In 2009, I traveled to Fiji as part of the Endoscopy Training Program, which had commenced in 2008 after many months of planning by incredibly dedicated and passionate doctors determined to fill the need for endoscopy services in the Pacific Island nations.
The first year that nurses participated in the program was 2009 and was a result of a recommendation from the previous year’s evaluations. I felt very honored to be the first nurse trainer in this amazing program and after 2 weeks felt that I had been the absolute winner.
I successfully applied to once again be a part of the program this year, 2013. I headed off with great expectations and was keenly interested to see if the ultimate plan to successfully transfer skills was actually happening. To my great delight, not only was the program meeting its many goals, it had expanded to include not only Fiji but the many surrounding Pacific Islands.
In 2013, there were 12 trainees and 3 teachers in the nursing program. The trainees, all staff nurses, came from Fiji and the surrounding Pacific Islands.
There were 4 from the Colonial War Memorial Hospital (CWMH) in Suva (Maraia, Pailato, Maikeli, and Mere); 2 from Lautoka (Monika and Evlin); Enosa from Samoa; Kirstein from the Cook Islands; Donna from Kiribati; Merlyn from Chuuk; Mihra from Pohnpei, and Enneth from the Solomon Islands.
The Nurse Educators, Anne Dowling, July 1 to 12, Catherine Conway, July 8 to 19, and Jane Hattley, July 15 to 26, were all from different Australian centers: Melbourne, Sydney, and Canberra.
Overlapping the trainers certainly streamlined the handover process and gave the incoming trainer an opportunity to get to know where everyone was up to in the program and time to orientate toward the new environment.
Procedurally and clinically, regarding endoscopy, there was a huge range of experience and expertise among the trainees.
The Fiji nurses from the CWMH had much more experience than the regional participants. Maraia, Maikeli, and Pailato have participated in the GeFITT training since its inception and were there when I first visited in 2009. Their experience was evident. All have developed competency in many areas and are skilled enough to train others in some basic endoscopy skills.
More advanced interventional skills need more practice. It is difficult to obtain competency doing a new procedure just once or twice.
Trainers worked within the competency framework developed by GENCA, and this was very effective. Each of the trainees was responsible for getting their log books signed off and it may be reasonable in the future to modify this document to include a column for having had training in a procedure, or just having watched a particular procedure, as it can take many years to gain competency in some of the more advanced interventional procedures.
The annual cleaning and reprocessing audit was completed by ALL trainees. Everyone achieved competency in this vital area, although the starting point varied enormously, from having never cleaned or reprocessed an endoscope to already being quite proficient. Being such a vital part of the training, a lot of time and emphasis was directed in this area.
The first week was spent training the candidates in the reprocessing of flexible endoscopes and accessories, some from scratch. By the end of the second week most had been assessed and were well on the way to competency. The third week saw the arrival of new equipment and 2 new trainees. The Fuginon Scopes came with a leak tester so the training was undertaken again and everyone was reassessed with the new equipment. Two of the doctors also undertook the reprocessing training.
There were a large number of procedures performed over the 4 weeks, which gave the trainees lots of opportunities to assist the doctors with the procedures and with a high yield of pathology ample training with taking biopsies, both for Helicobacter pylori testing and histology, labeling specimens for pathology, and also other interventional procedures such as dilatation, retrieval of a foreign body, heater probe for bleeders, hemorrhoid banding, and polypectomy.
The downside of so many procedures was that it was difficult to schedule in-service and teaching. We did, however, snatch opportunities to have short sessions on snares, clips, hand washing, bowel preparation, dilatation, and personal protective equipment.
However, the benefit of the hands-on-training far outweighed any downside.
An in-service on the capsule endoscopy program was conducted with the CWM nurses.
All trainees participated in the changing of the Gluteraldahyde, a high-risk activity. A “Chemical Spill Kit” was put together and training was carried out with all the staff on the emergency procedure if there was a chemical spill. We used “kitty litter” as the absorbing product and the rest of the kit consists of personal protective equipment and clean up and disposal products. Each of the trainees was given a list of items to put together their own spill kits.
Patient information sheets for the donated bowel prep, Moviprep, were devised and saved on the endoscopy computer desktop along with updated Picoprep instructions; the emergency bleeder box was checked and restocked and in-service with all trainees on the urease reagent for H. pylori testing was undertaken.
There was a large amount of donated equipment/disposables. These were distributed among the regions. It was felt that it is easier to send donations to Suva and then distribute from there. Distribution, storage, and use of donated goods remain an issue.
When the CWMH has a permanent home for endoscopy with a designated storage area , perhaps a better system can be put in place for stock rotation and distribution.
With such a lot of disposables on hand, it may be appropriate to reassess the reuse of critical single-use items such as biopsy forceps. I am loath to encourage waste or create a mountain of land fill, but there is a risk of transmission of infections when reusing single-use items that are difficult to reprocess appropriately.
Some items that would be very helpful and are in constant short supply are nitrile gloves for the cleaning room, spray nozzles for xylocaine throat spray, and large pump packs of lubricant.
A set of Savary Gillard dilators would be an asset as they are easy and safe to use and reprocess as compared with expensive balloon dilators. Gluteraldahyde efficacy test strips would be handy to have so if the glut is nearing its expiry, and stores have not arrived, it could be tested each use to guarantee efficacy.
What a great and rewarding time I had working with the fabulous team of 2013 and reacquainting with my dear friends in Fiji. What a privilege it is to share my experience and knowledge with the beautiful, keen, hard working nurses and doctors from the Pacific Islands. All the nurses were extremely caring and efficient in their roles when setting up for the procedures, monitoring the patient during the procedures, and recovering them postprocedure. They were also quite competent at giving preoperative and postoperative instructions to their patients, and all were keen to learn as much as they could about endoscopy and to assist and practice their new skills.
Thank you for this opportunity to share my experiences participating in this very worthwhile educational program.
“Bula” Trainers and Trainees GeFITT Program 2013 CWMH (Colonial War Memorial Hospital), Suva, Fiji.
“Don’t throw the baby out with the bath water”: Training in Endoscope Reprocessing. (Left to Right) Trainee Donna, trainer Anne Dowling, and Maraia NUM Endoscopy unit CWMH.