Duse Clinic, Eastern Kenya. Serves a popn of 3500 This clinic had an added challenge of Human Wildlife Conflict. due to the drought animals are seeking alternative grazing which creates complex relationships between communities and the wildlife they are seeking to protect.

How do you deliver safe health care with no water supply? This is Victor from Sericho clinic. He is the only nurse for a population of up to 10,000 This is victor turning on the only clinic tap. #globalhealth #sdgs #remotemedicine #drought #healthcareworkforce

Health needs assessments in culturally complex locations: Listening to the demands of the community is vital in gaining community buyin and government support. Time taken at Step 1 can save you time, energy and failure during the implementation and sustainability phases.

Telemedicine in action! This is Garba Tulla health centre. Catchment area of over 130km to remote communities. With this telemedicine facility the medical and clinical officers have access to specialists in Nairobi university which has huge impact on patient outcomes.

Dr Imara Gluning demonstrating to clinical officers and CHVs in Garfasa clinic the use of an Arclight (University of St Andrews) These excellent pieces of equipment are robust and solar powered allowing important opthalmology examinations to take place in remote settings.

Prof kelechi nnoaham gives excellent teaching on this theory during the Plymouth University Global Health Masters. Using this format in the current health scoping project has helped to focus what the real needs are, and how the needs vs demands vs supply can all be met.

What do health workers value most? Meet nurse Haggai Tirra: Born and raised in Kibera slums in Nairobi, he is no stranger to hardship. Haggai has earned the trust and respect of the community he works with and managed to instil important public health messages.

Meet Kadina Kadina is a nurse at Buliqo health centre, Kadina values maternal health and rights for mothers. Kadina had to fight to remain in school and not have a forced marriage. With her support the community has seen greater access to quality birthing facilities.

Meet Victor Victor values health accessibility. He moved to work in the remote area of Mado Gashi so he could develop community outreach programmes. With limited budget and resources, where you invest first? Join our Global Health course to discuss healthcare resourcing.

A photo taken on a commute to work by one of the Endeavour Medical Fellows. But how does the local population feel about these endangered animals encroaching on their community? Join our Global Health course in November to discover the intricacies of Human-wildlife conflict

Community engagement: the core to any successful health project. This is Maasai communities of Ntalbany and Leparua making their traditional birthing manyatta. Here mothers are able to deliver with the safety of a trained health professional, but also upholding cultural beliefs.

Remote medicine decision making: When you are the only medic, even simple decisions can seem daunting. You're in unfamiliar surroundings with the lack of your usual tools at your fingertips, and its not that simple just to check your management plan with a senior colleague.

Case study: You are acting as the medic on a cycling trip through Cambodia. One of the cyclists its a pot hole and falls sustaining left sided shoulder pain.

You examine them immediately after the injury: 7/10 pain. The shoulders look symmetrical with only a minor graze on the lateral and anterior shoulder. there is limited movement in the shoulder joint due to pain. They can touch their right shoulder with their left hand.

When you feel the shoulder there is point tenderness in the middle of their clavicle and swelling over this are. normal sensation, good pulses, nil other injury You are 4 hours from the nearest hospital, and this would also mean the group losing a day of cycling

What could this be? Fracture, Dislocation or Rotator Cuff tear? What do you do next? a) Give analgesia, sling if comfortable and arrange for immediate evac to the nearest hospital for Xray and, or Ultrasound?

b) Discuss with the patient what they would like to do and if they feel they need to go to hospital. check this plan by calling medical Top cover in the UK. c) Give analgesia and a sling Arrange for them to travel in he vehicle tomorrow and xray when you reach the next town.

Whilst none of these decisions are wrong, in the remote setting you have to consider what is best for the patient, for the group and what is safe for the distance from medical care.

This is most probably a clavicle fracture. An xray is unlikely to change what you do. Therefore analgesia, sling and a delayed xray is safe and adequate management of this injury.

Take home messages: Have confidence in your clinical acumen Always consider if investigations will have an impact in ongoing care Document and share your plan and reasoning with the patient and group leader. endeavourmedical.co.uk