A U T U M N 2 0 1 0

In this issue:

✦ PRIME Developments

✦ A PRIME Experience

✦ PRIME area groups

✦ PRIME-NCFI

✦ Palliative Care in Armenia

✦ A PRIME Challenge in Armenia

✦ PRIME-NCFI Conference, Scotland

✦ Did you know?

✦ Current PRIME partnerships in India

✦ Letter from Albania

✦ Further PRIME Developments

✦ PRIME/NCFI conference

✦ What is PRIME?

✦ How can I help?

✦ Support form

PRIME Developments So often our newsletters feature reports of visits by PRIME tutors to overseas destinations that it is easy to forget that the work of our partners goes on long after the teams have returned to their ‘day jobs’. Air travel is again becoming more expensive, as well as environmentally unfriendly and the sheer geographic size of PRIME’s work means that we are exploring new ways of resourcing and equipping partners in different parts of the world so they are PRIME in their institutions, areas and indeed nations. One aspect of this is the development of distance learning materials. Samples have been trialled in parts of Africa and have been well received and this development will be major feature of our work in the next 12 months.

Healthcare is teamwork and we were delighted earlier this year to sign a partnership agreement with Nurses Christian Fellowship International (NCFI). The first fruits of this agreement came with the visit to Armenia of a nursing team led by Prof Barbara Parfitt CBE, Director of the Caledonian Centre for Global Health and already a PRIME tutor. The agreement should see more nurses available to take part in other PRIME activities throughout the world and a greater demonstration of working together.

It was therefore with great pleasure that I was able to accept an invitation to be a part of the NCFI European Conference in Romania and share some of the lessons we have learned in PRIME over the past ten years. The weather was pretty awful but the wild flowers were blooming in abundance and the sheer vivacity and excitement of the nurses gathered there from many countries was exhilarating - as was the teaching from nurse tutors from USA, UK and other parts of Europe.

Then, whilst UK basked (briefly) in some of the hottest weather recorded, the ICMDA (International Christian Medical and Dental Association) was holding its four-yearly World Congress in a cold and very wet Uruguay. The Congress brought together over 700 doctors and student leaders from 80 national Christian medical and dental associations from around the world. PRIME once again led a pre-conference on medical education and then presented seminars in the main conference. With me in the PRIME team were Clare Cooper from UK, who had played the main role in organising PRIME’s participation, Carolyn Russell from Australia and Apolos Landa from Peru, reflecting the growing international diversity of our tutors. The relationships made with people there are already leading to new requests for partnership in places as diverse as Sudan, Zimbabwe, Mexico, Indonesia and Bulgaria.

John Geater - International Director

PRIME Support Fund The PRIME Support Fund, formed partly from PRIME general funds and partly from direct donations, is used to support

healthcare professionals from low and middle income countries to run or attend PRIME courses and conferences. Access to the fund is by application only. If you would like to make a donation to the Support Fund please visit our website to make

an online donation or contact the office for other ways to make a donation. Please ensure all Support Fund donations are clearly marked.

A PRIME experienceWhen I registered for the ICMDA conference in Uruguay in June this year (2010), I saw the advertisement for the two day PRIME seminar prior to the conference. I checked the PRIME website, but I have honestly to admit, that I didn't really understand the purpose of the organisation. ‘ P a r t n e r s h i p i n I n t e r n a t i o n a l M e d i c a l Education’...That sounded rather fluffy to me...

Even though Uruguay is quite a distance from Norway, where I live, I decided to sign up anyway and see what it was about. And I am so grateful that I did!

We were about 10 attendees at this seminar, a good mixture from nurses to GPs to dentists (that’s to say I was the only dentist....)

In the beginning we were asked what we would like to achieve by attending this seminar, and the answers were as mixed as the group. Some people had a clear vision of wanting to become PRIME tutors, I personally wanted to see if the PRIME concept could be of any help for my vision for Moldova.

I had been working in Moldova for six weeks in Autumn 2009 and the poverty and lack of knowledge regarding treatment and living conditions for disabled children, made a deep impression on me. We have a son of eight with an autism diagnosis ourselves, so these children have a special place in my heart. In these two days in Uruguay we got a picture of the vision of PRIME and were introduced to the concept of whole person medicine and role play.

John was so nice to take some extra hours with us to help get deeper into role play. He actually got me so deeply involved, that I was breaking down in tears because I was convinced that I was a poor Nepalese banana seller who couldn’t feed her children... It was a strange experience.....But it made us understand the power of role play.

After these days in Uruguay and meeting these inspiring people I really wanted to connect PRIME to the medical team at Voinicel in Moldova, the only centre for early intervention in the country.Carolyn was very supportive and positive for my idea and had helped already in Uruguay clearing the vision and helping me to think constructively.

In September I attended the PRIME conference in Cluj, Romania together with 2 doctors from Voinicel - one pediatrist and one psychologist. We again talked about whole person medicine, seeing the loved child of God in our patient and aiming to become a better doctor working with Christian values. The doctors from Moldova are not attending a church, but were truely moved by the heart and the vision, and they are hoping that PRIME can send a tutor team to lift the level of knowledge and also the hearts and spirits of the medical personal working with disabled children.

We start in October with a visit from a pediatrician from Voinicel to Norway, and then hopefully start with the first tutor team for Moldova in Spring next year.

What I like about PRIME is that it requests you to think for yourself, to be active and follow your heart and vision to build God’s kingdom. PRIME is like a firm hand on your back, which provides knowledge and support. I feel very blessed that I went to Uruguay and I am excited about what the future will bring!

Anna-Lena Løbakk

Carolyn Russell, Anita Davis, Anna-Lena Løbakk visiting Turda salt mines in Romania

PRIME UK Conference - March 2011The next introduction to PRIME conference will be held in Brighton in March 2010 (provisional date and location). This is aimed at those who want to explore the work of PRIME further and those who just want to equip themselves better for their everyday practice, teaching and training. It is for those involved in any branch of healthcare teaching. Bursaries will be available for those from overseas on low income.

Pictures from the PRIME-NCFI nurses team in Armenia

PRIME area groups. We are looking for coordinators who would build local PRIME supporters groups in their areas. We hope such groups would focus on local issues (eg local interest in a particular PRIME project or region) offer prayer support, especially of their local PRIME tutors and projects, improve cohesion and raise funds.

If you feel drawn to such a role do get in touch with the PRIME office.

Palliative care for ArmeniaIn 2008 PRIME was invited to bring a course of teaching about palliative care to Armenia for the State Medical University. Circumstances prevented our doing so in 2009, but in April 2010 three PRIME Palliative care tutors (two medical consultants and a specialist nurse) gave an Introductory course at the University and also single day courses for several nursing colleges and a church plus a weekend course for the Armenian Christian Medical Association. All this in two weeks!Amazingly, in the period of the delay an American palliative care specialist was invited to conduct an in-depth assessment of the need for pallliative care in Armenia and his report prepared the way for our courses.During our visit, the Vice-Directors of education at the State University and the National Institute of Health asked us to return six-monthly to lead a series of courses over three years - and to provide a workbook in English and Armenian. The team returned in October 2010 for the next fortnight, with the workbook ready for trialling before translation and publication of the completed version. The full curriculum for the three years has been outlined.

Not only so, but the project is being sponsired by an Armenian Church Foundation (the Saint Sarkis London Trust) in London, and the Gulbenkian Foundation are underwriting the translation and publication of the workbook in Armenian. We are thrilled with this provision.

Anthony SmithPRIME Palliative Care Director

A PRIME Challenge in Armenia

Trials, tribulations and rewards on delivering PRIME training...

We arrived to find that contrary to what we expected we were to teach fire and rescue staff with minimal first aid training who were joined by three ACMA dental members; in all we had 38 students including two high level Ministry observers throughout. Both were doctors, one in charge of the Fire and Rescue first aid training programmes and the other (although not declared until the last day) tasked with preparing medical teams. Despite assurances that we had a number of rooms available for the practical work we had one.

Our translators were provided from within the student body, something ACMA had tasked the ministry to do so as to keep them involved. It was soon apparent we were in trouble; Armenian is a rich language that utilises many more words than English yet our translators were only taking over short summaries and much detail and context was lost.

The first couple of days were very challenging; partly due to the translation issues but also due to the attitudes of a number within the group who took the stance that they knew all we had to teach them and challenged our need to be teaching them. The two observers at the back and a small core of senior (older) officers maintained a non-participative stance feeding questions and comments into the group (often provocative).

The group had only the week before received training from a NATO military team and had recently also been trained by teams from Brazil, USA and Sweden! Our course focus of preparing for a disaster response with little or no equipment was initially strongly opposed with questions on why we had brought no equipment and assurances that they had plenty (although none was available for training the student group despite being within the national training centre).

The matter of training the public in simple life saving first aid was met with a range of responses, the official o n e f r o m t h e observers being that this was already being done whilst the wider

student body mostly said the public were incapable of learning such skills. This, despite ACMA teams taking such training forward within churches and schools albeit on a limited basis with many of the previous trainees becoming less involved than hoped or having moved on in life or geography. By the end of the week this attitude had shifted considerably.We revised our course content nightly and maintained a flexible approach throughout for which

t h e t e a m i s t o b e congratulated. We found that the students responded well to v i d e o s f r o m t h e H a i t i earthquake and other disaster settings combined with case studies from my own pre-hospital experience. We used a system of initially teaching and discussing from within the ‘normal situation’ (i.e. crashes etc) and then moving the context and principles into the disaster response setting. This worked wel l and by the afternoon of day three only the two observers remained distant and somewhat antagonistic with many of the group now firm friends and allies.

The initial reluctance to p a r t i c i p a t e i n t h e practical skills by many soon melted away and by late Wednesday all bar the observers were participating but even they were moving into the group to ‘observe more closely’.

Wednesday through Thursday saw virtually all barriers break down and by Friday the doctor in charge of preparing medical teams was joining us for lunch and in a mix of French and English exchanging ideas and asking quest ions wi thout reservat ion. This transformation across the students and in particular amongst a hard core of senior officers and their Directors was nothing short of miraculous and we have left with firm friendships and strong mutual respect.

The Vice Minister for Health and Director of Emergency Preparedness was extremely positive in his feedback and in his closing speech commented on the importance of teaching the public first aid skills and of formulating an integrated emergency plan with training. He further commented a number of times on the importance of the psychological and spiritual aspects of care. At the closing ceremony the Chief Officer for Emergency Training in Armenia also joined us and participated in the presentation of certificates.

Did you know?

If you take part in a PRIME teaching team and pay for your travel but do not claim e x p e n s e s y o u c o u l d actually be losing PRIME money?

Under the rules of Gift Aid volunteers who claim expenses can legitimately donate some or all of those expenses back to the charity and their donation is still eligible for Gift Aid.

In 2009 for example PRIME sent out over 60 tutors. If we assume that each of those trips cost a conservative £200 per person in travel costs* and if those all those tu to rs c la imed and donated back £200 PRIME could have claimed back over £ 3 0 0 0 f r o m t h e U K Government at no additional cost to anyone.

This would pay for four Palliative Care training courses in Albania, our staff salaries for six weeks, or the office costs for four months.

To good to be true? Check out the rules for yourself at http://www.hmrc.gov.uk/charities/gu idance-notes/chapter3/sectionf.htm#ay

*Travel for some PRIME trips can cost as much as £1000 per person.

Current PRIME partnerships in IndiaPRIME now has established partnerships with two organisations in India, building on links and relationships formed over many years with key members of Emmanuel Hospital Association, the largest indigenous medical missionary organisation in the world.

We are working in partnership with the Evangelical Medical Fellowship of India (EMFI) – India’s equivalent of the British CMF, to train teachers in Whole Person Care. With the enthusiastic support of EMFI’s chief executive, this has the exciting potential of spreading the vision of a Christian whole person approach to practice throughout the extensive Christian medical community in India.

We are also, in collaboration with PRIME Australia, now regularly supplying tutors from both Australia and UK to the contact phases of the distance learning programme in Family Medicine run by CMC Vellore. This gives tutors the opportunity of not only helping to improve the clinical skills and knowledge of many isolated Indian doctors, but also inspiring them with compassion and integrity, as well as being challenged and encouraged by fellowship with colleagues serving sacrificially in remote and difficult places.

Delegates at a Whole Person Care seminar in Cochin, Kerala, 2010

Experienced GP Trainers/Tutors are needed in India for the contact phase of the distance learning programme from 9-19th February 2011. Generous per diems and accommodation/food will be provided by the hosts. If you could be available for this, contact Huw Morgan: jhcmorgan@gmail.com. The following article highlights one PRIME tutor’s experience in India.

As part of the debrief we facilitated an anonymous written review by the students and all the comments reflected the learning curve that had been undertaken and achieved especially in respect of team work, strategic operational command and the worth of the whole exercise, particularly given that they had no kit (for the exercise and in reality).

The end of course review was by anonymous written comments and equally as compelling with many mentioning how informative the course had been and how the focus on making do was so beneficial. One comment that was given to me personally by the senior uniformed officer (and initially one of the hard-liners) concerned the mutual respect that was apparent and how the methodologies focusing on having little or no equipment alongside contextualising the skills and procedures into their everyday work were so beneficial. Many of the comments stated how much they had learnt, how important the skills taught were, how important teamwork was, and how they found the background information and contextualisation to their daily work, as well as disasters, useful.

Tony Kemp

PRIME Executive CommitteeIt is PRIME’s Trustees who carry the final responsibility for all of its activities; and for many years they have formulated strategic plans for its development and given guidance for the practical delivery of its objectives. But the work of PRIME has grown dramatically, both in the number and variety of the overseas partners with whom it collaborates and in the range of educational input it is asked to provide.

With the numerous operational decisions that PRIME’s work now generates, it seemed good to the Trustees, and to the core staff team, to form a new Executive Committee to address the practicalities of PRIME’s outreach. The new Committee seek to put into practice the vision the Trustees share for the work of PRIME.Drawing on our excellent office and central academic staff the new Group comprises: John Caroe, David Chaput de Saintonge, Jo Clark, John Geater, Huw Morgan, Ros Simpson

The Group is chaired by Richard Vincent; and it has already started on the work of reviewing much of its foundational paperwork, the practicalities of tutor training and support, a country-by-country review of PRIME’s key activities abroad, an exploration of potential new activity in the UK, and the development of electronic learning. The new Exec also hopes to become more closely embedded in the Brighton and Sussex Medical School - a site that has already been agreed as the location of its regular monthly meetings. We are up and running!

A PRIME tutor here shares their experience of working in the family medicine distance learning programme run by CMC Vellore.

“I was privileged to be able to teach on the Family medicine contact programme in Delhi in February 2010. (This was part of a two-year distance learning programme, with three 10-day contact programmes during this time.) They were a mixed group of post-graduate doctors who were either practising in family medicine already or had an interest in doing this in the future. Two of the twelve doctors were Christian, and the rest Hindu or Muslim. It gave me the opportunity to hear of their situations and of the pressures under which they worked. The Family Medicine programme which Dr. Vinod Shah has instigated is of a high quality and stretches the knowledge of these doctors. (He is hoping to include advanced practical aspects as a follow-on course.) In the mornings they were able to see and examine some patients on the wards for their clinical teaching.Each afternoon there were lectures on DVD from CMC Vellore doctors, who tried to keep the subject content family-medicine based. After each lecture there was an opportunity for all participants from the various centres all over the country to ask questions of the lecturers and each centre could hear the questions and answers given in the different centres, to make the family medicine doctors feel part of a large group. The knowledge base and confidence of these family medicine doctors is being much improved by this excellent Distance Learning course.”

Janet Healey*****************************

Also in India, in June 2010 John Geater and Huw Morgan ran two two-day workshops with participants from the Evangelical Medical Fellowship of India (EMFI) - India’s equivalent of the British CMF - in Cochin, Kerala. These were on ‘Teaching to Change Hearts’ (an experiential introduction to learner-centred teaching methods) and Whole Person Care. At the invitation of Dr Manoj Jacob, the chief executive of EMFI, the idea was to launch the PRIME vision in India amongst a cohort of Christian doctors and nurses who will be able to take it forward in their own settings in major

medical and nursing schools in S India. Around twenty participants attended both seminars and plans are in hand for further workshops in other parts of India that will be run by some of them, with support from a PRIME UK tutor.

Thank you, Clare!

Clare Cooper: The visit to Uruguay marked the end of Clare’s three years as Associate Director of PRIME. During this time she played a significant role in the central administration of PRIME and the executive team are greatly indebted to her. She takes up other responsibilities but she and her husband Mike will continue as PRIME tutors especially in South America as they are both fluent Spanish speakers.

Many thanks, Clare.

Letter from AlbaniaImagine being given nine (model!) heads and five arms to take to Albania to use to teach medics how to examine ears and eyes and take blood from arms….

Imagine being asked to teach all levels of staff in the biggest of the mental health hospitals in Albania …

Imagine looking for a suitable psychiatrist…and imagine finding a newly retired Christian one who has been committed to this hospital for two years and was planning a visit in October anyway… and imagine his saying yes to my request that he think about joining me to teach there in December… and imagine that there just happens to be a big WHO mental health conference when he is there in October to which we have both been invited…

Imagine being asked by a Christian doctor who is doing community medicine to teach along side his team in Korca... and imagine a PRIME tutor being keen to come back and help...

Imagine that the big conference in Tirana for GPs PRIME was part of last May was so successful that we are planning a mini version in October...

Imagine having to teach palliative care and discovering that the translators are to be in the UK during the course…

Imagine that this is only a part of the work which PRIME tutors are delivering in Albania...

And imagine being a part of this – which you are… Thank you.Elizabeth Swain

The Albanian Medical Trust is once again sponsoring the Palliative Care and Educational Centre in Lehze, which provides multi-discipline palliative care and training. Thank you!

PCEC and PRIME work in partnership to deliver these courses.

Further PRIME Developments

One of the great joys of working with PRIME is to read the participants comments at the end of teaching programmes. So often we read comments to the effect: “We have never heard such things before - thank you for coming”. In Russia, one doctor jumped out of her chair and exclaimed, “All my life I have thought this was the way to practice – now I have permission!” One that brought tears to my eyes was from a student at the end of a session in Poland, who wrote, “The words I have heard in the last two hours will stay with me the rest of my life.” What a privilege to be entrusted with a message that can make such impact. Thank you to everyone who helps that message to be carried to “the ends of the earth”.

The World Health Organisation has said that mental illness is increasing worldwide and depression is rapidly becoming a top cause of illness. Unfortunately, mental health services in many parts of the world hardly exist – for example, until recently there was only one psychiatrist for the whole of Sierra Leone. PRIME is already involved in mental health training in several countries and we believe this is an area in which we should increase our involvement. For this reason we will be holding a special day on the mental health needs of the developing world, in partnership with CMF.Join us on Saturday 8th January 10 – 4.30 at the CMF Conference Room, 6 Marshalsea Rd, London SE1 1HL to hear of the need, stories from those already involved and explore how we can all be a part of the response. We will learn something of the new WHO approach to mental health from Dr Julian Eaton, a PRIME tutor based in Nigeria as Mental Health Adviser to CBM who has been involved in the discussions in Geneva. There will also be short snapshots of the work of NHS-Links in Sierra Leone, the training of church leaders to help them in their response to the needs of their communities, and a destigmatisation programme which PRIME is partnering in Nepal. Workshops will allow different areas or aspects of work to be explored in more detail. Please book your place through the PRIME website.

John Geater - International Director

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Have you visited the new PRIME website yet? www.prime-international.org.uk

PRIME/NCFI Conference, ScotlandIn June 2010 the first joint PRIME/Nu rses Ch r i s t i an Fe l l owsh ip International  (NCFI) conference was

held in Kirkintilloch, Scotland. We were very grateful for the hospitality of the members and premises of Kirkintilloch Baptist Church where a key senior PRIME tutor (Elizabeth Swain) is a member. Around twenty doctors and nurses attended and it was good to fully realise the extent of shared vision between PRIME and NCFI. A number of participants were planning or considering overseas trips in the near or more distant future and much positive feedback was obtained from this two and half day event.

PRIME - Partnerships in International Medical Education is a registered charity in the UK: Reg No: 1111521Registered Office: Innovation Centre, Highfield Drive, Churchfields, St.Leonards, East Sussex, TN38 9UH

What is PRIME?PRIME - Partnerships in International Medical Education is registered as a charity in the UK dedicated to improving standards of health worldwide, particularly in primary care, through educational activities in collaboration with local and national organisations in other countries. We seek sustainability through training trainers and equipping them with appropriate skills.

Further information on the work of PRIME may be found on our website

www.prime-international.org.uk

How can I help?PRIME is a highly cost efficient charity due to the voluntary donation of both their time and expertise by highly qualified Christian professionals dedicated to improving healthcare worldwide through the education of doctors, students and other healthcare workers. However, due to the growing number of invitations to a wide range of countries, there are increasing costs related to administration, fares and in country costs.

To make a financial donation contact Jo Clark or email admin@prime-international.org.uk or phone 0044

(0)1424 858258 during office hours.

If you would like to become a Partner in PRIME please consider making a donation or giving regular support. If you can help please complete this form and return it to: PRIME, Innovation Centre, Highfield Drive, St Leonards, East Sussex TN38 9UH

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