title: Improving access to school based education for South African children in rural areas who have a tracheostomy: A case series and recommendations.
abstract: OBJECTIVE
  Currently few children with tracheostomies attend rural mainstreams schools in South Africa limiting their ability to gain an education. We sought to document the current school experience for the few children attending school who have tracheostomies and devise educational tools for teachers and administrators that will facilitate greater acceptance and safety in classrooms for this population.
  
  
  METHODS
  The four patients that are currently attending school with a tracheostomy were identified from the patient records of a tertiary hospital with a pediatric tracheostomy home based care service. With the aid of a Zulu language translator, the mothers and classroom teachers completed a semi structured interview and closed item questionnaire in their home and school, respectively. Schools were visited to understand and describe the settings in which the children and their teachers were being asked to function. Tools for education were developed in conjunction with key stakeholders at schools already hosting such children.
  
  
  RESULTS
  The key teacher-identified barriers to enrollment were: teacher unfamiliarity with tracheostomies, uncertainty about the school's liability, and concerns about the response of other children. The safety barriers identified were: greater than 60 children per classroom - limiting teacher's ability to attend to the child with a tracheostomy, lack of running water, pit latrines separate from school threatening hygiene and isolating the child when they leave to use the latrines & sandy classrooms which can result in sand entering the airway. Identified needs for successful school placement include providing tracheostomy supplies and suctioning equipment, hand hygiene materials and training teachers in: identification of respiratory distress, performance of emergency tracheostomy changes, CPR.
  
  
  CONCLUSIONS
  Children with tracheostomies could likely successfully attend South African rural mainstream public schools with a training program for teachers. As a first step, an introductory booklet for teachers that explains tracheostomies and provides educational and safety suggestions was created. A list of recommendations for successful inclusion of students in the school system was developed together with and delivered to key stakeholders.
authors.affiliation: Geisel School of Medicine at Dartmouth College, Hanover, NH, USA. Electronic address: Chengetai.R.Mahomva.med@dartmouth.edu.
authors.forename: Chengetai
authors.initials: C
authors.lastname: Mahomva
authors.affiliation: Greys Hospital, University of Kwa-Zulu Natal College of Health Sciences, Kwa-Zulu-Natal, South Africa.
authors.forename: Sue
authors.initials: S
authors.lastname: Harris
authors.affiliation: Greys Hospital, University of Kwa-Zulu Natal College of Health Sciences, Kwa-Zulu-Natal, South Africa.
authors.forename: Narvanie
authors.initials: N
authors.lastname: Seebran
authors.affiliation: Childrens' Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Bridget
authors.initials: B
authors.lastname: Mudge
authors.affiliation: Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Catlin
authors.affiliation: VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, USA; The Section of Otolaryngology in Geisel School of Medicine at Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Davies
mesh_terms: D044383:Black People; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008282:Mainstreaming, Education / Q000706:statistics & numerical data*; D008297:Male; D012424:Rural Population; D012572:School Health Services / Q000706:statistics & numerical data*; D000070777:School Teachers; D012574:Schools; D013019:South Africa; D013334:Students; D011795:Surveys and Questionnaires; D014139:Tracheostomy / Q000706:statistics & numerical data*
keywords: Education; School; South Africa; Tracheostomy