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

2008, 2009 – BPKIHS, G Malla

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Nepal Medical Association

Annual Conference

2009

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2011-February Institute of Medicine

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Curriculum

DM Emergency Medicine

Tribhuvan University Institute of Medicine

Maharajgunj, Kathmandu, Nepal

2011

2011-October

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2012 – the old emergency room

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2012 – the new ED Red Area

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2013 – NEMsem13

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2013 – first consideration of nurse training

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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

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BP Koirala Institute of Health Sciences

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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

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2013

Rabin Bhandari

Gyanendra Malla

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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

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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

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Champions - Myint Thaung, Zaw Wai Soe, Maung Maung Htwe

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Myanmar EM Introductory Course (MEMIC)June 2012

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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

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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

Great

journeys

are taken

one step at

a time

31