Lesotho


Lesotho May 2010


The first visit to Lesotho was made by FoAN trainers, in May 2010, to deliver the first of a pilot programme of education merging the theoretical update and the theatre practice audit. Four trainers, two of whom are trustees and two Mölnlyke Award Winners made the journey.


We were delighted to welcome 31 participants from 7 of the ten districts were present for the Perioperative Workshop held at Victoria Hotel, Maseru from 3-6 May 2010. This was the first ever Perioperative care workshop held in Lesotho. The education takes into account the resources available and all the trainers made a visit to Queen Elizabeth II Hospital Operating Theatres before we began any education, to base the training in local reality. In addition, a visit was made as a comparison, to Berea District Hospital during the week.


The participants were very good students, actively listening, asking questions and writing notes. They have all been encouraged to return to their hospitals as "change agents", and reported that they will feedback to their matrons, and to enlist their assistance in the change process. There are some really excellent nurses working in Lesotho, we were impressed with their understanding and the level of questions and participation. However, there were few who had been educated in perioperative nursing and practice varied widely - and much of it needs to be updated.


Hospital Resources


Many of the participants reported that their hospitals were very short of resources - particularly staff. Due to lack of equipment resources, a large number of referrals are made to the main hospital in the capital - which makes their workload very difficult to manage.


Evaluation


Overall evaluation of the course delivered was that 61% said that the course exceeded their needs and 39 % said that it met their needs. 0% said it did not meet their needs.


There follows a sample of specific remarks made in answer to the question "What will you do differently, after the course?"
"Implementation of a different way of documentation. At present we do not do enough."
"teach colleagues and implement the way to alleviate anxiety of the patient pre- operatively."


"I am going to change most of the procedures we have long been doing in my department - ventilation, we have used for cooling and heating and not for infection prevention. Swab counting and instrument listing in trays was not done properly and not done at all. Documentation - we hardly document anything, so it's as if we have never done anything"
"To encourage my working team on how to practice aseptic technique at all times and do away with myths we had concerning infection. I will encourage proper decontamination and sterilisation as I have learned some discrepancies from my OT"


"I will be very strict on adherence to sterility and proper hand washing. Persuade my procurement unit to buy a board for recording swab count and instruments."
"Going to ensure that a new sterilising machine is made available as the one we have has poor drying effect on packs hence it does not sterilise"
"Going to share the knowledge I got with my colleagues and review our old policies and improve them where necessary."
"We are going to have an emergency trolley in the recovery area"
"I am going to do check-listing before and after every procedure to make sure that there are no instruments or swabs left in the patient."
"Challenge the re-use of abdominal swabs and if possible eradicate it."


Practice Audit


We were able to undertake an audit of perioperative practice in the Referral hospital. Unfortunately there was a strike in progress - and so not a great deal of operating was being undertaken. However, there were some emergencies and assessment of practice standards was possible.


It is to be hoped that some of the change referred to in the evaluation statements may be made in the Operating Theatres, by the participants who attended the education. An assessment by FoAN will be made of the benefits of undertaking the theory update and audit during the same week.


Thanks very much to Lesley Wood, Angela Konstanz and Rosie Macqueen for all their hard work, commitment and enthusiasm during our week in Lesotho. Kate Woodhead June 2010.