Good morning. Thank you for being here. I have 10 minutes to present some lessons learned from our mission in Ukraine. There are two individuals here that I want everybody to acknowledge. One of them is a Ukrainian colleague, Dr. Vlad Dayev, and Dr. Alexei Pistovital, that is Belarusian. And I will tell you, you can hear my accent. Of course, I don't look like from Ukraine, but leading the mission required me to have a tremendous openness to have their expertise because they know much better the culture and everything in that region. So, I don't have any disclosures. I can tell you that two specific messages in this 10 minutes are as follows. Number one, I think our humanitarian concept of serving and as a SCCM member in that part of the war was just went to a different level. And second, I saw a new opportunity from the business line, you know, regarding ultrasound. So, what happened was, you know, the team started like this. Like, you can see, there is like that sense of uncertainty. We didn't know what we were going to face. And then within 24 hours now, we're inside the building, and you can see now the smiles, and we're mingling with some of the local leaders. And then probably within three days now, I'm a father of a college student, and you are interacting with individuals that are the same age of your daughter, and I'm seeing tears in their eyes, and they give me this insignia that I'm wearing today and my blazer. So, that takes you to a very uncomfortable situation. We say, well, what is real? What is the real life for these people? So, you deliver. And this was a unique moment when I have in the audience, I have... Who are anesthesiologists intensivists in this room? I asked them who were anesthesiologists intensivists. I never have been in any meeting where the vast majority of the attendants were people with my background profession. So, I'm an anesthesiologist. We are a minority of intensivists in America. So, it was a distinct honor after 20 years serving for the SCCM. Then we continue, and you can see here, this delivery, giving them all these textbooks. They are not ultrasound textbooks. FCCS, we were actually launching all our products. We really continue collaborating with those leaders. Then there was something unique with direct relief, and I understood really well how direct relief was giving us some logistics, economical support, but they really rely on the expertise of our members, and that's very important for us because they acknowledge how important the society is for them. And then was the cultural component, and you can see here now we are actually wearing, you know, the chalk, and it was a great moment having the unity there. Then now, I will tell you, we cannot deliver the mission without the SCCM staff, and then something that I learned was that these SCCM staff were paying attention to every single detail. They have a very good awareness regarding the geopolitics, what was going on. So, Ken Clark and Colleen McNamara really excelled in that. I didn't tell Colleen to do the printing. We're in another country. She has the way to put things that increase that, I would say, that kindness with the locals. So, she put the yellow and the blue colors there, explaining them the schedule, and you can see even here some corrections in real time because they needed to have, let's say, more time for break, et cetera. So, that was really crucial. You can see that this is one of my favorite pictures. This is the, you know, first Deputy Minister of Health in Ukraine. Look at his smile. I love Colleen. It was a really, really good experience for me, and then for the second trip, this is my daughter's suitcase, and I brought some items, you know, for the hospital, but guess what? The suitcase got lost, and that actually disturbed me mentally, but I didn't know until I went back to Houston that they created this group, the Jose's Angels. I didn't know, but somehow, they were able to retrieve the suitcase, deliver the suitcase with the items to the hospital. This is all SCCN staff, guys. So, this is my quote. It's really, when I different all these different geopolitics and healthcare processes, for me, it was crucial to have the SCCN staff, and Teresa Woelki was here 2 a.m., 3 a.m. U.S. time, and then we were in Ukraine, and she was responsive 100% of the time. So, more importantly here, you have this individual in the front line sharing with me how he's applying the concepts that he learned during the two-day course in Ukraine. So, this is what we want as, you know, trainers, but then, there was, in the second, when we came back, I was thinking about it. This guy became a real extended family. This is my desk and my workplace, and I have them. I have them close to me and been thinking about it. So, when the second mission occurred in September, there was something else. It's how we can really move forward. We have a great product, but we need to think differently, and there was an aha moment. The aha moment was, actually, this was the first day. You can see here, new team members, my Lanspa, John Click, and then there was a moment where my Lanspa, which one of the most insightful ultrasound colleagues I have in the society, really challenged me to say, we're not doing this all the way up, and that was my second month in an MBA program. I started with Case Western University, and I talked to one of my professors there, and like, hey, you know, we need to be thinking about, different about this. So, I was actually over a module of digital transformation, and so what I did was, and I was going to be showing some slides that actually are not on my property, or the property of Case Western University, but I was trying to adapt the concepts to ultrasound. So, first of all, we shouldn't be just having ultrasound courses that we are selling, and we have buyers. We should be thinking differently. We have users. There is a value in the use. Every single experience that these users have will be very important. It will be more relation-centric, and it will be a recurring process. So, I started as a novice, but later on, I might be, yeah, I want to be an expert. So, here you have the digital value loop, and these are the components of the value loop. So, you think about it this way. We are able to deliver more, let's say, portable devices to those places, and then now, through discovery, and all, you know, experts we have in the society, we are able to really have more analytics, and even, you know, develop some algorithms. One, everybody's using the ultrasound device, and we are able to help them to navigate things. There's another way to do it. So, imagine you have an app. Imagine that we don't have all of us been traveling to these war zones, but actually empowering them through these wearable devices. So, the most important thing here is that who is that user? That completeness of the loop is very important, and how we can monitor that. So, imagine the coalition we can build with the ultrasound companies. Imagine that we have our own, SCCM owns the product. We have the app. We are able to put the content there, and then now, we can be more universal, and as Miles Laspa said, this is not about being with one side with the enemy or not the enemy. This is about really helping people that are injured or are critically ill, and I will hold myself accountable to see what we can do in that regard, but this part, how we can monitor those actions, we really need to go to the next level in terms of the digital transformation. There are specific effects, not only the learning, but the network. So, now, if there are crises in Gaza, how it comes that the users in Gaza cannot benefit from the experience of the users that were in Ukraine last year. What about we can have the simulators company incorporating this co-created network? So, we can really have a much better impact. So, it's definitely a transformational effect, and of course, this is my last slide, just to show you that this was when I was two years of age, and my family, since the beginning, believed that I needed to be a doctor. I don't know why, but anyways, and then this is my current workplace, but over the last 20 years, I wouldn't be who I am in front of you without this society. Thank you so much for allowing me to be a leader in this society. Good morning. Yeah, my name is John Sampson. I'm a faculty member, associate professor at Johns Hopkins University, and also the director, and sort of like the architect of the AIRS program, Johns Hopkins Society of Critical Care Medicine AIRS program, Africa Infrastructure Relief and Support program. What's the right side? Oh, left side. Got it. I'm a Mac person. All right. So, I'm going to give you an overview of the AIRS program. We're going to talk a little bit about the need for increased oxygen access, and how it impedes critical care medicine, and medicine in general, how you make oxygen, and then what are the unique aspects of this particular Society of Critical Care Medicine program that are unique beyond any other organization that's installing oxygen programs that we've met so far. The program is focused on the Gambia, Liberia, and Sierra Leone, all three West African countries. First of all, in terms of oxygen needs, the hospitals that we are working in basically had no suitable oxygen supply. They were using oxygen cylinders and oxygen concentrators. An oxygen concentrator, many people in the United States are not necessarily familiar with. You plug it in the wall, and basically it takes room air in. It's got a sieve that attracts the nitrogen from the room air, allowing oxygen, or at least 93 to 95% oxygen, to be pushed out of it. Oxygen concentrators work on the same principle as the type of technology that we're using on an industrial scale for hospitals for oxygen delivery. And obviously something like an anesthesia machine is of little use without oxygen. The tank you see in the back is a type of oxygen tanks or cylinders that they use in these environments. These cylinders are heavy, trouble, they're difficult to transport. There's a patient safety issue in terms of them falling over. Imagine these in the neonatal unit as well. They're unreliable in terms of always having oxygen and there's a lot of cost involved with utilizing these tanks. The oxygen concentrators also have issues. The oxygen concentrators which really were developed for care here in the United States but are used internationally are limited usually to about 5 liters per minute. Some have higher amounts. Whenever there's a power failure, your oxygen concentrator goes out. These environments are prone for power failures. And so what we're doing is we're actually installing oxygen generating facilities that utilize large industrial level equipment to use that same technology I just described, make the oxygen and then push it through pipelines that we have to now install because these are locations that have never had oxygen and that delivers oxygen throughout the entire hospital. The Minister of Health of the Gambia last week met with me and described his situation in 2017 before he was Minister of Health when he was Chief of Surgery at the largest teaching hospital and tertiary hospital in the Gambia. And he basically said that there was no, up until 2020 there was no hospital in the Gambia that had an oxygen delivery supply system. He was down to his last one half of a cylinder of oxygen for the entire hospital. So it's interesting because sometimes when we talk about situations in disaster areas, places that have had war or natural disasters, we talk about their system being brought to its knees and being brought to a situation that these places have to live in all throughout the year. So while medical missions and other short-term interventions have helped to treat patients, over the years, no intervention has addressed this limitation to the people living in these environments delivering healthcare themselves. So healthcare without oxygen. The COVID pandemic brought attention to this need and basically brought enough attention to bring donors and there also are international efforts by the World Bank and others to deliver oxygen generating plants to places in Latin America, Asia, and Africa. But there are some challenges. And the challenges relate to the overall goal. Is the goal just to build an oxygen generation plant or is it to have a comprehensive package that includes both piping it to all of the locations, that includes training the biomedical techs to maintain it and training the healthcare providers in order to use it the best. And now, also, how do you use that most? And I recommend anyone who's interested to read this book, Feed for Fuse and Diamonds by Paul Farmer because it describes the very countries that we are doing this project in and how the colonialism basically left them with an infrastructure that is broken resulting in the problems that we're discussing right now. So, basically, we put together a coalition of organizations that includes Johns Hopkins University Global Alliance of Paraoperative Professionals, which is a group that I created at Johns Hopkins. Direct Relief, which is the funder of this, which was responding to the COVID pandemic. The Diaspora Africa Forum, which is a diplomatic entity that represents all people in the African diaspora internationally outside of Africa and they represent those people to Africa. And the Gambia Ministry of Health and the Office of the Presidency of the Gambia. This is one of our heroes for this because she helps to make it happen. This is the First Lady of the Gambia and before she was First Lady, she would literally go to the hospital and hold the hands of infants that were questionable in their survival because of oxygen and other issues and pray that they survived the night. That is the level of compassion of her heart. So, she is intimately involved and wants all updates in terms of what's happening with our project and that helps, that type of support at the highest level helps this project to go through smoothly. So, this is just, we had a diplomatic mission and this is actually a picture from that diplomatic mission where we actually brought leadership from SCCM, leadership from the African continent at the West African region and we actually met with all of the different government entities that we will interface with to make sure that they fully agree, fully cooperate, fully collaborate and support the life-saving work that we're doing in these key hospitals in the Gambia, Liberia and Sierra Leone, okay? And here you can actually see some of the output. Some of these pictures were just from a couple weeks ago. I just returned from Gambia last week and you can see those copper pipes. They are literally going to every clinical location and the entire hospital of a 700-bed teaching hospital in the Gambia. So, in other words, not only could you not do critical care reliably because you could have a patient on a ventilator, you could have a patient on CPAP, BiPAP, high flow or regular flow and then tomorrow maybe there's no oxygen supply. It runs out because they have to get it from another hospital. And before 2020, their source of oxygen was often Banjul Gas Company which was an industrial oxygen company which made oxygen for welding and building. So, this was oxygen not meant for human consumption and that was their oxygen source and the purity of it was down to probably around 80%. So, some of the places that get oxygen generating facilities have them break down. On the right, that's the oxygen generating plant that was built in Sierra Leone by a company, Novair, it's a French company and basically it never worked for a single drop of oxygen because there was one item that was needed that was missing and they could never get that last item to install from the company and so literally it's just used, the shed that it's placed is just used to throw trash. And on the left, you see a burnt out circuitry which is another issue that was a donation as well for a hospital in that region. And so, you also have energy problems. This is a ship that's anchored off the coast of Freetown, Sierra Leone because the energy grid is so unstable that this Turkish ship sells electricity by burning crude off the coast, worsening our environment, carbon dioxide and also causing strain for the hospital as well. So, on the right, you see an example of one of the oxygen generating plants that we're actually installing. This is a 500 liter per minute plant and we'll have two of those at the Edward Francis Teaching Hospital in Banjul, Gambia and that's just some of the shipments where it's being installed. Finally, what we found by participating at Africa Climate Week in September of this year where we took SCCM and Johns Hopkins and international team to do a workshop at Africa Climate Week, we found that there were hospitals in Kenya and other places where they had gotten oxygen generating facilities but whereas those oxygen generating facilities did not have the ability to afford the amount of energy that it would take to power the oxygen generating facility. One hospital right here on the left has had their oxygen generating facility off for two years because of that expense. So, because of that, we're using an alternate technology for creating oxygen called vacuum swing adsorption and it's the most energy efficient by 30% than any other technology for producing oxygen making it more affordable and then on top of that we solarize the generation of the oxygen and sometimes the entire hospital. In this case, we actually did hook up. The brother is actually at the front of the table. He's the CEO, young CEO of this private hospital system and right now our team is actually installing a solar system that's not part of this project. He actually purchased that solar system from our group so that he could power his oxygen generating plant. So, the next thing is sustainability. This thing won't make any difference if everything breaks down right as soon as we create it. So, we have created a customized biomedical tech training system for the specific technology that we're using which there wasn't already a training system established because we're using a more unique technology and so this consists of both an online training and hands on training for both the Liberian and the Gambian biomedical techs and an iterative process where they actually, after they take the course, they retake the course and then they start teaching the course to each other and the fourth time of teaching it then the objective is for them to reach competency not only as implementers of maintenance but also as teachers of maintenance as well. And so, our best practices are first if we can identify how much money is being used on diesel generators, right, and to power oxygen generation and diesel generators to power a hospital and then convert that those diesel dollars into healthcare dollars, then we are bringing, well, that's our slogan, diesel dollars into healthcare dollars by using the most energy efficient form of oxygen generation. Next, if we can then take even the fact that we still have to use energy even if it's the most energy efficient form and then provide a solar answer to that, then now we've created more diesel dollars to healthcare dollars and then finally if we can pipe that oxygen to all of the locations of the hospital instead of using all of the increased energy for putting that in cylinders at high pressure and then transporting those cylinders all over the place, we've actually increased the efficiency of the hospital as well as bringing even more diesel dollars into healthcare dollars. And so, these are just some of the companies that we're collaborating with to execute this relatively complicated project. And I don't want to take any time from our other partners. I think I've gone over most of it. Let me just summarize by saying that our project is clearly an infrastructure development project for critical need. I don't think anybody here thinks that hospitals can deliver adequate care without oxygen, without reliable oxygen access. It's the most fundamental thing. All of the fancy critical care stuff won't work if you don't have oxygen and if you don't have energy. But at the same time, we want to establish and publish on the need. So, separate from this project, we have separate grants that are funding a number of different research studies, both quantitative and qualitative, to basically establish and confirm the impact that this project will have that we'll publish. Thank you. Thank you. Good morning. Yeah, just big thanks to Dr. Kwame and the SECM for bringing us all together and thanks to all of you for attending a global health talk. And thanks to Stephen for running our AV show over here. So yeah, I'm Anna Crawford. I'm at Stanford University. I'm trained in anesthesia and critical care. And I direct our global engagement strategy in the Department of Anesthesia there. I've been asked to talk about professional development and exchange programs within global health. And so I want to talk about why we want to do that, why we want to bring global colleagues here and how to bring global colleagues here. So I'm going to ask the audience to participate a little bit here. What's the best way to learn and deliver better critical care? Is it A, have someone tell you about it, B, reading about it, or C, seeing it, simulating it, practicing it, and quality improvement? Who votes for A? How about B? Okay. How about C? You guys got the right answer. Perfect. So the WHO defines health as a state of complete physical, mental, and social well-being, not merely an absence of disease or infirmity. We've had this definition of health since 1946. And over the decades, we have had lots of well-intentioned individuals, institutions, all of our colleagues doing really great work to try to bring health across the globe. And this has largely been done with mission trips and outreach programs, but also disaster response and conflict and epidemic and pandemic responses and donations of both time, service, and education. And so a lot of these things are things that we're doing now at the SCCM. But I want to kind of push our definition a little bit further around global health. And what we're really trying to do is achieve universal health coverage. And that means bringing the highest degree of health attainable by all people across the globe. And so in order to do this, we need to shift our thinking a little bit in global health and start to focus a little bit more on how we can build partnerships and how our efforts can be bi-directional. Kind of the days of good intentions and us helping them are over. We really need to be measuring our impact and we really need to actually be listening and learning for the lessons that we can take away as well. There's a greater focus now on education and training and professional development, advocacy and policy, quality improvement, and research. And I think we all know that education and training is an amazing tool, but we're only as good as the systems in which we work. So we really need to be working and Dr. Sampson made great examples of working along stakeholders, infrastructure, policy, advocacy, all of these things. This is a little bit of humor for you guys. So this is a group called RatiAid. They're out of Norway and they're hilarious, but they use their humor to make really, really important points for us. And some of it is how we think about global health and how we think about our efforts as we go and interact with others across the world. And they really help us to avoid some of these things that we've been guilty of, myself included, for many, many years. And that's a unidirectional mentality. It's preconceived notions of the problems and bringing our own solutions rather than listening to our colleagues abroad. And having this charity perspective only and then making a lot of cultural assumptions. I'm going to play you just 35 seconds of this video. We need to make a difference in Norway. We need to collect our radiators, ship them over there and spread some warmth, spread some light and spread some smiles. Say yes to RatiAid. So they go on to create this entire like music video with all these African folks singing about, it's basically like we are the world. And I really, really love this because it really challenges us to think about our own motivations and involvement. It also forces us to think about how are we actually portraying our colleagues abroad. So a lot of the, there's actually been studies done when you look at images that represent global health, it's usually a woman, a child, she's black or Asian and she looks destitute. Just because our colleagues don't have resources doesn't mean that they're not capable and very talented physicians and providers. So I really love this campaign to get us to think a little bit more about that. And some of the things we've learned, I've learned over the years and I've definitely been guilty of some of those same things, but we really need to understand the problem because if we make assumptions about the problem, we're going to bring our own solutions and just as Dr. Sampson pointed out, a lot of times they're not going to work. So we need to understand the healthcare systems, the stakeholders. We also need to have a good lookout for cultural differences. Things that we think like, oh, you just have to do it this way and you just have to tell your administration this or your hospital director that. Cultures are different. Sometimes cultures are more hierarchical and the things that we think should just be may not work in that culture. We also need to facilitate our colleagues. It's not us helping them or us coming with our own solutions. We really need to listen to their definition of their problem and their solutions and we need to be the facilitators to help them achieve their own goals. And this happens a lot through these bidirectional partnerships, collaborations, and an academic exchange. We need to look for lessons. We don't know everything just because we're in a high resource setting. They are much more adept at innovation because they are resource constrained. When they have supply chain disruptions, they don't lose their minds thinking I don't have any rock uranium. They find another medication to give, right? They also are really, really good at green practices. The amount of waste that we generate in high income countries is astronomical. When we leave the operating theater at Stanford, we'll have four to five huge bags of trash just from one surgery, one patient. In Rwanda, we have a kick bucket. So we have a lot to learn from our colleagues. We just need to open our eyes and ears and listen. This article is written by a good friend of mine, Farai Matsumoto. He was in Zimbabwe when I met him, but now he's in Botswana and he goes back to prove the same point that John Sampson made. At the beginning of the pandemic, I think you probably all remember that the world flooded low and middle income countries with ventilators. And at that time, only about 15% of patients actually needed advanced level critical care. Additionally, there were no intensivists. There was no power. There was no oxygen. So we really need to stop imposing our own ideas and understand the problems so that we can facilitate our colleagues' solutions. This article is a little bit older, but I really, really love it. And it's probably in every single talk I've ever given, but this is about questioning your own motivations for becoming involved in global health. And Dr. Phil Pott categorizes these into three different categories. Motivations I'd rather suppress. I want to do global health because it's sexy, because I get frequent flyer miles, because I get to travel. You might not want to tell people that. The second category is motivations that I can tolerate. I feel a sense of reward. I want to give back. Those are things that are tolerable for us to be involved in global health. But the things to which we really want to aspire is we are part of a global community. All of us are in this together. The pandemic certainly showed us that, right? And we need to do everything together to improve patient care across the entire globe because we're all in this together. So that's what I'd like to aspire to, improving patient outcomes. How do we do this? How do we bring our colleagues here? How do we create bi-directional partnerships and collaboration? Some of the pushback that I've gotten over the years is it's too expensive. I'm here to say it's no more expensive to send me or my residents or my co-faculty or my fellows to Rwanda. It's no more expensive than it is to bring them to us. And going back to the first question I asked you, is it better for us to go there and tell them how to do it or how we do it? Is it better for them to read it in a book? No. When you see the resources in a functional health care system that you've read about in books, it's eye-opening, right? So this is really what we want to develop in our colleagues. There are a lot of considerations. You have to determine if your visiting observers are going to be able to actually do patient care. In the United States, we make this exceedingly difficult, as most of you know. There are lots of us working on this. So there's work being done at the federal level for visas and then also work done at the state level so we can get people licensed under a supervised license or otherwise so that they can actually touch patients and take care of them. But for now, a lot of these programs are just visiting observers is what we call them at Stanford. I mentioned the visa and funding. Funding is a big issue. I hope that you can think just for a second, why spend the money on sending us there if we can spend the money bringing a bunch of them here so that we can actually share information about the resources? There's a lot of considerations around paying them. So there's a lot of rules around the type of visa that they're on, but also you want to make sure that you do not impose a tax liability on your guests. It's kind of rude. Travel, lodging, meals, these are obvious things you're going to have to consider, but also vaccinations and having your colleagues cleared through occupational health can also be quite a challenge. Some of my colleagues don't have access to the same vaccines that we have in the United States and so they may actually have to spend, you know, one, two, three, four days waiting to get their titers back from whatever vaccine they received in our occupational health office. You want to ensure that they are compliant with privacy and HIPAA. You also need help. You need, if they're going to be here for a few days, where are they going to go on each day? Who's going to take them around? So the scheduling and logistics requires a bit of effort. And then you want to make sure if they get sick, and trust me, I've had some really interesting situations with my colleagues coming here, including pregnancy and malaria, but you want to make sure that your colleagues are covered with insurance and evacuation for worst case scenarios. Again, cultural competence, when you're setting all this up, you really need to think about the environment from which your colleagues are coming, language barriers, whether or not to be assertive. So you think that your colleague is going to come and be really assertive and say, I want to learn this and talk to all the people in the hospital, but they may be shy or that might not be a cultural norm for them. And then communications, they don't have the same continuous access to the internet that we're all addicted to. So be sure that you can have good communication with them. And then we like to send our friends to the American Society of Anesthesiology Conference, but maybe I'll start sending them here to the SCCM. So these are all things to consider when planning to bring a colleague here. So we've been running these programs since 2015. We've had four cohorts come through. We had three pre-pandemic, and then we just restarted the program, which made my heart sing. And you can see we have people from mostly Africa, Asia, and then Central America. There have been numerous publications, presentations, grand rounds, deliveries, all of this for colleagues that would otherwise not have these professional development opportunities. So this is where I put most of my energy, is in this professional equity and exchange program. Professional societies have a huge role to play. I am so impressed with the amount of global health that has been featured in this conference. Thank you, Kwame. Because I think it really is great as a professional society to reach out and collaborate in other countries. So certainly Stanford is not the only program doing this. The American Society of Anesthesiologists does this. The World Federation of Societies of Anesthesiologists does this. And actually ACGME is now expanding their global services. So they're helping other countries when they're trying to develop residency training programs, fellowships, et cetera, how to set up accreditation processes. So this is really expanding quite a bit, which makes me really happy. You guys know the amazing work that's being done here at the SCCM and it continues to grow. And most of the people who do a lot of this are in this room and on this stage. One thing I do want to bring to your attention is at the World Health Assembly this past year we were really excited that the resolution was passed for health system strengthening for emergency critical and operative care, or the ECHO resolution, which is now in its implementation stages. So the SCCM is working with the acute care network and the WHO to be part of that and basically bringing critical care across the globe. So hopefully I've convinced you that you need to bring people here and create bilateral, bi-directional partnerships rather than us just traveling around the world in our capes. And hopefully I gave you a little bit of information on how to do that. I'm available to any of you who have questions about that and would be happy to share any of our experiences about developing these types of programs. Thank you very much. Good morning. My name is Winnie Alcey. I'm a pediatric intensivist in Haiti And I would like to thank Kwame for inviting me to share with you my experience And thank you for all of you for in your interest so I Don't I have no disclosure. I don't think it's something I would Allege you you know how is hard to get a critical care in low Resources and access to critical care is really a crucial component for of health care system and Resource-limited setting is 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 little resources who has a Critical care and they don't even have a real 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. We 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 the highest in the Caribbean, so We have only one pediatric hospital who has only 10 ICU bed I can tell you how is the burden of taking care of those six children? so As you know in limited resources health care providers face a lot of challenges not only about the knowledge The experience but also limited resources to take care of those patient patient and anonymous task Lack of Experienced people so if those pediatric patient is taking care of care of by adult generalist and Anesthesiologist even those who doesn't know anything about simple pediatrics care. So not talk about critical care impedance so this lack of Senior experience in critical care make things even more difficult for us to take care of patient Not to talk about multiple responsibilities of everyone in our hospital you are as well as the director of the hospital and 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 and Create a pediatric and then Epidemiological 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 become friends and family in the States We discussed a lot about how to do it We came out with we have some 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 we're gonna do it the only person the only our pediatric hospital with only ten beds of Critical care and The only one who knows the critical care so has to train nurses and doctors and Pediatric and pediatric residents, so it's a lot, right? So we because we came with the idea of a bi-directional 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 Wanted 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 the long days night and days Hours of work even weekends. I can't tell you when I came back. It was not easy. I didn't have any day off at all and And Not only that limited resources no technical is support no infrastructure We have to build everything from the ground not not easy and boom 2020 more problems Covid-19 make it worse not even that how a 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 he 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's to come to do Pass course for us and we talked about it and they said why not trying zoom and do the pass 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 the 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 gonna do it and creating a platform where it will be more Something formal go back and do the training and we begin a remote train 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 the resident knows and attending Understand what a the concept and For more participation case presentation has been done in prepared by resident attending international attending so we began all the session in early 2021 and Every two weeks depend on we had some interruption in early 2020 2022nd and we had approximately 52 interaction sessions and 10 case presentation So since there we grow we grew with this Other partner in in Africa saw the example of San Damien Hospital and wanted to join us So this is where we started having more hospital Getting into so this any Initiative add to full purpose. So he helped lessen the taxing force task of training education faced by short-ended colleagues because overwhelming hours overwhelming task and leverage the training and experience of the global community of pediatric real care doctors twin ends the instructions of this young physicians So We created the pediatric critical care in resource limited settings platform and her and this 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 weekends requests from different sites we identified champions partners and the curriculum was revised and established from different hospital and from January 1st 2021 to December 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 intensivist pediatrician pediatric resident consultant Had been part of those sessions and also nurses over 25 intensivist from different hospital partnership participate in the creating this program and we had 10 countries at parties so most From Africa and the only one in Haiti So we have from Ghana hospital from Ghana, Rwanda, Nigeria Ethiopia and sending me an 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 last year case of thinking, you know, the gang 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 eat to to participate with us and When they told me that the name of the of the intensive it 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 thinking quite a case of of dengue and it was an emoji can't be a Case and it was really interesting how we can Promote education and we had a lot of question a lot 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 to Despite language distance and all the barriers that can be so it helps improve the existing gaps He has between providers in limited resources and providers in high We resources and that it's an exchange the experiences between sites worldwide So I would like to thank you for listening

global health initiatives

resource-limited settings

humanitarian missions

ultrasound technology

oxygen access

bi-directional exchanges

critical care knowledge

remote training

global collaboration