Bridging the gap to peace

Australian health care prides itself on it its collaborative, team approach to caring for the sick and injured, something that is even more important in an emergency situation.

At Sydney Children’s Hospital, Randwick, we see more than 37,000 children via our Emergency Department every year. We are trained to think critically, act quickly and safely while also dealing with the emotions that come with a life and death situation. Parents and carers trust us to care for their children. To do that, we need to trust and work with our colleagues.

Trust and communication was at the heart of a recent course we ran at Hadassah Ein Kerem Hospital in Jerusalem, Israel.

Travelling to Israel to teach and share knowledge isn’t something many of us had on our radar, but came about thanks to an Israeli colleague Dr Saar Hashavya, who trained with us in 2015 as part of a Paediatric Emergency Medicine Fellowship funded by AUSiMED and Steven Lowy. Saar returned

to Israel with an ambitious plan: improve the emergency care of children and build relations between clinicians and countries through healthcare and education.

Following months of planning via email and teleconference, Dr Arjun Rao, nurse educator Jane Cichero and I made the 18 hour trip to Israel late 2017 to run a four day course with Saar and his team. Thanks to funding by Project Rozana and the Peres Institute for Peace, 18 doctors and nurses from Israel, Palestinian territories, Gaza and Iraq attended the course which focused more on providing hands on training through advanced simulations and skill stations, rather than lectures.

Attending a course in Australia is an innocuous task. Simply put on your GPS and drive in. In Israel, a number of course attendees had to make their way through various military manned checkpoints. All participants were professional and serious about attending. It was an eye opener.

While English was our shared language, we were teaching health professionals from varying cultures, with varying skill levels. From an experienced orthopaedic surgeon to junior paediatric trainees and nurses. We had to change our approach to teaching daily, if not hourly on some occasions. We had to maximise our time and tailor the content and teaching style to the needs of the candidates and the available resources.

Simulation creates a great opportunity for learning. In simulation a team manages a critical problem, then the instructors facilitate a discussion about how the team performed, exploring how and why things happened and how to improve. Doctors and nurses report that what they learn in simulation stays with them and helps them perform better in real life.

What we were expecting, and witnessed were doctors and nurses who were used to working in very small teams and would launch into action. Our approach was based on planning, communication, teamwork and leadership. While there are times when urgent action is needed, we emphasised a standardised and coordinated approach to care - making sure the team is well-prepared with a clear plan and the right equipment, that there is a systematic approach to assessment and treatment, that the team is attuned to changes in a child’s condition and can synthesise a range of clinical information, that each team member has a role and that their contributions are important and that the team needs a leader to coordinate and prioritise care. 

Each day we could see how planning, communication and coordination improved. Over the four days, we were pleased to see a shift in thinking and enthusiasm to a new way of working.

Planting seeds of ideas that rapidly sprout was a common theme over the four days. Why don’t we have a team leader who has a clear overview and coordinates and prioritises care? Why don’t we have emergency management guidelines and protocols?  Why don’t we debrief on what worked, and what we could do better? How do we know what vital signs are normal for children of different ages? We heard that even after the first day, candidates were asking these questions of themselves and their hospitals.

Upon our return to Australia we heard from Saar about how he had debriefed an excellent resuscitation on a child who had a cardiac rhythm problem as was successfully carried out by a young registrar. She had used the structured approach we had taught her at the course. We were also contacted by an Iraqi attendee, inviting Dr Rao to his hospital to teach a similar course. The Australian Government’s strong ‘do not travel’ advisory restricts his involvement.

The challenges faced by our colleagues in Israel are great. We discovered early on that four Kurdish doctors attending the course had taken care of children during the fight for the liberation of Mosul from ISIS. The atrocities they have and are likely to witness are horrifying.

There is a genuine commitment from Hadassah Hospital, together with organisations such as Project Rozana and the Peres Institute for Peace to use healthcare as a bridge to peace.

We were privileged to be invited, impressed by the commitment of the candidates and encouraged by the early signs of impact of the course.

Dr Matthew O’Meara