One in thirteen women in Africa die a maternal death. Lack of emergency obstetrical services remain one of the principal reasons for high maternal mortality in sub-Saharan Africa. Shortage of trained personnel means that woman often cannot get the care that they need during labor and delivery. The magnitude of maternal morbidity is more alarming when one considers that for every maternal death, 30 women are incapacitated by chronic problems, such as anaemia, fistula, urinary and fecal incontinence, chronic pelvic inflammation disease and infertility.
The Structured Operative Obstetrics (SOO) Course was developed by CNIS and piloted in 2 African settings: Addis Ababa University in Ethiopia in September of 2007 and Makerere University in Kampala, Uganda in January of 2008. In the Instructors Course, the participants will learn how to teach and implement a new Surgical Obstetrical Training Program. The clinical practicum occurs in the operating room and lasts up to 10 days. The learner performs 6 cases under direct supervision, with detailed feedback from experienced clinicians.
Learners in surgical programs are frequently called upon to provide services at an early point in their career. The SOO Providers Course brings the concept of structured operative learning to early obstetrical training. The goal is accelerating surgical proficiency. The Learners Course has 3 components: two lecture series and one laboratory setting with clinical practicum. In the laboratory sessions, the learners practice basic surgical techniques, vaginal delivery skills (postpartum hemorrhage, retained placenta, cervical laceration, vacuum extraction) and Cesarean sections skills using simulation modes.
The course includes a knot-tying station, where the students reviewed and practiced secure surgical knots, crucial to any surgical endeavor. Models and simulators are used to help with skills development. Plastic torsos with a new 'abdominal wall' attached are supplied for each student to practice opening and closing, as required during an actual cesarean section. These 'abdominal walls' are sewn by CNIS volunteers in Canada. In another session, the student practice opening and closing the 'uterus' inside the plastic torso. The students also use goat feet to practice skin closure techniques and beef hearts to practice uterine opening and closing. The beef heart has been chosen because the muscle of the beef heart is similar to the muscle of the human uterus.
The course is designed to help the students improve the skills they need when problems are encountered with vaginal deliveries. They get to practice with the vacuum extractor (used to assist with vaginal delivery), sewing a cervical laceration and removing of a retained placenta. The students also 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 Obstetrics and Gynecology.
Following the 3-day laboratory course, the students then move on to the operating room, where each performs 3 closures of Caesarean incisions (after the baby have been delivered) and 3 complete Caesarean sections, under the supervision of the faculty. The students recommend that the course be given to interns, teaching and reinforcing these obstetrical and surgical skills before they go out into the country for their work experience.
SOO Course Manuals can be purchased directly from the CNIS.
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