Timor-Leste Training Program
Background
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Timor-Leste, a developing nation with a population of 1.2 million, is located 450km north-west of Darwin. Despite being so close to Australia, its health outcomes are relatively poor. Infant mortality, while improving, remains at high levels: 57 children per 1000 live-births die by the age of 5 years, 5 times the World Health Organisation (WHO) European Region rate of 11 per 1000 live-births, and well above the global average of 43 per 1000 live births.
Malaria rates have declined by over 90% in the past decade, due to a concerted effort by the Ministry of Health in conjunction with the WHO. Hepatitis B is common in Timor-Leste. A recent study revealed a HepBSAg positivity rate of 2.8% of 755 women who attended the Bairo Pite Clinic in Dili for antenatal and post-natal care. Hepatitis B treatment and vaccination programs are being developed. |
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Partnership with Hospital Nacional Guido Valadares
Ms Megan Brewer (Australian Embassy), Dr Chris Kiely, Dr Zeto (Director General HNGV), Dr Celia Santos (HNGV) at the MoU signing
Hospital Nacional Guido Valadares (HNGV) is the largest hospital in the country, located within the nation's capital, Dili. It consists of 250 beds, with inpatient services across general medicine (80 beds), general surgery (80 beds), paediatrics, obstetrics and emergency. The busy emergency department sees approximately 150 patients daily. 21 patients presented with gastrointestinal bleeding in April 2016. Patients are also admitted for elective procedures through outpatient clinics, and are referred to tertiary level health-care facilities from the districts of Timor-Leste.
Following the arrival of Australian-trained gastroenterologist Chris Kiely in Dili in early 2016, and HNGV's agreement to establish a gastroenterology unit, ANZGITA Director Di Jones visited in August 2016 to train nurses and assess the unit’s capabilities and potential for assistance in moving towards a self-sustaining endoscopy unit over the coming years.
After a plan of engagement was approved by the ANZGITA Board and HNGV, two training programs were held in 2017. Chris took on the additional responsibility of program leader on behalf of ANZGITA. A Memorandum of Understanding (MoU), approved by the Ministry of Health, was signed with HNGV in 2017, cementing a continuing partnership between our organisations. In 2017, 950 gastroscopies and 200 colonoscopies were performed.
Following the arrival of Australian-trained gastroenterologist Chris Kiely in Dili in early 2016, and HNGV's agreement to establish a gastroenterology unit, ANZGITA Director Di Jones visited in August 2016 to train nurses and assess the unit’s capabilities and potential for assistance in moving towards a self-sustaining endoscopy unit over the coming years.
After a plan of engagement was approved by the ANZGITA Board and HNGV, two training programs were held in 2017. Chris took on the additional responsibility of program leader on behalf of ANZGITA. A Memorandum of Understanding (MoU), approved by the Ministry of Health, was signed with HNGV in 2017, cementing a continuing partnership between our organisations. In 2017, 950 gastroscopies and 200 colonoscopies were performed.
2022 Training Program at HNGV
Following a gap of two years, a Timor-Leste Training Program was run over two weeks, rather than the usual one, in August at the request of the HNGV unit. Two teams of 2 doctors (Chris Kiely, Damian Harding, Robyn Nagel and Tony Rahman) were assigned for a week each. Two nurses (Rachael Helm and Johanna Whiteley) were assigned for the two week period. In addition Peter Longden, an anaesthetist, was also part of the team in week 2. Unfortunately Damian Harding fell ill just before departure and had to pull out. He has fully recovered.
The structure of the program generally included endoscopy lists in the morning, which often flowed into the afternoon, followed by a lunch break, and lectures or tutorials in the afternoon if time permitted. Dr Celia Santos, the HNGV Program Leader, had arranged 8-10 training cases per day, with a focus on interventional gastroscopy and diagnostic colonoscopy. The ANZGITA nurse trainers guided their Timorese colleagues on procedure protocols and provided refreshers on endoscope decontamination and the use of endoscopy accessories. The dedication of the nurses to safe endoscopy practice through the use of the ANZGITA funded reprocessing and storage system is commendable.
The volume of endoscopy has increased over the past two years although Covid did present challenges for the unit. Two registrars are now attached to the unit which continues to have a positive impact on the treatment of inpatients and outpatients of HNGV. Both registrars will be undertaking further training in gastroenterology in China in the coming weeks.
The program was a success and Program Leader, Chris Kiely, has recommended another program in the first half of 2023.
Two one-week training programs were held in each of 2019 and 2018.
The structure of the program generally included endoscopy lists in the morning, which often flowed into the afternoon, followed by a lunch break, and lectures or tutorials in the afternoon if time permitted. Dr Celia Santos, the HNGV Program Leader, had arranged 8-10 training cases per day, with a focus on interventional gastroscopy and diagnostic colonoscopy. The ANZGITA nurse trainers guided their Timorese colleagues on procedure protocols and provided refreshers on endoscope decontamination and the use of endoscopy accessories. The dedication of the nurses to safe endoscopy practice through the use of the ANZGITA funded reprocessing and storage system is commendable.
The volume of endoscopy has increased over the past two years although Covid did present challenges for the unit. Two registrars are now attached to the unit which continues to have a positive impact on the treatment of inpatients and outpatients of HNGV. Both registrars will be undertaking further training in gastroenterology in China in the coming weeks.
The program was a success and Program Leader, Chris Kiely, has recommended another program in the first half of 2023.
Two one-week training programs were held in each of 2019 and 2018.
Endoscope Reprocessing, Drying & Storage Sysyem
In September 2018, the semi-automatic endoscope reprocessing system (pictured below) was installed at Hospital Nacional Guido Valadares (HNGV) in Dili, the capital of Timor-Leste. It was the culmination of over two year’s work by Dianne Jones, supported by others, to specify and source a system best suited to a developing country's conditions. The system enables the learning of best-practice skills and procedures for reprocessing during intensive training sessions by visiting ANZGITA teams and, most importantly, supports endoscopy practice which is free from equipment cross infection. Cantel Australia supplied and installed the system using equipment from a Chinese supplier, and committed to a multi-year support arrangement. The project was funded through a generous donation by the Ainsworth Foundation.
A Drying & Storage Cabinet Project has also been completed in 2022. More to follow.
A Drying & Storage Cabinet Project has also been completed in 2022. More to follow.
It will enable endoscopy procedural practice free from equipment cross infection at all times.
Whiteley Medical kindly donated a further pallet of cleaning products to be used with the system. The company also sponsored the attendance of HNGV's lead GI nurse, Mrs Augusta Menezes, to AGW2018 and to Logan Hospital to observe the operations of an Australian endoscopy unit.
Initially Drs Sydney Chung (Hong Kong) and Stephen Pianko (Melbourne) donated Olympus scopes and equipment. Olympus Australia have subsequently supplied further endoscopes and are providing on-going maintenance and support. They also plan to visit HNGV in 2019 to provide training on the care and support of their products.
Information relevant to training programs is available below to download.
Initially Drs Sydney Chung (Hong Kong) and Stephen Pianko (Melbourne) donated Olympus scopes and equipment. Olympus Australia have subsequently supplied further endoscopes and are providing on-going maintenance and support. They also plan to visit HNGV in 2019 to provide training on the care and support of their products.
Information relevant to training programs is available below to download.
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