Audit project in The Gambia Myriam Bonduelle Swansea Gambia Link

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)

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

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

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

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.

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.

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 Email and internet by the Swansea team for the duration of the projects, and analysis of data.

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.

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

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

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

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

Donation of books to Library

Workshop discussions

What happened next? Swansea team Emailed 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

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

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