Training and mentoring

Sangwari continued its efforts in supporting and strengthening public health system. The goal is thoughtfully reflecting in variety of activities taken up by the organisation. Sangwari is also helping other fellow organisations apart from the government system. In this quarter the activities were mainly directed towards mitigation and as a response to covid-19 pandemic. We supported by on site trainings, developing training materials and this time going beyond just supporting we actually contributed in service program, thus put a step forward for better camaraderie and involvement in the existent system.

Status	In progress
Objective	To identify training and mentoring needs of the local Public health cadre and develop the module based learning sessions with most of the staff like ANM, AASHAs, MPWs, MOs, etc. To build Referral Systems with government secondary and tertiary health care system to develop shared purpose, better camaraderie and involvement with the existent systems.
Activity dates	Planned: March and April 2021Actual: May and  June 2021
Progress	Trainings- Sangwari conducted several onsite and online trainings. Trainees were Mitanin Trainers (MT), ANMs, Staff nurses, RMAs and Medical officers. Topics for trainings were according to need of the system, trainees and the hour. We conducted 11 online trainings sessions for basic covid awareness, prevention, vaccinations and home covid care. These online sessions were mainly for the field workers of different fellow organisations like Ekjut, Chaupal, Sochara, Samata, CFAR, Yumetta, Sangata Sahabhagi Gramin Vikas Sansthn etc. Similar onsite training was conducted for Raigadh Ambikapur Health Association (RAHA) field workers at Ambikapur and Patthalgaon centres. According to the demand from local government health department, we have started 7 days residential training in covid critical care management at Ambikapur government medical college. The first batch of CHC doctors started from 28th of june. In the background of anticipated surge in snake bites, Sangwari conducted onsite block level training in 7 blocks of Surguja district for Animal Bites which included snake bite, scorpion sting, Rabid animal bite and bee-wasp sting. The basic purpose was to strengthen PHCs and CHCs for better management of these bites, better patient outcomes, closer-early care and lessen stress on tertiary referral units. After gaining experience in community home covid isolation care, Sangwari was invited for training Mitanin district/ block co-coordinators and Mitanin Trainers (MT). Training conducted for proper and effective use of PPEs, finger pulse-oximeter, digitals thermometer and Infrared thermometer on field. Services- Due to acute shortage of specialists to deal with massive load of sick covid patients at the tertiary level of Surguja division, Sangwari along with Doctors For You (DFY) and government health department signed a MOU to run a 20 bed covid ICU at medical college Ambikapur. Sangwari will look after covid ICU patients for 3 months in this covid wave from 15th May to 15th August this year. By this Sangwari actually took up the challenge and supported government system in the time of need. Details of which has been described later in this report. Services- In the 2nd covid wave as patients preferred to stay at their homes and inadequate system to take care of home isolated covid patients, some of them admitted late and succumbed to the disease. Sangwari along with Chaupal formulated Home isolated Covid Care for 26 villages. Details of which has been described earlier in this report.

A. Training and training Materials

1. Covid Training-

• Covid-19 2^nd wave hit us harder than the 1^st wave, not only because the virus has changed its structure but also inadequate preparedness of the system and lot of misinformation, myths still persisted around the virus existence, how it spreads, infects, make people sick, testing, management and prevention. Looking at the need we initiated training and awareness program. Due to lockdown, restricted mobility and gathering most of these trainings were conducted online. The topics were,
  • Covid-19 – general awareness and prevention
  • Covid 19- home isolation covid care
  • Covid 19- vaccination myths and facts
• Strengthening secondary level care-

As the 2^nd covid wave progressed, due to inadequately prepared secondary level health facilities, tertiary care hospitals were increasingly overwhelmed by the number of patients and seriousness of their illness.  Sangwari advocated for strengthening of secondary level centres like Community Health Centres (CHCs) through training health care workers (HCWs). With the advantage of providing critical covid illness care at the medical ICU, Sangwari proposed 7 days residential Covid ICU training for Medical officers (MOs) at CHCs. This training included

• Classroom teachings for- orientation for ICU, stabilization of critically ill patients, syndromic diagnosis, diagnosis of covid and managing severe covid, etc
• Bed side clinical teaching- examination and evaluation of critically ill patients, case presentations
• Daily rounds and Case discussion- detailed ICU rounds and learning.
• Evaluation- pre-test and post-test, case presentations and OSCE examination

• Strengthening Primary level care- With the continues learning from Home Isolation Covid Care program on the field discussed in details above, Sangwari was invited for Training Mitanin trainers for the same. Sangwaris shared their learning and training materials with Mitanin Distrcit co-ordinators (DC), Block co-ordinators (BC) and Mitanin Trainers (MTs). We conducted such one training at the district and 2 at the block levels. Training mainly included
  • Proper and effective use of Personal Protective Equipment (PPEs) provided to Mitanins
  • Hands on training and troubleshooting for use of finger-pulseoximeter, digital thermometer, Infrared thermometer.
  • SOPs for field visits for covid patients.

2. Animal Bite Training-

• Snake bites are particularly common during monsoon season and so as the mortality and morbidity due to them. Deaths due to snake bites are particularly more due to late presentation of the patients to the hospitals and inadequate management. Looking at this training need district level training was proposed for doctors and staff nurses who were actually handling these cases. Sangwari asked for block wise training and conducted training at all blocks of the Surguja district for better penetration. This training included
  • Snake bite- diagnosis, management and prevention
  • Rabid animal bite- management and reporting
  • Scorpion sting- management and prevention
  • Bee-wasp stings- management
  • Interactive case scenarios
  • System strengthening for managing these animal bites management.
• Pre-test and post-test evaluation done along with the feedback sessions from the participants to improve the quality of trainings and thus learning.
• Training Materials- Due to need of hour and urgency Sangwari has developed training materials for wider use. Link for the training materials- https://sangwari.net/publications/

Future Activities- Training of Medical officers for Sickle cell disease diagnosis and management, next batches for covid critical care management are due in the upcoming months.

Outputs- From  March 2021 to June 2021

362 volunteers/field workers/health care workers were trained in covid prevention, vaccination myth busting and home covid care through 11 online sessions. 65 Nurses and field co-ordinators were trained in covid prevention, vaccination myth busting and home covid care. 32 volunteers were trained in appropriate use of PPEs, finger pulse-oximeter, data collection and reporting for Home Isolation Covid Care. Out of 32 trainees, 26 actually took part in the programme.  121 trainees which included Medical officers, RMAs and staff nurses were trained onsite at respective 6 CHCs for snake bite, rabid animal bite, scorpion sting and honey-wasp sting diagnosis and management. They were also trained for system preparations in handling such cases through PPTs, case scenarios and interactive sessions. 97 trainees which included District Mitanin co-ordinators (DC), Block Mitanin co-ordinators (BC) and Mitanin trainers (MT) were trained for Home Isolation Covid Care. They were given hands-on training in finger pulse-oximeter, digital thermometer, infrared thermometer and PPE use. 7 Medical officers are being trained in handling critically ill covid patients in an ICU setup.