Good morning. My name is Jan de Waal from Belgium, and I'm the EASE ICM President Select. So today we're going to talk about money and the mission. And fortunately, if any of you had attended the opening session, we discussed some of the humanitarian efforts that are ongoing within the society. We have some pretty exciting events that are beginning. So we thought we'd start with some of the humanitarian efforts, you know, just brief on what we're doing. What we're working on within our organizations. And then a general discussion about, you know, how to keep those types of efforts ongoing. And other types of ways to pay it forward, other than just through the humanitarian efforts as well. So that's kind of the agenda we have for today. So I thought maybe we'd start with an overview again. We're going to pick on Vinay, who has been attending all kinds of sessions on some of our efforts. And we have a wonderful, we just saw Dr. John Sampson here as well. So you're welcome to chime in. So we can just explain some of our humanitarian efforts that are going on currently in Africa with the AIRS project. Vinay, did you want to start? Yeah. And I think for both societies, humanitarian efforts are not new. So these have been going on for many years. And oftentimes bubble up from sort of mission-based, individual-based sort of initiatives. And now what we're seeing, at least in this society, is a coalescence and sort of a change in venue from, at least for the SECM of being very fairly U.S. centric, to start to be able to entertain a more systematic approach to the international and global. And sometimes we think about sort of international sometimes as things that generate money for mission. And global more or less a sense of mission-related. You know, they may be money losers. So investments, the two that sort of come to mind with the Ukraine crisis, I think we heard a little bit about the rapid adaptation of the FCCS family of courses into Ukrainian language with a dissemination pathway to the area of conflict. And remote support, remote training, that is sort of systematically being built in. But it's more or less a template for future crises, future responsive, a reactive approach, but with a global face. On the other hand, John Sampson and others, but John in particular, has started to bring to us an approach which is building from the ground up. And that's to take some very basic tenets like oxygen and medical technicians and basic training and be able to systematically approach a region, a government, using diplomacy but also boots on the ground to get an external grant that would then support the society to have a ongoing relationship. And I think that's one of the thing that's been lacking, I think, and I'm speaking not as the SECM president from a personal standpoint, is that the sustainability has been limited in the past by good intentions, sort of mission-based work. But it oftentimes fizzles when the relationship of the individuals participating sort of fizzles out. And this is, I think we need to look for ways for the societies to sustain that. So that it can be ongoing beyond, let's say John retires at some point. The program should still go forward. It shouldn't depend on the individual. But almost always I think it starts on an individual or personal relationship that builds. You know, when, we'll go back to the first initiative, which is the, you know, the ongoing efforts to support Ukraine. I know that, you know, when this arose that, I don't know if we appreciate, but, you know, us working with ESICM because we were often in communications myself with both Maurizio and Eli with regards to how can we help? How can we help in not just SECM helping, but SEC helping with ESICM? And once you get news from the best way to put efforts forth to assist, how can we work together as organizations so that we can meet the needs of the people? And did you have outreaches as well from individuals with regards to that effort? Yeah, I agree. And I think that being two societies helping is always reassuring and very much healing for the people there. So we were guided by two kinds of different information. We had the people coming from Ukraine and letting us know who was the contact people on the scene, either in Mariupol or in Kiev or in other cities and other regions in Ukraine. So we were in contact with them in different ways. And we had the political affairs and the Ministry of Health also asking us what could be the best support they could provide from their side. So what we were doing is that we were asking our colleagues what were their needs. And we were quite surprised. Their needs were mostly to have training on alternatives to transfusion or trauma management. But at the same time, you know, they knew a lot of things much better than us. Because before the crisis, they also were very well trained and also had the experience of the 2014 war. So many of them were already very much trained to trauma. But their expectations were very important as they were waiting for those webinars that we were providing on the management of trauma alternative to transfusions, urgent infection disease. But what they were expecting for was mostly our presence. So I remember days where we could spend two or three hours with them either using our smartphones with FaceTime or with WhatsApp groups. So we were speaking with them. But, you know, most of the things we were sharing with them was not related to the war. It was just how it was, what people were thinking of them, if people knew what was the situation, et cetera. So it was mostly to keep contact with them and to, of course, address some medical questions and some critical care issues, but also to be there. They wanted us to be there. And for them, it was something very, very important. I remember when we did a webinar on trauma management, it was the day after there was a bombing in the region. So it turned to move from a webinar that was focused on a domain to something more on an open discussion. And it was something very healing from them to know that the global critical care community was caring for them. And I know that one of our discussions was around providing some telehealth services. You know, did you have any comment on how maybe ESICM was able to do that because I know it was one of the efforts for SCCM as well? So we didn't provide the direct telehealth services, but we were using a lot WhatsApp to be in video with them and to be in touch with them. And they were asking very specific questions. The thing where I think we were also quite useful was to guide the authorities and the government to what were the priorities in terms of material and in terms of drugs that were needed to be provided and to be sent to Ukraine. And of course, we were not saying something based on what we were thinking. We were saying something based on what were the real needs on the scene. So that has been very useful. We were also informing the European authorities because it was quite complex to bring things to Ukraine. There was an entire regulation that was very specific. But there were also information sent to through the members of European Parliament who were physicians. There are a certain number, 170 members of the European Parliament who are healthcare professionals. Some are physicians. Some are nurses. Some are physiotherapists. And so they were the one guiding the European Parliament to inform on what was needed. I wonder, can you comment a little bit about the discrepancy between what, under such a situation, between what a country or a government or an administration reports versus what people in the trenches report and how you ferret out kind of the needs analysis? Because to show weakness from a government standpoint might be an advantage for their conflict enemy. But the need is actually really there. How do you, how does that work? You are absolutely right, Vaini. We were quite surprised that there was a very big gap between what governments were saying on, so things are under control because A, B, C, D, E, and what people needed, which is completely different. And I think this is our role. Our role as ICU specialists being in touch with our colleagues on the scene was that we were able to really directly inform on the real needs. At a government level or at a structural level, something more, I would say, governmental, was that they had to be sure that people were able to deliver a certain number of patients receiving mechanical ventilation, a certain number of blood for blood transfusion, some drugs. So I think that the checklists were completely different. And sometimes everything was fine for the government, but not really for the people. So this is why we still have a role. And if it happens again tomorrow, I think all the hours that are spent are very, very useful to reassure the people, to let them know that we are with them, but also to inform on the real needs, and I think that we are the only one making that we are able to inform on the needs that are, we are guided by the colleagues who are on scene. But this is very true. There is a gap. Yeah, and an important message is when figuring out the needs for those areas is to, we reached out to our members, too, each time when we have these types of crises, you know, instead of deciding what is needed, reaching out to the members in those areas has been extremely helpful in communicating for continuous updates from those members. And so it's fortunate that our organizations do have, you know, very much international representation because it's beneficial in that regard. I know that starting the project in Africa, one of the things we were, have been trying to figure out is the logistics associated with that, right? What's the plan? How are we going to do it? What's the most effective approach? And I really think, Dr. Sampson, it's your experience there that's helped us to try to figure that out. So, you know what, if you could go to the mic and maybe tell us a little bit about trying to figure some of those logistics out, we'd appreciate your input. Just right there, yeah, that'd be great. So, yeah, so the first thing, the first step was, which was the easiest one for me, was what are some locations that needed this that don't have access to oxygen? So since I've been doing global health work for 20 or 30 years, you know, I had actually experienced places where I actually literally lost patients, you know, because they were on a ventilator. We thought we had enough oxygen because it's the system oxygen from the hospital system, but their system is based on tanks and they're not used to having ventilated patients like they would have when we have an intervention and it runs out and the patient actually dies. So I've experienced that. So I actually knew very well places that could need this. And so we, because over the years, we've actually worked with governments and healthcare providers and hospital leaders, we identified, we just contacted the ministries of health and had a conversation with them and were able to work out, you know, what places this would benefit the most. But we also were sensitive to the fact that there are ongoing efforts, especially with the COVID response to provide oxygen generating facilities. So we also were asking questions about competing, potential competing programs, potential competing international initiatives because it's not my goal to compete, my goal is to add. And so we were sensitive to that. I was also sensitive to the fact that there are oxygen generating plants where, one in particular in Sierra Leone that had been established in, I think it was a town called Kenema and it never produced a single drop of oxygen. Literally, there was some piece of equipment that I think a German provider was supposed to provide and they never got the last piece of equipment in some part of the plant. And so by the time that it was ever acquired, it was years later and the thing was deteriorated and they were actually using it to put trash in. So I was, I wanted to make sure that this plant had a good plan in terms of maintenance and training for biomedical engineers so that we could develop a maintenance culture. But if a country was already getting oxygen plants from an international fund, not to add more, but to look at other things like how are you going to power these oxygen generating plants. If I already know that the area has, is highly unstable electrical grid, then maybe the best way that we can actually provide oxygen is to stabilize the electricity thing with renewable energy. Then when you get to the actual amount of oxygen that you would need, then we basically had basically webinars with all of the stakeholders from Minister of Health, biomedical engineering person from the country, hospital leaders from the country and talk about how many ICU beds, how many operating rooms, what is the level of utilization of these facilities and then there are some general calculations that you can use to calculate the number of liters per minute that you might need based on the amount of oxygen consuming locations that are in the facility. And then also think just a little bit ahead in terms of are there any impending plans for expansion of that facility as well. And so through all of that, that's what we've used to come up with the amount that we would need for each facility. I think that answers your question. You know, just before you leave, I was some interesting things you were saying there with not just logistical issues, but I was thinking about sustainability issues is what you were also addressing. And the importance of incorporating the government agencies to assure that it's a supported effort. I don't know if there's any other. Okay. So now that's very interesting. The fact that he had been on the ground for 10 years before he went to make an ask. And he came back and back and back before making the ask. Right. So there's two regional bodies that are even beyond the individual government of the country, but regional bodies related to Africa. On the largest scale is the African Union, which you're familiar with the European Union. Now we have the African Union. Its headquarters is in Addis Ababa, Ethiopia. And the African Union actually designated African Americans as being the sixth region of Africa. And we actually are connected to the movements that advocated for that development, which only happened two years ago, believe it or not. So it's a fresh development, making this literally a historic project because it's one of the first major projects that's connecting to that new initiative. The next is another regional, but within West Africa is called ECOWAS, which is the Economic Community of West African States. Well, it turns out that our, this intervention with three African countries and major medical facilities got so much attention that it's brought the attention of ECOWAS itself. And we're having one of the presidents for community engagement and health promotion of ECOWAS is so interested in this project that he's actually coming with us to our diplomatic trip that we're going to have with Vinay. The next thing is we're trying to shore up support within the region, right? So we don't want, like, it's kind of hard for having someone from California go and maintain something that's in Gambia or Liberia, but someone in Ghana can do it much more efficiently. So we're actually using a lot of resources and expertise from biomedical engineers and auction-generating expertise in Ghana, which is a much more developed country than the smaller West African countries. And they're going to actually use their biomedical engineers to do the installation, add additional features like, hey, oxygen, but if you're putting pipes for oxygen, you just put another pipe next to it for medical oxygen. Hey, if you do medical oxygen, then you put a little device that manages the medical oxygen, and you have hospital-wide systemic suction for the operating room, neonatal units, and ICUs. So now the Ghanaian partner was able to actually, because they have experience doing this in African hospitals, say, hey, you guys, you know, you were talking to these American guys and they just were talking about oxygen. But we're telling you that it's just a small amount of money more and we can provide a huge increase in the features. Not only that, but we will be the one going there to train. Not only that, but we're going to be the one going to do additional maintenance and enforce the warranties for long-term sustainability. So now, by connecting with the African Union, ECOWAS, and a Ghanaian regional supplier for some of the equipment, we've added increased assurance for sustainability. Mm-hmm. It sounds really very impressive. And if I may ask, I mean, based on your experience, the whole process you went through in these different countries, what would be your main recommendations for, you know, similar projects, people who would want to embark on a similar project? Well, I think that the main thing is that, like, some people will say, like, hey, how did you pick this? In fact, I was on a board meeting for a different organization and a Ghanaian person actually challenged me. Samson, how did you pick that particular hospital in Liberia? It's not even in the capital. Isn't there a hospital that can provide more impact or more whatever to the place? And I kept saying, I didn't pick the hospital guy. I worked with the people in the region. And they, I was actually surprised. I thought that they were going to pick a hospital in Monrovia. That's the shining light to Liberia. No, they didn't pick a hospital in Monrovia. They told me to go to this other county that's a little bit more remote, and they said that those people were underserved people and that during the rainy season, they're literally cut off from getting healthcare in the capital. The people in the country are the ones, and not even people who live in that area, these are people who don't live in that area, and they're saying that area needs it. I'm listening to them. So it's not me as an American coming here saying that, oh, no, I know best. It should be here. This is going to have the biggest impact. It's me looking at them as their brother and saying that, look, you know, let's have a conversation, a bilateral conversation, and look at, I want to meet what you think will have the most improvement in terms of, you know, a gap that's in your system. And this is the location that they picked. So it's going to be a little bit more trouble for us because it's going to take us like a day to even get to that location, you know, when we bring the stuff in the country, but I'm very happy to hear, you know, other people who are in leadership in Liberia who don't live in that area, and they're not arguing for their area. They're not arguing for the capital. They're saying that's an underserved area. You know what? You guys need to keep your project right over there because they really need it. They're really suffering without this type of support. So I think that's one of the main things. Within it, we've spent a huge amount of time, and I actually had to invest some money to get accounting and budgetary help just to make sure that I have all of the money and the funds and all of that, and so I had to take personal risk in terms of investing into that because there was no guarantee for any support. At that point, it was just a possibility. I'm very interested by the feeling of frustration you are referring to because this is something we had in the experience with Ukraine is the number of people feeling a kind of moral distress for having to triage patients when they have to make a kind of prioritization selection for admission to the ICU. And they were very relieved when we just provided something that was completely disconnected is how we did triage during the COVID pandemic. So we went to them with another information, but just for them to understand that we have some time to triage based on certain criteria, so we report the guidelines, we report the priorities that were published by the teaching societies or by the groups. So sometime by bringing an information that is not really in relation with what they expect, you just show that in other settings, in other countries, for other events, you also have to meet their experience. And this community of experience was very relieving for them, and we were surprised. And this brought to another topic is the mental health of those people on scene. We as ICU specialists, we are facing this on a daily basis, and we try to understand what are the determinants of not only burnout, because burnout is a la mode as we say, but other plenty of symptoms and syndromes. I am personally very surprised to see after the COVID pandemic the number of nurses and young physicians having PTSD. And when you speak to them, you feel that they suffer, but you say, but this is not burnout. There is something that is different. All the things that are described are more into PT, and you are helped by the psychologist, and you start working on trying just to understand what is ongoing in your team. And the mental health is affected by all these crises. So Ukraine, you reported on the frustration that I have personally lived when I was working in Senegal for exactly the same reasons why they are not here, and the Ukraine. So there is something, and there is a continuum. It exists in our teams for some reasons that are mostly based on conflicts, on ethical climate, on the way we are able to make decisions in the ICU, but it's the same. There is a continuum with what happens even in big crises like what we have seen in Ukraine. So sometimes just witnessing our experience of doing triage where there is no war, there is nothing, but we have to do it, was something very relieving for them, and I was surprised. So I wanted to have your feeling about it, and if you experienced the same things. So I wouldn't say that necessarily it's a frustration because this is what I've always done, and actually I'm hugely deeply appreciative and have great gratitude for the SCCM and their connection with Direct Relief for being able to be able to do this particular project. If there was any frustration, it would be the frustration that how many decades it's been that I've been going to these locations and nobody cared that there wasn't any access to oxygen. Nobody cared that the power grid was all messed up, and yet there's millions of dollars coming in for big NGOs to do medical interventions and medical saving, life saving interventions and stuff like that, but nothing's connecting to strengthening the healthcare systems in a sustainable way, and a small amount of money probably could have been used, but more directed towards strengthening the healthcare system that could have saved lives. That would be frustration. The other part is like Sudoku or like a jigsaw puzzle. A jigsaw puzzle is challenging and it's interesting, but you do it because you like working with the jigsaw puzzle. So for me, that's the part of, you know, talking with them and just extending relationships that we already have with different regional partners in the many countries I have. So the first thing was they were just in disbelief that we even had the potential to do this, had to convince them that it's possible. Just give me the information, you know, and work with me. And so in terms of the specific mental health stuff, that was something that when I first started working with Liberia and Sierra Leone after their wars, they both had a common regional disruptions in terms of civil wars, I felt that that was going to be much more of a problem because there were horrendous things that happened to those wars that affected people all over the entire country. But by and large, I had to basically, you know, I guess sort of realize that to some degree, everyone's individual handling of a traumatic situation and every culture's handling of a traumatic situation has nuances that aren't necessarily directly translatable to the other group. And in Sierra Leone, for example, which Nigeria's in the same region, Nigeria has a huge conflict between Muslims and Christians and whatnot, where Sierra Leone has equal distribution of Muslims and Christians and sometimes a Muslim and a Christian marry each other. And people had to figure out long before I ever came there, how to work with a colleague who may have been doing horrendous things as a rebel force during the Civil War, but now they're tired of this and they actually are working together and they figured out how to do that long before I ever came. And there's really nothing that I can do as someone who grew up in the United States to modulate that particular relationship and practice already resolved to some degree. I think Liberia to me has more unresolved issues, but I don't feel that I'm equipped to really resolve those issues. Those are things that they're going to have to work out amongst themselves. John, you made a comment that nobody cares, nobody cares. And I think a lot of times it's not that nobody cares, everybody cares, it's that there's sort of a nihilistic, you know, you sort of generate in these situations the feeling like it just can't be changed, it's impossible to change and so you accept the severe limitations you have and to some degree to get by day to day we have to accept, in our own hospitals, we have to accept some of the limitations of the systems, et cetera, and work around however we can. But I don't know that it's a matter of caring, I think it's a matter of sort of helpless, feeling of helplessness and by targeting a few things that can be changed as you're doing and demonstrating and sort of it's oftentimes that project, that issue that sort of allows people to start to see that things can be changed even at the very basic level and starts them again working on that process rather than just sort of accepting the plight of where we're at. Right, yeah, I agree. I don't know, I've seen Ndidi Musa, you're here, I see. I don't know, you had come to us also with like a problem of humidification for bubble CPAP, et cetera. I just don't know if you want to make any comments of, you've had a lot of experience in both mission-based and process-based experiences in developing countries and some of the frustrations and difficulties. I wonder if you just could relate or if you have a comment. Yeah, thank you and thank you, John, for what you shared. I totally agree with you. You know, I was in Ethiopia helping to build critical care capacity to train Ethiopians to become critical care physicians. And we had this patient, and I think Andrew Argent was also there, and he had to extubate the patient. I'm telling you the story just to give you an example because he felt the patient needed to be extubated. And we got there, I was there, he was there, and the patient who was supposed to be extubated the day before was not doing well, and it turned out that when we finally took out the tube, there was insipid secretions on the tube. And we lost that patient because of lack of humidification. And I thought to myself, well, you know, what's the purpose? We had a ventilator, we had, you know, we're training physicians there, and yet we couldn't save this child from a simple thing. And that was when I shared with, I actually took a picture of the ET tube with a thick secretion, just blocking the ET tube. And I'm still trying, and this is many years ago, to figure out how do we get humidification that's cheap and easy. And I don't think we've quite figured that out. We thought about using, maybe creating an ET tube that, you know, with a seal, I think that was something we were going to look at. So there are all these things that one, you know, you're faced with in settings like that. But I think, you know, simple technologies like high flow, again, it does require humidification. And I found out that there's somebody who creates water from the rain, just like a solar panel. So I'm talking to that group, you know, that group to see what we can do to provide humidification as well. So that's something that's really needed because high flow nasal cannula for neonates or for infants is, you know, we, it's portable. It's just humidification. So if anyone knows how to humidify, you know, get a simple technology that can humidify for ventilators, for high flow, I'd be happy to talk to you. But I think building critical care capacity is so essential because we go there, we do a little bit, and we go back. But it's training people to work with their people and to deliver the care that can be delivered, not only systematic way of thinking, you know, teaching them how to resuscitate. We did the sepsis in Rwanda and, you know, so many other places. So thank you. That's my comment. Thank you. Thank you so much for sharing with us that important issue. You know, one of the things that when I introduced Vinay during the opening session, I mentioned some of his pay it forward work. And, you know, the one time, you know, when I first started having some deep conversations with Vinay, and he explained to me his efforts for Stop the Bleed in India. And I was just fascinated by the efforts that you took to train rickshaw drivers, shop owners, using drones to deliver the necessary equipment for the Stop the Bleed. Can you comment on some of that work? Yeah. And it wasn't just my work. Obviously, it's a team and boots on the ground. But it really emerged out of, you know, the SDGs of the World Health Organization, the recognition that India has a huge road traffic accident issue. And then digging down, working with GVK MRI, which is the largest EMS system, if you will, ambulance system in India. And they actually had tracked where these road traffic accidents were. And so I asked them, you know, can we just identify the highest road traffic risk corridors? And so they, like, opened the door of a storage room that had a stack of charts where they had hand recorded all of the accidents over the last 10 years. And they assigned, like, you know, 10 medical students to go put them into a spreadsheet, et cetera. And we were able to then geolocate where the accidents were. So we knew sort of where the problems were. And it sort of concentrated along these two highways. So as a demo project, we got some funding from the university to go and to actually develop a contextualized ABC Stop the Bleed program, adapted after the American College of Surgery program with permission, to adapt it to that environment. But as John was saying, and I was saying, that we used the folks in the trenches to contextualize it. So they decided where they wanted to do it. They went and interviewed the road shop owners, the rickshaw drivers that drove those roads, found out how many of them had witnessed life-threatening, bleeding events at road traffic accidents, and then decided where to focus this training. And rather than bringing, we trained the trainers at the main rural health facility outside of Hyderabad, but we actually dispensed the ambulance drivers to go to the rickshaw stands where they took their tea break to actually deliver the education without words because they were illiterate in their own language. It needed to be like a little picture book of how to identify life-threatening bleeding, how to apply pressure, how to make a do-it-yourself tourniquet with a wrench that they would always have in their rickshaws, et cetera. So it was very contextualized. And then there were boots on the ground who were constantly going back to these rickshaw stands, the shop owners, who would reinforce that. And whenever there was a save, whenever they responded to a traffic accident, the director of the DVK organization would go out to their rickshaw stand and give them a little plaque. It was like a 20-cent plaque in front of their peers. And that was the real motivating factor that kept them involved. And then they were like training their other guys. So it was a real experience in sort of how, you know, like a grassroots movement to get a public health intervention, stop the bleed, integrated. And then from there, they said, well, you know, this is good for the roads, but a lot of our accidents are not quite as severe, but they're happening at home. You know, people cutting themselves, burning themselves, et cetera, that might need this. And so they decided to go to the schools in the area. And so the school children in 10th, 11th, 12th grade were taught this simple ABC stop the bleed program and given the imprimatur to have a multiplier effect. So they were commissioned by their teachers to teach three other members who lived in their family and to send a what's up photo of them training them. And then they had a competition between the schools in order to compete to see who could train the most. And that concluded. And there were like 2,500 people who were trained. And in India, 2,500 people is like a spit in the wind. It's nothing. But it's more a proof of concept. It's more an idea, a concept that I think we could start to systematize and then start to roll out. And fortunately, now the police, at least in one state, in Telangana, in one state in India, have now picked up on it. And they are planning to roll that out. And the government is now going to fund the tourniquets and the training in order to at least have their state sort of flush it out. So it's sort of an example of I think very much of what John was saying, which is, you know, you have to have credibility. You have to have trust. You have the people on the ground. It's a patient-centered or a victim-centered design. And then the execution really oftentimes requires an external impetus, like the University of Pennsylvania, the, you know, the president-elect of SCCM endorses it. But then it's the people in the trenches who actually execute it. I think that from the many points that have been discussed, I remember very early at the start after the war in Ukraine. So people were saying, oh, you spent a lot of time with the war in Ukraine, but there are so many other people needing that in the world. So why Ukraine more than the others? And there are plenty of presidents, past presidents, and plenty of people in the room. So I think that that could be the opportunity for us to have a framework for giving priorities. So are members of our societies capable now to contact us and ask us to give priority to certain aspects of the care to who we should help and how we should help? So what all of you think about it? So I'm very interested to know. I remember the critics that was, there are wars and plenty of problems all over the world, but now in Ukraine, maybe you are scared because it's at the door with Europe. And, you know, many people from Ukraine were in our countries. So what is the reason for that? And what is the responsibility of our societies? How can we target any help? And what's the next steps for all of that? I think that this is a question for everyone. But as there are many presidents, past presidents, and future presidents, maybe it's something also for them. Yeah. Does anybody have any questions with regards to this topic or anything that's been explained? Go ahead, please. All right, the mic is there. I'm Sammy Zachary. I'm a cardiologist, critical care doc at Johns Hopkins. And one of my roles there is the global health pathway director for the internal medicine programs. And at least in my field, it's been a little bit more trickier compared to those who are trained in infectious disease or in policy. Because I guess the traditional model for working outside of your own country is in research-limited settings and focusing on communicable diseases. And yet, you mentioned it all about a huge need for critical care teams to really focus on the developing world or global health crises. How do you get fellows, residents, trainees involved in this? And how do we make it more sustainable so that somebody who's interested in making a difference in the global community involved? I've had to do it ad hoc. Including in Macquarie, in Uganda. And it's been more of a challenge. Do you want to speak about from the ESICM side? We are developing this LEAD program, which I think maybe would address it. But I know you also have some. Please share your program. I know that you were sharing some news of it at your ESICM meeting, your mentorship programs. If you have some details. So the mentorship program is supposed to cover those needs at a global level. The only problem is that you have to have people allowed to cross the borders and be helpful where they can. For Ukraine, it was not possible. Only journalists were forcing the barriers. We were not allowed to help. Somewhere at the very, very beginning, some were going through Poland and were crossing the border. But then very quickly, it was impossible. We had nurses and fellows who were looking forward to go and help, but it was not possible. The mentoring program was mostly to have a rapid response to the need. Training people to specific domains, of course, according to the emergency. And also allowing them to safely go to the place and be helpful. This was something that was completely forbidden by the authorities for the thing on moving to the place. But some people did that. I think if I interpreted your question correctly, it wasn't sort of the responsive to Ukraine, but it was more this ongoing when you have trainees or a fellowship program, et cetera, in global health. And I just want to mention that we met with the World Federation of Intensive Care Societies today and they are, I think, compending, they're making a compendium on trying to solicit where these fellowships and training programs lie so that there could be sort of a central global repository for those interested, both to train and also those interested to learn. Just to give example, one resident wanted to work on basically a disease I'd never even heard of. And it was easy to find out how to get that resident plugged in with an infectious disease specialist in a partner country. And then there's others who are interested in pulmonary care medicine who was very, very hard for me to say, okay, how do we build capacity in this country? And so something like that where you're proposing could make a huge difference for our trainees and maybe generate excitement. You know, we all have the same problems here. We have to take care of very, very sick things and maybe we could work together to fix it. I think that the response is very different in a country where there's a war as compared to a country where there is a surge for different epidemics or things like that. I know that, for example, during the COVID time in the French territories in Guadeloupe and Martinique in the islands, there was a huge amount of people from the French territories who went there to help them. And it was easy, it was organized. So we trained them, well, they were trained because they faced in front line the COVID pandemic. But we trained them to different things before they went there. And we were debriefing them on a daily basis because it was not so easy. The number of working hours and the number of days and the number of shifts were very, when they came there, they had to replace a lot of clinicians who were exhausted from maybe 10 to 15 days without any break. So that was easy. But for the Ukraine war, I think that we faced a kind of, the main barrier was that people were not able to go there. But we had plenty of volunteers who were ready to go on scene and to help. But, you know, sometimes it was not so easy to, people were not happy not to be able to travel. But the mentoring program is just to give a safe conduct for people to travel, to get there, to be welcomed there, and to be trained before they leave. And this is according to the response, either in a specific domain or in a broader, according to where they need help. And there is working with the SARAF in West Africa. There is the response with frugal ventilation that is now being developed. And there is a huge group with the Global Intensive Care Group at ESICM that is developing different methods. And there are people going, there are a lot of people going just to help and deliver oxygenation and ventilation in a certain way according to the different places where they go. And with the SARAF, it was quite active and they have a very big activity and a number of people involved. I noticed that there was another question. If you wanted to come forward, please, that'd be great. Hi, I'm Fatima. I'm a critical care physician attending in Wisconsin. So I actually wanted to make a comment with regards to your question about how to get trainees and fellows and to kind of collaborate. So I'm originally from Senegal, I was born and raised and then came and did medical school here and in attending. And I go back and forth. I try to go as many times as I can. And especially with the COVID era in this past two years, I've been really struggling finding myself to try to coordinate, I think too many projects that one person along with some help, it's just not possible. But with regards to the training, the physicians, the hospital there want help. They want the training and collaborate. What I find is that at least in the places they've been, they just don't know what's available to them. They just don't know. They want the collaboration. For instance, Senegal is a French speaking country. So they do have a lot of ties with France. A lot of the times the residents and the medical students can kind of continue the pathway in France and then kind of go back. So when I kind of go in some of the hospitals and the ICUs, they're asking me like right now, I am actually collaborating in the city. So I'm from Dakar, which is the capital and the main military hospital, a good friend of mine, he's an anesthesia critical care trained and he's trying his best to basically strengthen their ICU just so that it looks like some kind of general ICU because what I saw is just, they're doing their best. And he's just looking for more training. So he asked me if I could do event lectures with them. And I was working on those just to kind of do it like with Zoom and things like that. They want help, they just don't know what's available. And also sometimes you run into trouble with some of more politics. So the government and the minister of health, which is a big thing. So everything kind of has to be, basically the minister of health has to sign on it. And then you can do all those collaborations like finding a school or a medical school or a hospital here, it's possible. It's just they don't know what's available and then just kind of doing the collaboration. So that was just a tag along. And I'm not sure if it's answering also your question or just add to what the panel said. One question I have for the panel is, we talk a lot about things to do also to strengthen the hospital system. But one question I have is with regards to pre-hospital settings. It's a major problem even to get the patient there. For instance, my personal story experience of many, but one of my personal one is that I have a sister and she gets sick very often, critically ill. And trying to get her from the house to getting the proper care. First of all, many of the countries there don't have what we think of an emergency room, like one where everybody comes in, like here you have the ER doc and then they're coordinating. You'll show up in the hospital and it's this one little room that's kind of serve as the ER, at least in Senegal. And then if you have a stroke, your loved one have to take you to the neurology department, but mind you just have a stroke and then you go there and the CT scan can be kind of not working and whatnot. So for me, I consider my sister lucky when she needs critical care access because I can kind of call on some of my friends back home and just kind of call in and make some phone calls and they'll tell me, okay, don't take her to this hospital because it's full, bring her to this private clinic, we have a bed ready for her. And that's a major problem. There are many people who just die. I remember receiving a call when I was a fellow, it was my uncle who had COVID and my aunt had done five different hospitals looking for a place with oxygen. And she called me in Pan Am, middle of the road, I'm in America, I'm not there. And she's calling me, begging me, they just told me your uncle's O2 set was like in the 80s and he's in the car. And so I started making phone calls. I mean, luckily I kind of have some connection, started making phone calls. Long story short, we found him a private bed in a clinic. Lucky again, the average person can't afford that. When he arrived there, his O2 set was 73% and he was just on oxygen. So I'm wondering how he wasn't on more, they just didn't have it, anything that's more than that. So the pre-hospital settings, how to get the patients, how to connect the dots is also very important even before the triaging, because we're talking about the triaging with pre-hospital is important too. Yeah, I think you're bringing up two things. I think one was the pull and push. So there are those that desire training and seek it and it's difficult to identify mentors, projects, et cetera. So, and then there's the push, which is, we want to train, we wanna find people who want to do that. And the second is sort of that helplessness, hopelessness, the issue of critical care without walls or borders. We have to stop thinking about just the ICU physically, but more about the system of care. And it's not gonna be until we address or develop colleagues who will address each of the links of the chain of survival before we're gonna make a big, big difference. But we do have to start somewhere. And so I think the types of things that you're doing sound like they're making a difference. It's just, it feels like it's slow. Yes. Yeah. I just wanted to say something about, in Kenya, hospitals helped start a training program so that's an opportunity for people to go back and forth to help train fellows there to become pediatric intensive care specialists, as well as emergency medicine. Then the other thing I did was I connected with a Nigerian group because during COVID, people were not going to help with cardiovascular surgery. Like, so kids were dying because there was no, people didn't go there. So this group did cardiovascular surgery and during their COVID, they up-leveled themselves. So we provide through the, what is it, Zoom, we have a discussion with them. We have a cardiologist, an echocardiographer, an interventionalist, and we review all their cases once a week, just like we would do in the US. And that helped them because we can ask questions, we can review, after the surgery, we can discuss the case, help them take care of these patients. So that's another way you can build capacity by crosstalk from between North-South relationship. Thanks. Thanks very much for adding that. I do think when I hear the stories that there's, I mean, the needs are huge, needs are very diverse, but I do think on the other hand, that also in our societies, there's a lot of people who want to contribute, but maybe just don't know how to. And maybe there's a role for our societies in trying to connect the two, trying to channel also all the willingness, all the enthusiasm that for sure is there among many of the people in the room and those who are not in the room, to make it happen, to allow them to contribute. Because I'm just sure that many people, I mean, if you have connections in a certain area, if you've been there, if you've seen it, then you more or less know, but a lot of people don't know, but do want to help, I think. Which gets back to our theme this year, better together. So I really wanna thank everybody for sharing their individual stories and their individual pursuits. That's very helpful. Lots of great themes today, which is trust, sustainability, and making sure you're engaging those individuals who are on the ground because they're gonna be best to advise us and how to train the next future of individuals for global health initiatives. So thank you very much to everyone. Thanks.

humanitarian work

critical care

low-resource settings

trust

sustainability

collaboration

pre-hospital settings

healthcare system

training