News at Medicine - August 2016 - From here to Haiti

From here to Haiti
August 14, 2016
No matter where you are in the world, during a medical emergency, minutes matter. Through the use of sustainable simulation, it’s possible for health-care professionals to gain hand-on experiences in a safe learning environment. Memorial’s Faculty of Medicine has partnered with the Justinian University Hospital (JUH) in Haiti to help bring this teaching method to rural and urban areas throughout the country.
Recently, Drs. Tia Renouf, chair of the Discipline of Emergency Medicine and Adam Dubrowski, academic director of the Clinical Learning and Simulation Centre partnered with the JUH. Their objective was to help develop and deliver a sustainable, inexpensive, culturally and geographically relevant simulation-based educational program.

Members of the Memorial and JUH teams visited each other’s countries and formed a unique working relationship with the goal of cascading simulation-based medical education throughout Haiti.

“The collaboration began during a clinical trip to Bod Mer Limbe with Haiti Village Health, when the research arm of our team did a needs assessment with Haitian learners, physicians and clinical leaders”, said Dr. Renouf. “The Haitians told us that that they saw simulation as a moral imperative, but had reservations about its utility because of the expense and infrastructure needs that one associates with commonly-used high fidelity teaching methods.”

Together, with Drs. Zephyr and Norciede from JUH, the team implemented a Train-the-Trainer (TSimT) program that enabled the use of simulation as a training tool in both urban and rural medical education settings throughout the country. A key element of this program was to understand the needs of the medical professionals in Haiti and the limitations they face due to limited resources.

The use of expensive computerized mannequins to deliver simulation in Haiti was impractical due to cost, technology and maintenance requirements. As a result, inexpensive, practical and culturally relevant low-fidelity simulators were a staple of the program.

The Haitian doctors had already developed a low cost, locally-sourced laparoscopic simulator and “stomach” for teaching residents, which became the main task trainer for the program.

Drs. Dubrowski and Renouf worked with the JUH team to help them properly use and set up their simulator to provide the most realistic learning opportunities possible. They also observed several Haitian surgery and gynaecology residents use the simulator to practice their surgical skills.

When asked about future plans, Dr. Dubrowski said that going forward, the Haiti-based working group, led by Drs. Norcéide and Zephyr, will apply the skills gained in the TSimT program to JUH residency programs.

“We call it the cascading effect, where a small group of dedicated trainers trains a new cohort of trainers, with time moving outside of JUH into other schools and hospitals,” Said Dr. Dubrowski. This collaboration represented a new partnership between Memorial and the JUH, building upon long-standing relationships between Memorial and Haiti.
A laparoscopic task trainer developed in Haiti.

Dr. Dubrowski explained that rural physicians in Newfoundland and Labrador will also benefit,  because educational needs in developing countries are often similar to those in remotely distributed teaching sites.

“Just as in Haiti, many of our smaller rural health care centres may not be able to sustain or even operate complex simulation equipment. Therefore knowledge that we gain from working with the Haitians in coming up with alternative and sustainable simulators and teaching menthols may transfer to our rural communities.”