Summer 2010, Vol. 3, Issue 1 - Aga Khan University

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FeAtureCritical Care Journey: take-off in tanzaniadr tahir saeed, Pgme (Anaesthesiology) ’05 and dr Aijaz samad, Pgme (Anaesthesiology) ’08There has been a distinctimprovement in healthcare services in Tanzaniaover the past decade largelydue to the socio-politicaland economic situation stabilising,even though financialconstraints are still ahard reality. HIV/AIDS andmalaria efforts absorb amajor portion of the budgetleaving other health caresectors, especially criticalcare, struggling for attentionand funds.In the last two years,the situation has changed atAga Khan Hospital (AKH)in Dar es Salaam. We haveseen the formation of ateam of dedicated criticalcare professionals includingfour full-time residents,about 17 full-time nursesand one critical care nursingmanager. We now have ventilators,monitoring equipmentand well-trained intensivecare unit (ICU) staff,capable of managing adults, childrenand newborns, as well as prematurebabies. We have witnessedan intensive care facility that hasdoubled from its original four beds.As intensivists, we are proudto have played a vital, pioneeringrole in developing the ICU facilityat AKH, faced as we were with aserious lack of human resourcesand many other major problemsduring the start-up phase. Thesedifficulties did not deter us fromworking in collaboration with theUS Society of Critical CareMedicine to conduct a FundamentalCritical Care Support course – comprehensivecoverage of fundamentalmanagement principles for the first24 hours of critical care – and withthe Ismaili Health PhysiciansAssociation North America andinstructors from American Societyof Critical Care Medicine to conductAdvanced Cardiac LifeSupport and Paediatric AdvancedLife Support courses. The ICU continuesto be upgraded and recentlytelemonitoring via a central monitoringstation was set up. With thisintroduction, AKH has entered anew era of patient health care andquality improvements. Future plansinclude a separate neonatal intensivecare unit and services such asbedside dialysis, continuous renalreplacement therapy and bronchoscopy,among others.Jean-Luc RayThe AKH ICU has evolved intoa major referral centre, accommodatingover 20 per cent of directreferrals as well as transfers fromother hospitals around the country.Data collected by us shows lowermortality rates in both adults andchildren. Of those patients who arecritically ill and mechanically-ventilated,the survival rate is 59 per centin adults and 47 per cent for childrenwith an average bed occupancyof 85-90 per cent.While critical care is a novelconcept in Tanzania, authorities arebeginning to invest in it. But fornow, the ICU at AKH is the onlyone providing state-of-the-art facilities,particularly for babies.12
FeAtureteaching research through serviceAnthony gioko, med ’07Learning, based on exploring orsolving real problems, influences andtransforms students. Having learnedthis concept at AKU-IED in Pakistan,the next step was to put it into practiceat Aga Khan Academy, in theKenyan port city of Mombasa. TheAga Khan Academy prepares studentsfor the International Baccalaureate(IB) exam. The IB is an educationprogramme that develops inquiring,knowledgeable and caring youngindividuals through its challengingcurriculum and rigorous assessment.Diploma students, between the agesof 16 and 19, besides studying sixcourses, are required to fulfil threecore requirements: an extended essay,theory of knowledge and creativity,action, and service.To teach my students researchskills initially I get them to engagein mini-research initiatives, in smallgroups and then in pairs. Thisprocess hones their skills for theindividual work that they eventuallywill have to complete.Groups: I divided students intorandom teams and delved into issuesaffecting the community. Eventually,we zeroed in on hygiene issues inslums around Mombasa. One topicwas intestinal worms: how do childrenget infected and how can they beeducated to avoid infections. Beforevisiting the area, we prepped by identifyingan appropriate school, askingthe management for permission tovisit and developing our researchquestions. We also asked a doctor forde-worming medicine. Off we proceededfor our field work, accompaniedby our school nurse. My studentsinterviewed their counterparts abouthow they access hygiene informationand how many times a day they washhands; another group provide hygieneinformation to a number of theirThe extended essay is a requirementfor students to engage in independentresearch through an in-depthstudy of a question relating to one ofthe subjects they are studying.Theory of knowledge is a coursedesigned to encourage each student toreflect on the nature of knowledge bycritically examining different ways ofknowing (perception, emotion, languageand reason) and different kindsof knowledge (scientific, artistic, mathematicaland historical).Creativity, action, service requiresthat students actively learn from theexperience of doing real tasks beyondthe classroom.Students can combine all threecomponents or do activities related toeach one of them separately.The IB Diploma Programmehttp://www.ibo.org/diploma/A child receives de-worming medicinefrom a student.inquisitive peers. All the students whotook part in the survey were providedde-worming medicine, with the helpof the nurse, as well as toothbrushesand antiseptic soap.A lot of information was collectedduring this exercise and it wasused to gain knowledge about datahandling and analysis. The resultinginformation was used by the studentsto write their research reports. Thisapproach was successful in teachingstudents research skills while encouragingthem to engage in communityservice – raising awareness aboutmedical and hygiene issues that affectphysical growth and cognitive developmentamong children sufferingfrom water-borne diseases.Pairs: To further enhance skills,we used the same approach in pairs.We identified issues in the schoolcommunity that concerned studentsand, after a brainstorming session,selected the top 17 issues. Some ofthem included using social mediasuch as blogs and Facebook; theschool’s use of resources like paperand electricity; and student-relatedthemes such as study time and peergroup support. The students conductedtheir research within theschool, with fellow students, teachersand members of the administrationas their subjects. This piquedthe ‘subjects’ curiosity and outcomeswere eagerly awaited. Thefinal reports were of great interest tothe respective groups and some studentrecommendations are beingconsidered for implementation.My groups and pairs approachesdemonstrate the interdependencebetween students and their community,be it their immediate communityor the larger one. It is an experiencethat has also taught my students thepurpose of research and how issuescan affect them directly or indirectly,experiences that can help transformthem into responsible citizens. This isa crucial aspect of sustainable learning– an approach I learned during mytime at IED. In simple words, it isputting principles into practice.13
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Summer 2010, Vol. 3, Issue 1 - Aga Khan University

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