EBME Forums Forums Management Training Advice would be really appreciated

No Geoff - the Pacific has major problems with RHD and so we have literally hundreds of young people who will have a very short life expectancy if we dont do something about it - unless the family can afford to pay for the medical treatment in Australia or New Zealand and can convince the authorities to issue them with a visa (also difficult as a very large deposit is usually required). Thats also assuming that someone can come up with the $40 thousand a medivac costs, then its a death sentence - in Tonga a paediatrician who is a close friend actually started a screening program to target children in the suceptible age group (RHD as you may know is caused by a bacterial infection that is easily treatable with antibiotics if detected early enough) as a result of her efforts rates went from 17 % to less than 1 % and she was awarded the International Heart Associations international cardiologist of the year award last year - its having the privelege of working with people like that that makes my job so rewarding. By the way the last open heart visit which finished two weeks ago performed 32 proceedures including 29 single or multiple valve replacements in ten operating days - they are all Australian volunteers that give up there vacation time to come and do this so its humbling.

Yes. Good stuff.

So I guess I may as well mention another of my favourites, then:- having hospitals in the "Developed World" (or whatever we like to call it) sponsor hospitals and clinics "out there".

That is, not only with "working visits" of the kind you mention, but also exchange visits (or placements), equipment donations, advice, training etc., etc. ... in fact, "mentoring" in general.

To my mind, that way forward "ticks all the boxes"!

Meanwhile, as we know RHD is basically a preventable condition ... so it sounds a bit like the emphasis out there needs to be (more) on Primary Health Care!

it sounds great in theory but what i have found in practice (and we do have these partnership arrangements with hospitals in the region and the 'States) is that often they have a first world frame of reference - for example a visiting surgeon was insisting that the theatres buy an istat for immediate blood testing at a cost of several thousand $. I asked him to look out the theatre window to the opposite window several feet away and wave to the guy there - he seemed puzzled until I pointed out that was our haemotologist and the path lab was twenty feet from theatre where we have very capable staff and equipment to get his results quickly. I also run into the issue that staff at a partner hospital suddenly become zealots and send every item they can regardless of age, suitability or even checking if our clinicians have the skillsets needed to use the equipment, completely ignoring the procedures I have instituted for assesment - the WHO own figures indicate that less than 20% of donated medical assets are worthwhile and the rest, at least in my backyard, pollute some of the most exotic and breathtaking tropical islands in the world as I am paid well to live in these dream locations and feel a certain degree of ownership of the region I am not happy about that.

As for RHD and other chronic NCD's here - to give you an example - the Cook islands are made up of 15 small islands over a greater sea area than mainland Europe occupies - the Northern group are only accessible by a several day voyage in a chartered boat - primary health care here is only applicable if you can get the staff to the location - there is also a reliance on traditional healers - witchdoctors if you like - by the time we see them it is often too late and it negatively reinforces our image (they went to hospital and died anyway - the fact that if they had presented four weeks ago instead of getting a shaman to wave a smoky stick and chant over them we may have saved them).

Well, I guess we all know that surgeons often have to be handled with care!

Charity folk that I have come across here in the UK usually work against a "wish list" of equipment for donation. That is, it's a "pull" situation (as far as the recipient is concerned), rather than a "push" (from this end). This is as it should be, I feel.

Meanwhile ... Doom on all Zealots (not to mention purveyors of mumbo jumbo by the sound of it)!

Yes, the Grass is Always Greener (as "they" say) ... (even when it was in fact the dirt, as it was usually in my own case of adventures outside the Western Comfort Zone).

How's the internet access situation in the Northern Cook Islands, I wonder?

Internet is non existent - a lot of these islands dont even have a phone service - that's the same throughout the Pacific sadly except for Niue which is a single island and instituted free wireless internet over the entire island.
I have no mobile in the main island at the moment because i left my sim in Fiji and the telco has run out of sims and cannot give me a date for replacements - again our issues are much different to first world.

The WHO donated equipment guidelines are very clear on the point of not sending unsolicited donations but even in the biomed community I find there is very little awareness these guidelines exist

Satellite is the answer there, then.

Better get those on the "wish list" as well!

Not so much Third World -versus- First, but more like a small population sprinkled over many small islands, scattered over a vast expanse of ocean, I would have thought.

That ... plus long pipeline times to and from the "Mother Ship" (New Zealand, presumably).

Or, in a word:- logistics!

yes - certainly not a versus situation - but satellite phones are expensive and give someone a satellite phone here and it becomes their personal property much in the same way vehicles do with the result it does not get used for its intended purpose - actually I "lost" four laptops the same way a few months back.
first world help is nessesary and much appreciated but it needs to be done with an awareness of the unique cultures we have here - I have just helped plan and design two new referral hospitals - one was Japanese aid and the design team and I sat down for several weeks and came up with a really good well designed facility - the second was funded through China - they gave me the plans and said thats what we are building - when I asked about specifications and standards it was always "as we specify' or "Chinese standards" - they wouldnt even detail what light fittings they are providing - as a result the hospital is going to be struggling before it begins and the country will be faced with a very expensive bill if they choose to bring the hospital up to AS/NZ standards.

No, not satellite phones. I meant internet access via satellite (dishes).

And yes, I'm aware that the Chinese are "moving in" out there (as they continue to do in other parts of the world). Not much the Kiwi's can do about that, for sure.

It's the New World Order, after all.

most of these islands dont even have reliable power - a couple of hours every few days and the spikes kill electronics dead.
we operate on gas or solar powered equipment wherever we can but again if its gas we need or diesel powered we need a way of getting a regular supply - one of my hospitals served raw fish for a week as there was no cooking gas.

and thank whoever for non refrigerated pharmacuticals!

so I am afraid internet is, of nessesity,way down our list of priorities at the present.

BTW I am Australian myself - AusAid seem more focussed on discouraging Cuban Doctors moving into the region than China which is sad as the Cubans I have met are very professional and really nice folk.