Kenya, Uganda, Ghana, Nigeria and Sierra Leone are a long way from meeting Millennium Development Goal 4 - reduction of under-five mortality. Deficiencies in the quality of care provided by health care institutions, especially those serving rural and peri-urban populations, are an important cause for high death rates during admission and increased mortality after discharge. The Royal College of Paediatrics and Child Health’s (RCPCH) Global Links exchange programme addresses these deficiencies by sending UK volunteers to each of the five countries to implement quality improvement projects and conduct training in child health care. In addition, African doctors are receiving training in the UK for 6-12 months. Global Links organises a two week training programme for both UK volunteers and African doctors, preparing them for their placements.
One of the goals of the training programme is to address potential gaps in knowledge and skill that volunteers may have when working in a new clinical environment overseas. The volunteers take part in a two week pre-departure training course which includes a one day ETAT+ training, covering the main tropical paediatric presentations they are likely to encounter overseas (e.g. HIV, Malnutrition, TB) and a three day Child Health in Low-Resource Settings (CHiLS) course. The latter has been specifically developed by Global Links to prepare volunteers for scenarios and conditions specific to local environments with limited resource available. The course also covers practical preparation, like security training tailored to the specific local security situation. In addition, the training prepares the volunteers for approaches, including capacity building and quality improvement, which will form a large part of their work overseas.
The Training of Trainers (ToT) element of the course is highly appreciated by volunteers. Most are highly trained clinicians, but do not necessarily have much teaching experience. The ToT enhances volunteers’ understanding of teaching methodologies, planning interactive lessons, applying structure to teaching sessions and practicing their new skills in mini-teaching sessions. This also covers contextual considerations. For example, organising the training so that it limits the strain on the daily operation of the health institutions by introducing individual mentoring and on the job training, instead of plenary teaching sessions.
Most importantly the two week preparation course serves to manage volunteers’ expectations, so these align with the partner hospitals in country. The first day of the course focuses on discussing similarities and differences of health systems in the five African countries and the UK. In addition, returned volunteers are invited to talk about ‘an average doctor’s day’ offering insight into how to behave in a new working environment. Sharing between the African doctors and UK volunteers is often cited as the most beneficial aspect of the training programme. Both groups get Gto hear first-hand accounts of the challenges and successes of UK and African health systems helping to add to their knowledge and preparedness.
Additionally, ethical and cultural issues are discussed during the the training, attempting to unpack how one might respond to an unfamiliar scenario. During the CHiLS course, various ethical issues naturally arise, which include cases where expectations, low availability of resources, cultural practices and other issues complicate clinical decision making. Whenever these occur there often exists immense pressure to navigate and act quickly. Therefore, it is important to enable volunteers to arrive at informed decisions under pressure, by considering the advantages, disadvantages, ethical issues, various actions and their consequences beforehand.
The African doctors also share their experiences of working outside their country for prolonged periods of time. As well as trainers who are experienced working in different cultural settings. The emphasis Global Links places on sharing experiences and knowledge ensure that volunteers and African doctors on placements are well prepared and can contribute meaningfully, helping to improve health services for the long-term.