Immaculate Nagaddya is a registered nurse, working in Lugada Hospital in Uganda. It is a small hospital with about 10 000 visits per year, where she receives critically ill patients, presenting with conditions like status asthmatics, status epilepticus and severe dehydration from watery diarrhoea. Together with seven other nurses and between one and three doctors she keeps this emergency department open day and night, all year round.
Equipment is scarce in Immaculate’s emergency department: 2 blood pressure cuffs, 2 monitors, 2 pulse oximeters and 1 digital thermometer. But there is oxygen for all eleven beds and the hospital offers x-ray and ultrasound scans. Even though it is a 270 bed hospital, the emergency room has only been in place since August 2013. Immaculate and her colleagues are working hard to improve the quality of emergency care they can provide. That is why Immaculate was chosen by her hospital to go to the AFCEM conference in Addis Ababa in November. But Immaculate is not going.
AFCEM is the biannual meeting of the African Federation of Emergency Medicine (http://www.afcem2014.com). It covers the same kind of topics any emergency conference would: Closed head injury, stroke, the acute abdomen, airway management etc. Yet the information and recommendations conveyed will be very different from what one can hear on podcasts or learn from blogs. Good quality emergency medicine in low and middle income countries is just as evidence based as anywhere else. It just needs to be based on evidence that is applicable to a low resource setting. And this is what the AFCEM meeting is about.
The organizers of AFCEM were hoping that registration fees from American and European delegates would finance a sponsorship program covering half the cost for registration and accommodation for 30 doctors and nurses from African hospitals. But the Ebola outbreak is keeping the foreign doctors away and 23 of the planned sponsorships have been cancelled. Immaculate is number 16 on that list. There is no way she is going to go.
Dr Jeremiah Njenga wants to bring the specialty of emergency medicine to Kenya together with his mentor Dr. Wachira Benjamin. Jeremiah is the first name on the list of people waiting for sponsorship. I felt certain that it wouldn’t be difficult to raise money for him to go, so I launched a Twitter and Facebook campaign. Many people supported this campaign and started spreading the word. Therefor I was surprised to see that the only ones who had actually donated money, were two of my personal friends.
I’m saddened by the irony of Ebola impeding the development of a sustainable healthcare structure, the very lack of which is the reason Ebola has been able to spread so rapidly. From my own, very limited and immensely frustrating, experience of working in a resource limited setting, I know that it requires highly dedicated people. These people need to be encouraged. They need to be selected by their hospitals to go to meetings where they can learn more, interact with others and get inspired to keep improving emergency care for their patients.
I don’t believe that most of you who read this blog post wouldn’t be willing to donate 25 or 50 dollars just so send a clear signal to Immaculate and Jeremiah that their hard work and engagement is important to all of us. I do, however, believe that some are put off by the rather complicated process of donating through the Givengain website. I wish it would be less tedious to contribute, but this is the only option AFEM has, since they are based in Africa.
There is no quick fix for emergency care in Africa. It is not the lack of equipment, and definitely not of knowledge, that are the biggest obstacles to improving care. In the long run, only dedicated people like Immaculate and Jeremiah can make this happen. As an advocate for emergency care in my own country I know the commitment and perseverance it takes and how important it is to meet others, fighting the same battle, to keep you motivated. I will personally make sure that Jeremiah goes to the AFCEM meeting in November. But Immaculate is not going.
from the edge
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.