Teaching Overseas

Delivering EMS education overseas presents new and unique challenges not seen in the U.S. classroom. Local customs, peculiarity in dialects, even misconceptions about the United States and the host country may all play a part in how successful your education program is.

I have had the opportunity to teach and work with people from around the world, in places like Calcutta, Hong Kong and Freeport, Grand Bahamas. In addition, I have hosted students from Italy, Central and South America, and taught students from Kuwait at George Washington University in Washington, DC. Whether you are teaching an AHA CPR course in India or a U.S. DOT EMT-B program in the Bahamas, you will be confronted with many different problems.

Technology Breakdowns

In the days before computers, using slides was de rigueur, but customizing slides could be difficult and cost-prohibitive. The advent of programs like PowerPoint and lightweight computer projectors allows anyone with a laptop and a little talent to put together a professional presentation. Some pitfalls to think about, however:

If you cannot access 110-volt power in the country where you are teaching, you will need an adapter with the appropriate plugs. Try to use technology that works with either 110 or 220 volts. Then, all you may need is an adapter for the plug.

If you bring your own LCD projector and have a problem with it, will you be able to get it serviced wherever you are? Will the service center provide you with a loaner while yours is being repaired?

If you will not have access to an LCD projector, consider bringing a laptop with true multimedia capability; specifically, one with a TV-out card. Then you can plug your laptop into any TV that is VCR-compatible. You will still be able to do PowerPoint presentations, just on a smaller screen. Play around with it ahead of time. There are different standards worldwide (NTSC versus PAL), but I haven't run into any situation yet where I could not get it to work. Just make sure you know how to adjust the settings for NTSC or PAL on your laptop.

The electrical capabilities of the community may not be able to meet the operating requirements for your computer equipment. In this instance, print your presentation as overheads on transparencies ahead of time and pack them with you. It may lack the punch and flash of using the computer and it will be in black and white, but the content is what counts.

Logistics

With any program of study, there are handouts, booklets, etc., for the program participants. If, as part of your service contract, your organization must supply these materials, ask two questions before proceeding. First: Is it cheaper to copy the materials at home and ship them ahead? Or is it cheaper to have the materials copied/produced on site or at a local business?

In some parts of the world, photocopying on site is cost-prohibitive, so this information is crucial to find out ahead of time. The best scenario would be to have the local organization assume reproduction as part of the burden for hosting the course and assisting in its production. This must be determined prior to signing any agreement.

Second: Where will you get office support? If you need additional materials copied, need to send a fax, require Internet access, must produce additional classroom materials on the fly or conference call with other individuals in your organization, where will you accomplish this?

For short programs, the sponsoring/host organization may be amenable to providing these services, within reason. For more intensive, longer-form programs, the use of office space and materials may need to be negotiated. The local version of Kinko's or Mail Boxes Etc. may break your bank. If demand for service is anticipated to be low, request support/updates via e-mail to the home office. An occasional fax should not be a problem for most organizations.

Language

George Bernard Shaw said, "England and America are two countries separated by the same language." Even in English-speaking regions of the world, local dialects and catchphrases may mean different things. Prior to traveling, try to learn some of the local phrases and what they mean. A note of caution: If traveling to an Asian country, be careful of what you say and how you phrase it. The Asian culture is very precise with other languages in order to avoid making an error, and they will expect the same from you.

Before I visited the Bahamas, I asked a Bahamian friend what I should be aware of when I traveled there.

He laughed and said, "When they ask you if you like the conch (pronounced 'conk'), it is a subtle joke. They consider conch to be a powerful aphrodisiac."

Sure enough, after my first day or two in the Bahamas, I was asked if I had tried any of the local delicacies, in particular the conch. I replied yes, to which the follow-up question was, "Do you like the conch?"

I looked my smiling inquisitor in the eye and asked, "Sir, if I may ask, how many children do you have?" He proudly replied, "Six." My response was, "Oh-you must love the conch." Amazed, he stared at me, and when I smiled, he broke out laughing and gave me a big hug. After that, I got along famously with everyone.

If the local language is not English, try to find an interpreter who is not only well-versed in English, but who is a trained medical professional (physician, nurse, paramedic). If a physician trained/educated in emergency medicine or even internal medicine is not available, then a well-educated nurse with a critical-care background is your next best choice. This will reduce the amount of time spent educating a non-medically trained interpreter on what you are trying to communicate.

If handouts need translation, have them translated and reviewed before your trip. Sometimes, in translation, the message or definition isn't as clear, or the importance of a topic is lost. You want to make sure everything is correct prior to dissemination of materials.

Culture

The key word here is R-E-S-P-E-C-T. Everyone thinks that their own culture is superior. Whether I was in Hong Kong, Calcutta or the Bahamas, or working with students from Kuwait or South America, people at different times tried to explain the peculiarities of their system, often apologizing for what they perceived as lacking. The best bet is to always take a relaxed, non-judgmental attitude. Praise what is good about their system. Remind them of flaws in your own local system that you are working to improve. Give them the respect they show you and treat them as equals. You should not come off as the "pro from North America."

I was at the Temple of Wong Tai Sin, the oldest Buddhist temple in Hong Kong. A couple of gentlemen from the management consulting company I was working with, who were natives of the region, were with me. I had my camera and I needed to change the film. As I knelt down to do so, I overheard one of them say to the other, "Look, he is praying. He is showing respect." I stopped what I was doing and reflected on life. I then got up and changed my film.

When I went back to work the next day, my "praying at the temple" had passed through the office where I was doing the consulting project. That misunderstanding increased my credibility, while also raising my awareness.

Try to accommodate people within reason, but make sure they understand that when teaching a program for the AHA, PHTLS, etc., you are bound by the rules of the organization. Strive to be customer-service friendly, but within the convention of whatever program you are presenting. The students will have a greater respect for you as an educator and they will also hold the program in high esteem. Anywhere I have taught, when I meet a student who has taken PHTLS, they hold their card up as a badge of honor.

Evaluate prior EMS education before attempting to custom-design a program and drawing up a schedule and syllabus. If the students' EMS education is lacking in certain areas, either allot more time to present additional materials, or, before you arrive to present your course, have certain topics covered by the local EMS education team.

Time is culture-dependent. In the Caribbean, "island time" may mean we schedule the class for 8 a.m., but most students won't show up until 8:45, 9:15, maybe 9:45. Let the students know that you have to start and end at particular times. Many people in the Caribbean hold second and third jobs due to the high cost of living. Bear this in mind and perhaps build a "make-up day" into your program.

In Asian communities, especially the Pacific Rim, the program's start time will be very precise. The students will expect a syllabus and a schedule with time frames for each lecture, even for a basic CPR course.

Never forget where you are, and always ask questions. Danger lurks even in paradise.

In the Caribbean, as we ended class for the day, I was approached by the emergency department medical director asking if I would see a patient at his house. This patient's son had drowned the day before while trying to save him. This incident had appeared in the local papers and on the news. He did not go to the hospital, and family and friends were asking for assistance, worried about his health and state of mind.

I agreed to go and took a LifePak 5, a penlight, a BP cuff and a stethoscope. As an employee from the hospital drove me to his home, I casually asked who this man was.

"He is the biggest drug dealer in all of the Caribbean."

Oh.

We were already pulling up to the man's house, so it was too late to ask to go back. Since I was a paramedic and an RN, and since the medical director and the entire staff of the hospital were afraid to go to this man's house, they figured if they asked me, maybe I would go. Three men with machine guns, who were not with the police or any military agency, moved barricades and let us in.

My point is, I am a paramedic from Newark, NJ, the violence capital of America. I never would have done this in Newark. Whatever you do, try not to be the lead story on CNN. It is definitely poor form.

If you are developing materials for a class, try to learn as much about the culture, social and economic conditions as possible. Learn as much about the demographic and health profile of the community as you can. Devise scenarios using these constructs as your guide. If you have ever taken an educational program where the instructor devised his own off-the-cuff scenarios that weren't realistic, you may have come away with a negative impression.

Try to use local examples whenever possible. Remember that people learn in different ways, but it seems that scenarios derived from actual experience and hands-on practice using these scenarios are the best. They seem to transcend cultures.

In Calcutta, if I used a scenario of a person falling off the platform of the Newark city subway and getting hit by the subway car, it would have been totally unrealistic for the students. If I gave them a scenario of a man being run over by a "Ta-ta" (manufacturer of trucks and buses in India), being trapped underneath and the crowd pulling the driver out of the vehicle and pummeling him (which I actually saw), this would have been more understandable.

In summary, treat others as you would want to be treated. Act with respect for religious and local customs. Never forget where you are.