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Tue Apr 24 18:31:31 BST 2007

I think such courses  would have an impact.Due to lack of trained personnel
and absent pre-hospital care, a doctor would probably be the first trained
person to see a trauma patient, unlike in the west where trained paramedics
would see them at the roadside. in such a situation, unless the doctor (most
of them inexperienced, unsupervised juniors)know what to look for and treat,
the patient is a goner.

Even if it is not a fully equipped course like the ATLS, merely giving them
an idea of the potential problems and what to look for (protection,
stabilisation etc) before referring the patient onto the nearest appropriate
facility, should do wonders for their confidence and pateint care.

Dr.K.R.Rajesh, MS,DipNB,FRCS,FRCS(Orth)
Consultant Orthopaedic Surgeon
Division of Upper Limb , Arthroscopy & Joint Replacement Surgery.
Cosmopolitan Hospital
Trivandrum,Kerala,India.

Advisory Board Member
World Road Safety Partnership
www.worldroadsafety.org

"If you drink and drive, you are a bloody idiot !"

Mobile-9447191205

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Andrew J Bowman
Sent: 24 April 2007 10:22
To: Trauma &amp, Critical Care mailing list
Subject: Re: Trauma training in low income countries

Although not exactly trauma, it does remind me of my experience about 9
summers ago.

I was asked to jojn a group of physicians going to India to teach ACLS. The
coordinator of this project had completed his medical school in Hyderabad
before coming to the US to complete his residency and set up shop in
Indiana.

While I was honored to be included on this trip I came away with a lingering
question; were we really providing a service to the close to 100 physicians
and few nurses who attended this program? From the seemingly overwhelming
numbers of potential patients (11 million+ in Hyderabad) with seemingly few
hospitals and seemingly difficult access to basic emergency care it did not
seem to me that ACLS was what the participants needed.

I admit, I had just a week to see this country and city but I did not feel
that my 3 day ACLS course would have much of an impact.

Andrew Bowman

On 4/23/07, Sanjay Gupta MD <sanjaygupta99_91 at yahoo.com> wrote:
>
> I left India about 6 years ago.  I keep a close tab on
> medical systems in India and to the best of my
> knowledge, there is no community based trauma training
> which is appropriate for most doctors.  And that is
> exactly my point - getting a course by ACS or any
> other organization is not going to help.  The training
> program has to be developed in the country and
> training imparted to everyone by easily available
> resources and by major organization efforts by thought
> leaders in India, rather than by paying for the $1400
> ATLS course for every doctor in the country.  It is
> not the lack of knowledge or training, but rather of
> organizing and implementation.
>
>
> Sanjay
>
>
>
> --- "Joel U. Macalino, M.D." <jamac at pacific.net.ph>
> wrote:
>
> > In the Philippines, we have adapted a national
> > trauma course we now call the
> > B.E.S.T. (Basic Emergency Skills in Trauma). The
> > course was developed
> > through the efforts of the Philippine College of
> > Surgeons and is now offered
> > almost monthly to accommodate all the trainees in
> > surgery. It features
> > didactics and skill stations on knowledge we have
> > identified to be necessary
> > from national injury census and studies. The course
> > likewise includes
> > disaster management and mass casualty incidents as
> > our country is one of the
> > most disaster prone area in the planet.
> >  Joel U. Macalino, MD
> >
> > ----- Original Message -----
> > From: Miranda Voss <mvossak at yahoo.co.uk>
> > To: <trauma-list at trauma.org>
> > Sent: Monday, April 23, 2007 8:12 PM
> > Subject: Re: Trauma training in low income countries
> >
> >
> > Dear Sanjay and others,
> >
> > I have only spent 4 months in India but did have the
> > impression that you are in the same situation as we
> > are in SA: while the urban teaching institutions
> > (such
> > as AIIMS and Tygerberg) are world class, there are
> > many peripheral government hospitals which struggle
> > to
> > provide a good service and some are frankly awful.
> > It
> > is in these environments that a systematic approach
> > to
> > trauma training should be useful.
> >
> > I am not suggesting that Indian trauma surgeons need
> > US style training, but that GPs working in
> > peripheral
> > hospitals and occasionally (but increasingly) seeing
> > severe trauma would find a taught system of managing
> > severe trauma useful. I certainly did in my GP days.
> >
> > Have any of your teaching hospitals developed trauma
> > training outreach programmes yet?
> >
> > Miranda
> >
> > Dr M Voss FCS(SA)
> > Eben Donges Hospital,
> > Worcester
> > W. Cape, RSA.
> >
> > From: "Robert F. Smith" <rfsmithmd at comcast.net>
> > Subject: RE: Trauma training in low income
> > countries.
> > Date: Fri, 20 Apr 2007 18:15:39 -0400
> > To: "'Trauma & Critical Care mailing list'"
> > <trauma-list at trauma.org>
> >
> > Plain Text Attachment [ Scan and Save to Computer |
> > Save to Yahoo! Briefcase ]
> >
> > IMHO your thoughts are totally correct.
> >
> > R. Smith
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]
> > On Behalf Of Sanjay Gupta MD
> > Sent: Friday, April 20, 2007 5:36 PM
> > To: Trauma &amp, Critical Care mailing list
> > Subject: RE: Trauma training in low income
> > countries.
> >
> > Hi Sohail and other members of the trauma list who
> > work in India and other "soon to be rich countries"
> >
> > I have worked in India as a surgeon for 12 years and
> > then I trained in US and I am working as a trauma
> > surgeon now.  I think that the trauma surgeons in
> > other parts of the world (outside the rich
> > countries),
> > should keep on doing whatever they are doing.  I
> > think
> > they (until very recently we), do an excellent job
> > of
> > assessing and managing these patients without
> > overinvestigating and over diagnosing non-existent
> > conditions.  The money to take the ACS trauma course
> > and then to do CT scan for (almost) everyone would
> > be
> > much better spent in buying some good trauma
> > textbooks
> > and in organizing teams in hospitals where all
> > specialists needed are easily available, blood and
> > other resources are defined and made available and a
> > good ICU with all resources is available.  My
> > professors and other much junior faculty members in
> > All India Institute of Medical Sciences (just taking
> > an example) are as good surgeons and organizers as
> > any
> > in the Western world.  Rather than getting an
> > outside
> > organization get the money to run the course,
> > organize
> > it with local talent which is abundant and
> > excellent.
> > Remember also that in many parts of the world, the
> > trauma patient is primarily taken care of by ED
> > physician who then calls the surgeons of various
> > specialities as needed.  Most surgeons in India (at
> > least if they train from a standard institute and
> > make
> > the effort to do a senior residency) are very well
> > trained and competent to do all sorts of trauma
> > surgery.  Just my opinion and an advice to save some
> > money.
> >
> >
> >
> >
> >
> > Sanjay Gupta
> >
> >
> >
> >
> >
> >
> > --- Thomas Anthony Horan <thoran at sarah.br> wrote:
> >
> > > Sohail,
> > > I can certainly support that sentiment, the people
> > > who most need the course are in governemnt
> > hospitals
> > > that are cash poor for this sort of thing. People
> > I
> > > talk to here say it , (as well as the vast
> > majority
> > > of other NA and european CME), is simply priced
> > out
> > > of their budget range. Tom
> > > > ----------
> > > > From:
> > >
> >
> trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org]
> > > on behalf of Sohail
> > > Muzammil[SMTP:sohailmuzammil at hotmail.com]
> > > > Reply To: Trauma & Critical Care mailing list
> > > > Sent: quinta-feira, 19 de abril de 2007 15:10
> > > > To: Trauma & Critical Care mailing list
> > > > Subject: Re: Trauma training in low income
> > > countries.
> > > >
> > > >
> > > > The ACS has enough money so why can they not
> > earn
> > > some goodwill and waive
> > > > the franchise and other fees for third world
> > > countries? Beats me.
> > > >
> > > > S Muzammil, FRCS
> > > >
> > > > ----- Original Message -----
> > > > From: "Matt Oliver" <moliver1 at iinet.net.au>
> > > > To: "'Trauma & Critical Care mailing list'"
> > > <trauma-list at trauma.org>
> > > > Sent: Thursday, 19 April, 2007 2:15 AM
> > > > Subject: RE: Trauma training in low income
> > > countries.
> > > >
> > > >
> > > > WHO was promoting PTC (Primary Trauma Care)some
> > > years ago, this may also be
> > > > worth looking into as India is on the list of
> > > countries participating. See
> > > > http://www.primarytraumacare.org/
> > > >
> > > > Matt Oliver
> > > > Bendigo
> > > > Australia
> > > >
> > > > -----Original Message-----
> > > > From: trauma-list-bounces at trauma.org
> > > [mailto:trauma-list-bounces at trauma.org]
> > > > On Behalf Of Miranda Voss
> > > > Sent: 18 April 2007 22:07
> > > > To: trauma-list at trauma.org
> > > > Subject: Trauma training in low income
> > countries.
> > > >
> > > > The International Comittee of the Red Cross also
> > > > offers the Emergency Room Trauma Course (ERTC)
> > as
> > > a
> > > > cost effective alternative to ATLS in lower
> > income
> > > > countries.
> > > >
> > > > Miranda.
> > > >
> > > > Dr M Voss
> > > > Eben Donges Hosital
> > > > Worcester
> > > > W Cape, RSA.
> > > >
> > > >
> > > > From: "Hardcastle, Tim, Dr <tch at sun.ac.za>"
> > > > <tch at sun.ac.za>
> > > > Subject: RE: world road safety.org (was -
> > Disaster
> > > in
> > > > Roanoke - Proximity oftrauma centers)
> > > > Date: Tue, 17 Apr 2007 10:49:18 +0200
> > > > To: "Trauma & Critical Care mailing list"
> > > > <trauma-list at trauma.org>
> > > > Plain Text Attachment [ Scan and Save to
> > Computer
> > > |
> > > > Save to Yahoo! Briefcase ]
> > > > Rajesh
> > > >
> > > > You do, however have NTMC - the IATSIC lower
> > > income
> > > > country trauma
> > > > course. If yuor passion is strong get involved.
> > > > Contact through Indian
> > > > Trauma Society.
> > > >
> > > > Tim
> > > > Dr T C Hardcastle
> > > > M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
> > > > Senior Surgeon / Senior Lecturer: Surgery
> > (Trauma
> > > and
> > > > ICU)
> > > > ATLS  instructor and DSTC Cape Town Course
> > > Director
> > > > Intern program Coordinator: Surgery
> > > > M.Med (Emergency Medicine) Executive Committee
> > > member
> > > > Clinical Head (Director): Diana Princess of
> > Wales
> > > > Trauma Unit
> > > > Division of Surgery (General) Room 4064
> > > > Department of Surgical Sciences
> > > > Tygerberg Hospital / University of Stellenbosch
> > > > PO Box 19063
> > > > Tygerberg 7505
> > > > Western Cape
> > > > South Africa
> > > > e-mail: tch at sun.ac.za
> > > > Cell: +27824681615
> > > > Office: +27219389281 or 4911 pager 0302
> > > >
> > > >
> > > >
> >
> >
> >
> >
> >
> >
> ___________________________________________________________
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>
>
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>
>
> Sanjay Gupta MD
> Tel: 412 335 6304
>
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Trauma training in low income countries