International Child Health
Our clinicians have saved countless children at Alder Hey, but their remarkable work doesn’t just happen here at the hospital.
The International Child Health (ICH) team reach children across the globe, and use their expertise to improve healthcare in developing countries. Members of the team all have experience of working and researching overseas, and come from various departments across the trust.
Our humanitarian work focuses on the developing world, where some 80% of children reside. The trust already has links in Malawi, Nepal, Pakistan and India and the ICH team hope to strengthen these partnerships and make new connections with institutions and Healthcare professionals across the globe.
The group, led by consultants Barry Pizer and Atif Rahman, believe that international work has great outcomes for Alder Hey staff and the trust as a whole. Working overseas gives our staff a chance to expand their skills in a radically different setting and return to Alder Hey with an enhanced perspective and a wealth of new experiences. “Our international work is increasingly being recognized as a valuable contribution to global health” says Rahman of the team.
The ICH Group aim to expand over the next ten years and have two main objects for the programme:
- To save lives and promote health in resource-poor settings – by assisting research, education and service development.
- Be at the cutting edge of innovations in health by developing research and educational links with top centres in resource-rich settings.
The International Child Health team work all over the developing world.
In the early 1980’s Iraq’s hospitals were on a par, if not superior to those in the west. Unfortunately two wars and continuing unrest have severely restricted and limited medical education in the Middle East.
The Royal College of Paediatric and Child Health (RCPCH) have long standing links with paediatricians in Kurdistan, and together they have developed a postgraduate Paediatrics and Child Health training programme.
Alder Hey has been involved since 2008, and has provided resources for a paediatric resuscitation nurse specialist, along with mannequins, consumables and online support via a Moodle based virtual learning environment. Though initially held in Jordan for security reasons, more recently the course has taken place in Iraq itself and the scheme will soon become self-sustaining as more and more local paediatricians are trained to deliver the course. To date it has reached over 70 doctors, and October 2011 saw nurses participating for the first time.
On each trip, several courses are conducted simultaneously. They cover a variety of topics and include:
- Paediatric resuscitation/Advanced Paediatric Life Support (APLS)
- Newborn Life Support
- Management of the seriously ill child
- Child protection
- Teaching paediatrics and child health
- Evidence-based medicine
Malawi is one of the world’s least developed countries, with a largely rural population and agricultural economy. The government rely heavily on aid to meet their development targets. The country is blighted by several health issues, including a high prevalence of HIV and AIDS across the population.
Alder Hey’s partnership and collaboration with the University of Malawi College of Medicine and the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi has a long history. Some former Alder Hey staff have taken up leading roles in the College of Medicine, notably Principal Professor Robin Broadhead and Professor Elizabeth Molyneux- Head of Paediatrics at QECH. In addition, a nurse exchange programme has allowed for paediatric nurses to gain experience of nursing in quite different environments. A number of paediatricians have gained Wellcome Trust fellowships to conduct research on childhood illness with Professor Cunliffe in Malawi.
Professor Enitan Carrol completed a Wellcome Trust Fellowship in Clinical Tropical Medicine on invasive pneumococcal diseases in Malawian children. The study was based at the Malawi-Liverpool-Wellcome Trust Clinical Research Programme and Enitan focuses on improving the diagnosis of serious bacterial infections and understanding mechanisms of disease. She is a member of the International Meningococcal Genetics Consortium: a group that has just received an €12 million EU FP7 grant to study the genetics of life threatening infection in children in Europe and Africa.
Nigel Cunliffe has conducted studies into diarrhoeal disease in children in Malawi since 1996. These studies, based at the Malawi-Liverpool-Wellcome Trust Clinical Research Programme and the University of Malawi College of Medicine, culminated in the first clinical trial of rotavirus vaccine in Africa, which in turn led to a WHO global recommendation the vaccine. Currently, he holds funding of more than £4 million to evaluate a range of paediatric vaccines in Malawi including vaccines against rotavirus, pneumococcus and malaria.
In 2005 James Bunn was appointed Associate Professor in Community Health at the College of Medicine in Malawi, where he worked until 2008. He developed, and raised charitable grants, for a Diploma course for refugee doctors, part of which was delivered at Alder Hey. Whilst working in Malawi he researched malaria, severe malnutrition and HIV. He has advised and conducted training courses for WHO, UNICEF and WFP, and contributed to policy development in Malawi, and in the UK.
Dr. Melissa Gladstone, Senior Lecturer in Paediatric Neurodisability and International Child Health, is working on projects in Malawi in conjunction with researchers at the College of Medicine in Malawi and the department of Paediatrics in Malawi. This includes work on creating better training programmes which are linked to competencies for community based rehabilitation workers working with children with disabilities. She is also working on interventions in the community which include health, nutrition and stimulation programmes provided through women’s groups to improve outcomes for children in terms of their development.
With a population of 30 million and a GDP of just $1500, Nepal is one of the world’s poorest countries. Delivering care in a developing country where healthcare and education are underfunded and side lined is difficult enough, but include Nepal’s mountainous, challenging terrain and the task becomes even tougher.
Kanti Children’s hospital, in capital city Katmandu, is the only government funded paediatric facility in the country. The Hospital has approximately 320 beds and provides neonatal care, general paediatrics, surgery, cardiology and cardiac surgery, oncology and intensive care. There are also paediatric clinics and a paediatric emergency room.
Alder Hey’s links with Kanti began some 20 years ago, when then Alder Hey manager Carmel Dersh set up the charity ‘So The Child May Live’ after a trip to the region and to the Hospital. Since then the charity has helped many Alder Hey Staff travel to Nepal to support The Kanti, and in 2013 the two hospitals signed a Memorandum of Understanding to work together to develop services in Nepal.
The outcome for Nepalese children with Cancer is poor. In the UK, around 80% of children diagnosed with Acute Lymphblastic Leukaemia recover but in Nepal this figure falls to just 20%. Alder Hey consultant Barry Pizer has worked with Kanti for a number of years, and provides support on individual cases as well as advising and helping develop the department and support for families of Oncology patients.
Burns are a serious health problem in Nepal. A large amount of families live in remote areas without electricity, and rely on open fires for cooking and to heat their homes. Their location also means that children with burns often arrive at the hospital days after the injury happened, a factor which greatly increases the risk of infection. Despite this heightened risk for the countries children, Kanti hospital doesn’t have a specialised burns unit. As such, Kanti’s link with Alder Hey Burns specialist and Plastic Surgeon Sian Falder is especially beneficial, and Sian has visited Nepal seven times since joining the project in 2008.
Advanced Paediatric Life Support (APLS) is taught as standard in most developed countries, and Kanti were keen to adopt the methods in their practice. Theatre sister Sunitha Dunghana is now responsible for training the entire medical and nursing staff at Kanti in BLS. It is a unique undertaking for a nurse in Nepal to take such an important role and we committed to funding her salary for 2 years. This period has now come to an end, and Sunitha’s role is embedded at Kanti and the hospital has taken over her payment.
Consultant Neurologist Dr Rachel Kneen is working with professionals from the Institute for Global Health (IGH) and The University of Liverpool to improve neurology services at The Kanti. Back in 2010 The IGH/Kanti team secured a THET grant to improve paediatric epilepsy services, and measure the outcome of the programme as part of a research study. The project will train Kanti staff at Alder Hey, whilst also running the first International Paediatric Epilepsy Training (IPET) course in Kanti. Dr Kneen is also involved in a research project looking at the fluid management of children with acute encephalitis syndrome at Kanti hospital.
Mr Arvind Chandna has helped The Department of Paediatric Ophthalmology collaborate with overseas centres of excellence to conduct Research Programmes. These included working with multiple centres on Capacity Building Programmes to provide teaching and training in paediatric ophthalmology in developing countries over the last 20 years.
King Edward Medical University, Mayo Hospital and College of Allied Vision Sciences Lahore, through Professor Asad Aslam Khan
Over the past 15 years this partnership have developed a comprehensive paediatric eye care team with unique outpatient and surgical facilities, as well as working within the tertiary eye care centre and in rural communities. This is part through training, and the development of a 4 year B.SC Vision Science course that produces 23 graduates annually, all of whom go on to work within the Health Service of Pakistan.
Fred Hollows Foundation (FHF) and Alder Hey
In a landmark agreement between Alder Hey and FHF, the department undertook training of paediatric eye care teams from Pakistan. These clinicians were largely from tertiary eye care centres and each participant travelled to Alder Hey every 6 months over 2 years.
Mr Chandna has also conducted one to week workshops in Sudan, Ghana, Tanzania, Saudi Arabia, India, Pakistan, China, Burma over the last 15 years through direct partnerships and charitable organisations (Volunteer, Chair of Programme Committee and Chair Orbis UK). Mr Newman has conducted programmes in India thorough Orbis.
A regular advisor to the World Health Organisation and Unicef, Atif Rahman’s international work has helped identify maternal depression as a risk factor to be addressed by global health programmes.
This initial research highlighted critical links between maternal mental health and the growth, health and early development of infants in developing South Asian countries. Rahman has developed psychological interventions that can be delivered by non-specialists, a strategy which helps combat a shortage of specialist manpower.
With the help of several research grants, Atif successfully completed the largest trial of a psychological intervention ever conducted in the developing world, and is now establishing a collaborative network of South Asian institutions to address gaps in the regions Mental Health Care.