Closing Ceremony

We concluded our health training of trainers yesterday. We held one last teaching session at the Schweitzer Hospital outpatient clinic. Nurses from the General Hospital led sessions on HIV/AIDS and family planning. Both topics created some excellent discussions and an informative question and answer session. I know I said this before, but I am really proud of their work and their commitment to this training.

Following the last teaching session we held a closing ceremony (photo included of all the trainees) in which I thanked them for their hard work, discussed future plans, and distributed certificates of participation for each of the trainees. Regarding future plans, I have spoken with the current moderators, Mme. Nze and Mme. M'Badinga (aka Mamma SIDA) and they have agreed to continue to serve as moderators for future health training sessions. The nurses and midwives would like to continue with this training and they recognize that we have just scratched the surface as far as covering important health education topic are concerned.

The best news of the day came when I ran into the Director of Care. She informed me that subsequent to the closing ceremony, she was in the hospital and overheard some of the trainees discussing their plan of action for training the remaining nurses on their respective hospital service and strategies for conducting health education sessions with the patient population. I truly believe that we had an excellent group of trainees that will follow through with their work and our initial objectives.

So that wraps up my public health work in Gabon. I have written a final report summarizing the steps taken to organize this training, the different contacts made, the results of the pre- and post-test questionnaires and my thoughts /reflections on my experience here. I have also left copies of all of my presentations and teaching materials. I will work with the PMI (Protection Maternal et Infantile...a.k.a. the community health clinic) on Wednesday and Thursday and then I will leave Lambarene early Friday morning. My flight for Ethiopia departs at 2:30PM on Saturday.

I will spend the following 9 days in Ethiopia seeing the sights and enjoying the people and some of the best food around.

Final Health Education Training Session

We concluded our training of trainers teaching sessions this past Friday with a presentation on Buruli ulcers. The last session went very well and I feel that the nurses are well prepared to train the remaining staff throughout the hospital. In the end the trainees participated in over 24 hours of training on 6 different subjects (Malnutrition, Family Planning, Tuberculosis, Malaria, AIDS and Buruli ulcers). Their enthusiasm for learning and creativity in the numerous activity sessions that complemented the teaching sessions was encouraging.

We conducted our first teaching session in the hospital yesterday. We held the teaching sessions in the community health clinic and ended up presenting two health topics (malaria and tuberculosis). Both sessions went extremely well. We projected the illustrations created by the artists on to a screen and the nurses gave commentary and reviewed the main teaching points for the patients. Approximately 50 women and children were in attendence. We are going to hold two more teaching sessions before my departure at the end of next week.

Here are some other examples of the illustrations the artists created for the health education program.

Tuberculosis illustrations:

HIV/AIDS Illustration:

Other photos from the last couple weeks:

View of the sunrise from my front porch:

Flurina and Adriana (the two Swiss medical students working at the hospital):

Bamboo grove in Belle Vue (one of the villages we visit with the community health team):

Here is a photo of a baby elephant found alone in the forest near Lambarene (subsequently she was sold to one of the National Parks in Gabon) :

Mr. Taranchula:

Women and children listening to the health education session at one of the community health centers (in N'Goumou)

Children in N'Goumou

Lambarene's central market:

Health Education Illustrations

The artists have completed 3 of the 6 sets of health education illustrations. It has been a lot of fun working with them as it has provided for an excellent opportunity to teach them about disease etiology, disease transmission, preventative techniques, and different therapies available. I sit down with the artists and review the pertinent information for each health topic and then we brainstorm different ways in which we can convey the important information using illustrations. I try to provide the artists with as much creative freedom as possible. I have been very impressed with their work and am pleased with how the project has worked out. Here are a few example of the illustrations they created for the malaria prevention flip chart.

And here are a couple from the HIV/AIDS series:

Time really passes fast here. It is hard to believe that I only have 4 weeks left! I feel lucky that I have had the opportunity to do both clinical and public health work as this work has kept me very busy and has provided for some very different experiences. Things have been extremely busy and I just took a long overdue day off yesterday. I spent most of the day in Lambarene, walking around the market and just watching (African) life go by. I think it was just what I needed.

There have been some bumps in the road regarding the health education training program. Last week, the director / moderator of the training decided that she would no longer participate. The real unfortunate thing is that she didn’t tell me until the night before she was to give the presentation on family planning. I ended up working through the night and put together the presentation myself and then gave the presentation. I broke the talk up into two 50 min long presentations and I learned that it is exhausting to speak in French for 2 hours straight. For some reason I had difficulty pronouncing one of the technical words in French. I tried about 5-6 times to get the correct pronunciation much to the amusement of the group. When I finally got it right, I got a standing ovation. It really made me smile.

In the end I think everything went well and we have had some excellent discussions. So far we have covered malnutrition and family planning. I think the highlight of the training sessions are the case studies/ role playing exercises. The nurses and midwives that I am working with are quite talented. They are so incredibly animated and I have been impressed with their creativity.

There is some concern in my eyes about the sustainability of this program now that our leader has stepped down. I am in the process of talking to an epidemiologist that works with the Ministry of Health in Lambarene. She has expressed interest in helping out with the training so I am hopeful that she can replace our previous moderator. In addition, I am working with "Mamma SIDA" a local woman who organizes community health education session on HIV prevention. She has a strong presence, is knowledgeable and has a booming voice. She is scheduled to present the HIV talk next Monday and I am hopeful that she will continue to assist with future health sessions.

Ultimately the goal is to have someone continue to lead these health education sessions on a monthly basis. We can eventually expand the training to include the nursing assistants that work in the rural health posts throughout the region.

In other news, the health illustrations that the artists have created are incredible. I am extremely pleased with their work. The two artists that I am working with are very motivated and talented. The illustrations really capture the important points concerning the selected health topics. We are hoping to have the illustrations for 4 of the 6 subjects completed by the end of next week.

We will be able to use the Malaria education illustrations for this week's presentation. I will eventually scan all of the images onto my computer before my departure on March 14th. I then plan to have the illustrations enlarged and printed in a flip chart format. After looking into prices here in Gabon, I think it will be less expensive to do the printing in the US. Future Schweitzer Fellows and other staff can hand deliver the charts once they are completed.

The pediatric work continues to be a highlight of my time here. I really look forward to the trips out to the villages. Not only is the clinical work exciting and challenging but traveling out to the villages provides for a rich cultural experience. Recently there seems to be an increase in malaria cases. After speaking with the malaria research center here I think that can mainly be attributed to the seasonal rains. It really can be challenging working in
the rural villages without any lab/ diagnostic tests to support a diagnosis. On one hand, it is challenging to make the diagnoses without the myriad of tests that we have at our finger tips back at home but on the other I truly feel that my clinical skills have been tested and as a result have improved significantly. You really only have the patient history, a stethoscope, otoscope / opthalmoscope and your brain to rely on. I have medical reference books that have also provided some useful information.

Over the past few weeks, some of the cases I have seen include malaria, upper and lower respiratory infections, shingles, buruli ulcers, gastrointestinal infections, fungal skin infections, malnutrition, dehydration and conjunctivitis. Some of the children are very sick when they arrive at the health clinics. The health team can help transport the very sick to the hospital with their truck and over the past 2 weeks we have brought back 5 children (2 with cerebral malaria and the other 3 extremely dehydrated and malnourished/ failure to thrive).

Thanks again for following the blog. I will continue to post photos as often as possible.

Here are a few more random photos I thought I would share......a cobra, killed about 20 yards from my house.

Dinner out on the town:

Additional Photos

Here are some more photos from my time here. I will continue to do my best to provide updates. Thank you for taking the time to follow my work here.


Just joking around:










Community Health Team:
Marie Benoite, Mamma Sophie, and
Hortance











Vaccinations:

Overlooking Zile:

Rainy day:

Pet monkey:

Mamma Sophie at Albert Schweitzer Hospital:

Peds consultations:

X-ray of pediatric patient with miliary tuberculosis:

ER equipment










With Veronique during rainstorm:

In the OR at the Albert Schweitzer Hospital:

Hospital in Fougamou: