Bring healthcare to thousands in rural Nepal

Date: 31 Aug to 3 Sept 2022
Place: Salyantar Primary Health Centre,Tripurasundari Rural Municipality
Dhading District, Central Nepal

Participants: (Auxiliary Nurse Midwife)
4 from Gangajamuna and 6 from Tripurasundari Rural Municipalities

Trainers:
Drs. Sumita T and Susmita R, Thapathali Maternity and Women
Hospital, Kathmandu

Inauguration program: 

Chairperson: Dr. Sanjaya B, Salyantar PHC
Chief Guest: Devraj D, Vice-chairman of Tripurasundari Rural Municility
Guest: Indra B. K, Chief Admin officer of Tripurasundari Rural Municipality
Guest: Yam Bdr. S, Health In-charge of Tripurasundari Rural Municipality
HHC staff and participants

Total four days of training was conducted and the team was divided into 2 groups. This is the fifth year in a row and 9th obgyne training that conducted by HHC to the midwives serving in rural health centers of Dhading district.

The training sessions covered the following topics:

First day of Training (31 Aug 2022

History taking
1. Introduction of patient
2. Chief complaint
3. History of present illness (HOPI)
4. Menstrual history
5. Obstetric history
6. Contraceptive history
7. Past medical; surgical history
8. Personal history
9. Occupational history; family history

Physical examination
GC (general condition): fair, ill looking, conscious or unconscious,
Vitals: T, PR, RR, BP (temperature, pulse, respiratory rate and blood pressure)
PILCCOD: (pallor, icteric, cyanosis, clubbing, edema, dehydration)
Chest examination: B/L normal vesicular breath sound and equal air entry, crepitation and wheeze
CVS (cardiovascular system): s1 s2 or any added sound
A/P (per abdomen): any mass feel and tender
P/S (per speculum): polyp, discharge, erosion on cervix and its position
P/V per vaginal: feel any cyst or mass and motion tenderness on cervix

2nd Day of Training (1 Sep 2022
Types of vaginal discharge:
1. Physical: reproductive age, menstrual and hormonal
2. Pathological: infected and non infected
Infected
Sexual infected: TV, Chlamydia, Gonorrhea, Syphilis, HSV
Non sexual infected- BV, Candida (mostly below 25 Year
Non infected: foreign body, atrophic (dryness) and malignant
PID (Pelvic Inflammatory Disease): cause by ascending infection from the endocervix or may from descending infection from organs and 25% cause by Chlamydia and gonorrhea
DUB (dysfunctional uterine bleeding): defined as abnormal uterine bleeding in absence of pregnancy, genital tract pathology or systemic infection

3rd Day of Training (2 Sep 2022
Labor and abortion:
Safe abortion service: condition within law, family planning and types of abortion
Early pregnant bleeding: grading of bleeding and management
Preterm labor: inj Dexona 6 mg 6 hourly 4 doses or 12 mg 12 hourly 2 doses to make mature lungs of baby but caution to be taken while giving to GDM (Gestational Diabetes Mellitus) mothers.
Hyperemesis dravidarum: urine acetone to be done. Inj. RL III pint, Inj 5% dextrose 1.5 ltr IV over 24 hourly. Inj Metoclopramide 10 mg IV TDS. Inj Ranitidine 50 mg IV BD. Pyridoxime 10 mg PO TDS.

4th Day of Training (3 Sep 2022)
Ectopic pregnancy:
PPH (post-partum hemorrhage): any amount of blood loss that threatens the
woman’s hemodynamic stability and estimated blood loss of & gt;  500 ml
from the genital tract at vaginal delivery & amp; & gt;1000 ml in caesarean
section or 1500 ml at caesarean hysterectomy
Types
Primary: 3rd stage labor to 48 hours of delivery
Secondary: 48 hours to 6 weeks of delivery

The condom tamponade: if medical intervention failed, then this procedure is applied and counsel about procedure and prepare instruments

Procedure of condom tamponade:
Inflate 250-500 ml saline & amp; bleeding stops in 0-15 minutes in most cases

Pre-eclampsia and eclampsia:
Preeclamsia and eclampsia are pregnancy related high blood pressure disorders. In preeclamsia, bloood pressure reduces the blood supply to the fetus thus supplying less oxygen and few nutritients. Eclampsia is when pregnant women with preeclamsia develop seizures and coma.

Risks:
Lack of oxygen supply and nutrients to fetus, preterm birth, and still birth. Also the children born preterm have higher long-term health risks.

Patients served: (Total 6)
Due to severe weather condition and heavy rain, the number of patients served during the training period was limited.