Advanced Paediatric Life Support Lusaka 2011

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 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
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
Contacting organisations
› Resuscitation Council / ERC “don’t support
ventures outside Europe”
› Advanced Life Support Group
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
Sourcing and buying equipment
› Resuscitation mannikins etc
Finding suitable and willing APLS & GIC trainers
› UK-wide
› South Africa
Selecting likely future trainers for 1st APLS course
Choosing course venue
Sourcing Lusaka butchers...
› 9 suitcases full of mannikins, airways, chest drains etc
 Mobile phones
 Roleplay
 Adapting algorithms
 Presidential election
 Lusaka butchers
 Wildlife
24 candidates
 9 Zambian instructor candidates (ICs)
+ 4 (UK) instructors
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
Even those who “failed” said they enjoyed
the course & would change their practice
 Some ICs were stars, others grew with the
 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...)
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
 We need to run PLS as well as APLS for
maximum reach
 South African connection very beneficial
– hopefully both ways
Further tranche of courses planned
May/June 2012:
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)