On-site targeted clinical and population-based training for local medical assistants and generalists in a refugee camp in Africa

Background

In a refugee setting, local generalists and medical assistants often treat and manage broad range of medical and population-based problems but commonly lack proper skills and training. Historically aid agencies haven't focused on on-site systematic training during long-term crisis. In general, lack of ongoing training contributes to poor compliance with standard guidelines and promotes symptomatic therapies and inefficient use of limited resources.

Method

We introduced a two-month on-site training for 15 medical assistants and physicians working in an IDP camp in Africa. Based on epidemiology of diseases and input from participants, we developed and offered daily practice-based didactic sessions and clinical teaching rounds in hospital on individual patient to reinforce providers' fund of knowledge and to assure proper patient care. Didactic sessions were interactive workshops and seminars, case-based discussions, black board teaching, written exam, homework assignments and power point presentation. A preliminary exam evaluated thier base of knowledge in proposed topics.

Overall curriculum included:

1) Refugee public health with emphasis on diarrhea, respiratory infections, meningitis and measles, malnutrition, food programs, complex humanitarian emergencies, child health and mortality, reproductive health, community based approaches, and water and sanitation.

2) Clinical topics included approach to common tropical diseases, abdominal pain, bloody diarrhea, headache, cough, skin conditions, eye diseases, fever in outpatient and in-patient, urologic symptoms, gynecologic symptoms, STDs, isolation cases, surgical cases, proper duration of antibiotics, criteria for admission, proper history taking and physical exams, and management of wide range of chronic diseases. Psychiatric and psychological training included delirium, depression, psychosis, PTSD, substance abuse and smoking cession.

We offered targeted lectures to home visitors and sanitation workers.

Findings

Using anonymous questionnaires, most participants reported 70% increase in their baseline knowledge in management of presented topics, and rated the quality and diversity of sessions and teaching rounds as excellent. Majority performed satisfactory in final exam. Ongoing observation in in-patient and out-patient settings demonstrated improved service quality.

Recommendations:

Our experience demonstrates significant lack of knowledge and skills in the management of refugees' common clinical and public health problems among local medical providers. It also demonstrates the importance, feasibility, and effectiveness of an on-site didactic and practice-based teaching.