The Nepean Intensive Care Web Site

http://www.nepeanicu.org

Nepean ICU & Indonesia

This page intends to give some detail of a joint Australian Indonesian Intensive Care educational program that has been under development informally since 1985 and on a formal level since 1994. It is a program that has been enthusiastically embraced by the Nepean Intensive Care Unit and its director Associate Professor McLean and many of the nursing and medical staff have been involved in it.

Intensive Care in Australia

Australian Intensive Care Units were first established in the 1960s. They were intended to care for critically ill patients who needed constant nursing and medical attention. It was not however until the 1970s that Intensive Care became recognised as a medical specialty. This was formally recognised with the formation of the Australian and New Zealand Intensive Care Society (ANZICS) in April 1975 and subsequently with specialised training in Intensive Care medicine. Since 2001 this training has been by the Joint Faculty of Intensive Care Medicine, Australian and New Zealand College of Anaesthetists and Royal Australasian College of Physicians.

Intensive Care Nursing is a recognised specialty in Australia. Registered nurses are now trained through university degree programs and have further postgraduate training available from universities and professional colleges in Intensive Care nursing. In comparison to other countries Australian Intensive Care nurses are well paid, although in line with the international crisis in nursing it has become increasingly difficult to attract nurses to Intensive Care areas and to retain existing staff.

Intensive Care in Indonesia

While the western world has been enjoying a long period of prosperity and progress many parts of Asia have been in poverty. Often primary health care, which has the potential to help many, has been a higher priority than the very expensive Intensive Care, which benefits comparatively few. However economic growth in many parts of Asia is now very fast and this is reflected in the growth of Intensive Care in Indonesia.

Intensive Care medicine has not however traditionally been recognised as a speciality in Indonesia. The same challenges that have been faced in Australia are seen in Indonesia: the problems of developing a new specialty that crosses areas that existing specialists such as surgeons, physicians and anaesthetists regard as their own. A major step forward was made in 1979 with the formation of the Indonesian Society of Critical Care Medicine (ISCCM) and also by the creation of a sub-specialisation program in Intensive Care in 1995 by the Indonesian Society of Anaesthesiologists.

Nursing in Indonesia has significantly lower status than in Australia and is considered to be poorly paid. An even greater problem is the lack of formal education prgramse which are needed to produce highly trained Intensive Care nurses. This received a major boost with the formation of the Indonesian Society of Critical Care Nurses, which became an independent organisation from the ISCCM in December 1996.

The Program

On the background of informal educational ties between the two countries a formal association between the ISCCN and ANZICS began in 1993. At the time funding was successfully applied for from the Australian Agency for International Development (AusAID). Funds were provided under its Professional Association International Development Scheme (PAIDS). The first joint workshop was organised in the Harapan Kita Hospital, Jakarta, in January 1995. Considered a great success another was organised in the same year.

Over the following years further funding from AusAID has enabled Indonesian Medical Officers and Registered Nurses to travel to Australia and work in Intensive Care Units including the Nepean Intensive Care Unit. As well Intensive Care Medical Officers, Registered Nurses and Physiotherapists have traveled from Australian Intensive Care Units to lecture, workshop and work alongside Indonesian Intensive Care staff in such hospitals as Yogyakarta. Staff from the Nepean Intensive Care Unit have enthusiastically participated in this program.

Some of the workshops have focused on the development of clinical practice protocols for the local area. For example protocols were established for 'Management of Severe Acute Pulmonary Embolism' and 'Management of Severe Head Injuries' amongst many others. As well sessions for nurses focused on practical issues such as central line management, management and troubleshooting of ventilators and dialysis techniques. Other areas covered included management of Intensive Care Units and the collection and use of data related to critical care illness.

A Summary

To quote from an article written by Associate Professor McLean of the Nepean Intensive Care Unit, Australia and Dr Iqbal Mustafa of the Harapan Kita Cardio-Thoracic Unit, Indonesia:

"Intensive Care is a relatively new specialty. Developing adequate ICUs to cater for the populations of developing countries is a large challenge, not only in economic terms but also from the provision of well trained medical and nursing staff, good management and useful information systems. To translate much of the experience and expertise from advanced intensive care systems present in developed countries to a country more limited in such facilities requires consideration of cultural, economic, geographical and political factors. ..... This cooperative international venture is only the beginning and the remaining work in this area is an enormous challenge."

References