sidHARTe's Senior Emergency Medicine Specialists in Training Strengthen Care Capacity in Rwanda's Hospitals
For the first time, senior Rwandan trainees in specialist emergency care meeting international standards will be a part of Rwanda’s public health system, thanks to the ongoing Human Resources for Health (HRH) program training supported by sidHARTe of Columbia University’s Mailman School of Public Health and Brown University.
Master of Medicine (MMed) trainees in Emergency Medicine started their final year of training this week at Centre Hospitalier Universitaire de Kigali (CHUK) in Kigali, Rwanda. They are working as instructors of more junior trainees, skilled clinicians advocating for the highest quality emergency health care for their patients, and dauntless advocates for the development of the specialty of Emergency Medicine in Rwanda.
The Columbia University sidHARTe Program has been an implementing partner and has contributed 17 full-time equivalents of Emergency Physician faculty time in the exciting next phase of this program, which is one of the cornerstone projects of the seven-year Human Resources for Health program being rolled out country-wide. This program represents a broader partnership between the government of Rwanda, the Global Fund and a consortium of United States universities, forming a core part of the overall strategy of strengthening the health education infrastructure and workforce in Rwanda. The emergency medicine MMed is creating a cadre of Rwandan clinicians and educators who are also specialist physicians capable of providing international-caliber emergency and acute care.
While Emergency Medicine is not a specialty that has historically been offered as a part of medical training in most of Africa, it is a growing specialty in the region, with established training programs in Tanzania and new programs starting in Uganda, Mozambique and the Democratic Republic of the Congo. The robust growth of the specialty in Rwanda means that patients admitted to public hospitals for acute illness or injury will not languish, receiving limited or poor-quality care. Instead, in the Emergency Department at CHUK, they will receive state-of-the-art resuscitation and stabilization from senior Rwandan specialist trainees, supervised by faculty partners of the HRH program, thereby saving lives and healing sick patients. These senior MMed students are in their final year of a comprehensive training program that will also upgrade emergency care expertise for years to come, with additional specialist trainees in first three years of the program as well as training projects strengthening the skill levels of general practitioners at district hospitals and nurses in emergency care. These clinicians will elevate the level of life-saving acute care provided as they graduate and take on leadership roles, not just at CHUK, but across the entire public hospital network of Rwanda.
The training that these future specialists have received will address critical needs in the health care system in Rwanda and will allow them to graduate not just as skilled emergency physicians but also as gifted educators with the capacity to effectively engage with the health professions education needs of the nation and the ability to train nurses, medical students, general practitioners and future specialists in the skills required to provide skilled emergency care to any ill or injured patient. As they take the helm of leading the MMed training program over the next two years, they will position the public health system of Rwanda and the University of Rwanda to sustain these improvements in health workforce and continue to provide international-caliber training that is among the best in the region. This will ensure sustainable and comprehensive capacity-building ideally positioned to meet Rwanda’s need for emergency care.
Ghana Acute Care Systems Program Acute Care In-Service and Supportive Supervision Trainings
As part of the Ghana Acute Care Systems Program (GACSP), sidHARTe and Ghana Health Services have held three Acute Care In-Service (ACIS) trainings between March and July 2017. These trainings were held at Sandema Hospital, Bolga Regional Hospital, and in the Upper East Region. Sixty-six practitioners, including general nurses, physicians, nursing officers, and physician’s assistants, were trained. Participant feedback was overwhelmingly positive, and scores across the board improved between the pre-course and post-course assessments.
In addition, a facilitative supportive supervision training was held in UER, with the objective of improving collaboration between supervisors and supervisees, and with it, the quality of acute care. The training comprised one day of theory, and two days of practical facilitative supportive supervision exercises at selected health facilities. Participants were also able to dialog with trainers about concerns and suggestions arising from their own experience.
Ghana Acute Care Systems Program Technical Working Group on Emergency Medicine Data Systems
The Ghana Acute Care Systems Program (GACSP) partnership which included the GHS Upper East Regional Directorate, GHS Institutional Care Division and GHS Planning, Policy, Monitoring and Evaluation Division held a technical working group in June centered around strengthening emergency medicine data systems. The technical working group focused on the creation of the Ghana Health Service (GHS) registries for triage, referral, and emergency units to feed into the HIMS system in Ghana to better assess patient outcomes. Participants included directors from Ghana Health Service, data specialists from Navrongo Health Research Center, and local surgeons, general practitioners, physician assistants, and chief nursing officers.
sidHARTe Ghana CPAP Child Survival Study Published in The Lancet and Named Editor's Choice
In June, The Lancet published sidHARTe’s study “Continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label, cluster, crossover trial”, which was also named Editor’s Choice for this issue.
This study evaluated the effectiveness of continuous positive airway pressure (CPAP), a form of non-invasive ventilation, in decreasing all-cause mortality in children presenting with undifferentiated respiratory distress at two district-level hospitals in Ghana.
After adjusting for clinically important variables, the study found a significant decrease in two-week mortality for children 1 year old and younger in the CPAP group versus the control group.
This outcome contributes to the body of evidence on the use of CPAP in lower-middle-income countries— CPAP technology is less expensive, has lower complication rates, and requires less technical skill than invasive mechanical ventilation, making it an attractive option in limited-resource settings. sidHARTe’s findings demonstrate CPAP is both effective and safe to use in district-level hospitals by nurses whose work is largely carried out without direct physician supervision.
sidHARTe Founder Receives Lifetime Achievement Award
Ghana Acute Care Systems Program Acute Care In-Service Trainings
The Ghana Acute Care Systems Program (GACSP) is a sidHARTe and Ghana Health Services (GHS) partnership to increase access and delivery of high-quality acute care for Upper East Region residents. As part of GACSP, GHS held nine sidHARTe Acute Care In-Service (ACIS) trainings and refresher trainings between November 2016 and March 2017. In this time, the five-day ACIS training has been taught to general nurses, physicians, nursing officers, and physician’s assistants in the Upper East Region of Ghana. These practitioners are based in Community Health Planning and Services Centers, Health Centers, District Hospitals, and Regional Hospitals.
Happy Holidays from the sidHARTe Team!
sidHARTe at the American Public Health Association Conference
On November 1st, Dr. Cara Taubman, sidHARTe Emergency Medicine technical expert, presented at the American Public Health Association (APHA) annual conference. Dr. Taubman’s presentation, A State of Emergency: Assessing Acute Care Systems in Low and Middle Income Countries, focused on sidHARTe’s development of the emergency services resource assessment tool (ESRAT), and lessons learned from Ghana, Rwanda, and El Salvador.
sidHARTe Celebrates Another Success in Rwanda
Under the Rwanda Ministry of Health (MOH) sidHARTe developed and published the Rwanda Emergency Medicine Clinical Guidelines. Physical copies of the guidelines were printed for all hospitals and distribution is on-going.
sidHARTe Rwanda Phase I Closeout & Phase II Planning Meeting
After five successful years in Rwanda, the Ministry of Health requested that sidHARTe hold a meeting focused on closing out the first phase and planning for the next five years. The meeting with held on September 21st with stakeholders from the government, emergency physicians, nurses, and the academic community. In breakout sessions the teams outline proposals on: pre-hospital and referral care, infrastructure, education, and quality improvement and health information.
sidHARTe was a proud sponsor of the Rwanda Emergency Care Association’s (RECA) first annual conference, which was held from August 22nd to September 2nd. Participants from the U.S., Europe, and the east and southern African emergency medicine community were present. sidHARTe Founder, Dr. Rachel Moresky presented on the “addressing missing middle” of the the healthcare system pyramid and ways to address access to acute care in resource limted settings. The sidHARTe team was presented with the Rwanda Emergency Medicine Association Award, awarded to an individual or group whose activities promote and improve emergency care through teaching, research, and education.
Note from the Field: reflections on my MPH practicum in Ghana - by Kelly Sprague
For my summer practicum this year, I travelled to the Upper East Region of Ghana with sidHARTe where I spent two and a half months working closely with Ghana Health Service to conduct a Needs Assessment of health facilities’ capacity to provide emergency care services. This experience was unique and invaluable in that I was present for all stages of the Needs Assessment—from adaptation of the survey through training of data collectors, data collection and eventually data analysis. I felt extremely supported throughout my practicum by the sidHARTe team and was really able to “dive in” and utilize skills that I have learned as a part of my public health training. I built close relationships with the data collectors and was inspired everyday by their passion and motivation to improve their health system. Ultimately, my experience in Ghana this summer has affirmed my desire to continue health systems strengthening work and I am excited to continue working with sidHARTe this semester, learning from their exemplary leadership and team, in a concerted effort to reduce inequities and provide quality acute care services in sub-Saharan Africa.
April & May 2016
sidHARTe’s Director co-led a workgroup at the African Federation for Emergency Medicine 4th Consensus Conference
On April 22nd Dr. Rachel Moresky co-led a workgroup alongside Ivy Muya and Emilie Calvello at the African Federation for Emergency Medicine 4th Consensus conference held in Cape Town, South Africa. The topic of the session was “Clinical Quality Indicators of Facility-based Emergency Care”, with lively discussions on context-appropriate quality frameworks and clinical quality indicators for low and middle-income countries.
The conference was attended by over 150 delegates, and the three working groups examined issues surrounding out of hospital emergency care, clinical quality indicators, as well as the geographic function of specialist emergency physicians.
sidHARTe participated in the 16th International Conference on Emergency Medicine (ICEM) in Cape Town, South Africa
On April 18-21st, sidHARTe’s Director Dr. Rachel Moresky along with Dr. Cara Taubman, Dr. Elizabeth De Vos, as well as other International Emergency Medicine fellows headed to Cape Town for the annual International Conference on Emergency Medicine. In addition to meeting with key stakeholders and local partners, sidHARTe presented on the following topics:
"Health Systems Strengthening: A new paradigm for global health interventions"
by Dr. Rachel Moresky
"Characteristics of pediatric trauma patients receiving prehospital care in Kigali, Rwanda"
by Dr. Olivier Felix Umuhire
"EM: A new specialty in Rwanda"
by Dr. Gabin Mbanjumucyo
"Conflict(ed): Health care delivery for refugee and internally displaced populations"
by Dr. Rachel Moresky
"How to implement a national emergency medicine organization"
by Dr. Elizabeth De Vos
"Emergency Medicine in Africa –is the cart before the horse?"
by Dr. Olive Kobusinge
sidHARTe was also invited to join a side meeting jointly held by the World Health Organization and the International Federation for Emergency Medicine. The meeting included discussions on the current and future WHO emergency care initiatives.
The Rwanda Emergency Care Association (RECA) just announced its first ever RECA conference to be held in Kigali, Rwanda on August 26th, 2016. The conference will follow a two-week "Emergency Medicine in the Tropics "course taught at the University Central Hospital of Kigali's Emergency Department, and the theme of this year's conference is "Emergency Care in a Thousand Hills." Guest speakers include: Dr. Lee Wallis, President of the African Federation for Emergency Medicine and the International Federation for Emergency Medicine, Dr. Colin Graham, Editor-in-Chief of the European Journal of Emergency Medicine, as well as Dr. Rachel Moresky, sidHARTe's Founding Director. More information on the event can be found at RECA's website.