Indian Pediatrics 2001; 38: 1195-1196  

Continued Medical Education Through Telecommunication for Field Functionaries

Madhya Pradesh is a large state full of natural resources. But it is still unfortunate to have the highest Infant mortality rate in India, i.e., 97/1000 birth (year 1998)(1). The early neonatal mortality rate is 47 which constitutes 49.4% of the infant deaths(2). Hence, there is an urgent need to train the paramedical workers about essential neonatal care mainly concentrating on care at birth. The conven-tional training programs conducted by expert trainers, are useful. However, it is not possible to organize these programs more frequently to cover a large number of paramedical personnel. Such training programs also require time, money and immense efforts on part of the trainer. Satellite transmission can be good cost effective alternative to train such a large number of audience simultaneously(2).

The Department of Pediatrics, Gandhi Medical College, Bhopal conceptualized state level training on essential newborn care through telecommunications. The telecom-munication was organized by the Department of Public Health and Family Welfare, Government of Madhya Pradesh, through a center of ISRO (Indian Space Research Organization) placed at Ahemdabad. ISRO Ahmedabad provides facility to telecast the educational programs all over the country. The State Government has setup DIET (District Institute for Education and Training) centers at each district which are connected to Bhopal main center which telecasts only educational and administrative programmes. Each DIET center is equipped with a television screen and sitting arrangements of about 40-45 persons and facility of STD and Fax.

A small twelve page booklet in Hindi was distributed to all the participants for updating their knowledge about one week before training. At each center one Medical Officer from the local district hospital co-ordinated the training by satellite transmission. The program consisted of: (i) Demonstration of Resuscitation from initial steps to bag and mask ventilation; (ii) Care in labor room and cord care; (iii) Prevention of hypothermia; (iv) Methods of keeping baby warm; (v) Identification of preterm and LBW babies; (vi) Identification of danger signs in newborn and (vii) Infant feeding and feeding of LBW babies.

A small film on each topic was prepared in the Departments of Pediatrics and Obstetrics and Gynecology. The total duration of film was 30 minutes.

After demonstration of each topic, an interactive session was kept. Approximately 40 phone calls and 25 Fax were received from different areas of Madhya Pradesh. Whenever the questions were asked from a particular place either by phone call or Fax, the map of Madhya Pradesh was seen on the TV screen with a dot on that place so that the participants from the DIET center came to know that they are on line and their question is being answered.

The queries were solved by the Head of the Department of Pediatrics along with faculty members, who were available at the main center at Bhopal.

The most frequently asked questions were: (i) Why a newborn baby should not be heldupside down during resuscitation? (ii) Why not to give mouth to mouth breathing in apneic baby; (iii) Why to receive the baby in arms not in the tray? (iv) What is the role of drugs like Coramine and Decadron? (v) Why not supplement water during summer? and Few questions were related to some particular patient like, what to do for the baby who is delivered in autorikshaw or if the baby is not accepting feeds.

The total duration of session lasted one and a half hour. To evaluate the immediate impact of training program, a pretest and post-test was held for 50 nurses, who had visualized the program (Table 1). The center selected was DIET Center of Bhopal.

It is obvious that there was significant impact of training on the knowledge of trainees. Certain questions related to breastfeeding were answered correctly (by 90-95% trainees) even before training because of previous training in programs like Child Survival and Safe Motherhood Program and Reproductive and Child Health Programs.

Table I - Results of Pre and Post Program Tests