Taking Advanced APLS Techniques from Haifa to Kenya
Sometimes, all it takes to make a change that saves lives are two physicians and one nurse from Israel. Haifa’s Rambam Medical Center recently sent two senior physicians and a pediatric nurse to Nakuru, Kenya, to teach the local medical teams advanced resuscitation skills. Just a few days of lectures, practice, simulations and individual training transformed the African hospital teams and gave them a taste for improving their abilities to treat youngsters.
The course was conducted through the mediation and at the initiative of Prof. Ruth Margalit, who is responsible for the field of global medicine at the Technion-Israel Institute of Technology’s Rappaport Medical School, to which Rambam is affiliated. Until now, Rambam’s Children’s Emergency Team had gone only to European countries, such as Romania, to train medical workers, but never before to Africa, where physicians are few and far between and the skills and medical technology are way below those in the West. “They were very successful in the past, but we were a bit nervous about doing it in Africa,” admitted Prof. Itai Shavit, director of Rambam’s pediatric emergency department at Rambam Health Care Campus, and a clinical associate professor the medical school who headed the three-member team. Still, said Shavit, when they accepted the proposal, they “didn’t hesitate for a moment. We have the knowledge and skills to help save lives in places where they are needed.” Dr. Hadas Levin-Cnaani, a senior physician in the emergency room, was the second member, while Ravit Adelman was the experienced nurse. The trio went to teach an advanced pediatric life support (APLS) course to the Kenyans.
In the late 1970s, American pediatrician Dr. Martha Bushore-Fallis was working with Dr. Jerry Foster at the Children’s Hospital in Columbus, Ohio, to dialogue with their colleagues and improve emergency medicine for children. From their efforts evolved the American Academy of Pediatrics’ section on emergency medicine. Armed with a concept, but no endorsement, funding or even accepted clinical guidelines for many critical conditions, Bushore-Fallis and several colleagues began working on a manual based on the courses they had been teaching for several years. The first APLS course, implemented in 1984, was the result, and five years later, the first edition of the APLS manual was printed; since then, the manual was updated several times, and it was with this knowledge and experience that the Israeli team went to Nakuru Hospital.
“First, we spent a day learning about what existed in the field,” said Shavit. “It was very important to know what we were up against. We wanted to see what they needed for resuscitation, what conditions were common and what their priorities were. Once we understood the gaps, we decided where the emphasis should be and suited the APLS syllabus to local needs. There are huge gaps between Western and African medicine, but they wanted to learn.” Levin-Cnaani brought along special medical equipment including sophisticated simulation dolls on which the African doctors and nurses could work.
“It was the first time in their lives that they had touched simulation dolls to learn new techniques. Before that, if they made a mistake, it was at the expense of children. With simulation, they could learn, make errors and improve after watching films of what they had done,” added Adelman.
“It is important for nurses in the developing world to improve their skills, as there are few doctors; nurses are the first professionals that patients see and very often the last. They are the majority of the medical force there. We helped them improve their skills significantly, even in only a few days,” the Rambam nurse continued. Their Nakuru participants in the training agreed heartily.
To Israeli eyes, it is hard to imagine how the best medicine can be provided to patients in the Kenyan hospital,” added Shavit. “The infrastructure is old or non-existent; there is a great shortage of basic medical equipment, medications and manpower. There are very few doctors, and most of the work is done by nurses, but we came to improve the situation.” The Rambam team taught doctors and nurses how to perform lifesaving basic and advanced cardiopulmonary resuscitation, case management and the division and pace of work. They used equipment that the Nakuru teams had never encountered before. Their response and curiosity were amazing,” said Adelman. “At first, they were hesitant and embarrassed, but from moment to moment they felt more eager and confident. The challenge was great, but it was equally exciting to see how quickly the changes were made and how easy it is to make a difference.”
“We plan to continue this APLS training in Africa on a regular basis and to reach any place where we and our experience can help,” concluded Shavit, who was very pleased with the results achieved in such a short period of time.
In the Picture: Prof. Itai Shavit with nurses and doctors at Nakuru Hospital. (Rambam Medical Center)
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