1. Audit project in The Gambia
Myriam Bonduelle
Swansea Gambia Link

3. The Swansea-Gambia Link aims to:
Form working partnerships between staff and students in Swansea and The Gambia to improve health care outcomes 
Establish a broad partnership in health - including clinical care, health service delivery, teaching and research 
Emphasise capacity development of staff and students involved in the Link by including education and training as part of activities wherever possible
Identify key areas of common interest that can be developed as stand-alone projects
Focus on facilitating improved health care delivery (i.e. use teaching and training as part of broader projects to improve service delivery)

4. Visit to The Gambia September 2007
Royal Victoria Hospital, Banjul
Medical School Banjul
Party of 8 people from Swansea went out to establish contacts
Met up with representatives from most departments

5. Visit to The Gambia September 2007
Achievements:
Projects for collaboration identified:
Audit support
Support for pathology lab
Technical support
Student exchanges
Stimulated local discussion about future of first batch of junior doctors

6. Audit project Swansea Participants:
Dr Myriam Bonduelle, Consultant O&G, ABMU Trust
Dr Sharon Evans Consultant Radiologist, ABMU Trust
Ms Sharon Morgan, Clinical Audit and Effectiveness Manager, ABMU Trust
Jess Griffiths, Learning technologist, Swansea Medical School
Dr Stephen Allen, Reader in Paediatrics, Swansea Medical School and Honorary Consultant, ABMU Trust

7. Purpose of the project
The overall aim of this project was to combine audit capacity development of a key group of health care professionals with the establishment of a means for local staff to evaluate and improve health care delivery in The Gambia.

8. Phase 1 Adaptation of Swansea training materials for use in The Gambia
training in the principles of Clinical Audit to the Junior Doctors and selected nurses and midwives at The Royal Victoria Teaching Hospital in Banjul, The Gambia.

9. Phase 1
Identification of local audit champions among the Senior Staff of RVTH and establishment of local audit Committee
support the identification and development of audit projects by all the participants during the initial training, with encouragement of multidisciplinary groups
continuous support through and internet by the Swansea team for the duration of the projects, and analysis of data.

10. Phase 1
After completion of projects presentation of projects to all staff in RVTH, as well as to the Clinical Governance team
presentation of prize to best project.

11. Phase 2: Assistance with possible publication of projects.
Continuing support through the local Clinical Governance Group for future audits

12. Achievements of phase 1
grant was received from the Welsh Assembly Government
Teaching materials developed, books on audit purchased
July 2008: 31 participants (25 junior doctors, 4 Midwives, 2 general nurses).
workshop also attended by 3 senior members of the Hospital

13. Six multidisciplinary groups formed, six projects identified:
Management of severe pre-eclampsia and eclampsia
Management of molar pregnancy
Staging of breast cancer
Postoperative wound care
Use of the triage form in A&E
Management of advanced cervical cancer

14. Achievements
Proformas designed for the projects, with identification of the standards which were to be audited
Team leaders identified
Senior staff members identified to provide support
CMD confirmed support for the concept

15. Donation of books to Library

17. Workshop discussions

18. What happened next?
Swansea team ed all the groups on return with formalised audit pro-formas
First group of junior doctors who were generally team leaders all sent to Taiwan for further training
Practically no further contact with any of the team members despite various attempt from us
No replies from identified senior Hospital Doctors

19. Rescue plan:
Swansea students to go out during the summer holidays to attempt to complete at least one of the projects

20. Pitfalls and lessons learned
Need for food during workshops! – and possibly per diems
Even though in our eyes the project was not ambitious the reality has proven otherwise
Working life is extremely busy for local doctors – small projects would be best