Dr Anne Creaton talks about the healthcare capacity building in Fiji. Fiji was struck by Cyclone Winston in 2016. It caused widespread devastation and the impact will be felt for a long time in the future. The most important thing that Fiji has taught her is faith, patience and persistence. Anne begins by talking about the three Rs that are essential in trainees who want to work in Fiji or similar situations. The three Rs being: Realistic, Resilient and Resourceful. Emotional intelligence is also very important. Most of the people are highly trained, but always in a high resource environment. Dysfunctional systems in places like Fiji, can impact the clinician’s welfare and performance. Critical care systems are made up of multiple building blocks with doctors playing a small part. Anne compares critical care systems in Fiji to a game of Jenga. This is because multiple blocks that are essential for critical care systems are non-existent. Anne divides the Jenga blocks of a critical care system into three: a pre-hospital block, a hospital block, and an administration and governance block. The pre-hospital block consists of scene care, transport care, communication, hazmat, decontamination and retrieval. The hospital blocks consist of factors like triage, medical assessment, equipment, drugs and patient flow. The administrative and governance block provides data, audits, leadership and human resource activities such as training, recruitment and retention. All these blocks put together form the critical care system. This illustrates how when the different blocks in critical care services are removed, it makes it very difficult to successfully treat a patient. She explains how doctors face multiple difficulties like faulty equipment, untrained staff, lack of timely transport vehicles, inaccessibility to interventional cardiology, lack of risk management and quality improvement. They also lack hazmat, decontamination, personal protective equipment (PPE), proper communication. Anne then gives an example of using the three Rs technique to reduce VF arrest by early defibrillation. Realistic: Automatic external defibrillator (AED) for all health facilities. Resilient: Placed all AEDs in pelican cases. Resourceful: Acquired the AEDs via Twitter. Anne ends by saying that life is about expectation management and you need to understand that there will be a gap between the type of care you want to provide and what you will be able to provide in situations like Fiji.
So, are you ready to play critical care Jenga?
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