1. Global ALSO Belize Lt Col Lyrad Riley, MD, FAAFP October 11, 2013

2. 2 Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Dr Riley has no commercial interests to any programs or products mentioned in this presentation.

3. Objectives Describe recent Global ALSO course Discuss funding/logistics for providing such a course Illustrate military/civil cooperation model Illustrate a sustainable, recipient-centered Train-the-Trainer educational program Introduction to US Air Force IHS program 3

4. Global ALSO Owned, developed by AAFP; designed to be exported Content of Advanced Life Support in Obstetrics Plus another ~200 pages with addenda on topics such as HIV/malaria, nutrition, and adjusting protocols for fewer resources Train-The-Trainer design; students become instructors, take over ownership of course Additionally, BLSO course exists for students with less training (ED, community health workers, nurses)

5. IHS Program Air Force Initiative, started 2000, intent to improve international health engagements Emphasis on joint and civilian cooperation Draws from all medical specialties Two types of IHS: –A: database of people with specific skills/experience –B: full-time geographic and functional teams

6. IHS team at each Combatant Command HQ; structure and utilization vary widely Various language and regional experience needed

7. New Horizons Exercise Large US military exercise- build schools, do med outreach, $ millions to execute; objective to train US forces (engineers, comm, PA, medics) scheduled yrs in advance IAW Theater Security Cooperation plans I was invited to planning conference Dec 2012 as former IHS; initially very broad (unfocused) objectives

8. Project Contributors AAFP/GALSO program- royalty-free intellectual property (exchange for data) AAFP Foundation- mannequins LDS Charities- student cards, posters Project HOPE- personnel, reproduction costs USAF New Horizons Exercise- transport/lodging for US forces, students Belize Ministry of Health- (site visits, student coordination)

9. Belize Background Information Former British colony, English speaking, size of MA, POP ~300K Per capita health care expenditure $262 (c/w $8,608 for US) No medical school; community health centers with nurses, +/- doctor, and 4 regional hospitals Strong public health system headed by Ministry of Health

10. Coordination of supplies, approvals, participants, locations Jan- April Assemble team in Belize city May 14 May Four teams assess maternal child processes and facilities (15- 18 May) Convene in Dangriga, mini instructor course, prepare materials/rooms 20 May 21-22 May 2013 GALSO course Lessons learned, meetings with US leadership and MOH 23-24 May Depart to US 25 May 10

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23. Way Forward with Belize GALSO 9-13 Dec planning to meet with GALSO Belize board; conduct ALSO instructor course; assess 1 st course with graduates Hope to train 6 instructors to participate in Summer 2014 GALSO course #2 Belize MOH to participate on Board, willing to accept ownership of future courses (working to be feasible to continue without US military subsidizing)

24. Learning Points/Summary When able, ideal to assess local circumstances prior to educational event Think long-range about sustainability Medicine can be a “tool of diplomacy” Exposure to Global ALSO course Leverage NGOs, US and host government programs