EXCELLENCE IN PEOPLE
Maternal and Child-health Advocacy International
Dr Alice Clack MRCOG talks to O&G about her experiences in Brikama Major Health Centre in The Gambia.
T
his was not my first time visiting or working in West Africa, as I had worked for Médecins Sans Frontières
(MSF) in Liberia previously. I knew before arriving that we were undertaking an ambitious project in a difficult environment, but I think I only realise now, having returned, exactly how ambitious it was. The purpose of my trip to The Gambia was to help implement and run a pilot obstetric training programme for junior doctors and senior midwives at Brikama Major Health Centre. Our aim was to train a small cohort to the level of junior registrars in emergency obstetrics over one year. Skilled practitioners are scarce in The Gambia and, although they opened a medical school over five years ago, it is not yet able to offer any specialist training in-country. As a result, doctors wishing to specialise generally leave the country at great cost, and many never return. There is also a tendency
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for doctors to congregate in the large cities where they have access to better facilities and private practice. Therefore, our obstetric training programme was to include midwife trainees as well as medical trainees, in the hope that task shifting might provide a partial solution to the skills gap.
Realities of Brikama I arrived in Brikama armed with a curriculum, some teaching tools, my stethoscope, nine years of training and trepidatious optimism. It didn’t take long, however, to realise that Brikama Major Health Centre would not be a suitable centre for training without considerable organisational and clinical input. The operating theatre was non-functioning, the maternity unit was grossly understaffed and lacking in basic organisational tools, and there were chronic shortages of essential materials. In summary, it was a unit in which neither losing track of a patient for several days nor
We are taught that postpartum haemorrhage is the leading cause of maternal death worldwide. I no longer believe this to be true.
running out of needles in the middle of the night could be considered a remarkable or an uncommon event. Yet the unit was busy. With 6,000 deliveries a year, just two obstetricians in total and only
O&G November 2015
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