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Implementing an EM training
program in Nepal and Myanmar
The 2nd IEC Symposium, 2013
Chris Curry
Assoc. Professor, University of Western Australia
Emergency Physician, Fremantle Hospital
chris@chriscurry.com.au1
Strategies
Derived from
• New Zealand 1986-1996
• Papua New Guinea 2001-2007
“A perspective on developing emergency medicine as a specialty”
International Journal of Emergency Medicine 2008; 1: 163-167
2
Strategies - 1
For creation you need
- champions
- a ‘union’
- administrator support
- bottom-up development
- top-down development
- energy, endurance
Brahma - creator
3
Strategies - 2
To prosper
- use benchmarking
- borrow from others
- take advantage of local events
- take advantage of local interests
- recognize local appropriateness
- link EM to primary care and
public health
Lakshmi - prosperity
4
Strategies - 3
To succeed
- educate everybody
- organize an independent training
program
- become instructors
- look for sustainability
- prioritize the direction of effort
- overcome roadblocks…
Ganesh - success
5
Seven years in Nepal
2007 IEMSIG Newsletter - BPKIHS
EMCON 2007
2008 visit to BPKIHS
2009 Nepal Medical Association Conference
visits to BPKIHS, TUTH
2011 Nepali delegation to ACEM
Doctor of Medicine in EM at TUTH
2013 NEMsem13
Fellowship in EM at BPKIHS, PAHS
Emergency nurse training
6
2007
7
Textbook of Emergency MedicineSuresh David, Anthony Brown, Brian Nelson, Ashis Banerjee, V. Anantharaman
India 123
USA 42
Singapore 40
Australia 24
UK 17
China 5
South Africa 4
Malaysia 3
Hong Kong, New Zealand,
Nepal 2
Bangladesh, Sri Lanka, Oman,
Israel, Malawi, Liberia, Italy, France,
Sweden, Germany, Canada 1
Authors
8
2011-February Institute of Medicine
11
Curriculum
DM Emergency Medicine
Tribhuvan University Institute of Medicine
Maharajgunj, Kathmandu, Nepal
2011
2011-October
12
Delivery of support to IOM/TUTH
2012 – Mark Monaghan, Chris Curry (x2), Ryan Tan,
Adrian Goudie, Gina Watkins, Athol Steward,
Tony Mattick
2013 – Jamie Hendrie, Chris Curry (x4), Adrian Goudie,
Sanj Fernando, Tom Morton, Gina Watkins,
Kavita Varshney, Brian O’Connell, Ruth Burns RN,
Mike Nichols, Guru Nagaraj, Jennifer Rush,
Mark Monaghan, Ros Taylor, Rob Currie,
Margaretha Offringa RN, Tony Mattick, Jo Koryzna
17
BP Koirala Institute of Health Sciences
18
Ten years at BPKIHS
2004 Owen Lewis Prof GP&EM
Gyanendra Malla to Adelaide
2006 EM Curriculum Workshop
- Suresh David, Anantha
Application to Academic Committee
2008 visit
2009 visits
2012 New VC, BP Das, visited Perth
Academic Committee approval
2013 Fellowship in EM: October
19
2013
Rabin Bhandari
Gyanendra Malla
20
Delivery of support to BPKIHS
2012 – hosted Vice Chancellor BP Das
at Fremantle Hospital
2013 – Chris Curry (x2), Gaynor Prince,
Mark Monaghan, Ros Taylor, Rob Currie,
Ric Todhunter, Jacqui Thomson
21
Five years in Myanmar
2008 Cyclone Nargis
2009 Primary Trauma Care
2011 Prof Zaw Wai Soe
to ACEM ASM Sydney
2012 Symposium
Myanmar 18 (M18)
MEMIC
PTC, EMST, ASSET
2013
22
Champions - Myint Thaung, Zaw Wai Soe, Maung Maung Htwe
23
Myanmar EM Introductory Course (MEMIC)June 2012
24
2013
FACEMs in residence Chris Curry, Michael Augello,
Shona McIntyre, Georgina Phillips, Antony Chenhall
Courses ELSi, MIMMS,
TotR, Pain Mx,
ACLS (HK),
Ultrasound (HK),
APLS, Alfred Trauma, Toxicology
AVID FACEM Rose Skalicky
AVID Ambo trainer Nigel Klein
25
2014
Repeat of 18month Diploma in EM
AVID positions – x2 FACEMs, x2 ambo trainers
Visiting short courses
Etc
Towards an MMedSc EM
26
For creation
BPKIHS IOM/TUTH Myanmar
- champions 2004-
Owen Lewis
Gyanendra Malla
2007-
Ramesh Maharjan
Pratap Prasad
2009-
Zaw Wai Soe
Myint Thaung
Maung Maung Htwe
- a ‘union’ Myanmar Medical
Association
- administrator support In 2012 Partial Yes
- bottom-up
development Gyanendra Malla Ramesh Maharjan Some of M18
- top-down development VC, Rector Director, IOM
Med. Ed. Dept.
Minister of Health,
Rector UM1
- energy, endurance Gyanendra Malla Ramesh Maharjan champions, M1827
To prosper
BPKIHS IOM/TUTH Myanmar-use benchmarking Time in Adelaide Visits to Australia Visits to Australia,
Hong Kong
-borrow from
others
ACEM ACEM ACEM, RACS, IFEM,
Hong Kong
-take advantage of
local events
Change of VC Med Council India
recognition of EM
Cyclone Nargis
-take advantage of
local interests
Rivalry with IOM Need to lead SEA Games Dec13
-recognize local
appropriateness
MDGPs in EDs MDGPs in EDs No ED at NayPyiTaw
1000 bedded
hospital
-link EM to primary
care and public
health
MDGP MDGP Leading pre-
hospital care
training28
To succeed
BPKIHS IOM/TUTH Myanmar- educate
everybody
Under way Under way Under way
- organize an
independent
training program
Yes Yes Yes
- become
instructors
PTC PTC PTC, ELS
-look for
sustainability
Future credibility, acceptability, employment
- prioritize the
direction of effort
To provide local
faculty
To provide local
faculty
SEA Games, ED
leadership,
MMedSc EM
- overcome
roadblocks… 29
Realities
“Things to do.. take time in Nepal”
“Things can change.. even in Nepal”
Culture trumps logic,
seniors trump juniors,
Nepalis trump foreigners
30
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