Almost half of the 600,000 annual pregnancy-related deaths recorded world-wide occur in sub-Saharan Africa: one in thirteen women in Africa die a maternal death. For every maternal death, 30 women are incapacitated by chronic problems, which reduce a woman’s quality of life and her capacity to care for her family. 15% of pregnancies result in complications, most of which cannot be predicted prior to delivery, but can be treated if the knowledge base is established. Our students have recommended that our obstetrics course be given to all interns, in order to teach and reinforce these vital obstetrical and surgical skills.
In 2007, Structured Operative obstetrics (SOO course) was piloted in Addis Ababa. The course is now taught regularly in Kampala and Mbarara, Uganda and Kigali and Butare, Rwanda. In 2011, the course was introduced in Ethiopia and in the fall of 2012, the course will be introduced in four locations in Tanzania. Over the next five years, expansion of SOO to all our partners is a priority.
The SOO instructors course certifies participants to teach and implement a Surgical Obstetrical Training Program. The certified African instructors go on to teach the SOO providers course, which brings structured operative learning to early obstetrical training. With three components of lectures, laboratory sessions and a clinical practicum, the course helps students with problems encountered with vaginal deliveries, including vacuum extraction, cervical laceration and removing a retained placenta. Students also have the opportunity to practice plotting the course of a hypothetical patient’s progress in labour on a partogram, as recommended by the World Health Organization and the Federation of Gynaecology and Obstetrics.
In the three-day laboratory session, students practice basic surgical techniques, vaginal delivery skills and Cesarean section skills. Knot tying is learned and mastered and models and simulators help with skills development. Plastic torsos with a snap-on ‘abdominal wall’ are used to practice opening and closing incisions, as required during an actual Cesarean section. The students also practice opening and closing incisions on the ‘uterus’ inside the plastic torso. Goat feet are used to practice skin closure techniques and beef hearts are used to practice uterine opening and closing because its muscle is similar to that of the human uterus.
Following the laboratory course, students move to the operating room where they each perform three closures of Caesarean incisions and three complete Caesarean sections, under the supervision of faculty.