1. ASHIA Clinical skills preparation Workshop 13:00 doors open / welcome 13:30 – 14:00 – Approach to a patient in Africa – History taking – Illnesses you may encounter 14:15-14:30 – Basics of suturing and vena puncture 14:30-14:45 – Break 14:45-16:45 – Suture skills lab / Vena puncture 17:00-17:15 – Neonatal resuscitation project Group 1Group 2 14:45Vena punctureSuture skills 15:45Suture skillsVena puncture Important resources Where there is no doctor by David Werner Sim-vivo online training guide on suturing 1

2. Approach to a patient in Africa Ask the person’s name and if needed, confirm this with identification Age (remember that sometimes they do not know their exact date of births) – Special care to elderly patients Gender: Be sensitive of the patient’s wish to be referred to as a male or female. Ask them why they are in hospital Ask SOCRATES – Site of pain (where is the pain the worse?) – Onset (when did it start?) – Character (how would you describe the pain? Dull, sharp, tightness ache?) – Radiation (does the pain move to another location?) – Associated factors (are there any other symptoms with the pain for example is there fever, nausea, headache, vomit, yellow skin etc?) – Timing (how long does the pain last?) – Exacerbating/relieving factors (is there something that you know that makes the pain worse or better?) – Severity (From a scale of 0-10 how bad is the pain? Do you want analgesia?) Other body parts; don’t forget to ask about their health in general; – Any ear, nose or throat symptoms? Any headache or visual problems? – Problems breathing – Chest pains or palpitations? – Gastrointestinal: any worries about stools? – Urogenital: Problems passing ‘water’?; pregnant? Menstruation cycle? – Skin: any itching, bumps? Use of medication – Ask if they are taking other medication even over the counter or what a family member or friend may have given them – Many patients will not admit that they see a ‘medicine doctor’ but you should still ask. Look for unexplainable ‘wounds’ or scars on patients body to guide you Family history – Ask what has happened recently to a family member – Any similar symptoms in those close to them Don’t forget to ask the patient what it is they would like – Sometimes patients want reassurance instead of medication so try to understand their point of view before you propose a therapy Remember to talk to the patient. Aim for an open dialogue so that the patient feels comfortable talking to you Don’t forget to discuss each patient with your supervisor. 2

3. Serious illness you may encounter in Africa: Airway problems IS an EMERGENCY! Signs that the airway is compromised: Inability to talk Choking, Drooling Gurgling sound Stridor Coma/unconscious When Airway is in danger – patient stops breathing! Clear the airway (look for foreign objects Chin lift / Jaw thrust Give oxygen through re- breath mouth-to-mouth bags/mask (you can buy these online and take them with you!) 3

4. Serious illness you may encounter in Africa Circulation problems are life threatening if not treated immediately! Dehydration due to D&V or severe burns Blood loss due to road traffic accidents or internal bleeding. Think about substituting the loss with - ORS - Intravenous fluids - Blood transfusion Skill lab technique: IV cannulation for fluids/medication 4

5. Serious illness you may encounter in Africa There are many causes of loss or lowered level of consciousness. Think about these and try to reverse it ALWAYS check the GLUCOSE – Hypoglycemia is an emergency and can be reserved! A B C D Airway Breathing Circulation Disability Step by step 5

6. Serious illness you may encounter in Africa Temperature is a sign of an infection. Give paracetamol, fluids and keep patient cool Sepsis is life threatening! There is a window of approximately 1 hour to start treatment with antibiotics to save a life! If fever and low blood pressure low, high respiratory rate, low oxygen (difficulty breathing) and/or confusion  high chance of sepsis Oxygen Fluids Antibiotics 6

7. Vena puncture / IV cannula Procedure of entering a vein with a needle Main purpose is to Obtain blood for diagnostics Procedure when a vein is entered with a needle and a cannula is left behind has 2 main purposes Blood collection for diagnosis Therapy (fluids, medication etc) 1.Choose a vein 2.Confirm patient / date of birth 3.Decontaminate hands/ gloves 4.Inspect and palpate arm 5.Clean skin 6.Apply tourniquet 7.Place hand 8.Take needle with dominant hand and insert in vein 9.Collect blood in appropriate tubes / remove needle for cannulation 10.Remove tourniquet as soon as blood appears in tube 11.Use gauze to apply pressure on puncture site 12.Handle specimens carefully 7

8. Suture skills lab Wound closure is important to Decrease wound contamination Stop the blood loss Better tissue healing Steps 1.Assess the wound 2.Gather materials 3.Local anaesthesia 4.Clean the wound 5.Sterile environment 6.Suture 7.Bandage 8.Discard 9.Give advise for follow up/care of wound 8

9. Feedback form Section I: Workshop Evaluation This section helps us understand how future training may need to be adjusted to best respond to participants’ needs. On a scale of 1-4 where 1 is strongly disagree and 4 is strongly agree, please circle the most appropriate answer: The workshop venue was: Comfortable1 2 3 4 Well located1 2 3 4 Food and refreshments were adequate1 2 3 4 The workshop content was: Relevant 1 2 3 4 Comprehensive1 2 3 4 Easy to understand1 2 3 4 Workshop handouts: Supported presentation material 1 2 3 4 Provided useful additional information 1 2 3 4 Were clear and well-organized1 2 3 4 The workshop was: Well paced1 2 3 4 Breaks were sufficient1 2 3 4 A good mix between listening and activities1 2 3 4 The facilitator(s)were: Knowledgeable1 2 3 4 Well-prepared1 2 3 4 Responsive to participants’ questions 1 2 3 4 What did you like best about this workshop? ______________________________________________________ What did you like least about this workshop? ______________________________________________________ How could this workshop be improved (use this space if you did not provide comments above)? Content: _ Hand-outs: Activities: Facilitators: Other: Would you recommend this workshop to a colleague? Yes _____No _____ Why/why not: 9