RoleRole ofof BARTCBARTC (Bangkok(Bangkok AnesthesiaAnesthesia RegionalRegional TrainingTraining Center)Center) IInn cooperationcooperation inin educationeducation andand trainingtraining inin developingdeveloping countriescountries ProfProf TharaThara TritrakarnTritrakarn DirectorDirector ofof BARTCBARTC 14th WCA, Cape Town, South Africa, 3/1/2008 Oslo Center, Norway, 12/1/2008 ShortageShortage ofof anesthesiologistsanesthesiologists AA worldwideworldwide problemsproblems MoreMore seriousserious inin developingdeveloping poorpoor countriescountries MarkedMarked variationvariation amongamong countriescountries EconomyEconomy - Most important determining factors - Three levels of wealth & health - Rich countries (per capita GNP > $ 10,000) - Medium to low (GNP $ 1,000-10,000) - Poor countries (GNP < $ 1,000) RichRich && MediumMedium countriescountries GNPGNP PeoplePeople NumberNumber PeoplePeople perper capitacapita perper ofof perper (US(US $)$) doctordoctor anesthetistsanesthetists anesthetistanesthetist USA 33,799 387 23,300 11,500 Japan 34,715 522 4,229 20,000 Singapore 22,710 667 150 26,600 Hong Kong 23,597 772 150 40,000 Australia 19,313 2170 10,000 Malaysia 3,248 1,477 250 88,000 Thailand 1,949 2,461 500 124,000 Philippines 1,048 1,016 1176 64,600 MediumMedium && PoorPoor CountriesCountries GNPGNP PeoplePeople NumberNumber PeoplePeople perper capitacapita perper ofof perper (US(US $)$) doctordoctor anesthetistsanesthetists anesthetistanesthetist Indonesia 617 6,7866,786 350 591,000591,000 Pakistan 492 2,0002,000 400 340,000340,000 Lao PDR 263 4,3004,300 10 500,000500,000 Bangladesh 299 12,50012,500 200 650,000650,000 Vietnam 370 2,2982,298 400 197,000197,000 Cambodia 280 9,0009,000 20 500,000500,000 Nepal 230 12,00012,000 80 287,000287,000 WhyWhy anesthesiaanesthesia ?? WithoutWithout properproper anesthesia,anesthesia, surgerysurgery cancan notnot developdevelop andand remainremain inin simplesimple formform NumberNumber ofof anesthesiologistanesthesiologist perper peoplepeople cancan reflexreflex thethe levellevel ofof medicalmedical andand surgicalsurgical carecare TheThe ultimateultimate goalgoal - Provision of safe anesthesia - Easier to achieve in developed world * All supporting facilities - More difficult in developing world * Limited and scarce resource BangkokBangkok AnesthesiaAnesthesia RegionalRegional TrainingTraining CenterCenter (BARTC)(BARTC) FoundedFounded inin 19961996 Initiators:Initiators: – Dr Kester Brown (Australia) – Dr Robert Hare (Australia) – Dr Mitsugu Fujimori (Japan) – Dr Haydn Perndt (Australia) Reactors:Reactors: - Dr Thara Tritrakarn (Thailand) – The Royal College of Anesthesiologists of Thailand BARTCBARTC ObjectiveObjective -- PromotePromote teachingteaching andand trainingtraining ofof anestheticanesthetic personnelpersonnel inin developingdeveloping countriescountries inin AsiaAsia AimsAims -- TrainTrain futurefuture trainerstrainers toto formform aa criticalcritical massmass andand enableenable themthem toto teachteach moremore juniorsjuniors inin theirtheir ownown countries.countries. (Teach(Teach howhow toto catchcatch fishes)fishes) BARTCBARTC WorldWorld FederationFederation ofof SocietiesSocieties ofof AnesthesiologistsAnesthesiologists (WFSA)(WFSA) –– providesprovides 33 –– 44 scholarshipsscholarships // yearyear RoyalRoyal CollegeCollege ofof AnesthesiologistsAnesthesiologists ofof ThailandThailand coordinatescoordinates teachingteaching andand trainingtraining 33 universityuniversity hospitals,hospitals, 22 provincialprovincial hospitalshospitals andand 11 childrenchildren hospitalhospital provideprovide teachingteaching andand trainingtraining ScholarshipScholarship 33 scholarshipsscholarships inin 19961996--19981998 44 scholarshipsscholarships sincesince 20002000 Provides:Provides: –– 11 roundround triptrip economiceconomic airfareairfare –– LivingLiving expenseexpense andand accommodationaccommodation (same(same amountamount asas locallocal ThaiThai anesthesiaanesthesia residentresident doctor)doctor) -- BooksBooks andand otherother trainingtraining materialsmaterials ParticipatingParticipating institutesinstitutes FacultyFaculty ofof MedicineMedicine :: Siriraj Hospital, Mahidol University Ramathibodi Hospital, Mahidol University Chulalongkorn Hospital, Chulalongkorn University ProvincialProvincial hospitalshospitals :: Chonburi Province, Ministry of Health Ratchaburi Province, Ministry of Health National Children Hospital, Bangkok, Ministry of Health Faculty of Medicine Ramathibodi Hospital Children Hospital Ratchaburi Hospital Chonburi Hospital ParticipatingParticipating institutesinstitutes -- NoNo tuitiontuition fee,fee, nono universityuniversity chargecharge -- Teacher,Teacher, mentor,mentor, tutortutor dodo notnot getget paymentpayment forfor extraextra work.work. AllAll contributecontribute onon thethe basisbasis ofof goodgood intention,intention, highhigh spiritspirit ofof goodgood deed.deed. -- DepartmentsDepartments receivereceive minimalminimal compensationcompensation forfor consumableconsumable trainingtraining materialsmaterials (( 100100 US$/month/trainee)US$/month/trainee) EntryEntry requirementsrequirements ApplicantsApplicants mustmust bebe anan MDMD HoldingHolding aa permanentpermanent postpost inin aa governmentgovernment teachingteaching hospitalshospitals inin thethe targettarget countries.countries. HavingHaving atat leastleast 33 yearsyears experienceexperience inin anesthesiaanesthesia inin homehome countriescountries withwith oror withoutwithout enrollingenrolling inin formalformal trainingtraining HavingHaving communicablecommunicable spokenspoken andand writtenwritten EnglishEnglish TargetTarget countriescountries DevelopingDeveloping countriescountries inin AsiaAsia :: – Bhutan, – Cambodia, – Lao PDR, – Mongolia, – Myanmar, – Vietnam TeachingTeaching programprogram TwelveTwelve monthsmonths structuredstructured trainingtraining programprogram Language:Language: EnglishEnglish 2020 lectureslectures coveringcovering basicbasic andand clinicalclinical anesthesiaanesthesia 88 specialspecial experiences:experiences: CPR,CPR, AdvanceAdvance CLS,CLS, medicalmedical informatics,informatics, attendattend medicalmedical congressescongresses && meetingmeeting inin BKKBKK TeachingTeaching programprogram 2 HandsHands--onon trainingtraining inin operatingoperating roomsrooms –– LogLog bookbook recordingrecording casescases donedone // observedobserved ParticipateParticipate inin allall departmentaldepartmental teachingteaching activities:activities: –– MMMM conference,conference, journaljournal club,club, interestinginteresting casecase conferenceconference etc.etc. RotationRotation 77--88 monthsmonths inin aa universityuniversity hospitalhospital toto gaingain basicbasic knowledgeknowledge && skillskill 44 monthsmonths inin 22 provincialprovincial hospitalshospitals forfor moremore practicalpractical skillskill 11 electiveelective monthmonth SpecialSpecial requestrequest forfor pediatricpediatric ,, thoracicthoracic anesthesia,anesthesia, painpain clinic,clinic, ICUICU Training Products - High quality: western standard ? - Appropriate & relevant to local practice ? - Excellency Vs availability & accessibility ? - Quality Vs quantity ? TrainingTraining productsproducts GiveGive safesafe anesthesiaanesthesia CompetentCompetent && adaptiveadaptive toto locallocal practicepractice AbleAble toto teachteach theirtheir juniorsjuniors PursuitPursuit ofof continuingcontinuing educationeducation –– BookBook && journaljournal areare expensive,expensive, scarcescarce –– InternetInternet isis goodgood butbut maymay notnot availableavailable EvaluationEvaluation PretestPretest –– AfterAfter 22 monthsmonths ofof adaptationadaptation FormativeFormative evaluationevaluation:: – Progress in learning, performance, clinical skill – Weight 60 % SummativeSummative evaluation:evaluation: Oral and written examination (MCQ), 40% FinalFinal passingpassing mark:mark: 60%60% CertificationCertification WithoutWithout certification,certification, trainedtrained doctorsdoctors willwill notnot bebe recognizedrecognized asas specialistspecialist atat homehome WFSAWFSA DiplomaDiploma ofof AnesthesiaAnesthesia (DA)(DA) wouldwould bebe idealideal butbut…….. BARTCBARTC DiplomaDiploma ofof AnesthesiaAnesthesia (DA)(DA) isis wellwell recognizedrecognized (equivalent(equivalent toto MasterMaster Degree)Degree) . BARTC trainees by country (1996-2008) Graduated 2007 Lao PDR 12 12 Cambodia 10 10 Mongolia 16 13 Vietnam 4 4 Myanmar 4 3 Bhutan 2 2 Total 48 44 OverallOverall problemsproblems LanguageLanguage barrier:barrier: EnglishEnglish isis thethe thirdthird oror fourthfourth languagelanguage afterafter FrenchFrench oror RussiaRussia VariationVariation inin backback groundground knowledgeknowledge andand skillskill ClashingClashing withwith prepre--existingexisting residencyresidency andand nursenurse anesthetistanesthetist trainingtraining CommunicationCommunication gapgap withwith colleagues,colleagues, patients,patients, medicalmedical recordsrecords ExtraExtra loadsloads toto busybusy consultantsconsultants PostPost trainingtraining followfollow upup OfOf 4444 graduates:graduates: –– 4242 remainremain inin homehome countriescountries (95.5%)(95.5%) –– 11 MongolianMongolian movedmoved toto KoreaKorea –– 11 VietnameseVietnamese movedmoved toto AustraliaAustralia FollowFollow upup inin MongoliaMongolia BARTCBARTC graduatesgraduates havehave formedformed criticalcritical mass,mass, makingmaking dramaticdramatic improvementimprovement inin anesthesiaanesthesia carecare && education.education.