Training, toolkits and shared experiences in Armenia

Dr Rebecca Inglis writes about her experience as part of the UK Emergency Medical Team’s coronavirus response in Armenia at the end of last year.

“I am an intensive care doctor and UK-Med register member with a research interest in improving the care of critically ill patients in countries with limited intensive care services.

I spent the first nine months of the pandemic in Laos in Southeast Asia, working with the World Health Organization to support the government’s COVID-19 response. I had only been back in the UK a few weeks when I received a phone call asking if I would deploy to Armenia as part of the UK Emergency Medical Team.

We were responding to a call from the Armenian Ministry of Health to support the delivery of care to severe and critically ill patients with COVID-19.

A daunting situation

I was stationed at Surb Grigor Lusavorich hospital for five weeks. It’s the largest hospital in Armenia and the flagship of the country’s COVID response. All wards have been repurposed to care for severely ill COVID-19 patients, including a 50-bed intensive care unit (ICU), where we were based.

It was daunting to walk onto this busy specialist unit, staffed by highly experienced nurses and doctors, with our humble offer of support. Our overriding priority was to provide input that was actively welcomed by the local team and wholly aligned with the wishes of the lead nurse and doctor on ICU. Their engagement and support proved essential to getting our training program off the ground in such a short space of time.

I worked alongside Trish McCready, a critical care nurse at Guy’s and St Thomas’ NHS Foundation Trust. Earlier in the year, Trish had trained swathes of nurses in preparation for their redeployment on intensive care units in the UK, as well as contributing to a Europe-wide intensive care training initiative, so her expertise was invaluable.

Practical, hands-on training

Training at the height of a crisis needs to be short, simple and immediately relevant. Drawing on previous work  in Laos, I developed training sessions that were interactive, practical and hands-on.

We set up the classroom as though it was an intensive care unit, with oxygen, ventilators and all the other equipment to allow the staff to practice what we were teaching.

Keeping people as active as possible from their first day in hospital has been shown to have a big impact on improving their quality of life after they have been discharged.  So, an important focus of our training was promoting the early rehabilitation of critically ill COVID-19 patients.

The science of behaviour change

My research work uses the science of behaviour change to improve the quality of care that patients receive in ICU. This entails not just teaching nurses and doctors what they ought to do, but also making it as easy as possible for them do the right thing.

So, for example, in Armenia we created a toolkit containing everything you need to safely start a patient on a ventilator, and then hung one on each ventilator. We also made signs to stick up in ICU to help with infection prevention and control.

Sharing experiences

One of the most important elements of my time in Armenia was being able to share and reflect on our common experiences of caring for patients during the pandemic.

The sweaty indignity of the protective equipment we wear. The grinding fear of bringing contagion home to our families. The universal horror of patients suffering away from loved ones. The anguish is the same in Laos or London or Armenia.

Many of the nurses would come to our training sessions straight after working a nightshift on ICU. They would arrive numb-eyed and exhausted, full of the things they had just seen.

After one particularly upsetting shift, we pushed the chairs to the edge of the room and played a game of one-legged musical statues. The first person to topple over had to answer questions about what they had learned in the preceding session.

Dancing around the room to Shakira in that moment of collective escapism is a memory of Armenia that will stay with me.”

In addition to Rebecca and Trish, the The UK Emergency Medical Team in Armenia included  Emergency Medicine Consultants Paul Ransom and Dave Clarke.

We’ve been working in the UK and around the world to respond to COVID-19. To read more about the work that UK-Med have been doing, visit our COVID-19 response page.