Establishing emergency bronchoscopy in Timor-Leste: a health care needs assessment-driven novel model of training
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Background
Bronchoscopy is an integral component of the practice of respiratory medicine. Multiple challenges to establishing and maintaining a service in low income countries (LIC) are recognized, with establishing and maintaining bronchoscopic competence being a key barrier to implementation. A critical gap in care at the leading hospital in Dili, Timor-Leste, was identified following multiple adverse outcomes due to lack of bronchoscopy for management of foreign body aspiration (FBA) in 2023, including two deaths.
Methods
A healthcare needs assessment (HCNA) was completed to identify setting-specific requirements, and a novel training program designed to rapidly upskill local clinicians for performance of emergency FBA retrieval.
Results
HCNA revealed heightened risks (no negative pressure ventilation, limited anaesthetic staff capacity) and reduced diagnostic utility (lower lung cancer rates, no treatment for advanced cancer or TB strictures), but noted significant infrastructure and workforce capacity for bronchoscopy due to the endoscopy training program established by the Australian and New Zealand Gastroenterology International Training Association (ANZGITA). A novel training program, comprising short intensive skills training and ongoing remote mentorship (including ‘just-in-time procedural support) was implemented to rapidly upskill local HNGV clinicians. In the sixteen months following bronchoscopic training, three paediatric patients successfully underwent bronchoscopic removal of FBA without complications.
Conclusion
This model demonstrates the value of intensive training and remote support for successful establishment of bronchoscopy for targeted indications, and offers a potential framework for other LICs to establish essential emergency bronchoscopy services despite resource limitations and low procedural volumes
