A U T U M N 2 0 0 9

In this issue: From the Chair of

PRIME PRIME Bursary Fund Palliative Care in

Zambia ICMDA World Congress

- Uruguay 2010 Palliative Care in

Albania Short Term Medical

Training Trips Update on Russia Health Teaching for

Church Leaders Spreads

Transformation - Albanian GPs Meet

Work a week (or a day) for PRIME

What is PRIME? How can I help? Support form

From the Chair of PRIME We try in these newsletters to give you little vignettes not only of our activities month by month but also of the ongoing vision that drives us forwards. We are very reliant on encouragement not only from our friends overseas, but also from you as you support us. We might otherwise feel i s o l a t e d a n d m o r e v u l n e r a b l e t o t h e

discouragement of the inevitable struggles. So thank you to everyone.

Since we are also receiving encouragement from official groups such as the Royal College, we felt justified in working out that a year or so back, our overseas training could be valued at around 400K, at current consultancy rates. Then considering that nearly everyone kindly gives their time and airfares free we realised that this had been achieved on a budget of around 50K. Apart from some tiny grants, this has been with the generosity of only about 30 regular supporters. Thanks so much to these true friends.

We do need to grow. Potential openings abroad (which can have very expensive travel costs, such as Nepal or parts of Africa) continue to expand, and we also need to develop far more resources to nourish these. Manuals, DVDs and teaching plans will hopefully lead on one day to the development of distance learning. These are skilled tasks requiring skilled people, to be matched by well-qualified administrative support.

Could you consider supporting us on a regular basis? Our personal calling has been strong enough for us to commit thousands of hours over many years and across many nations. Please could you stand with us in that calling to extend the Kingdom of Heaven within this caring profession?

Dr John Caroe, Chair of PRIME

PRIME Bursary Fund PRIME is establishing a Bursary Fund to support health professionals from low and middle income

countries or professions to travel to attend PRIME courses. If you would like to make a donation to the fund please visit our website to make an online donation or contact the office for other ways to make a

donation. Please mark any donation clearly for the Bursary Fund.

This Course Has Been a Real Eye-Opener!

A PRIME Course in Palliative Care in Zambia, July 2009

Dr Tom Garrett was PRIMEs co-ordinator in Southern Africa, and he really started something...

In July, four PRIME tutors from England, Scotland and the Netherlands - hospice consultants, a specialist nurse and a GP - arrived in Lusaka for two weeks of intensive training.

This Zambian course followed on from a similar course led by Tom in 2007, which taught palliative care (or hospice-type medicine) in Lusaka, the capital of Zambia, where he himself had visited and where members of his family lived. He introduced us to Dr John Mudenda, then principal of Chainama College of Health Sciences, a medical doctor and educationist who has become instrumental in further developments in PRIME in Southern Africa.

Twenty-seven medical and nursing teachers from the College had booked up for the course. They were highly intelligent, well trained and motivated Africans, who gave themselves whole-heartedly to the theory of caring for people with incurable and fatal disease, notably cancer and AIDS. But the course was not classroom-bound. To our joy, the African organisers had developed our suggestion of a second week to introduce the trainees to hospices, to practical patient-care and to needy people.

This meant that the course became eight very full days of participatory sharing of experience. We visited three local hospices in and around Lusaka, met patients in the hospital and hospices and spent a fascinating period exploring different traditions of care for dying people and the bereaved.

Course members filled a personal (but anonymous) questionnaire at the beginning of the course and repeated it during and at the end of the course, showing how their understanding and confidence in caring had increased during the period - but it was the unexpected consequences which particularly thrilled us. Like the course member who, during the visit to the Cancer Disease Hospital, volunteered her services as the (only) social worker for the patients of that brand-new and very high-tech hospital. Like the nurses who, seeing the stretched circumstances of the city centre hospice, offered to set up a support service among themselves to help with funds and provision for patient-care. And the director of human resources at the college who determined to organise groups of trainee nurses to have placements at the hospices, not only to give the students wider experience of good nursing practice, but also to help with the staffing needs of the hospices.

As one of the doctors on the course said, This course is a real eye-opener!

Thank you, Tom, for starting something very exciting in Southern Africa.

And thank you, Toms fellow parishioners, for your giving towards the work of PRIME through the Tom Garrett Memorial Fund, money which will be used to extend the opportunities for other professionals to have their eyes opened also.

Anthony Smith, Prime Trustee and Palliative Care Consultant.

Group work in the Zambian sunshine - in the cold of Zambian mid-winter!

Course members meet patients in the hospital.

PRIME team and course members at Chainama College. Dr John Mudenda on far left, Dr Anthony Smith kneeling.

2010 World Congress of ICMDA The 2010 World Congress of ICMDA will take place in the beautiful coastal resort of Punta del Este, Uruguay, from 4th-8th July 2010. PRIME will contribute to this, the main congress, and in addition will run a pre-conference stream (Gods values in training healthcare professionals) from 2nd-3rd July. Here we will run four sessions on the PRIME vision for whole person medicine and spend time looking at spiritual and emotional intelligence and working in teams effectively.

The theme of the main congress is Priorities in Medical Practice Who Are You Working For? We will consider what place God has in our plans; what space do we give to our families; are we aiming for excellence and commitment in our work; who are we serving?

The distinguished speakers will include Dr David Stevens, President of the Christian Medical and Dental Association of the USA; Dr Pablo Martinez, psychiatrist, President of the EA in Spain; Dr Aldo Fontao, cardiologist and church leader at national level in Argentina, and Mr Philip Yancey, renowned author from the United States. This promises to be an exciting congress in a fabulous location. If you are able to join us do make some time for leisure and sightseeing in this historic area with great natural beauty.

The other conference streams will include: Students and Junior Doctors; Psychologists and Psychiatrists; Saline Solution; Nurses.

Full details on the ICMDA website: www.icmda2010.org

Update on Palliative Care in Albania In the lobby of the Liss hotel in Lezhe is a picture of the town with a group of children in the foreground. All are happy, healthy and are playing with kites which sail across the blue sky of the Lezhe of a different era. This was the era when youth and health were idealised. Does this attitude still prevail?

Is this why Palliative Care is not recognised as a speciality and why, neither, is care of the elderly and why mental health care is in its infancy and medical staff are so poorly paid? How does this marry up with a modern day Albania newly admitted to NATO and longing to be a part of the EU. How long will this gap remain?

The last conference held by the National Association of Palliative Care in Albania was in 2005 - others have been thought about but not happened. It may be that a second one is held in the early part of this November. Certainly the office bearers of the Association are keen for this but there are a number of issues yet to be resolved - Is there a venue? Is there funding? Will the Ministry of Health respond to invitations? Will the academics come?

PRIME Australia has come into being and tutors in the form of Peter and Beth Ravenscroft have been to help with the Lezhe training course. Peter is Professor of Palliative Care at Newcastle University in New South Wales and Beth is on the Pastoral Care team (her initial training was as a paediatrician). This course was the largest ever with some 30 attendees hospital and family doctors and nurses from a variety of institutions as well as a pharmacist and some students. This is the fifth such course and the first question in the final plenary was when is the next? Answer - January 2010 DV, thanks to funding from the Albanian Medical Trust.

And we were on Lezhe TV part of the PCEC (Palliative Care and Education Centre) vision to widen the understanding in the town to their existence and service.

The children depicted in the hotels picture are now at the age when their health is failing. The kites have long since flown away and now the reality of years of smoking and the absence of a cervical smear programme and one for breast screening are coming home to roost.but few people want to talk about it.

Maybe the TV and the conference will help Elizabeth Swain

Recurrent Short Term Medical Teaching Trips The world of medical mission is changing. Todays electronic systems and speeds of communication mean that increasing links and networks are being created between developed and developing countries without the intermediary of traditional mission agencies. Relatively cheap airfares mean it is possible for those in rich Western countries to travel to distant places for short periods quite easily. Some dynamic new groups are at the cutting edge in exploring the possibilities of this new world.

Partnerships in International Medical Education (PRIME) PRIME is a registered charitable network of doctors and other health care workers involved in medical education that is seeking to use the opportunities provided by medical teaching as a vehicle for holistic mission. It enables those with skills and experience in medical teaching in the UK and other developed countries to link with partners in developing countries who wish to invite them to come and provide educational programmes for their personnel. Links have been forged with those of other faiths (or none) who share a commitment to good, whole-person care, high ethical standards, and a spiritual perspective in medical care. PRIMEs vision is to teach and model good learner-centred educational methods. PRIME currently works in many Eastern European and former Soviet countries as well as some in South Asia and Africa. Initially the majority of people involved in PRIME were General Practitioners, as GP (Family Medicine) development is a current growth area in many countries and there are a number of opportunities for those experienced in GP education to serve overseas. However there are increasing numbers of hospital specialists and allied professions members who have also worked with PRIME, and it is now networking with Nurse Tutors and others as new opportunities for teaching in needy situations come to light. If you are

an experienced teacher in your discipline, and are willing to spend a week or two a year (or longer) teaching in a developing country at your own

expense, PRIME will be interested to hear from you. PRIME tutors normally travel in pairs so the first trip would be made with another experienced tutor whod previously visited the relevant country. Some PRIME tutors (including the author of this article) have spent many months in host countries contributing to the deve lopment o f va r ious med ica l educa t ion programmes.

The rewards Its a great privilege to meet enthusiastic and committed healthcare professionals and other colleagues in different cultures who have a vision for improving health care in their country. Often they are trying to do this in the face of very limited resources and indifference or even hostility from government and university authorities. The presence and input of international experts is usually a great encouragement to them, and repeated visits enable us to see what progress they are making and signal an on-going interest from supportive overseas colleagues in their struggles. Introducing new ideas and learning methods to under-resourced colleagues, modelling learner-centred approaches to teaching and seeing eyes light up with enthusiasm is very exciting. Facilitating the development of doctors and others serving the poor in isolated rural situations,

and so hopefully improving health care for people in the real, developing, world, is rewarding. It is exciting to see agreement with the values and principles we teach. In a few places it has been very gratifying to find that consultation/communication skills training in particular has transformed some doctors appreciation of the value of what they do, and they have found patients wanting to see them rather than other types of doctor, because theyve developed a reputation for really listening to the patients problems. All PRIME work is built on forming relationships, and it has been very rewarding to build these over years with doctors and others in many countries that appreciate the support we give. Spiritual values and compassion really do revolutionise health care, and it is great to see colleagues in many countries truly grasping this for the first time when they participate in PRIME programmes. Many have thus been inspired for the first time to see medicine as a spiritual vocation, so potentially having a transforming effect on their countrys health care system.

Did you know... If you take part in a PRIME teaching team and pay for your travel b u t d o n o t c l a i m e x p e n s e s y o u c o u l d actually be losing PRIME money?

Under the rules of Gift Aid vo l u n t e e r s who c l a im expenses can legitimately donate some or all of those expenses back t o the charity and their donation is still eligible for Gift Aid.

In 2008 for example PRIME sent out over 50 tutors. If we assume that each of t h o s e t r i p s c o s t a conservat ive 200 per person in travel costs* and if those all those tutors claimed and donated back 200 PRIME could have claimed back over 2,500 from the UK Government at no additional cost to anyone.

This would pay for four Pal l iat ive Care training courses in Albania, our staff salaries for a month, or the o f f i c e cos t s f o r t h ree months.

To good to be true? Check out the rules for yourself at http://www.hmrc.gov.uk/charit ies/gu i d an c e - no t e s / c h ap t e r 3 /sectionf.htm#ay

* Tr a v e l f o r some PR IME trips can cost a s m u c h a s 1 0 0 0 p e r person.

The challenges These are mostly to do with the expectations and beliefs that we carry from Western culture coming up against those from very different cultures. These could relate, for example, to time orientation and directness. In most Eastern and African cultures more emphasis is placed on the importance of relationships and time spent on building them.

Interactive teaching methods are largely unknown in many countries and participants may take time to adjust to them as they transgress familiar hierarchical cultural norms. There is the need to be constantly aware of the poverty of developing countries and the implications of this in terms of lack of equipment, very low pay for healthcare workers and general lack of infra-structure that makes running teaching programmes, planning activities and organising meetings much more of a challenge than it is in the developed world. Failing power supplies often interrupt teaching sessions so you cant necessarily depend on projected PowerPoint presentations or even an overhead projector, and simple things like getting handouts printed can be a major task. Having to work through interpreters is also an interesting challenge, although one that is quickly adjusted to, and not a great hindrance if, as is usually the case, they are medically qualified or medical students.

You need to be an enthusiastic traveller and be prepared for the usual hassles associated with international travel, but all of these challenges pale into insignificance compared to the privilege and excitement of using teaching skills to improve the health care of those in the real, Two-Thirds world.

Huw Morgan MBChB MRCGP Cert Med E FHEA Consultant in International Medical Education (for PRIME)

Update on PRIME in Russia PRIME's collaborative work with our Russian colleges is going from strength to strength. Opportunities have opened up at Moscow Medical Academy and at Kazan State Medical University to lead courses on how to teach communication skills to medical students. One of the most encouraging aspects of this work is that both of these prestigious centres of excellence want their courses to consist of multiple visits, with time for the participants to practice what they have learnt in between. This wi l l provide greater opportunity for detailed two-way feedback and ensures that participants are able to make t he mos t o f t he i r l ea rn i ng opportunities. We are also finding that multiple visits by the same PRIME team is providing opportunities for research links to develop with our Russian partners. The aim is to pursue research questions that will yield useful data within a Russian context, so that communication can be taught within a relevant evidence base. As both the UK a n d R u s s i a w o r k t o w a r d s f u l l implementation of the Bologna Agreement many more opportunities are opening.

Moscow Medical Academy

Kazan State Medical University

Health teaching for church leaders spreads Recently there has been considerable correspondence on the Health Information for Africa website (www.hifa2015.org) concerning the role of churches in providing healthcare within Africa. The church in Africa has been one of the main agents in the fight against AIDS but now WHO also regards working with Faith Based Organisations (FBOs) as a necessary part of improving general health in deprived areas.

In December last year (as reported in a previous newsletter), PRIME tutors Dr John Geater and Rev Dr David Moynagh worked

with two Nepali NGOs (Shanti Nepal and CMC Nepal - both established by United Mission to Nepal) to offer teaching in basic healthcare to nearly 100 rural church leaders and their wives - often from areas with little or no health infrastructure. As a result of that, the Nepal Churches Fellowship has asked Shanti Nepal

to provide five day courses three times a year in different parts of Nepal.

In May, John Geater, David Moynagh and Rob Sadler were invited to Serbia - a very different situation - by the Evangelical Theological Seminary in Serbia to conduct a two day seminar with their students. The response was very positive - ("I never knew these things" was a typical response) with requests for follow-up.

Having tried out programmes suitable for different situations, this activity will now be a part of PRIME's programmes, bringing together the Church and Medical communities in countries in which we work.

TRANSFORMATION - Albanian GPs meet to transform the future PRIME tutor Eralda Turkeshi (who heads up MDKSH - the Albanian equivalent of UK's CMF) was the main organiser of Transformation, the annual national GP conference financed by the Albanian Health Fund in US with whom PRIME has worked in close harmony over the years. 200 family doctors and GPs from all over Albania attended, with teaching provided by Albanian, Kosovan, US and UK doctors. PRIME tutors Prof Richard Vincent and Drs Elizabeth Swain (PRIME's UK deskholder for Albania), Andy Charley and John Geater all conducted seminars on a variety of subjects related to chronic disease management, sharing their sessions with young Albanian teachers. Prior to the two day conference, a high level meeting of all those involved in the development of primary care in Albania was held, which included the deputy Health Minister and Director of

Public Health. A presentation on the role of PRIME in Albania was given and greeted enthusiastically.

It is good seeing the huge leaps forward in the quality of care offered by family doctors across Albania and we have been privileged in being able to play a part in this with such excellent Albanian partners.

Dr Eralda Turkeshi

Novi Sad Theological Seminary

United Missions Hospital, Nepal

Work for PRIME for a week... or a day... or even a session... Not able to go away to teach on a PRIME course because of commitments at home?

You can still provide teaching where it is so necessary by working that week at home and donating the money to PRIME to finance the work of one of our increasing number of tutors living and working in the developing world.

They are unable to fund the expenses needed - but even a day's work might be enough to enable someone like John Mudenda in Zambia to travel to Mozambique to share his

mental health and medical education skills (not to mention his passion for compassionate care). With Gift Aid, you do not even need to pay tax - and the weeks work back home will be a lifeline to others.

PRIME - Partnerships in International Medical Education is a registered charity in the UK: Reg No: 1111521 Registered Office: Innovation Centre, Highfield Drive, Churchfields, St.Leonards, East Sussex, TN38 9UH

What is PRIME? PRIME - Partnerships in International Medical Education is registered as a charity in the UK dedicated to improving standards of health worldwide, particularly in primary care, through educational activities in collaboration with local and national organisations in other countries. We seek sustainability through training trainers and equipping them with appropriate skills.

Further information on the work of PRIME may be found on our website

www.prime-international.org.uk

How can I help? PRIME is a highly cost efficient charity due to the voluntary donation of both their time and expertise by highly qualified Christian professionals dedicated to improving healthcare worldwide through the education of doctors, students and other healthcare workers. However, due to the growing number of invitations to a wide range of countries, there are increasing costs related to administration, fares and in country costs.

To make a financial donation contact Jo Clark or email admin@prime-international.org.uk or phone 0044

(0)1424 858258 during office hours.

If you would like to become a Partner in PRIME please consider making a donation or giving regular support. If you can help please complete this form and return it to: PRIME, Innovation Centre, Highfield Drive, St Leonards, East Sussex TN38 9UH

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