2.  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

3.  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

4.  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

5.  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

6.  Sourcing and buying equipment › Resuscitation mannikins etc  Finding suitable and willing APLS & GIC trainers › BSUH › UK-wide › South Africa  Selecting likely future trainers for 1 st APLS course  Choosing course venue  Sourcing Lusaka butchers...  Transporting: › 9 suitcases full of mannikins, airways, chest drains etc

9.  Timekeeping  Mobile phones  Roleplay  Adapting algorithms  Presidential election  Lusaka butchers  Wildlife

11.  24 candidates  9 Zambian instructor candidates (ICs) + 4 (UK) instructors

12.  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

13.  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

14. Everyone, pass or fail, hung around for handshakes and photos! (and the elections went off peacefully in the end...)

15.  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

16.  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)