Cole Shaver and Graydon Ratushny are paramedics working in British Columbia who share their experiences working in Kibosho District Hospital in Moshi, Tanzania, as part of the Austere Critical Care Master's program. They discuss the challenges of practising medicine in a resource-limited setting and the importance of improvising and adapting clinical skills to the local context. They highlight basic clinical assessments, such as percussion and auscultation, and the value of non-technical skills in making diagnoses and providing care. They also discuss the social determinants of healthcare and the impact of a user-pay system on patient access to medical services. The conversation explores the themes of telehealth and remote health assessments, the importance of old-school clinical skills, the resilience of patients in resource-limited settings, the use of CPAP in rural healthcare, the value of the CoROM Field Guide, and the benefits of international healthcare experiences. takeaways Adapting clinical skills to a resource-limited setting is crucial for providing effective care. Basic clinical assessments, such as percussion and auscultation, can be valuable tools without advanced diagnostic equipment. Non-technical skills, such as observation and clinical gestalt, play a significant role in making diagnoses and guiding treatment decisions. The social determinants of healthcare, including a user-pay system, can profoundly impact patient access to medical services. Telehealth and remote health assessments are shaping the future of healthcare, allowing for transmitting imaging and audio findings to specialists in established facilities. Old-school clinical skills, such as physical assessments and clinical signs, are underappreciated in Western medicine but highly relevant in resource-limited settings. Patients in rural and remote areas are often more resilient than expected, and healthcare providers can take a step back and gather more information before intervening. CPAP devices can effectively manage respiratory distress in resource-limited settings, and collaborative teaching and learning between healthcare professionals from different backgrounds is invaluable. The CoROM Field Guide is a valuable resource for remote and rural clinicians. It provides essential information and prompts when data connectivity is limited. International healthcare experiences provide a broader perspective and appreciation for different healthcare systems and practices, fostering collaboration and knowledge sharing. Chapters 00:00 Introduction and Background 03:00 Adapting Clinical Skills in a Resource-Limited Setting 08:34 The Value of Basic Clinical Assessments 13:42 The Role of Non-Technical Skills in Diagnosis 20:04 The Impact of Social Determinants on Healthcare Access 29:48 The Future of Healthcare: Telehealth and Remote Assessments 32:23 The Value of Old School Clinical Skills in Resource-Limited Settings 35:35 Resilience of Patients in Rural and Remote Areas 39:23 CPAP: A Game-Changer in Resource-Limited Healthcare 52:51 The Quorum Field Guide: A Must-Have for Remote Clinicians 56:11 The Benefits of International Healthcare Experiences

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