Eric Cheng and Respiratory Therapists Without Borders

Respiratory Therapists Without Borders (RTWB) is a volunteer organization with the mission to “improve respiratory health through educational advancement of local healthcare providers worldwide” (RTWB.ca). This global organization is co-founded by Mr. Eric Cheng.  RTWB works with Healthcare Education Partners (HEPs) around the world (RTWB Prezi).  He accepted my invitation to talk and to answer few questions.


Google Maps:  http://goo.gl/LTHHO

Can you tell us a little bit about yourself?  How did you hear about the respiratory field and what made you decide to become an RT?

Growing up, I never thought I would do anything in the medical field. Born to a family of engineers, no one could stand the sight of blood – literally. My father and grandfather would faint at the sight of blood. But as a systems design engineering student, I had the privilege to do a co-op term at Princess Margaret Hospital (Ontario Cancer Institute) where I was exposed to animal models to verify imaging hardware. I always had an interest to work directly with people. So naturally after a failed academic term in engineering made the transition to respiratory therapy and kinesiology.

 

Outside of work, what do you enjoy to do?

I love my family. We can be found roaming around Port Moody in Beautiful British Columbia where we live, work and play. We do everything from stalking garbage trucks to exploring local trails or just hanging out. There is no shortage of world-class mountain biking trails to explore here too.

 

What were some aspects about yourself that you had to improve to  become a better RT/leader/ an RTWB-Contributor and Co-founder?

Interesting question, I’ve never really been a fan of the leadership title. I’ve been trained that “patient care in a privilege”. As such, we are to stand in the gap as patient advocates. The lives of my patients and people that we service through RTWB has taught me to be a more passionate/strategic advocate for patients – not just in resource limited settings, but also in our current healthcare system. I’m continuing to learn daily how to navigate various healthcare systems in order to improve the quality of care available.

 

Where do you see the future of the Respiratory Therapy field?

Great question! I believe that the future of healthcare will be led by those in the developing world. Developed world healthcare systems are often not as dynamic and flexible to the ever changing demands of our world. With technological advances, collecting data for best clinical practises is increasingly becoming easier and more accurate. Along with this will be challenge to stay current. Clinical teams need to be agile and quick to adopt practises/workflows at an ever increasing pace. The lack of structure and unfathomable demands of healthcare systems in the developing world make them highly adaptive ready to embrace emerging technologies to excel leaps and bounds. An example from the telecommunications sector: villagers who have never seen motorized transport or used a landline, are adept users of smartphones now readily available globally. Healthcare providers are now able to get latest research at their fingertips.

 

What is the story behind the birth of RTWB?

I wanted to volunteer on a medical mission of some sort. Medcines Sans Frontiers (Doctors without borders) at that time listed respiratory therapist as people not to contact for volunteer opportunities. This pained me along with Annette Lievaart (RRT in Edmonton), Clement Hui (SRT in Toronto) and Pauley Ting (Engineering classmate of mine). Together we met on Skype for the first time in 2010. We still have yet to all meet in person; but we have done board meetings in 3 different continents in 4 different time zones. With our mission of ‘improving respiratory health through educational advancement of local healthcare providers worldwide’ solidified, we’ve kept an open invitation to anyone and everyone interested in joining our cause to be empowered. Our team includes everyone from student and seasoned respiratory therapists to accountants/engineers/business professionals to vacationers who want to transport goods for us. We are a completely volunteer run organization with a clear vision and open door to anyone/everyone interested in improving respiratory care worldwide.

 

What is a typical day for you (as a leader at RTWB)?

As a completely volunteer run organization, everyone puts in whatever they can with spare moments. It is a charity for all respiratory therapists. We believe that every respiratory therapist has something to offer and my job is to facilitate opportunities for respiratory therapists to give back using our expert skills, knowledge and judgement. Getting back to your question, we have an excellent team of talented volunteer professionals making work light and fun.

 

Do does your organization find remote hospitals to help, or hospitals/clinics approach you/your organization?

Both, we’ve approached places and others have come to us. All healthcare education partners (HEPs) must be reputable healthcare establishments with a documented respiratory education gap. Some of our volunteers have signed on HEPs while on vacation and others have found us on the internet.

 

What are some of the current projects that RTWB is working on?

A list of deployment opportunities is available at www.rtwb.ca -> Get Involved -> Get Deployed or Volunteer Postings. If there isn’t anything that suits your strengths/passions within the organization, please feel free to write your own job description for something you are passionate about that “improves respiratory health through educational advancement of local healthcare providers worldwide.” It is my firm belief that each respiratory therapist has a unique way to contribute and I invite you to dream with us about how you can use your skills/passions to get involved in OUR charity.

 

What are your main obstacles (i.e. financial? RT volunteers? Supplies? International relations? Etc.)?

At this point, our biggest need to RT volunteers to be deployed. We have no shortage of sites eager to have an RT on the ground.

 

Where do you see the future of RTWB?

Wayne Gretzky once said, ‘you miss 100% of the shots you don’t take.’ Our vision is to see the respiratory profession synonymous with ‘giving back’. Within the Canadian healthcare system, RTs follow orders, I believe that RTs need to recognize the value of our collaborative voice at the interprofessional table and start taking more shots – especially in the charitable world. Our future is bright, but we are in desperate need of a generation of sharp shooters that will bring us to the next level of our game. RTs are the underdogs of the healthcare system and we don’t give up easily, we hope to be ever accelerating our global contributions to respiratory health whether it be in research or education.

 

E.g. of cool projects

  • Bubble biphasic – concept pitched by RTWB to team of engineers who have developed a product that attaches onto existing bubble CPAP systems to provide the next level of respiratory support with nothing more than an adaptor on already familiar equipment. Currently undergoing clinical safety trials
  • One of our volunteers has 2 young children and can’t travel, so she does skype in-services to a room full of ER docs periodically to help start using a retired home BIPAP in the ER… Results? COPD ICU admissions are reduced by 86%!!! https://drive.google.com/file/d/0B1xpscMQ_Xb1b1d5bW1NR1gyMFk/view

 

What are the ways RTs can get involved with RTWB? 

www.rtwb.ca -> Get Involved

 

What is the process for an RT who is interested to travel abroad to volunteer at a remote hospital?

www.rtwb.ca -> Get Involved -> Get Deployed

 

Can you give us an example of how it feels to volunteer at hospital abroad? What are some of the sources of satisfaction/challenges?

www.rtwb.ca -> Get Involved -> Share your story

https://drive.google.com/drive/folders/0B1xpscMQ_Xb1MmpOUWZFcmNYbmc

 

What are the ways companies/organizations can be involved with or give to RTWB?

www.rtwb.ca -> “DONATE”

Time, money, resources or whatever other creative idea you have. Pitch your ideas to ideas@rtwb.ca. We are eager to hear from you!

 

Any final words?

With the ease of global travel and communication, the RT practise is a global one. We need to have a global consideration in our practise. This includes learning from what our healthcare colleagues are doing in developing world contexts where clinical skills and education are pushed to their limits and beyond. I encourage everyone to explore how you can be involved. Thanks Farzad for these thought provoking questions. Thank you (the reader) for tuning in so far, if you have, I encourage you to get involved with RTWB where we hope to empower you to take your best shot at improving respiratory health.

Thank you Eric for taking the time to answer my questions, and to share your perspective and experience with us!

To learn more about Eric and RTWB, you visit his LinkedIn profile and RTWB’s website at:

https://www.linkedin.com/in/ericocheng/

www.rtwb.ca

Farzad ‘Raffi’ Refahi

Reference:

-RTWB Overview: https://drive.google.com/file/d/0B1xpscMQ_Xb1ZHBDRmNaeEhHMFk/view

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Competence

At times we are wrong about our perceived level of competence. To better deal with it, this TED video suggests: 1. To ask for feedback and 2. To keep learning. Watch the video for more details.
-Who are the people you can ask for constructive criticism and feedback? Preceptor ? Manager?Experienced RT/colleague?Patient?
-Which areas you can further study?certificates? Articles? Workshops? Teaching?shadowing?


https://m.facebook.com/story.php?story_fbid=1958934734394472&id=1556650734622876

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Give Back

Volunteering for COPD Day

Last Wednesday was the World COPD Day. I contacted Sheery Tse RRT from Markham-Stouffville Hospital (MSH) to inquire about her plans for the lung health awareness display. I met Sheery at the Respiratory Centre and took few items to Cornell Community Centre and Library.  While setting up, we were joined by MSH staff, vendors, educators and volunteers (including current and previous patients of the hospital).  During my four hours there I met many individuals ranging from those who read and saw the e-mails and brochures, hospital staff who were visiting the community centre during their lunch, and members of community who were at Cornell Community Centre for other activities.

It was amazing to watch Sheery and the other volunteers interact with people, listen to their questions and concerns, and share their thoughts and the printed documents.  Four of the volunteers were COPD patients who have benefited from Sheery’s hard work at the COPD Clinic.  The volunteers were inviting, caring and open.  They would start conversations with people, tell them their story and of their struggles which allowed people to open up.  People saw hope.  They realized that they are not alone.  Some people for the first time recognized that it is not too late to quit smoking.  They were motivated to read up about COPD, and to seek consultation from doctors, interprofessional health teams, and to utilize the support systems available to them.

My role was to share my experience and knowledge as a respiratory therapist while ventilating healthy and “smoker” lungs for observers.

I suggest that you find volunteering opportunities in areas that interest you. Don’t necessarily think of it as what you are offering for “free” (i.e. your time and experience), but rather, think of the invaluable experience you are gaining. You could receive a sense of satisfaction that you have made a difference for that organization, make a connection with other driven people, make a difference to the people you meet, and get exposure to people, stories, projects, and perspectives that you may have missed if you maintained your daily routine.

This volunteering opportunity encouraged me to more openly connect with people who stepped forward to have a conversation, those who opened up, those who allowed themselves to express their feelings of joy, concerns, fear and confusion.  It helped me realized that despite my busy schedule, I still have free time to contribute.  While experiencing a slightly busier week, I felt more energized and driven.

What are some areas that you would like to volunteer in?  How often you would be able to make that commitment? How much time you can free up by reprioritizing the activities in your day or week? What are some of your strengths, skills, knowledge and resources that you can offer? What are areas that you can benefit from by volunteering?  Who are the people you need to get in touch with to make it happen? Ask yourself these questions if you are curious about finding a volunteer opportunity to suit your skills and interests. Then reach out to the organizations that you have interest in to start a conversation about where your skills and interests match their needs as an organization.

Good luck!

 

Farzad ‘Raffi’ Refahi
Edited by Jessica Morgan
Photos from Respiratory Therapy by Farzad Facebook Page

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United

The college strike, which also effected some RT programs in Ontario, has come to an end (CBC News. Nov 21 2017). Students, faculty and Practice Leads are now working together to make the best of the time left. It is natural, especially for students, to feel a certain level of anxiety about this. I would like to encourage the RT community to stick together and work even harder to make the transition from SRT to GRT a smoother journey for current students. I also encourage students to remain positive and work close with your preceptors to make the remainder of your year as productive as possible despite the added hurdle.
Stay positive, 
stay united and 
Good luck!

Farzad ‘Raffi’ Refahi

Resources:

-Image source: https://static1.squarespace.com/static/52e95746e4b0809fd8c13593/551aabefe4b0db1c17b4e6be/56e58973746fb91c91d4bfa9/1457947846159/working+together.png?format=1000w
-CBC News .Nov 21 2017. http://www.cbc.ca/news/canada/toronto/ontario-college-students-return-to-classrooms-after-5-week-strike-1.4411720
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COPD Day 2017

November 15th is the World Chronic Obstructive Lung Disease (COPD) Day.  Based on a study by World Health Organization (WHO) in 2015, COPD is responsible for “5% of all death globally that year” (WHO. Nov 2016).   When it comes to care for COPD patients, many names come to mind; One of these dedicated individuals is Mrs. Sheery Tse.

Sheery is an active RRT who works and volunteers with COPD patients at Markham-Stouffville Hospital and Scarborough and Rough Hospital (Birchmount site).

The first time I met Sheery was in May of 2017 at a social event for COPD patients, where she was facilitating it on her own time.  She is passionate about her work and is full of energy.  She is praised and respected by her patients and colleagues as she truly cares and advocates for her patients.  To get to know her better, I sent Sheery few questions:

  • When did you first hear about the respiratory therapy field? What made you decide to become an RT?  I heard about being an RT when I did some volunteering at HSC. There I ran into a high school mate who was working as a RT. After spending some time with her and the team, I decided to apply to Michener for the respiratory technology course as it was called many, many years ago.

 

  • What are some of your memorable jobs/roles so far?  In an acute setting I was always more interested in helping patients in the ER, providing care so they may breathe easier and giving a quick education of their puffer needs was very rewarding.
    Now I love doing education whether it’s in the COPD clinic or at a healthcare office, seeing the patients understand their airway disease and why certain puffers work and how is rewarding.

 

  • What are your career goals? (and do you feel that you have accomplished them?)  Given my age and how many years I’ve been in their field, I feel I have accomplished most of what I set out to do. Starting the COPD clinics in Markham and Scarborough from scratch has been very rewarding.
    There are still a few goals I would like to see happen, a support group with just patients input and more exercise sessions available would be the biggies. Patients self-management at home is another area I would to see happen too.

 

  • How did you get involved with patient education (with COPD patients)?When Dr. M. Forse first came up with the idea of having a clinic for COPD patients, it sounded like something I would enjoy. I applied and was chosen as the educator. Now came the challenge, getting certified as an educator and quite trained.

 

  • How does a typical day look like for you?
    Don’t think there is ever a truly typical day. It could be as simple as setting up for the clinic with patients charts and assessing the patients to triaging all new referrals, returning phone calls and emails from patients to meeting with pharma reps to hear what’s new, studies and of course being the nosy educator what’s on the pipeline for puffers. In between that I also need to triage patients into the exercise programs we have and call to see if they are willing to come in and for afternoons or evenings. Tuesday’sWednesday’s and Thursdays, I try to go to the exercise classes to provide some support and answer any question the participants may have. I’ve been called the “spy” as I do inform the respirologists if there are concerns about the participants, including possible flare up and low sats. Through these interactions we have been able to prevent patients from being seen in ER when the respirologists could fax a script for them, or as simple as asking if they started their on-hold meds. Low sats often, if they are with ProResp, I could get a RT to come assess on the track, other vendors, I ask the patients to contact their 02 providers and ask to be reassessed and the respirologist is informed.

 

  • What are some of the challenges and joys of working with COPD patients?
    Joys is seeing the patients in a follow up visit tell us how well they are doing, having the patients return from a trip they did not think they would be able to go on because of their airway disease, seeing how well they’re exercising. Challenges is trying to convince the patients they need to use their maintenance puffers regularly, and the same with those on 02. Most often, they are so used to being deconditioned and breathless, they’ve adapted to do without. Smokers are the biggest challenge, getting them to even think about quitting is often a huge step. Cutting back with each follow up is rewarding to hear, telling us they’ve actually quit is even more so.

 

  • Based on your experience, what are some of the common struggles for COPD patients, and how can RTs better assist these individuals?
    The most common struggle, is self-management and deconditioning. They’re breathless so often they feel they can’t do much. Try is one of my favourite word to use at the clinic and at exercise classes. Knowing if and when they need to be seen is a biggie too. They really are independent and don’t want to bother their healthcare team and often end up getting worse and needing to be admitted.   Providing tools for them to figure out if it’s a simple cold, a flare up or more is something all healthcare providers need to give so they may manage their disease better and hopefully not get to the point they become very ill.

 

  • What are your thoughts on the latest 2017 COPD Guidelines and New Medications in the market? *
    New guidelines are constantly changing, latest is to decrease use of ISC with COPD patients unless they have at least one exacerbation a year to decrease the chance of getting pneumonia. When we first started the COPD clinic we had short acting puffers (Ventolin, Atrovent) ICS(Flovent) combo (Advair, Symbicort) and a LAAC(Spiriva) that just came on the market. Now we have choices, we can provide patients with the puffers they need in a device that is easier for them to use so compliance increases. There may be more I the future, good for the patients, more challenging for healthcare providers as we will need to know them, how they work and how to use them to provide better support for patients.

 

  • Any advice or final thoughts to share with RTs?
    Final words, healthcare is an amazing profession, there are many different streams available, even for RTs from in hospital, to clinics, to home care. Patients safety and wellbeing should be the most important thought in our work. Giving patients respect, support and information should be on going.
    The best review in the COPD clinic is when the patient comes in, and asks for a hug, calls you by your name and remembers what you said and did for them. At the end of the day, my hours spent volunteering means they get the support they need. From a simple support I have been given so much more I return from them. It is very rewarding, even in sadness when they pass. We have family call to let us know how much they appreciate all the support we gave to their loved ones.

 

Thank you Sheery for your dedication and hard work!

*To the readers of this post, please continue to refer to the guidelines and medication pathways provided by the facilities/organization you work at.  The answers provided my Mrs. Tse is to provide perspective and is not to replace the protocols provided by your employer or RT governing body.

Here are some useful resources I came across:

-Canadian Thoracic Society.  https://cts.lung.ca/guidelines

Alpha-1 antitrypsin deficiency targeted testing and augmentation therapy (2012)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20FINAL%20A1AT%20GUIDELINE%20APRIL%202012.pdf

-Managing dyspnea in patients with advanced chronic obstructive pulmonary disease  (2011)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf

-Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease (2010)
https://cts.lung.ca/sites/default/files/documents/cts/CTS_COPD_Guidelines_Pulmonary_Rehab.pdf

 

-The Lung Association. Various PDF documents to study, to print and to share.  https://www.lung.ca/lung-health/lung-disease/chronic-obstructive-pulmonary-disease-copd/resources

 

-RTSO- COPD. https://lungontario.ca/disease/copd/

-Global Initiative for Chronic Obstructive Lung Disease . https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf http://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf

 

Farzad ‘Raffi’ Refahi
Nov 15 2017

References:

-WHO. World Health Organization. COPD. Fact Sheet. November 2016.

http://www.who.int/mediacentre/factsheets/fs315/en/

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