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<p><b><span lang="EN-GB"><font size="3"><font face="Times New Roman">Advanced training course in Sweden arranged jointly by: </font></font></span></b><b><span lang="EN-GB"><font face="Times New Roman" size="3"> </font></span></b><b><span lang="EN-GB" style="FONT-SIZE: 11pt"><font face="Times New Roman">Columbia University, Averting Maternal Death and Disability (AMDD) program, New York, USA Karolinska Institutet, Division of International Health (IHCAR), Stockholm, Sweden</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font face="Times New Roman" size="3"> </font></span><b><span lang="EN-GB" style="FONT-SIZE: 18pt; LINE-HEIGHT: 150%"><font face="Times New Roman">"Enhancing access to human resources for maternal and neonatal survival through task-shifting by training of non-physician clinicians for emergency obstetric care: from scientific evidence to action"</font></span></b></p>
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<p style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">Application forms for this course are available from</span></i><span lang="EN-GB"> <<a href="mailto:staffan.bergstrom@ki.se" target="_blank">staffan.bergstrom@ki.se</a>>. </span></font></font></p>
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<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">There is <u>no tuition fee</u> and accommodation and all meals and all course material, books and handouts will be provided <u>free of cost</u>. </font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><u><span lang="EN-GB"><font size="3"><font face="Times New Roman">The course will run August 17-30, 2009 in Gotland, Sweden.</font></font></span></u></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span lang="EN-GB"><font size="3"><font face="Times New Roman">Background and rationale</font></font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">The 5<sup>th</sup> Millennium Development Goal to reduce maternal mortality by 75% during the period 1990-2015 is the MDG by far the least on track to be fulfilled. This has been called the "Scandal of our time" and the human resource issue is the most fundamental cause of failure. Doctors are absent in rural areas, where the bulk of maternal mortality occurs. </font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">In an article in the Lancet an analysis of 47 African countries has shown that in more than 50% of these countries <i>"non-physician clinicians" </i>are actually fulfilling much of the needs of advanced clinical skills in the absence of conventionally trained physicians. The concept of <i>"task-shifting"</i> (originally much used in the context of HIV care) has come to mean an important advancement also in comprehensive emergency obstetric care. Very few countries in Africa, however, have a formally legalized category able to perform life-saving surgery to save mothers' and newborns' lives. <u>Tanzania</u> has "assistant medical officers" almost since its independence and <u>Malawi</u> has "clinical officers" since 1976. <u>Mozambique</u> embarked upon a similar development in 1984, in which a three year training to become "técnico de cirurgia" was started. <u>Zambia</u> initiated in 2002 a three year training of clinical officers to become "medical licentiates" and in early 2009 <u>Ethiopia</u> is embarking upon a three year MSc training programme of "integrated emergency obstetrics and surgery" aimed at upgrading skills of "health officers".<span> </span>Several countries, <i>not only in Africa but also in Asia and Latin America</i> are now grappling with the problem of enhancing maternal and neonatal survival with the foreseeable failure of attaining MDG 4 and 5. </font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">Since 2006 we have been able to address the problem of scarcity of human resources with special focus on "task-shifting" for maternal and neonatal survival through the courses in Gotland, Sweden. Our target group of interest is "mid-level providers of care", <i>including midwives</i> in various African, Asian and Latin American countries. We have, presumably, the only course in the world targeting these health workers, whom we consider key individuals to improve the availability of comprehensive emergency obstetric care to women in need.</font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">The challenge to provide life-saving obstetric surgery among the most deprived segments of populations in poor countries is made almost impossible by the shortage of doctors. The medical profession is largely drained away from rural to urban areas and also away from low-income countries to greener pastures abroad due to adverse living conditions, low salaries and weak health policies in countries most in need of live-saving skills to the poorest, particularly women. </font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">There is an urgent need of propagating and disseminating recent research results, which are quite sensational but not yet recognized in the medical world. These observations comprise the following items:</font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt 34pt; TEXT-INDENT: -19.8pt"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">1)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">In Malawi a nationwide study of all district/rural hospitals in the country with surgical facilities (n = 38) has shown that non-physician clinicians (clinical officers) currently perform more than 90% of all caesarean sections. </font></span></font></p>
<p style="MARGIN: 0in 0in 0pt 34pt; TEXT-INDENT: -19.8pt"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">2)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">In Mozambique an almost identical picture prevails at district hospitals (n=23) in that 92% of all caesarean sections are carried out by specially trained "técnicos de cirurgia", i.e. surgically trained assistant medical officers. In the whole country, including national university hospitals, provincial hospitals and general hospitals the corresponding figure is 54%. In other words: the vast majority of all obstetric emergencies are already carried out by non-physician clinicians in Mozambique. This figure is sensational.</font></span></font></p>
<p style="MARGIN: 0in 0in 0pt 34pt; TEXT-INDENT: -19.8pt"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">3)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><font size="3"><span lang="EN-GB">In Tanzania two regions, Mwanza and Kigoma, all hospitals have been analysed and <span> </span>the situation is similar with around 85% of all such operations carried out by non-physician clinicians. </span><span lang="EN-GB"></span></font></font></p>
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<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">We are interested to get full names and e-mail addresses of those being interested to get an application form. Like previous years we count on having application forms from various non-physician clinicians incl. midwives and medical doctors involved in training of such cadres in Africa, Asia and Latin America.</font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">Target groups:</font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt 0.5in; TEXT-INDENT: -0.25in"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">1)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">Non-physician clinicians (NPCs) - i.e. clinical officers, assistant medical officers, técnicos de cirurgia and midwives - with experience of comprehensive emergency obstetric care and in surgery from Africa, Asia and Latin America</font></span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.5in; TEXT-INDENT: -0.25in"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">2)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">Medical doctors with experience of training NPCs in these fields in the continents mentioned.</font></span></font></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span lang="EN-GB"><font size="3"><font face="Times New Roman">Course objectives</font></font></span></b></p>
<p style="MARGIN: 0in 0in 0pt 0.5in; TEXT-INDENT: -0.25in"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">1)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">Share task-shifting experiences between participants in emergency obstetric care.</font></span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.5in; TEXT-INDENT: -0.25in"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">2)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">Provide tools for improving quality of care through use of audit and process indicators.</font></span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.5in; TEXT-INDENT: -0.25in"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">3)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">Develop occupational profiles of NPCs cadres in a team approach.</font></span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.5in; TEXT-INDENT: -0.25in"><font face="Times New Roman"><span lang="EN-GB"><span><font size="3">4)</font><span style="FONT: 7pt 'Times New Roman'"> </span></span></span><span lang="EN-GB"><font size="3">Upgrade clinical knowledge and skills in emergency obstetric care.</font></span></font></p>
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<p style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">Application forms for this course are available from</span></i><span lang="EN-GB"> <<a href="mailto:staffan.bergstrom@ki.se" target="_blank">staffan.bergstrom@ki.se</a>></span></font></font></p>
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<div style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font size="3"><font face="Times New Roman">THE <u>DEADLINE</u> FOR APPLICATION WILL BE <u>FRIDAY 1<sup>ST</sup> OF MAY 2009</u>.</font></font></span></div>
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<h1 style="MARGIN: 0in 0in 0pt"><span lang="EN-GB" style="FONT-SIZE: 18pt; mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-GB"><font face="Times New Roman">APPLICATION FORM</font></span></h1>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><b style="mso-bidi-font-weight: normal"><u><span lang="EN-GB"><font size="3"><font face="Times New Roman">When application is submitted, please send an e-mail with this form attached or fax the form. </font></font></span></u></b></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><b style="mso-bidi-font-weight: normal"><i style="mso-bidi-font-style: normal"><span lang="EN-GB"><font size="3"><font face="Times New Roman">Selected participants will be informed at the latest on Friday 15<sup>th</sup> May, 2009.<span style="mso-bidi-font-weight: bold"></span></font></font></span></i></b></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><font face="Times New Roman" size="3">I hereby apply to participate in the above mentioned course:</font></span></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">Surname/Family name</span></i><i style="mso-bidi-font-style: normal"><span lang="EN-GB"> (as in your passport):</span></i></font></font></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><i style="mso-bidi-font-style: normal"><span lang="EN-GB"><font size="3"><font face="Times New Roman">First <span style="mso-bidi-font-style: italic">name</span> (as in your passport): </font></font></span></i></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">Nationality:</font></font></span></i></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">Male/female: <span style="mso-spacerun: yes"> </span></font></font></span></i></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">Birth date (year/month/day):<span style="mso-spacerun: yes"> </span>_ _ _ _<span style="mso-spacerun: yes"> </span>_ _<span style="mso-spacerun: yes"> </span>_ _</font></font></span></i></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">Category: </span></i><span lang="EN-GB" style="mso-bidi-font-style: italic"> assistant medical officer<span style="mso-spacerun: yes"> </span><i></i> clinical officer<span style="mso-spacerun: yes"> </span><i></i> health officer<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span> medical licentiate<span style="mso-spacerun: yes"> </span> <span style="mso-spacerun: yes"> </span>medical doctor and tutor <span style="mso-spacerun: yes"> </span> midwife<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span> other (specify):</span></font></font></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">Profession/educational level:<span style="mso-spacerun: yes"> </span></font></font></span></i></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">Affiliated to (university/college or other institution if applicable):</font></font></span></i></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">Current hospital (or other) employment:</font></font></span></i></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">Complete air mail address</span></i><i style="mso-bidi-font-style: normal"><span lang="EN-GB">: </span></i></font></font></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">Best telephone no. to contact</span></i><i style="mso-bidi-font-style: normal"><span lang="EN-GB"> (country and area code): </span></i></font></font></p>
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<p class="NoSpacing" style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">Fax</span></i><i style="mso-bidi-font-style: normal"><span lang="EN-GB"> (country and area code): </span></i></font></font></p>
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<h2 style="MARGIN: 0in 0in 0pt 99pt"><span lang="EN-GB"><font face="Times New Roman" size="3">PERSONAL BACKGROUND (use more space if needed)</font></span></h2>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">1)<span style="mso-spacerun: yes"> </span>I am interested in this course for the following reasons:</font></font></span></i></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">2)<span style="mso-spacerun: yes"> </span>In my professional work I have been involved in <u>emergency obstetric care</u> in the following way (brief description):</font></font></span></i></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><span lang="EN-GB" style="FONT-SIZE: 11pt; mso-bidi-font-style: italic"><font face="Times New Roman"> </font></span></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">3)<span style="mso-spacerun: yes"> </span>In my professional work I have been involved in <u>surgical activities</u> in the following way (brief description):</font></font></span></i></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><font size="3"><font face="Times New Roman"><i><span lang="EN-GB">4)<span style="mso-spacerun: yes"> </span>Research project involvement (describe briefly title of research project - if any - and special research interests</span></i><span lang="EN-GB">)<i style="mso-bidi-font-style: normal">:</i></span></font></font></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><i><span lang="EN-GB"><font size="3"><font face="Times New Roman">5)<span style="mso-spacerun: yes"> </span>I am prepared to share my experiences in a short presentation on the following topic related to the course theme:</font></font></span></i></p>
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<p class="MsoBodyText" style="MARGIN: 0in 0in 0pt"><span lang="EN-GB" style="mso-bidi-font-size: 12.0pt"><strong><font size="3"><font face="Times New Roman">Please submit this filled in application form as an attachment by e-mail to:</font></font></strong></span></p>
<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><span lang="EN-GB"><strong><font size="3"><font face="Times New Roman"><<a href="mailto:staffan.bergstrom@ki.se">staffan.bergstrom@ki.se</a>> <u>at the latest on Friday 1<sup>st</sup> of May 2009</u>. All inquiries about the course can be sent to the same address. </font></font></strong></span></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><b><span lang="EN-GB"><font size="3"><font face="Times New Roman">You can also <u>fax</u> this form filled in to:</font></font></span></b></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><b><span lang="SV" style="mso-ansi-language: SV"><font size="3"><font face="Times New Roman">Professor Staffan Bergström, IHCAR/Karolinska Institutet, Stockholm, fax +46-8-31 15 90</font></font></span></b></p>
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<p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><b><span lang="EN-GB"><font face="Times New Roman" size="3">GENERAL INFORMATION TO ALL APPLICANTS: Please note that all applicants have to plan to get financial coverage from home setting to Stockholm, capital of Sweden. From there everything will paid by the course organizers during the period August 17-30, 2009, including travel in Sweden from Stockholm to course venue in Gotland, insurance fee, all costs for accommodation and meals, tuition fee, course material like books and handouts etc.</font></span></b></p>
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