International | Articles
APLS in Sri Lanka
APLS in Myanmar
APLS in the Maldives
APLS in Fiji
APLS in Cambodia 2000
APLS in Cambodia 2017
APLS during the Christchurch earthquake
APLS in Malaysia
IPLS in Iraq
APLS in Samoa
In depth: How to start an APLS international project
Skill station, APLS Sri Lanka (photography by Tom Walwyn)
Rasika was having a well-earned rest from his demanding paediatric practice.
It was Boxing Day morning and he was walking along the beach with his family and friends. His wife and their 8 month old son were 50 metres ahead with the other women – when he saw the wave coming.
He ran forward but was hit by the wave before he could reach them. Swept tumbling inland, he was able to grab a tree branch and secure a hold. By some twist of fate his wife was nearby and he was able to reach her and bring her to the tree.
But their baby was lost.
Within a few minutes the baby’s body surfaced not far away. Again Rasika entered the water to retrieve the now lifeless body. He immediately gave mouth to mouth and, miraculously, the baby started crying.
60,000 Sri Lankans were not so lucky that day. The 2004 Boxing Day tsunami took a devastating toll across a country already wracked by the countless tragedies of a 20 year long civil war.
It was on a background of stories such as this that in 2005 Simon Young and I separately approached contacts in Sri Lanka with an offer to bring APLS to the country.
We were fortunate enough by chance to meet Dr Srilal de Silva, the Director of PICU at the Lady Ridgeway Children’s Hospital in Colombo. He is a man of quiet humility but of magnetic leadership. He introduced us to Prof Sujeewa Amarasena, the current president of the Sri Lankan College of Paediatrics, a man of small stature belying an endless energy and a tremendous capacity to get things done!
I have just returned from my 8th visit to this beautiful island of so many contrasts. Together with 18 dedicated volunteer Australian instructors over the years we have run a series of Provider and Instructor courses throughout the island.
I feel one of the most important was in 2013 when Srilal, soon after the end of the war, arranged for a course in Jaffna for the many doctors who had been isolated for years by the fighting. We hope that in some small way this has helped in the difficult healing process.
This year the courses were run in the Hill Country in an army training camp and it did indeed seem strange teaching about the seriously ill and injured child surrounded by razor wire and AK47’s!
However, we have now trained over 70 local instructors. Sri Lankan instructors ran this year’s GIC. Srilal was able to report that there has been 34 local courses training over 800 doctors. This was achieved with a small grant from UNICEF and great dedication by the local instructors.
In a recent poster presented at the Cairns RACP meeting the Sri Lankan investigator was able to show a reduction in preventable deaths from 16 in 2011 to 1 in 2013 in their Emergency Treatment Unit at the Lady Ridgeway Hospital, following staff APLS training.
On the last day of this year’s Instructor Course, Sujeewa made an announcement. The Director General of Health has dedicated funds to set up 9 training centres throughout the country with the ambitious plan of having all health professionals dealing with children APLS and neonatal trained within 5 years.
Each of us who have gone to Sri Lanka have been overwhelmed by the generosity, hospitality and comradeship provided by our Sri Lankan colleagues. We have all been left with many indelible memories and have enjoyed wonderful sights and tremendous food.
I am hopeful that there will be opportunities for others to support the local faculty as they undertake their challenge. Watch the International web page for details.
APLS returned to Myanmar in June 2017 to the University of Medicine 1, Yangon as guests of Rector Professor Zaw Wai Soe.
On this third APLS visit to Myanmar, our team successfully conducted the first APLS instructor course for 12 Myanmar candidates whom had previously completed the APLS provider course either in 2013 or 2015 during our earlier visits.
Given the years that have passed since these provider courses, we elected to conduct an APLS refresher day just prior to the instructor course to refresh our candidates on the new course content and teaching modalities. This day was well received and also gave us an opportunity to provide clear expectations and identify mentors for the next three days of the instructor course.
The instructor course ran very well, and we now have 12 Myanmar instructor icndidates who were both excited (and a little nervous) to teach the APLS international provider course.
Following a very well deserved rest day, our newly minted instructor candidates embarked on their first three day provider course. The course was delivered to 25 third year Masters of Emergency Medicine students in the last six months of their three year Masters course and who represent the first ever cohort of Masters of Emergency Medicine doctors in Myanmar.
Our faculty for this course was made up of 11 Myanmar instructor candidates teaching their first provider course, supported by a nine member Australian faculty. The course was a tremendous success with all 25 candidates successfully passing (three candidates were required to resit the MCQ at a later date and all were successful).
The Masters of Emergency Medicine candidates impressed us greatly with their enthusiasm, passion for learning and already impressive knowledge base and it was most rewarding to have the opportunity to work with this lead group of new Emergency Medicine Specialist doctors in Myanmar. A massive amount of planning and work has gone into making the Masters of Emergency Medicine course a reality. A significant number of Australians have worked closely with the University of Medicine 1 in Yangon, contributing their expertise and vast amounts of time to this exciting development.
As with previous visits we were very generously hosted by all our Myanmar colleagues and friends. In particular we would like to thank Dr Aye Thiri Naing for her tireless commitment both to ensuring our visit went smoothly and for her unwavering commitment to embedding APLS teaching into Myanmar in partnership with Rector Professor Zaw Wai Soe.
We were able to visit both Yangon General Hospital and the Yangon Children’s Hospital thanks to Dr Rose Skalicky and Dr Aye Thiri Naing. It was fantastic to see significant improvements in both the physical spaces and equipment available for emergency care at those two hospitals – especially when compared to our first visit in 2013.
I would also like to pay tribute to the enormous amount of work that Michelle McCarthy did in the role of course coordinator / faculty member for a number of weeks prior to the course and thoughout the seven days we were there. In addition, a big thank you to Sharlene Kinnaird, Sally Guthrie and Phillip Davies from APLS Australia as well as the APLS International Subcommittee for their significant support of this wonderful partnership in the acute care of Myanmar children.
During our visit, Noel Roberts generously donated a pair of ALS child mannequins and Stephen Priestley provided the latest 3rd Edition of the Pocket Guide to Teaching for Clinical Instructors to the 12 instructor candidates.
On this third visit it was wonderful to have an Australian group made up of four “Myanmar returnees” in addition to five APLS instructors making their first international teaching trip. Our new instructors were immediately engaged and enamoured by the special relationship we have developed with a large number of colelagues in Myanmar.
Future plans for 2018 include returning to conduct at least two provider courses supporting our Myanmar instructor candidates, and consideration of running courses outside of Yangon in the future. We greatly look forward to seeing the future development of APLS in Myanmar and will continue to support the local teams towards self-sufficiency.
“Eleena, the country’s only paediatric cardiologist, learnt Hindi for medical school in India – then her paediatric cardiology training required her to learn Thai...”
2017 marked our third successful visit to this country of revealing contrasts.
The pre-course dinner again showed that cultural differences are no barrier to the engagement in the APLS ideals. The dinner saw cultural exchanges of traditional Maldivian dance and songs give way to Oz Faculty rendition of Waltzing Matilda and the unforgettable adaptation of local dance steps by Adam Buckmaster!
Provider course candidates were a mixture of nurses, local and overseas doctors from paediatric, emergency, anaesthetic and medical officer backgrounds. The course gave local instructors their first chance to apply skills they learnt last year. They performed magnificently and showed true dedication to the highest standard of teaching and a wish to add to their skills.
This was followed by the second Maldivian Instructor Course, successfully bringing local instructors up to 15. The support of this venture by Sri Lanka through Dr Srilal de Silva and Dr Bhiruntha Sivakanthan (instructor and coordinator) was instrumental in our success. This underlines the importance of local support networks.
Integral to the success in any overseas project is the local heroes. I first met Dr Ismail Shafeeu in Sri Lanka when he travelled to do his APLS provider and instructor course. His unselfish dedication to bring improvements to the care of children in his country was vital to the success of the program. Subsequently the involvement of Niyasha Ibrahim (Head of Paediatrics) with the support of UNICEF, the CEO of the Indira Gandhi Memorial Hospital and the Ministry of Health has ensured ongoing viability of the project.
As first mentioned, the Maldives is a country of contrasts. Known as a luxury tourist destination, its major industry, it is much more than this. It consists of 26 atolls and over 1000 islands. It is the world’s lowest lying country with the highest point being 2.7m! Male is the world’s most densely populated capital, with 40% of the population living there but you can walk around it in two hours.
From the medical education point of view, it has challenges. There is no medical school so all local doctors are subsidised to go overseas to train. For example, Eleena the country’s only paediatric cardiologist went to medical school in India necessitating her to learn Hindi and then did her paediatric cardiology in Thailand requiring her to learn Thai! Half the doctors come from other countries including Nepal, one of the world’s most elevated countries! This eclectic mix of doctors brings vibrancy to the local medical scene.
It is hoped that the APLS program will ensure ongoing postgraduate training in acute paediatrics for doctors and nurses. Already secondary gains in teaching are being seen.
We look forward to returning next year hopefully with an improved cultural contribution.
“For many it was the only resuscitation teaching they had ever received…”
Dr Sarah Dalton, Dec 2008
In August and October this year several Australian APLS instructors braved the wild seas of the South Pacific and headed over to Fiji to conduct the first APLS course in that country. Many years of planning came to fruition with the help of Joe Kado and Elizabeth Rogers, local paediatricians who completed their APLS Instructor courses in Australia.
Fiji is a nation of more than 300 islands, with one tertiary paediatric hospital situated in the capital, Suva. The Colonial War Memorial Hospital is a teaching hospital for the Fiji School of Medicine – the only medical school in the South Pacific and situated right next door to CWM. Postgraduate training programs are coordinated by these institutions and registrars are rotated throughout Fiji during their training. Many of these trainees are now APLS providers.
Three APLS provider courses were held at CWM, attended by an incredibly diverse and enthusiastic group of candidates. From distinguished Professors to first year registrars in paediatrics, anaesthetics and surgery, they all had a lot to give and seemed to lap up the opportunity to learn.
For many it was the only resuscitation teaching they had ever received and for most, their first experience of scenario based learning. For us it was amazing to learn about their experience of tropical illness and seriously unwell children, as well as to wonder at how they manage without purpose-built intraosseous needles, defibrillators and many of the other tools we take for granted in intensive (and expensive) care!
The courses ran very smoothly and were enjoyable for participants and instructors alike. Some of the scenarios had to be modified to be believable (skiing injuries were out!) but there were plenty of local adaptations to be made … just see the photos.
The candidates did extremely well, and all of them passed the practical aspects of examinations which were conducted to the same standard as APLS Australia. It was fantastic to see each of them develop over the 3 days and at the end of the course everyone was exhausted but very pleased.
Our next challenge is supporting the new APLS Fiji in their future development. After one instructor course there are now 10 local instructors, with plans underway for more instructor and provider courses in 2009. Thanks to everyone who has been involved in the process, from funding applications to equipment management and, of course, the faculty who gave up their time and leave to introduce APLS to a whole new family.
"We now have a critical mass for APLS Cambodia to be fully self-sustainable..."
Dr Setthy Ung, Feb 2010
In the late 1970s the Pol Pot regime destroyed most of Cambodia’s infrastructure, including its healthcare system. It has only been in the last decade that economic and political stability has begun to return, giving APLS Australia the chance to contribute to the redevelopment of Cambodia’s paediatric acute care health system.
During December 2009, the sixth APLS Provider course and third APLS Instructor course were held in Siem Reap at the Angkor Hospital for Children (AHC).
Thanks to the highly successful nature of the courses, and many Australian Instructors, APLS has become well established in Cambodia’s developing paediatric health system as a pre-eminent paediatric resuscitation training and accreditation framework.
Now, at the beginning of 2010, there are 140 accredited APLS Providers, 9 fully qualiﬁed Instructors and 15 Instructor Candidates. This is a critical mass for APLS in Cambodia to become self-sustainable, and look to the creation of its own franchise. Faculties are now approaching 100% Khmer, with two local Course Directors each having completed their ﬁrst Director Candidacy.
From here, we are looking to accredit Khmer Instructors to teach on the Instructor courses, and to obtain approval from the Cambodian Ministry of Health, for APLS to be the ofﬁcially recognised standard for paediatric resuscitation training in Cambodia.
For further information about Cambodia, please see the AHC website, www.fwab.org
"In 2005 when APLS training began, Cambodia had 65.4/1000 livebirths die under the age of five years. In 2015, that figure was 28.7..."
Dr Setthy Ung, July 2017
As Cambodia now enters its second decade of APLS training to its paediatric hospital clinicians, its leaders and senior instructors sought to evolve its curriculum to match with its blossoming paediatric acute health care system and that of the rest of the international APLS courses.
The first APLS Provider course in Cambodia was held at the Angkor Hospital for Children (AHC) in Siem Reap comprising a full Australian faculty. With the support of many Australian APLS instructors donating time and teaching resources between 2005-2015, the AHC holds the three day APLS Provider and more recently the one day PLS course throughout the year to ensure the highest standard of acute paediatric resuscitation is provided across the country.
With now over 500 trained APLS providers and over 50 Khmer APLS instructors, it has developed the faculty base to ensure training continues well into the future and as of consequence, the lives of many children saved from acute reversible causes. In 2005 when APLS training began, Cambodia had 65.4/1,000 livebirths die under the age of five years. In 2015, that figure was reported to be 28.7. Although contributed by many factors including economy development, one would ponder whether the APLS movement in Cambodia played at least a small role in this improvement.
During the inception of APLS in 2005 the defibrillation module of the APLS curriculum was purposely omitted as at the time, the level of acute health care was not compatible with it. However, as cardiac surgery has become a regular service performed at the AHC and the growth of a fully equipped post-operative cardiothoracic services in its PICU, the need for the introduction of defibrillation into the Cambodia curriculum finally came to pass.
The defibrillation component was introduced into the Cambodia curriculum first by re-training the senior Khmer instructors, many of whom had achieved their initial APLS accreditation in Australia. Secondly, I ran an intensive one-day workshop for predominantly its senior faculty to be trained the elements and how to teach defibrillation utilizing the four stage technique. Thirdly, I supervised the senior Khmer instructors teach the remainder of the Khmer instructors. Lastly, the most recent APLS Provider Courses have included defibrillation to bring it on par with other courses run internationally.
""We were practicing with mannequins, and suddenly everything became very real..."
APLS New Zealand chair Dr Jeff Brown was directing an APLS course at a central Christchurch hotel when the 2011 earthquake struck. The faculty and candidates were some of the first medical staff on the scene of the disaster. Listen to his experiences here:
The Malaysian APLS project has been the first joint UK/Australia APLS outreach project.
Under the direction of Dr Chris Vallis, a senior APLS Instructor and anaesthetist from the UK, who was also part of the original British team that brought APLS out to Australia, a small team of British and Australian instructors ran the first APLS Provider and Instructor courses in Alor Setar, Malaysia in 2010.
A key paediatrician was chosen from each province by the local champion Dr Teh to attend the first Provider and Instructor courses. Many courses were subsequently run each year in multiple other sites including Epoh, Penang and Kuala Lumpur. With great buy in, initiative, hard work and dedication from the local Malaysian faculty, they were running APLS Provider courses self-sufficiently within three years.
Those original key paediatricians then became the local APLS Directors in their provinces. Several local instructors were also chosen to become members of the GIC faculty with the goal that one day soon Malaysia will also be self-sufficient for the Instructor courses.
The Malaysian APLS project has been an extremely successful and rewarding venture, as well as a great culinary experience, and lifelong links between the three countries have been made.
Dr Abdul Rasaq-Musa
Dear APLS instructors,
I thought to write a summary of the first Iraqi Paediatric Life Support, IPLS course we recently run in Iraq from 25th May until 5th June 2014.
The IPLS is a three day course. The first two days covers various aspects of Paediatric-resuscitations that are suitable to developing countries using mixture of lectures, videos, skill stations, round table teaching methods and clinical simulation scenarios focusing on the management of cardiac arrest in children as well as the management of seriously unwell child. The IPLS course also teaches non-technical skills among the resuscitation team like leadership, effective communications and task allocations.
One of the big hurdles of the course was finding suitable pre course reading material. The help & assistance came from APLS Australia which donated 50 copies of APLS manuals which were distributed to the candidates. The APLS book was a huge hit in the course as the candidates found it very useful with its precise, well structured, well illustrated and easy to read chapters.
The IPLS faculty would like to thank APLS Australia for its help, cooperation and willingness to give. APLS Australia should be proud of its philanthropic arm and assistance to many developing countries.
To ensure sustainability of the course and training continuations to other health professionals in Iraq, we did these three steps:
1. Train the trainers: On day three of the IPLS course, we selected 16 out of the 59 candidates who attended the course in the three hospitals and did well in the first two days and trained them to be IPLS trainers. We now have 5-6 trainers in each Province.
2. We provided all the relevant teaching materials, both in electronic form and hard copies as well as a box containing all the necessary equipment to run the course.
3. Agreement with the relevant Health Authorities to ensure the training continues and delivered to other health professionals in the Province.
The above three day IPLS course was repeated three times in three different children's hospitals in three Provinces in Iraq over a two week period.
The course was great success and things went quite well. The fifty-nine candidates who attended the IPLS course in the three children's hospitals were senior medical staff (Pediatricians, Paediatric trainees, General Emergency Physicians, Anesthetist & ICU Consultants) and nursing staff (ICU, ED, NICU and Paedaitric wards). This interdisciplinary mixture of health professional was important break the hierarchy of the medical system in Iraq and removes the boundaries between medical and nursing staff).
Finally, we feel the IPLS design and contents is suitable to any developing countries where resuscitation training is either scarce or non-existent.
Find out more about IPLS via www.iplscourse.com
“This golden opportunity APLS granted me is not just helping me but my country as well…”
Dr Mika Ah Kuoi is the A&E Registrar at TTM Hospital, Apia, Samoa. He received a Paediatric Emergency Scholarship for an APLS course and attachment at Royal Children's Hospital, Melbourne, Aug 2010.
What a month of experiences I had!
It all started when Samoa underwent hard times with the tsunami on September 2009, where the opportunity was introduced to me by the Royal Children’s Hospital Melbourne team that was letting a hand to help with the disaster’s aftermath.
Then, the hunt for all the required documents and research for the application was initiated knowing that I will face a slim chance because the scholarship was for Asia and Pacific. However, it was an enjoyable festive season after being awarded the scholarship on 18th December 2009.
The coordination of the whole trip with the bookings and communication was greatly done. The accommodation was excellent, being safe and very close to the hospital just made everything convenient.
Getting to explore Melbourne was great, especially with the help of the pre-guide information that was provided; it just made my involvement in social events and functions even better.
The attachment at the RCH gave me lots of new ideas, especially eye-witnessing most of their practices that are not done here in Samoa. It also gave me the appreciation of what the Samoan doctors are delivering to the people after identifying the similar hitches that are found in TTM Hospital as well. The Emergency Department staff nurses and doctors at all level were friendly and helped me throughout.
Learning throughout the clinical attachment was pleasant especially with the teachings on Wednesdays and Fridays. It was also an honour for me to take part in presenting on the 10th March grand-round together with Mr Julian Meagher from the Department of Human Services and A/Prof Simon Young, director of RCH Emergency Department.
A temporary registration to have contact with patients will give a much more broader experience, however, it is understandable as these measures are put in place to protect the integrity of a health service.
Ambulance Services experience on the Air Ambulance and the MICA single unit responder was just another excellent perception of picturing a complete scenario of patients that are stabilised before they arrived at Emergency Departments. It was also an opportunity for me to explore Victoria on the same time from air view and getting to know people and their duties on the field.
After all the intense APLS course was great learning and good opportunity to meet up with some other doctors around the globe. Materials and the whole curriculum are realistic and can be easily applied even in a setting like Samoa. Passing the course and being invited to become an APLS instructor is giving my whole trip a greater value.
Lastly but not the least, many thanks to the APLS programme especially its current President, A/Prof Simon Young, for hosting me throughout the whole month of staying, learning and enjoying Melbourne.
This golden opportunity APLS granted me is not just helping me but my country as well as I will now use and share this knowledge in delivering our services to the community.
Moreover I hope to see the APLS course running in Samoa soon as this is just the beginning of my journey as an emergency physician.
By Setthy Ung
As the population of APLS Australia & New Zealand instructors grows, there is increasing capacity for its volunteer members to make a difference in other parts of the world.
Many of you have become APLS instructors because you believe in a cause greater than yourselves; to improve the standard of acute health care for children and to ultimately save lives through developing the systems of others.
Many of you will travel throughout the developing world and some of you will donate your time and skills to volunteer in their health facilities. I am certain those who have in the past or currently work in developing systems would all agree that in comparison to flogging yourself and others resuscitating every sick or injured child you can find yourself, the greatest gain for a developing country is when a teaching curriculum such as APLS can be implemented and spread across its entire acute paediatric health system.
Getting the idea from a mere thought of altruism to proposal draft, to full implementation and then on to long term sustainability can be a lengthy, resource intensive and arduous process. It can be very rewarding to both the population of children who will benefit from it as well as the volunteers who donate their time, energy, heart and souls throughout the process.
But how do you go about turning that light bulb moment into a reality? The following is a simple list of what I would recommend to others to consider before embarking on such a pilgrimage.
1 | SUSS OUT THE PLACE FIRST
Doing your homework first includes understanding what resuscitation curriculums are already in place (eg. Emergency Triage Assessment Treat - ETAT), what the state of the health system is (currently and predicted for the future) and what the state of the nation is.
Many developing nations may already have philanthropic parties or NGOs providing the WHO ETAT course which can both complement the APLS curriculum (eg. Airway opening maneuvers are taught the same) and contradict it (eg. Heimlich maneuver still taught by ETAT) thus there may be a need to sit down with the local health authorities to negotiate what APLS content you will teach and which content you will not teach until agreement between the APLS curriculum and national resuscitation guidelines or policies can be achieved.
Some health systems do not have any acute health care systems in place (eg. no acute hospitals) nor equipment to resuscitate (eg. no oxygen supplies, no ETTs or BVMs and no IV catheters) which may make APLS training moot as an APLS trained clinician without emergency equipment may not be able to provide effective care once back in their usual workplace despite being trained to do so.
If there is a lack of political stability (or worse open warfare), trying to implement the APLS curriculum would perhaps be futile. The success of any long term APLS project relies heavily on communities being stable enough to build equipment pools, develop healthcare networks and to retain its trained providers long enough to become instructors themselves to teach future generations. Wars and unstable governments tend to result in equipment going missing or destroyed, networks being disbanded, and healthcare providers being displaced from hospital environments (or worse targeted by aggressive factions).
Also, to consider is the level of tourism of the potential city or country. Even though most APLS Instructors are like-minded people who enjoy teaching others, with the exception of a handful who may have particular cultural experience or affiliations with the community you are investigating, at the end of the day most of the faculty you will try to recruit will be tourists. Thus, apart from the safety and security issues for your traveling faculty, you will need to consider how appealing the hotels, local food, tourist sites, airports and means of transport are.
2 | DO SOME HARD TIME
Just because you and the entire APLS Instructor membership think a community or nation would benefit tremendously from inserting APLS into their mandatory paediatric training systems, unfortunately doesn’t automatically generate buy in from the locals.
Earning a level of respect and credibility in the eyes of the local health care authorities and providers is of the utmost importance in trying to implement a self-sustaining education curriculum. In the long term, money nor the donation of medication supplies or expensive medical equipment can buy it either.
I think the best way to ‘pave the way’ is to display your own APLS skills and to give them snippets of resuscitation teaching by living and working alongside the local healthcare providers. The period required to do this may vary depending on how far away from acceptance you are as a colleague when you have started to develop a rapport. However, once accepted as a colleague and suspicions of hidden religious or political agendas have been dismissed, requests for you to contribute your APLS skills and knowledge will undoubtedly follow.
3 | FIND A LOCAL CHAMPION
At the end of the day, you will never be considered a ‘true local’ and unless you are intending to spend the entire project period of 5-10 years there physically, you will need a local champion to advertise, facilitate, encourage and help coordinate the first and future courses. Invariably, it will be one of the local senior doctors or nurses who the healthcare system already gravitates to and respects.
The person selected will need to have a pivotal influence within the local health system, be charismatic and ultimately have the qualities of being a good Instructor (and Course Director). It is hugely important that the right person is selected for this role as it will minimize the effort you will need to input to maintain then sustain the project. Once identified, this champion may then access the Paediatric Emergency Development Scholarship offered by APLS Australia to come to Australia to attend their own APLS Provider or Instructor Course.
4 | GATHER YOUR FIRST TEAM
Your first faculty will need to comprise Australian instructors who are experienced instructors and it is also wise to have at least some who have taught on international courses before to draw on their experiences when the unexpected occurs. The smaller the faculty the better, to minimize the perception of ‘invasion’ by the locals as well as make it easier to transport and accommodate. Unlike the usual faculty of around 12, I recommend a faculty of about 8 not including the course coordinator and course director. It means more work for everyone involved but the locals will get to know your faculty better and vice versa. If you can find instructors who are multilingual or speak the local dialect then it will give you better flexibility to assist candidates who may not have good English. A good mixture of age groups, genders and craftgroups (ie. Nurse instructors, Anaesthetists, Emergency Physicians, Intensivists, Paediatricians etc) also allows flexibility when allocating mentors when faced with unexpected cultural (hospital and social) challenges.
If there are already local APLS Providers trained in Australia, UK or elsewhere already but not yet trained as Instructors, they can be excellent support staff during your first provider course and invariably you will benefit by getting them to serve with your faculty.
The International Subcommittee handles a database of instructors experienced and interested in international courses and can help recruit your first and ongoing faculties.
5 | INVITE ALL THE VILLAGE ELDERS
Although it can be quite painful, when running the first provider course, I recommend making a song and dance of it and inviting all the local VIPs such as the government health official, heads of departments and even royalty if they are around. Not all will attend and some will send a minion in their stead but it will appease the local deities and assist in ensuring the maintenance and sustainability of the project. Even invite them onto the course as a candidate if they are of the appropriate background but god help you if they fail.
6 | PREPARE AS IF YOU'RE GOING INTO SPACE
Ensure that you spend some time prior to the first course (and I suggest even before leaving the country) that everyone is briefed on cultural issues and expected barriers. Travel insurance, mobile phone roaming activation and itinerary sharing with contingency plans for emergencies should be considered well before anyone steps on to an airplane.
Refer to DFAT and know the risks of the country you are heading into as you usually would do when traveling overseas. To make it easier on yourself, it is wise to choose a first faculty who are experienced travelers, who have traveled to the environment before and who even have traveled with other faculty members before.
Physically take your first teaching kit with you if possible. It may feel weird to carry manikins through security and customs but unless you have already ensured your first course’s venue has a full teaching set equipped through your own hands, I would not recommend risking having a teaching kit travel separately from your faculty. Developing countries tend to have the least reliable freight (and sometimes luggage) handling services so don’t put your first course at risk of not being equipped.
7 | BE PREPARED FOR THE EXPECTED & UNEXPECTED
Every course you run internationally, no matter how fastidiously you prepare something will go wrong. Good preparation will minimize the impact (eg. packing enough travel medications for you and your entire faculty) and ensuring that you are well-connected with your faculty throughout the entire travel period will be the best thing to ensure that no matter what calamity occurs you can all deal with it together as a team.
8 | START TRANSITIONING OWNERSHIP EARLY
Hold Instructor courses as soon as possible after Provider courses to take advantage of the momentum and enthusiasm many strong candidates your faculty selects to become local instructors possess immediately after their Provider Course. This often maximizes the donated time of the Australian Faculty that you have recruited and has traveled with you.
As soon as you have identified the future leadership and ownership of the curriculum, get the local instructor candidates to first shadow the Australian faculty then instruct the courses (including the Generic Instructor Course) themselves. Especially with the ‘train the trainer’ concept, they will need mentoring to eventually fully take responsibility for the sustainability of the courses.
9 | ASSESS & AUDIT
Encourage the Course Directors of the local faculty to collect data, course report and course feedback information from the start so that they can modify the teaching of and the content of their courses as a dynamic process to help improve the compatibility of the course curriculum to the needs of the particular health system being targeted for development.
Setthy Ung is an Australian-Khmer Emergency Physician for Campbelltown Hospital-Sydney, NSW. APLS Course Director & Instructor, Medical Volunteer for the Angkor Hospital for Children in Siem Reap-Cambodia, Cambodia and the Lao Friends Hospital for Children in Luang Prabang-Laos.
Selected photography by Tom Walwyn, Setthy Ung.