Limpopo Obstetric Response Team (LORT)

This is the continuation of team’s support to LORT, that was provided under the University of Limpopo Trust, and this include the following:

1. The launch of the Limpopo Obstetrics and Gynaecology Protocols and Standards

The team supported the Department of Obstetrics and Gynaecology in developing and launching the first-ever Limpopo Obstetrics and Gynaecology Protocols and Standards. This work started in 2021 with a small team led by the Head of the Clinical Department, Dr Kaizer Baloyi, who led the drafting of the protocols, followed by two consultative workshops to get feedback from the rest of the LORT team members. The protocols were finally finalised and approved. The team decided to have a launch for better dissemination to the entire province

 The launch was held on 28 October 2022 in Polokwane during the Rural Health Matters campaign in Capricorn District. This meant that over 60 healthcare providers who were participating in the Obstetrics and Neonatal training drive were able to attend the launch. The booklet covers obstetric and gynaecology protocols, anaesthesia protocols and guidelines, the updated Limpopo Maternal Health Standards and the RMC SOP. This was necessitated by healthcare providers using protocols from the institutions where they were trained. This posed a challenge where as much as the basic principles of obstetrics remain the same across various training institutions, their protocols are primarily tailored for the health systems in which the training institutions are located (e.g. KwaZulu-Natal, Western Cape, Gauteng) and not for Limpopo.

2. Women’s Health Drive in 2022

The Women’s Health Drive in 2022 occurred on August 18 – 22 during the Rural Health Matters Campaign in Waterberg district. The Women’s Health Drive was based in Polokwane, and it aimed to reduce the surgical backlogs for urogynaecology and urology. The target was to operate on 26 patients from rural communities and transfer skills to about 50 specialists from the province from the leading team of surgical experts. The surgical team included our champion Dr Muavha, Dr Masegela, a urologist and Head of Clinical Unit: Urology at Pietersburg Hospital, Prof Kruger, a urogynaecologist from Alberta University in Canada, Dr Moshokoa, a urologist (first black female in SA) in the private sector, Dr Brouard, a urogynaecologist from UCT/Groote Schuur Hospital, Dr Ndhlovu a reproductive medicine specialist in the private sector, Dr Blaauwhof a gynaecologist in the private sector. 

3. Virtual Provincial Obstetrics Symposium in 2020

This was the first and most successful virtual symposium series focused on key topics of the international Essential Steps in the Management of Obstetrics Emergencies (ESMOE) and Basic Ultrasound training programmes. The virtual symposium ran 6 weeks (09 September – 04 December 2020), included national and international facilitators, and reached a national and Southern African Development Community (SADC) region audience. The sessions from the symposium were recorded and made accessible to healthcare providers who could not attend the live sessions. The symposium reached a minimum of 4723 health care professionals from all 9 provinces in SA and other African countries, i.e., Zimbabwe, Malawi, Namibia, Botswana and Ghana. This is because the official numbers are unique logins, and there were facilities, especially in Limpopo, where a team in a facility or ward logged in with one computer.

Breakdown of ESMOE course participation by topic

4. Other Clinical Mentoring and Support

Prof Fawcus giving a lecture and demonstrating the use of NASG with participants in 2020

Prof Fawcus also provided periodic in-person and virtual mentorship visits to support LORT in improving their clinical leadership in addressing critical bottlenecks in providing quality obstetrics and maternal health services throughout the health system. These include:

Prof Fawcus’ site visit 30 August – 03 September 2021

Prof Fawcus visited the province at the backdrop of a three-week support of three Limpopo hospitals by three newly qualified specialist obstetricians from the UCT. The team was organised by Profs Fawcus and the support costs were funded by SAfAIDS. During her visit, she visited 9 hospitals (Malamulele, Nkhensani, Helen Franz, Jane Furse, and Dilokong, Elim and Donald Fraser [district hospitals], and Letaba [regional hospital] and Pietersburg [tertiary hospital]). She was accompanied by Dr Kaizer Baloyi (provincial Head of O&G, Dr Dakalo Muavha (urogynae specialist at Pietersburg hospital and co-coordinator of the LORT and Prof Salome Maswime, Head of Global Surgery at UCT) on all days and Dr Nyatozi Chirwa (specialist at Pietersburg hospital) for two days. The purpose of the visit was to review the impact of LORT and the placing of the three specialists at the district hospitals and assess the successes and challenges around maternal health care in the hospitals visited. The Chief Executive Officers (CEOs), Clinical managers, maternity doctors and midwives participated in the visits and hospital walk abouts.

From this visit, Prof Fawcus shared improvement recommendations, which were both immediate and long-term. Immediate recommendations included the finalisation and dissemination of protocols for clear guidance on managing patients on the ground and the commencement of outreach from Regional and Tertiary hospitals to cover all District hospitals to maintain the momentum started by deploying the O&G specialists. Other recommendations were specific to the key issues at the hospitals visited and the appointment of specialists at Letaba and St Rita’s, the two regional hospitals without specialists in the province.