Advanced Paediatric Life SupportLusaka 2011

Paul Seddon Royal Alexandra Children’s Hospital

BrightonSomwe wa Somwe

Department of Child HealthUniversity Teaching Hospital

Lusaka

How did it come about?

Brighton-Lusaka link› PS external examiner 2007› A personal contact: Somwe wa Somwe, Head of

Child Health, UTH› An ongoing conversation over a few Mosis:

Lots of kids don’t make it past the admission ward There’s no sense of urgency Doctors & nurses feel powerless Wouldn’t it be great if we could ....

› Set up Paediatric Life Support course in Zambia

Making it possible -2008-10

Making a case› 62% of child deaths at UTH happen within 48

hours of admission› Most of these are from potentially treatable

causes (pneumonia, gastroenteritis, malaria)› Limited resources are a problem, but so are

knowledge, skills and attitudes Getting the funds:

› DelPHE application 2009 – unsuccessful› THET Large Project 2010

Success: £82,000 from THET/BritishCouncil

Project Aims

reduce the mortality rate among paediatric admissions in the first 48 hours

build capacity in paediatric life support skills for doctors, nurses and clinical officers working in the emergency paediatric areas at UTH

build adequate resources to enable the sustained delivery paediatric life support courses in Lusaka, other healthcare institutions in Zambia and neighbouring countries

enhance recruitment, retention and professional development of healthcare workers

Making it happen 2010-11

Contacting organisations› Resuscitation Council / ERC “don’t support ventures

outside Europe”› Advanced Life Support Group

APLS? Developing country – consider EMNCH? (Not really appropriate for UTH) OK then – APLS it is

› Original plan: Run APLS course 2010 Select and train suitable candidates Return to do further APLS with new trainers

› Revised plan: do all the above in one trip

Preparations Mar-Sep 2011

Sourcing and buying equipment› Resuscitation mannikins etc

Finding suitable and willing APLS & GIC trainers› BSUH› UK-wide› South Africa

Selecting likely future trainers for 1st APLS course Choosing course venue Sourcing Lusaka butchers... Transporting:

› 9 suitcases full of mannikins, airways, chest drains etc

APLS 1

Challenges

Timekeeping Mobile phones Roleplay Adapting algorithms Presidential election Lusaka butchers Wildlife

Generic Instructor Course11 candidates

APLS 2 24 candidates 9 Zambian instructor candidates (ICs)

+ 4 (UK) instructors

APLS 2 “hard” outcomes

12 candidates (including 2 nurses) passed as APLS providers

10 of these flagged as potential instructors (will offer place on next GIC)

7 failed only knowledge MCQ – to retake this under supervision by Zambian ICs

4 did not achieve APLS, but passed as PLS providers – can retake whole course

1 failed to complete (illness) All 9 ICs passed: need to teach 2 more as IC

“Soft” outcomes

Even those who “failed” said they enjoyed the course & would change their practice

Some ICs were stars, others grew with the challenge

Advocates for change› Young bright Zambian instructors› Older respected opinion leaders

Looking at extending course to other centres in & beyond Lusaka

Link with South African APLS programme – mutually beneficial

Everyone, pass or fail, hung around for handshakes and photos!

(and the elections went off peacefully in the end...)

What we have learned

We need to train more than 8 instructors› Clinical commitments, natural wastage etc

APLS course is relevant to low resource hospital settings, but even better if adapted

We need to run PLS as well as APLS for maximum reach

South African connection very beneficial – hopefully both ways

Consolidating 2012-13

Further tranche of courses planned May/June 2012:› GIC – PLS – APLS

Start to recruit candidates ± instructors from outside Lusaka:› Copperbelt, Eastern Province

Re-audit health outcomes within UTH:› Broad brush (eg early mortality)› Detail (eg blood glucose)