{"id":6769,"date":"2024-08-13T14:12:05","date_gmt":"2024-08-13T18:12:05","guid":{"rendered":"https:\/\/www.pathfinder.org\/?post_type=essay&p=6769"},"modified":"2024-08-27T08:18:27","modified_gmt":"2024-08-27T12:18:27","slug":"low-dose-high-frequency-how-a-clinical-mentoring-program-saves-womens-lives-in-democratic-republic-of-the-congo","status":"publish","type":"essay","link":"https:\/\/www.pathfinder.org\/impact-stories\/low-dose-high-frequency-how-a-clinical-mentoring-program-saves-womens-lives-in-democratic-republic-of-the-congo\/","title":{"rendered":"Low Dose, High Frequency: How a Clinical Mentoring Program Saves Women’s Lives in Democratic Republic of the Congo"},"content":{"rendered":"\n
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LIRE EN FRAN\u00c7AIS<\/em><\/strong><\/a><\/div>\n<\/div>\n\n\n\n

About USAID PROSANI<\/mark><\/strong><\/h2>\n\n\n\n

PROSANI USAID (USAID’s Integrated Health Program) focuses on six areas of health: maternal, newborn, and child health; reproductive health and family planning; nutrition; malaria; tuberculosis; and water, hygiene, and sanitation (WASH). The program runs from 2018 to 2025.<\/p>\n\n\n\n

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“I was between life and death,” said Annie Banza Kamona. “The doctors told me that my blood pressure was very high and that I was having seizures… When we arrived at the health center, the nurse told me that my case was complicated. They sent me to the hospital.\u201d<\/p>\n\n\n\n

But Annie Kamona was lucky; she ended up at the Adra 41 hospital, where Dr. Gracia Tshimanga, the Medical Director, was on duty.<\/p>\n\n\n\n

“Kafubu Health Zone (where Adra 41 is located) has experienced cases of maternal mortality in similar circumstances [to Banza\u2019s],” said Dr. Gracia. “The hospital did not have clear protocols to manage these cases,” he added.<\/p>\n\n\n\n

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Dr. Gracia Tshimanga, Medical Director of Adra 41 Hospital in Kafubu Health Zone, Haut-Katanga Province, Democratic Republic of the Congo<\/figcaption><\/figure>\n\n\n\n
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Annie Banza Kamona<\/figcaption><\/figure>\n<\/figure>\n<\/div>\n<\/div>\n\n\n\n

But Dr. Gracia and his team received training through PROSANI USAID, which strengthened the ability of staff at Adra 41 to handle complex cases like Banza’s. PROSANI USAID supports health zones in nine of Democratic Republic of the Congo\u2019s (DRC) provinces to implement high-impact interventions that save mothers\u2019 and newborns\u2019 lives through clinical mentoring\u2014an approach called\u00a0“Low Dose, High Frequency<\/strong><\/a>.” This approach trains providers on \u00a0a range of care interventions\u00a0 for mothers and newborns, including childbirth, neonatal resuscitation, postpartum family planning, care of low birth weight newborns, and breastfeeding. Through the approach, providers practice on \u00a0mannequins at clinical mentoring sites and mentors provide close follow-up. Ultimately, these trainings allowed providers to properly manage cases of preeclampsia, postpartum hemorrhage, and complicated pregnancy and delivery cases referred late to the hospital.<\/p>\n\n\n\n

A critical shift<\/strong><\/strong><\/strong><\/h2>\n\n\n\n

DRC has one of the highest maternal, newborn, and infant mortality rates in the world. The maternal mortality ratio is  547 deaths per 100,000<\/a> live births, and its neonatal mortality rate\u2014 the number of babies who die within 28 days \u2014is 27 per 1,000 live births.<\/a> “I regret that we have lost women who had come to give life in this way before the arrival of PROSANI USAID in our health zone,” said Dr. Gracia. <\/em><\/p>\n\n\n\n

Since the fifth year of the project in Haut Katanga province, PROSANI USAID has been working with health zone authorities and healthcare facilities to implement high-impact interventions that save the lives of mothers and newborns through clinical mentoring. This started with training mentors including Dr. Gracia, followed by mentors training maternity service providers in Kafubu Health Zone. At the end of the training, PROSANI USAID set up clinical mentoring sites, serving as spaces for continuing education, practical sessions, and learning for providers in the health zone.  These sites include training and learning materials such as MamaNatalie<\/a>, which helps providers master techniques for managing postpartum hemorrhage, the leading cause of maternal death.<\/p>\n\n\n\n

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Dr. Nadine Kabwe from the Kikula Reference Health Center with her ultrasound machine, provided by PROSANI USAID in Haut-Katanga province. The machines are rechargeable, with a battery life of three days.<\/figcaption><\/figure>\n\n\n\n
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Mimie Kibawa, with equipment provided by USAID. USAID has equipped the operating room of Adra 41 Hospital with operating tables, lightbulbs, and boxes of instruments for surgery, including cesarean sections. PROSANI USAID also provided equipment including ultrasound machines, delivery tables, inpatient beds, operating tables, an oxygen extractor, surgery boxes, delivery boxes and examination lamps\u2014equipment that Dr. Gracia and his team are using to save lives.<\/figcaption><\/figure>\n<\/figure>\n<\/div>\n<\/div>\n\n\n\n

PROSANI USAID has trained providers in Kafubu health zone\u2019s 46 basic maternity wards  in the care of pregnant women, and the most complicated cases received in these maternity wards are referred to Adra 41 Hospital. “Families often arrive in desperation\u2014 having traveled far in the hope of saving their sisters, daughters, mothers and wives. Sometimes, all the young people in the village help with the transport.\u201d Previously, Dr. Gracia and his team struggled to treat these cases. They had neither the necessary training nor the necessary equipment.<\/p>\n\n\n\n

“I feel more competent now when it comes to maternal health,” says Dr. Gracia. \u201cBefore, when a woman had preeclampsia or postpartum hemorrhage, we were almost helpless. But now we always have a sense of satisfaction knowing that when a woman comes in and is in danger… We can save her life.”<\/p>\n\n\n\n

Over the past year, PROSANI USAID has expanded clinical mentoring using the Low-Dose, High-Frequency approach in  six additional zones of Haut Katanga province. Dr. Gracia and his team continue to train providers in neighboring health zones, including seven healthcare facilities in Ruashi Health Zone. Since this training, Dr. Delile Kizanga, Chief Medical Officer of the Ruashi Health Zone, has seen improved performance of these seven healthcare facilities, and he has mobilized local resources to train all the providers in his health zone, which has helped to reduce maternal mortality in the area.<\/p>\n\n\n\n

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Dr. Delile Kizanga, Chief Medical Officer of Ruashi Health Zone<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

And for pregnant women and women who have recently given birth, the support of PROSANI USAID is very significant. “Dr. Gracia reassured me and took care of me, I gave birth well and everything went well,” Annie said. “We have doctors who know their job and I thank God for that. Here I am, me and my baby, all alive. Thank you to USAID, which continues to support our hospital by providing equipment and medicines.\u201d<\/p>\n\n\n\n

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Mentor Dr. Gracia works to train providers, Daddy, Kazadi, and Marie<\/figcaption><\/figure>\n\n\n\n
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A service provider with a mannequin used for training<\/figcaption><\/figure>\n\n\n\n
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Service providers train on mannequins to develop their skills<\/figcaption><\/figure>\n<\/figure>\n<\/div>\n<\/div>\n\n\n\n

The USAID Integrated Health Program (PROSANI USAID) is implemented by Abt Associates, which is the lead agency, in collaboration with other organizations, including Pathfinder International.<\/em><\/strong><\/em><\/strong><\/strong><\/p>\n\n\n\n

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Petite dose, Haute Fr\u00e9quence: Comment un programme de mentorat clinique sauve la vie des femmes en R\u00e9publique d\u00e9mocratique du Congo<\/strong><\/h1>\n\n\n\n
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\u00c0 propos de PROSANI USAID<\/mark><\/strong><\/h2>\n\n\n\n

PROSANI USAID (Programme de sant\u00e9 int\u00e9gr\u00e9 de l\u2019USAID) se concentre sur six domaines de la sant\u00e9 : la sant\u00e9 maternelle, n\u00e9onatale et infantile ; la sant\u00e9 reproductive et la planification familiale ; la nutrition; le paludisme; la tuberculose; et l’eau, l’hygi\u00e8ne et l’assainissement (WASH). Le programme s’\u00e9tend de 2018 \u00e0 2025.<\/p>\n\n\n\n

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\u00ab J’\u00e9tais entre la vie et la mort \u00bb, a d\u00e9clar\u00e9 Annie Banza Kamona. \u00ab Les m\u00e9decins m’ont dit que ma tension art\u00e9rielle \u00e9tait tr\u00e8s \u00e9lev\u00e9e et que j’avais des convulsions… Quand nous sommes arriv\u00e9s au centre de sant\u00e9, l’infirmi\u00e8re m’a dit que mon cas \u00e9tait compliqu\u00e9. Ils m’ont envoy\u00e9 \u00e0 l’h\u00f4pital. \u00bb

Annie Kamona a eu de la chance ; elle s’est retrouv\u00e9e \u00e0 l’h\u00f4pital Adra 41, o\u00f9 le m\u00e9decin directeur, Dr Gracia Tshimanga, \u00e9tait de service.<\/p>\n\n\n\n

\u00ab La zone de sant\u00e9 de Kafubu (o\u00f9 se trouve Adra 41) a connu des cas de d\u00e9c\u00e8s maternels dans des circonstances similaires [\u00e0 celles de Banza] \u00bb, a d\u00e9clar\u00e9 le Dr Gracia. \u00ab L’h\u00f4pital n’avait pas de protocoles clairs pour g\u00e9rer ce genre de cas \u00bb, a-t-il ajout\u00e9.<\/p>\n\n\n\n

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Dr Gracia Tshimanga, M\u00e9decin directeur de l’h\u00f4pital Adra 41 dans la zone de sant\u00e9 de Kafubu, dans la province du Haut-Katan, ga, en R\u00e9publique D\u00e9mocratique du Congo<\/figcaption><\/figure>\n\n\n\n
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Annie Banza Kamona<\/figcaption><\/figure>\n<\/figure>\n<\/div>\n<\/div>\n\n\n\n

Mais le Dr Gracia et son \u00e9quipe avaient b\u00e9n\u00e9fici\u00e9 d\u2019une formation dans le cadre de PROSANI USAID, ce qui avait renforc\u00e9 leur capacit\u00e9 \u00e0 g\u00e9rer des cas complexes comme celui de Banza. \u00c0 travers le mentorat clinique utilisant l\u2019approche \u00ab Petite dose, Haute Fr\u00e9quence<\/strong><\/a> \u00bb, PROSANI USAID soutient la mise en \u0153uvre des interventions qui sauvent la vie des m\u00e8res et des nouveau-n\u00e9s dans les zones de sant\u00e9 de neuf provinces en R\u00e9publique d\u00e9mocratique du Congo (RDC). Ce mentorat donne aux prestataires de soins de sant\u00e9 une formation sur une gamme d’interventions telles que les soins autour de la naissance (accouchement), la r\u00e9animation n\u00e9onatale, la planification familiale du post-partum, les soins aux nouveau-n\u00e9s de faible poids \u00e0 la naissance, l’allaitement maternel, etc. L\u2019approche comprend des s\u00e9ances pratiques sur la simulation avec des mannequins dans les sites de mentorat clinique o\u00f9 les mentors les suivent de pr\u00e8s. Ces formations permettent aux agents de sant\u00e9 de prendre en charge correctement les cas de pr\u00e9\u00e9clampsie, d’h\u00e9morragie du post-partum et des cas compliqu\u00e9s r\u00e9f\u00e9r\u00e9s \u00e0 l’h\u00f4pital.<\/p>\n\n\n\n

Un changement d\u00e9cisif<\/strong><\/strong><\/h2>\n\n\n\n

La RDC a l’un des taux de mortalit\u00e9 maternelle, n\u00e9onatale et infantile les plus \u00e9lev\u00e9s au monde. Le taux de mortalit\u00e9 maternelle est  de  547 d\u00e9c\u00e8s pour 100 000<\/a> naissances vivantes, et son taux de mortalit\u00e9 n\u00e9onatale \u2013 le nombre de b\u00e9b\u00e9s qui meurent avant un mois d\u2019\u00e2ge \u2013 est de 27 pour 1 000 naissances vivantes.<\/a> \u00ab Je regrette que nous ayons perdu des femmes qui \u00e9taient venues donner la vie dans ces conditions avant l’arriv\u00e9e de PROSANI USAID dans notre zone de sant\u00e9 \u00bb, a d\u00e9clar\u00e9 Dr Gracia.<\/em><\/p>\n\n\n\n

Depuis la cinqui\u00e8me ann\u00e9e du projet dans la province du Haut Katanga, PROSANI USAID travaille avec les autorit\u00e9s des zones de sant\u00e9 et les \u00e9tablissements de sant\u00e9 pour mettre en \u0153uvre des interventions \u00e0 haut impact qui sauvent la vie des m\u00e8res et des nouveau-n\u00e9s gr\u00e2ce au mentorat clinique. Cela a commenc\u00e9 par la formation de mentors, dont le Dr Gracia, puis la formation des prestataires de soins de sant\u00e9 des services de maternit\u00e9 dans la zone de sant\u00e9 de Kafubu par les mentors. \u00c0 la fin de la formation, PROSANI USAID a mis en place des sites de mentorat clinique, qui servent de lieux de formation continue avec des sessions pratiques et d\u2019apprentissage pour les  prestataires de soins de la zone de sant\u00e9.  Ces espaces comprennent du mat\u00e9riel de formation et d\u2019apprentissage tel que MamaNatalie<\/a>, qui aide les prestataires de soins de sant\u00e9 \u00e0 ma\u00eetriser les techniques de gestion de l\u2019h\u00e9morragie post-partum, la principale cause des d\u00e9c\u00e8s maternels.<\/p>\n\n\n\n

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Dr. Nadine Kabwe, du Centre de Sant\u00e9 de R\u00e9f\u00e9rence de Kikula, avec son \u00e9chographe, fourni par PROSANI USAID dans la province du Haut-Katanga. Les appareils sont rechargeables, avec une autonomie de trois jours.<\/figcaption><\/figure>\n\n\n\n
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Mimie Kibawa, avec du mat\u00e9riel fourni par l\u2019USAID. L\u2019USAID a \u00e9quip\u00e9 la salle d\u2019op\u00e9ration de l\u2019h\u00f4pital Adra 41 avec de tables d\u2019op\u00e9ration, de lampes de salle d\u2019op\u00e9ration et de bo\u00eetes d\u2019instruments pour la chirurgie, y compris pour les c\u00e9sariennes. PROSANI USAID a \u00e9galement fourni d\u2019autres \u00e9quipements, notamment des \u00e9chographes , des tables d\u2019accouchement, des lits d\u2019hospitalisation, un concentrateur d\u2019oxyg\u00e8ne, des bo\u00eetes de chirurgie, des bo\u00eetes d\u2019accouchement et des lampes d\u2019examen \u2013 des \u00e9quipements que Dr Gracia et son \u00e9quipe utilisent pour sauver des vies.<\/figcaption><\/figure>\n<\/figure>\n<\/div>\n<\/div>\n\n\n\n

PROSANI USAID a form\u00e9 des prestataires de soins de sant\u00e9 \u00e0 la prise en charge des femmes enceintes dans les 46 maternit\u00e9s de base de la zone de sant\u00e9 de Kafubu. Les cas les plus compliqu\u00e9s sont transf\u00e9r\u00e9s vers l’h\u00f4pital Adra 41. \u00ab Les familles arrivent souvent d\u00e9sesp\u00e9r\u00e9es \u2013 apr\u00e8s avoir voyag\u00e9 de loin dans l’espoir de sauver leurs s\u0153urs, filles, m\u00e8res ou \u00e9pouses. Parfois, tous les jeunes gens du village aident avec le transport \u00bb. Auparavant, Dr Gracia et son \u00e9quipe avaient du mal \u00e0 traiter ces cas. Ils n’avaient ni la formation ni l’\u00e9quipement n\u00e9cessaires.<\/p>\n\n\n\n

\u00ab Je me sens plus comp\u00e9tent maintenant en mati\u00e8re de sant\u00e9 maternelle \u00bb, d\u00e9clare Dr Gracia. \u00ab Avant, lorsqu’une femme souffrait de pr\u00e9\u00e9clampsie ou d’h\u00e9morragie du post-partum, nous \u00e9tions presque impuissants. Mais maintenant, nous avons toujours un sentiment de satisfaction en sachant que lorsqu’une femme arrive et est en danger, nous pouvons lui sauver la vie.\u201d<\/p>\n\n\n\n

Au cours de l’ann\u00e9e derni\u00e8re, PROSANI USAID a \u00e9largi le mentorat clinique selon l\u2019approche Petite Dose, Haute Fr\u00e9quence dans six autres zones de sant\u00e9 de la province du Haut Katanga. Dr Gracia et son \u00e9quipe continuent de former des prestataires de soins de sant\u00e9 dans les zones de sant\u00e9 voisines, y compris sept \u00e9tablissements de soins de sant\u00e9 dans la zone de Ruashi. Depuis la formation, Dr Delile Kizanga, m\u00e9decin en chef de la zone de sant\u00e9 de Ruashi, ayant constat\u00e9 la bonne performance de ces sept \u00e9tablissements, a mobilis\u00e9 des ressources locales pour former tous les agents de sa zone de sant\u00e9, ce qui a permis de r\u00e9duire la mortalit\u00e9 maternelle intra-hospitali\u00e8re dans la zone.<\/p>\n\n\n\n

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Dr Delile Kizanga, m\u00e9decin en chef de la zone de sant\u00e9 de Ruashi<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

Pour les femmes enceintes et celles que viennent d\u2019accoucher, l\u2019appui de PROSANI USAID est tr\u00e8s significatif. \u00ab Le Dr Gracia m’a rassur\u00e9 et a pris soin de moi. J’ai bien accouch\u00e9 et tout s’est bien pass\u00e9 \u00bb, a d\u00e9clar\u00e9 Annie. \u00ab Nous avons des m\u00e9decins qui connaissent leur m\u00e9tier et je remercie Dieu pour cela. Me voici, moi et mon b\u00e9b\u00e9, en bonne sant\u00e9. Merci \u00e0 l’USAID qui continue de soutenir notre h\u00f4pital en fournissant du mat\u00e9riel et des m\u00e9dicaments \u00bb.<\/p>\n\n\n\n

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Le mentor Dr Gracia travaille \u00e0 la formation des  prestataires de soins de sant\u00e9, Daddy, Kazadi et Marie<\/figcaption><\/figure>\n\n\n\n
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Prestatire de soins de sant\u00e9 avec un mannequin utilis\u00e9 pour les exercices pratiqu\u00e9s<\/figcaption><\/figure>\n\n\n\n
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Les mannequins qui servent \u00e0 d\u00e9velopper les comp\u00e9tences des  prestataires de soins<\/figcaption><\/figure>\n<\/figure>\n<\/div>\n<\/div>\n\n\n\n

Le Programme de sant\u00e9 int\u00e9gr\u00e9e de l’USAID (PROSANI USAID) est mis en \u0153uvre par Abt Associates, qui est l\u2019organisation principale en collaboration avec d’autres organisations, dont Pathfinder International.<\/em><\/strong><\/strong><\/p>\n","protected":false},"featured_media":6795,"template":"","class_list":["post-6769","essay","type-essay","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.pathfinder.org\/wp-json\/wp\/v2\/essay\/6769","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pathfinder.org\/wp-json\/wp\/v2\/essay"}],"about":[{"href":"https:\/\/www.pathfinder.org\/wp-json\/wp\/v2\/types\/essay"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pathfinder.org\/wp-json\/wp\/v2\/media\/6795"}],"wp:attachment":[{"href":"https:\/\/www.pathfinder.org\/wp-json\/wp\/v2\/media?parent=6769"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}