Words from Dr. Sunita T (Facilitator):
The gynecological training conducted by Himalayan Health Care from 25th December to 28th December in Gajuri Rural Municipality, Dhading was initiated with the aim of training midwives (ANM/Staff Nurse) to improve quality and safety in women’s health. It was mainly focused on gynecological examinations (history taking and physical examination), identifying and treatment of common gynecological infections, management of abnormal uterine bleeding and uterine prolapse, screening methods such as VIA, PAP smear. Management of obstetrical conditions such as hyperemesis gravidarum, antepartum hemorrhage (APH), postpartum hemorrhage (PPH) were also discussed.

The trainees were enthusiastic, hardworking and actively participated in discussion and provided good patient care at the gynecological outpatient under supervision. They were comfortable in managing obstetrical patients but had confusions in managing gynecological patinets. Therefore, these kind of trainings should be held rgularly as it will help them in providing quality of care to the gynecological patients and improving the standard of care.

Words from Dr. Richa S (Facilitator):
We started with history taking and then went into discussions of diseases like vaginal discharge, sexually transmitted disease, pelvic inflammatory disease, dysfunctional uterine bleeding, etc., and a variety of cases were demonstrated to the trainees during the training sessions. The trainees had some knowledge about all that we discussed but we expanded on them to help them learn more. I believe that these types of trainings must be provided to all health workers working in remote areas so that the women patients will benefit greatly and they will also be more open to discussing their women problems.

The trainees had very little knowledge about vaginal discharge, types of discharge and treatment and we spent an entire day explaining about types of vaginal discharge, their cause and treatment. We kept the training sessions interactive throughout so that the trainees were submerged. We did demonstration on some patients who presented with vaginal discharge in the outpatient department. During the demonstration period the participants got to variety of cases and were able to determine what the case was. At the end of the training they were able to identify different kind of discharge cases and were able to provide treatment accordingly. I am happy with the training I was able to provide to these young women.

 

 

 

 


Attachments:
Oct 28, 2019

Himalayan HealthCare Dhading Medical Camp Report

HHC Dhading Medical Camp Report, Northern Villages of Dhading District

HHC with participation of 9 international volunteers carried out medical training camp in 3 villages namely Tipling, Sertung and Lapa VDCs of Dhading district, central Nepal from 20th to 30th September. In total 865 patients were registered during the camp and 72 of them have been referred to higher centers in Kathmandu. The medical trek itinerary was as per below:

Medical Trek Program

Day 1 (20 Sep) - Drive Kathmandu to Parbavati Kund (Rasuwa)

Day 2 (21 Sep) - Hike to Somdang

Day 3 (22 Sep) - Hike to Marmelung

Day 4 (23 Sep) - Half day Hike to Tipling

Day 5 (24 Sep) - Health camp in Tipling HP

Day 6 (25 Sep) - Half day health camp at Tipling HP and half day hike to Sertung

Day 7 (26 Sep) - Health camp in Sertung

Day 8 (27 Sep) - Half day health camp in Sertung and hike to Borang

Day 9 (28 Sep) - Hike to Lapa and half day health camp in Lapa

Day 10 (29 Sep) - Half day health camp in Lapa and hike to Percho

Day 11 (30 Sep) - Hike half day to Darkha and drive to Kathmandu

 Abbreviations Used:

RTI -respiratory tract infection

ENT -ear, nose, throat

COPD -chronic obstructive pulmonary disease

OA -osteoarthritis

UTI - urinary tract infection

GERD - gastric esophagus reflux disease

STD - sexual transmitted disease

MRO - male reproductive organ

ANC - antenatal care

Patients treated in medical camp:

Tipling: 212, Sherthung: 385, and Lapa 268.

Referred Patients:72

All patients were provided contact number of HHC office in Kathmandu for any help required. So far two patients have come to Kathmandu. One has had surgery and the other is going through investigations.

 

    


Attachments:
Jul 29, 2019

Gynecological Follow-Up Training Camp

Lapa Midwife Training
Lapa Midwife Training

After permission from the Ruby Valley Rural Municipality on 25th April 2019, specialist Dr. Rakshya P (NMC license # 14706) travelled and trekked to Sertung and Lapa Villages and successfully carried out two back to back follow-up trainings for ten midwives at the government village health posts and returned to Kathmandu on 12th June. The name of the trainees are as following:

Participants at Sherthung Health Post 2 to 5 June, 2019:

Anita S, Tipling Health Post, ANM

Phulamaya T, Puru Community Health Unit, Tipling, ANM

Kiran T, Sherthung Health Post, ANM

Raily Alisha MG, Borang Community Health Unit, ANM

Bhumika T, Hindung Health Center, Sherthung, AHW (Women Health Worker)

 

Participants at Lapa Health Post 7 to 10 June, 2019:

Sita T, Lapa Health Post, ANM

Rasa M BK, Lapa Health Post, ANM

BimMaya T, Kapurgaon Health Unit, ANM

Asha T, Ree Health Post, AHW (Women health Worker)

Nima K, Ruby Valley Rural Municipality, ANM

 

The training started with discussion on various cases the participants had come across in last 6 months since they received the training in December 2018. Since the log book of the cases were not recorded properly, the trainer then revised about history taking and examination of the gynecological cases.

During training, lectures were conducted on key topics selected by the trainees. 24 patients with classic disease presentations were used as subjects for observation and for interactive and hands-on clinical practice sessions where fundamentals of gynecological history-taking and physical examination were drilled each day ensuring that each midwife could independently and confidently conduct a proper basic examination of patients. Using basic instruments correctly, identifying diseases prevalent in the region and making correct and timely referrals were highlighted. Basic cervical cancer screening tests with VIA (visual inspection with acetic acid) were taught and key obstetrical procedures revised. Likewise, pelvic organ prolapse, its risk factor, prevention, types, stages and conservative management with Kegal's exercise a ring pessary were discussed. The trainees also learned about pregnancy categories of drugs and neonatal resuscitation.

At the end of the training, the participants were incredibly grateful for the training and were eager to serve their community with acquired knowledge and skills.

Sherthung Midwife Training
Sherthung Midwife Training
Patients waiting to be examined
Patients waiting to be examined
Hands on Training
Hands on Training
 
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