Essential Surgical Skills

One of the main objectives of our trip was to help facilitate a week long Essential Surgical Skills (ESS) course. This course focused on essential surgical skills such as knot-tying and suturing, chest tube insertion, colostomies, obstetric emergencies, cast application, and many other surgical procedures. These skills are basic, but given the right application of all these skills...they are LIFE-SAVING! The course was developed by Canadian Network for International Surgery (CNIS) and have been delivered in 7 African countries; Zambia now the eighth country on this list. (http://www.cnis.ca/). We are the first team to bring this course to Zambia, which was very exciting. But this is also the first time CNIS has brought the ESS course to a rural facility, which is our very own Lewanika General Hospital!


Bob and Bill pointing out Zambia on a CNIS poster

Two of our surgeons, Dr. Bill Nelems and Dr. Gary O’Connor, spent a week in Calgary last year taking the training that was required to teach the ESS course. They were joined by Dr. Bob Taylor from CNIS and Dr. Glynn Jones who is an general practicioner, with a speciality in anesthesia.

We had a total of 23 doctors, clinical officers, physician liciensciates, and a registered nurse complete the training. There were 10 doctors from Mongu (all the doctors who work at the hospital) and 13 others from surrounding rural towns in Western Province. The group gathered everyday around 9 o’clock (think 'African time')and finished the day around 5 pm. The group completed hands on teaching done in 4 stations each day.The strongest piece to the ESS course was how it required the students to learn by doing hands on practical skills. This is a concept that is very different to the traditional lecture-stlye teaching that most Zambians are used to, but very well received by all of our participants. There was a break for coffee and a catered lunch by the best caterer in Mongu, Rueben.

Bob teaching the art of 'knot-tying'


Gary teaching venous cut-downs

By the end of the week the health professionals were laughing and enjoying themselves while basking in a wealth of knowledge. Bill’s blog describes the recipients reactions beautifully.

What was our roll in all of this? Jessica and I helped facilitate the course. What does this mean…we really didn’t know what to expect at first. We knew we had a pretty good idea of where most things could be found in town and if we were unsure we knew who to ask. This skill was very useful. Part of our duties as facilitators included:

-getting pig legs, pig chest walls, intestines, and beef hearts from the local butcher (to use as teaching tools for the course)

-ensuring the caterer had all the food he needed for the next day (usually a trip to the market, harbour, and daily Shoprite runs)
- making budgets
- attending dance lessons from our nursing students

- to get 80+ liters of fuel in the 4 hour petrol line-up...when they are only handing out 10 Liters at a time
- ordering a tire from Lusaka for the vehicle
- making sure each team member had an I Heart Zambia Shirt

- serving lunch
- making sure all of the men ate (that even meant buying groceries for our doctor’s for dinner)
- looking after extra-curricular activities such as road trips to Senanga, and play dates with the children at the orphanage
- planning a thank-you dinner for 200 people
- reconnecting with all of our old friends and colleagues in Mongu, and making new friends

These and many more activities were part of the role as facilitator. We also joined in every morning and took part in the learning and teaching. In the afternoons we ran a 2 hour in-service for the matrons/sisters in charge of the wards at Lewanika Hospital. We discussed topics such as chest tubes (thank goodness for the fish spear accident), catheter care, NG tubes, post operative care, peri-operative care, cast care, and surgical wound management. After the discussion we brought the nurses to the ward where we would do a “case study” with one of the patient’s and discuss the appropriate nursing care for that patient. In total 10 nurses were educated with the hopes that the information would be disseminated to the rest of the ward nurses. We distributed handouts and posters to all the wards and included nursing students in our ward discussions.

The 'Fish Spear' patient allowed for great teaching on the ward


Jess and Lianne with all the charge nurses who attended our in-services

Overall, both the nursing and medical components were extremely effective. It was very rewarding to see the changes that had occurred in such a short timeframe. There was widespread acceptance of knowledge and practice. The course was very rewarding as we saw professional growth as well as intersectoral collaboration. One day we even brought the our nurses to the CNIS course, and had them observe a chest tube insertion. It was fantastic to see the nurses and doctors alongside each other, and also promoting OkaZHI's philosophy of intersectoral collaboration. This was the first time a CNIS course has ever had a nursing component complement its content. The general consensus was how very important it was to have nursing education delivered, that would compliment the surgical skills the doctors learned.

Good work team!