And I would like to thank Kwame for inviting me to share with you my experience. And thank you for all of you for your interest. So I have no disclosure. I don't think it's something I would allege you. You know how it is hard to get critical care in low, limited resources. And access to critical care is really a crucial component of healthcare system. And resource-limited setting, it's a burden and it's substantial, especially when you cannot get access. And there's no data. And most of the country of limited resources who has critical care, and they don't even have real critical care and have enough data to talk about. So it's only Nepal and Uganda who has a national capacity, who has some limited data, who can find some statistics. But I can tell you Haiti, country of 11 million, where we have the poorest country in the world. And we have the most infant and children mortality, highest in the Caribbean. So we have only one pediatric hospital who has only 10 ICU beds. I can tell you how is the burden of taking care of those six children. So as you know, in limited resources, healthcare providers face a lot of challenges, not only about the knowledge, the experience, but also limited resources to take care of those patient in an onerous task. Lack of experienced people, so those pediatric patients taking care of by adult, generalist, and anesthetist, even those who doesn't know anything about simple pediatrics care. So not talk about critical care in kids. So this lack of senior experience in critical care make things even more difficult for us to take care of patients in Haiti. Not to talk about multiple responsibilities of everyone in our hospital, you are as well as the director of the hospital, you're doing the administration part, and you're also the caregiver. So it's really, really a burden and a hard holding. So everything started with a young woman who has the dream of becoming an intensivist and create a pediatric care in her country. So she has to travel all, after her pediatric training, she has to travel all over India doing two years of fellowship and come back to her country, but to face even more challenges. And how to do it? So we've partners and friends, we become friends and family in the States. We discussed a lot about how to do it. We came out with, we need someone in the ground who knows critical care, so that's why I had to go and get the training. But coming back, how are we going to do it? The only person, the only pediatric hospital with only 10 beds of critical care and the only one who knows the critical care, so has to train nurses and doctors and pediatric residents. So it's a lot, right? So we came with the idea of a bidirectional exchange where fellow from the States will come and help and our attending, pediatric attending will go there. But not only that, you know, there's a lot of pediatric critical care fellowship going all over the world, in India and most in Africa and throughout the regions. But challenges again and again, even with that, right? More problems, having, wanting to do, to create a fellowship, it's not that easy. You have to have the person, the experienced person, you have to have a lot, enough people to do the training, but that comes with overwhelming hours, more duties, long days, night and days, hours of work, even weekends. I can tell you when I came back, it was not easy. I didn't have any day off at all. And not only that, limited resources, no technical support, no infrastructure. We have to build everything from the ground, not easy. And boom, 2020, more problems, COVID-19 make it worse. Not even that, our country, we are isolated and more even, our situation, political issues became worse. We cannot have anyone come to our country because it's dangerous. So this is what all I was preventing, having someone in the ground who knows critical care. So what we did is, at this time, it was the time for us to do PALS for our resident. So I had to reach out to the people, the people in our partner in Minnesota, who was to come to do PALS course for us. And we talk about it and they said, why not try Zoom and do the PALS, which was a success. We even publish an article about it. And based off the data, we find out that it was really a successful and we continue doing. So come back with the fellowship in education in critical care. I reach out to my friends and partners in the US and they were like, yes, let's try. So we reach out to multiple people and partners who created a pediatric critical care curriculum. We discuss about how we're going to do it and creating a platform where it will be more something formal. Go back and do the training and we begin a remote training. So we had to record presentation for repeat listening for the learners, followed by interactive session where we discuss on the presentation, difficulties, asking questions and more questions and make sure that the resident knows and the attending understand the concept. And for more participation, case presentation has been done and prepared by resident attending, group of international attending. So we began all the session in early 2021 and every two weeks, we had some interruption in early 2022 and we had approximately 52 interaction sessions and 10 case presentation. So since then, we grew with this. Another partner in Africa saw the example of Sandimian Hospital and wanted to join us. So this is where we started having more hospital getting into. So this initiative add to full purpose. So he helped lessen the task of training education faced by short-handed colleagues because overwhelming hours, overwhelming task and leverage the training and experience of the global community of pediatric care doctors to enhance the instructions of these young physicians. So we created the Pediatric Critical Care in Resource Limited Settings platform and his mission was to improve the care of severely ill children by promoting education, partnership and collaboration among pediatric critical care providers from around the world. So based on requests from different sites, we identified champions, partners and the curriculum was revised and established from different hospital. And from January 1st, 2021 to last December, 2023. So we had a total of 252 teaching sessions, 207 interactive sessions and 11 different hospital was part of this initiative. But in 2,500 intensivists, pediatric resident consultant had been part of those sessions and also nurses over 25 intensivists from different hospital partnership participate in the creating this program. And we had 10 countries as part of it. So most are from Africa and the only one in Haiti. So we have from Ghana, hospital from Ghana, Rwanda, Nigeria, Ethiopia and San Damien Hospital where everything started. So to end this, I'll tell you how it's important that network was for us. We had a couple of last year case of dengue, you know, the dengue in Asia, it's the most, it's really important and they really know what is dengue. So I had this case of dengue and we wanted to present it. And one of our partners said, oh yes, I know an expert in dengue. I will ask her to participate with us. And when they told me that the name of the intensivist, it was actually one of my professor back in India. So it was really amazed and you see, small world. Just from Haiti to India, we were discussing about dengue, a case of dengue and it was an emergency case and it was really interesting how we can promote education and we had a lot of questions, a lot of answers also from that. So to take home messages for this is remote training provides a unique opportunity for learners, for providers, for professors too, despite language distance and all the barriers that can be. So it helps improve the existing gaps it has between providers in limited resources and providers in high resources and exchange the experiences between sites worldwide. So I would like to thank you for listening.

critical care

resource-limited settings

pediatric care

remote training

international collaboration