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SEA-ORCHID Update June 2007

Given the amount of activity that is happening right across the project, this is a bumper edition of the SEA-ORCHID Update. In the next issue, we will feature the fellowships that are currently taking place in Australia.

New SEA-ORCHID Team Member
CPG development workshop, Jogjakarta
RHL@10 meeting, Khon Kaen
Detty Nurdiati receives EBM Teaching Bursary
Sivasangari receives ‘Best Paper’ award
Philippine node produces Cochrane Library poster

Thai node produces labour ward posters
AUS Educator workshops in Thailand
Cochrane systematic reviews update
Activity update
Fellowships update
New articles
Next newsletter – Please submit!

New SEA-ORCHID Team Member

We would like to welcome the latest addition to our SEA-ORCHID team, Cynthia Anzures’ new baby girl, born on May 21 and weighing in at 3900g. Both mother and baby are doing well.

SEA-ORCHID Project team participates in CPG development workshop, Jogjakarta

Hakimi, Mario, Jadsada & Jackie Mario with eager students

Mario Festin reported that the CPG development workshop, held in Jogjakarta in April, was a resounding success. Everyone was enthusiastic and eager to learn more about the process and was also keen to know more about the experiences in the Philippines. Members of the Indonesian Society of Maternal Fetal Medicine who attended the workshop asked Mario to make a presentation to the ISMFM board so that the leaders would know about the importance of developing evidence-based guidelines and develop an agenda for it. Congratulations to the Indonesian node for holding such a successful workshop.

RHL@10 Meeting – SEA-ORCHID Project

Mario & Malinee enjoy Isan hospitality Isan dancers delight

Paul van Look remarked during his opening address that few WHO initiatives reach the 10-year milestone, and so this meeting in Khon Kaen was something quite special. There was a big turnout from SEA-ORCHID members, and we’d all agree with Caroline’s observation that it was a privilege to be at this particular birthday party. Sir Iain Chalmers was a keynote speaker and, as usual, he gave a lucid and thought-provoking presentation – this time on the early history of the RHL and the impetus behind it. Several other speakers, notably Justus Hofmeyr, gave interesting personal insights to the use of RHL in different settings.

SEA-ORCHID contributed with a workshop and presentation on the final afternoon of the meeting. For the workshop, Ruth had prepared several scenarios concerning episiotomy. This proved a popular topic and each small group was determined to feed back their discussions despite running out of time! Ruth did a really fantastic job. The presentation was a joint effort with Pisake - trying to cover the full range of SEA-ORCHID activities and achievements was a challenge in the time available.

Metin Gulmezoglu and Pisake were an amazing double-act and deserve much of the credit for putting together a varied program and enticing some leading specialists from around the world. The conference organisers were super-human and were well-supported by the ‘home team’ – thank you Natthaleeya, Rabieb and Geek. The photos give you an idea of how well we were looked after and what an enjoyable three days it was.
[Steve McDonald]

Detty Nurdiati receives EBM Teaching Bursary

Congratulations to Dr Detty Nurdiati, Clinical Educator for the Indonesian node, on her recent award of a bursary to attend the Teaching Evidence-Based Practice workshop, to be held 10-14 September 2007 at St Hugh’s College in Oxford. The SEA-ORCHID Project is proud to sponsor Detty to attend this event.

Sivasangari receives ‘Best Paper’ award

Congratulations to Sivasangari Subramaniam, Clinical Educator for the Malaysian node, on receiving the ‘Best Paper’ award in obstetrics at the Perinatal Society of Malaysia Congress in March. Her paper, based on the Malaysian primary data and plan for intervention, was entitled ‘Variation in the use of evidence based practices during pregnancy and childbirth in two Malaysian hospitals’.

 Philippine node produces Cochrane Library poster

Congratulations to the SEA-ORCHID team in Philippines on producing a great poster announcing free access to the Cochrane Library at the UP Manila PGH library. Hopefully initiatives such as these will have a positive impact on Cochrane Library access and evidence uptake. SEA-ORCHID resources have also been used to set-up Internet access at Jose Fabella Hospital enabling hospital staff to access the Cochrane Library for the first time.

Thai node produces labour ward posters

Congratulations to the SEA-ORCHID team in Thailand. At Khon Kaen Hospital, they have just produced three posters for their labour ward and O&G department covering the concepts of EBP and the selective use of episiotomies, as well as information on how to prevent perineal tearing. The posters are of high quality and look very inviting, hopefully motivating clinicians to change their clinical practice regarding the use of routine episiotomy.

AUS Educator workshops in Thailand

After the WHO RHL@10 workshop, Ruth Martis was invited to give further workshops at the three SEA-ORCHID sites in Thailand. Eight three-hour workshops were given to a total of 201 participants.

At Khon Kaen University Hospital (Sringrarind Hospital) two workshops were held. The three-hour workshop on exclusive breastfeeding was attended by 10 participants, mainly fourth year medical students. The assistant HOD of the OBGYN department was able to attend as well, and he became very motivated during the workshop to promote exclusive breastfeeding for 6 months. This was the first breastfeeding workshop he had attended, and he voiced his desire to advocate for this topic to be included into the medical undergraduate curriculum.

The afternoon workshop was on EBP and the selective use of episiotomy and how to prevent perineal tearing. The small group discussions and feedback from the various scenarios highlighted important principles to overcoming barriers at KKU. In particular it was voiced that the nursing curriculum needs to include EBP, and maybe a collaboration could be initiated between the two training institutions.

Jadsada once again did a wonderful job translating all the workshops. Being able to hear the EBP information in Thai has been very effective and participants appreciated being given the choice to speak in Thai or English and the ability to read the scenarios and some worksheets in Thai or English. A big thank you to Natthaleeya who assisted greatly with the written translation.

Participants at KKU Episiotomy EBP workshop Jadsada with Assistant HOD, OBGYN

The workshops at Khon Kaen Hospital covered introduction to EBP and exclusive breastfeeding and the evidence about mobility during labour, continuous labour support and birth positions. While mainly attended by medical students and doctors, it was encouraging to have nurses from the labour ward attend and brainstorm how mobility in labour could be achieved at their hospital.

Mrs. Oratai Puntala, the Head of the nursing school, attended this SEA-ORCHID workshop and spent some time with Ruth after the workshop discussing how EBP could be integrated into their nursing curriculum. She was very interested to receive further curriculum development information and will endeavour to collaborate with Dr. Thitiporn. If anyone has any information regarding SE Asian nursing curriculum development, Mrs Oratai Puntala would be interested to hear about it and network with other SE Asian countries. Her contact details can be obtained via Ruth Martis.

Participants at KKH Breastfeeding, Mobility, Support and Positions EBP workshop

At Kalasin Hospital the exclusive breastfeeding workshop was well attended by medical and nursing students, as well as some doctors. It was a privilege to meet up again with some previous participants and have discussions on how much clinical change has been achieved since the February workshops.

Participants at KLS Exclusive Breastfeeding EBP workshop

Bunpode had also arranged to hold two SEA-ORCHID workshops at K’amalasai Hospital, one of 13 district hospitals that feed into Kalasin hospital for tertiary care. The morning workshop covered EBP and the selective use of episiotomy, how to prevent tears, the use of routine enemas, shaving and mobility in labour. The afternoon workshop covered the role of corticosteroids in premature labour, fluid and food restriction in labour and how to use the RHL. Participants came from all 13 district hospitals, mainly nurses and some doctors. They were a lively group and participated well in discussions, small group work and scenario feedback on how to overcome barriers to implementing the evidence-based clinical topics presented in the workshops.

Participants at K'amalasai Episiotomy,
Corticosteroids, Shaving & RHL workshop

The highlight was the growing understanding by participants that their clinical practice around corticosteroids needed to change. A meeting was held and, under the guidance of Bunpode, an agreement was reached that all 13 district hospitals need to have the same clinical practice guideline in respect to premature labour management, including the administration of corticosteroids prior to transferring a women in premature labour to Kalasin hospital. Congratulations on a great example of collaboration.
[Ruth Martis]

Cochrane systematic reviews update

New titles continue to be registered at an impressive rate. Five Pregnancy & Childbirth and Neonatal Group titles have been registered since April and another two will soon be registered by our Indonesian SEA-ORCHID fellows. The list of titles now stands at 33, which is a remarkable achievement. Of course, a lot of work lies ahead to translate these into protocols and reviews but we have to start somewhere! Several protocols are in advanced draft form and we hope the upcoming Fellowships will help move these to the next stage. Congratulations to everyone involved either in writing reviews or supporting the growing cohort of review authors in the region.

For full details of Cochrane systematic review activity, visit: www.seaorchid.org/knowledgebank/activities/SRUpdate.php

Activity update

All SEA-ORCHID sites have had a very busy and productive start to 2007. The activity updates provided by each site are now available to view on the SEA-ORCHID website at www.seaorchid.org/knowledgebank/activities/activities.php.

Fellowships update

 Tunjung, Diah, Fauziah, Caroline, Ruth and Resti in Adelaide
 Thitiporn, Steve, Lu, Ruth & Bussarin performing the "I Love Fellowships" dance
Steve, Thitiporn and Lu catching up on some shopping

The Fellowship Programme is progressing well. In addition to plenty of academic and clinical exchange, there have been new opportunities for koala spotting, hot chocolate drinking, beach walking and harbour cruising. Across the three Australian sites of the Women and Children’s Hospital at Adelaide University, Australasian Cochrane Centre at Monash University, and the Centre for Perinatal Health Services at University of Sydney, nine fellowships have already been hosted and another eleven will be completed by the end of August this year. Doctors, nurses and medical libraries from all nine South East Asian hospitals participating in the SEA ORCHID project have taken advantage of some protected time in Australia to develop their evidence-based research and clinical skills, draft clinical practice guidelines and develop training packages.

The six-month fellowship evaluations have been received from the medical librarians and suggest that great work is continuing in all four countries. Library resources and exhibitions have been developed to assist in evidence-based searching, road shows and conference workshops have been delivered to hospital clinicians and university staff and students. Reports from clinicians who have returned from fellowships suggest that they are running regular staff training and incorporating EBP principles in ward rounds and CME sessions.

One of the striking outcomes from the fellowship is the ability of each person, regardless of their profession or level of seniority, to recognise the valuable role they can play in the application of evidence-based practice. This feedback from one of the medical librarian fellows sums up this notion.

“I have been surprised by the way librarians make their profession relevant in the decade where IT has developed much quicker than ever and utilise the technology available to offer optimum and effective support to strengthen evidence-based practice.”

We look forward to hosting the remaining fellowships this year and continuing to be in contact and offer support to all those who have completed fellowships. Keep up the great work and remember that CHANGE IS POSSIBLE.

For more details about the SEA-ORCHID Fellows, visit www.seaorchid.org/knowledgebank/activities/fellowships.php

[Jacki Short]

New articles

Please find below references for some recently published articles that may be of interest.

Haws, R. A, Thomas, A. L, Bhutta, Z. A, Darmstadt, G. L, ‘Impact of packaged interventions on neonatal health: a review of the evidence’, Health Policy Plan. 2007 0: p. czm009v1-23


Shantharam Baliga, B., Raghuveera, K., Vivekananda Prabhu, B., Shenoy, R., Rajeev, A. ‘Scaling up of Facility-Based Neonatal Care-A District Health System Experience’, J Trop Pediatr 2007 53: p. 107-112

Senarath, U., Fernando, D. N., Rodrigo, I., ‘Newborn Care Practices at Home: Effect of a Hospital-based Intervention in Sri Lanka’, J Trop Pediatr 2007 53: p. 113-118

Bhutta, Z. A., Darmstadt, G. L., Hasan, B. S., Haws, R. A., ‘Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence’, Pediatrics 2005 115: p. 519-617

Online Atlas of Millennium Development Goals
The new World Bank Online Atlas of the MDGs is a visualization of the Millennium Development Goals:
  • Explore maps of key indicators for each of the eight MDG goals. It is designed to make a wide range of data for over 200 economies easily accessible
  • Resize countries to reflect comparative values.
  • Zoom in on countries and pull up quick tables of supporting indicators

Next newsletter – Please submit!

Do you have any news from your site that you would like to share with the team? If so, please email Melissa text and photos for inclusion in our next issue (mthomas@usyd.edu.au).

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