Background: The World Health Organization have assessed all forms of asbestos as being carcinogenic to humans. Nevertheless, the market for chrysotile asbestos remains strong in some countries in the WHO South-East Asian or Western Pacific Regions. Many of these countries have limited knowledge about, and capacity to diagnose, asbestos-related diseases (ARDs).  The objective of this project was to increase awareness about the risk of exposure to asbestos and improve the diagnosis of ARDs, in order to contribute to the elimination of ARDs in low and middle-income countries (LMICs), particularly in South-East Asia.
Methods: the clinical training programs were developed in full consultation with the local partner organisations, the Australian Government, Asbestos and Silica Safety and Eradication Agency and Union Aid Abroad – APHEDA. Questionnaires were distributed to partner organisations prior to the development of the training program to gauge their needs and expectations, and the outcomes they anticipated from it. Questionnaires were also distributed after the delivery of the training programs to measure success in meeting these goals. Face to face clinical training was delivered in Jakarta, Indonesia in June 2023, and in Vientiane, Lao PDR and Hanoi, Vietnam in May 2024. The programs each ran over three days, covering introductory sessions on the risks of asbestos exposure, clinical instruction on what ARDs are and how they are diagnosed, and next steps in the learning process.
Results: The clinical training was delivered to between 50 to 60 participants in each of Vientiane and Hanoi and between 50 and 200 participants in Jakarta, depending on the session.  Participants were medical specialists (radiologists, pathologists), primary care professionals (general doctors, nurses) and public/environmental health officials. Despite an expectation that participants would have reasonable knowledge about asbestos and its health effects, it became clear as the training proceeded that this was not the case. This resulted in the program content being changed to focus on more basic aspects. The content also needed to be modified to take into account the local circumstances and available equipment used for clinical diagnostic tests, pathology investigations and clinical care. Qualitative evaluation from participants found the training content was very relevant to them, with site visits to clinical facilities valued as an important element of the training process.
Conclusion/Implications: The only way to prevent ARDs is to stop use of chrysotile asbestos and impose national bans across the region. Until that happens, clinical training can assist in both raising awareness about the dangers of asbestos exposure and improving the skills and expertise of medical personnel in diagnosis of ARDs. Training programs need to be tailored specifically to the circumstances of each country to ensure effectiveness, requiring extensive consultation with local partners and key collaborators throughout the entire process, including after training activities. When developing training programs in LMICs, our experience is that there needs to be an assumption that participants’ knowledge and experience of ARDs is very low and that any training program should cover basic aspects.