Written by: Omeed Saghafi, MD, GECC Volunteer, Chief medical editor, how2med.com “She is going to…
Written by: Kevin Fisher, GECC Research Assistant
Global Emergency Care Collaborative is an organization that thrives on teaching, learning, and most of all, working together to mobilize limited resources into the best medical care possible. The Emergency Care Practitioners (ECPs) are highly trained and operate on a familiar level with the community and the medical problems associated with rural Africa. The mix of Ugandan and American doctors provide essential mentorship for these people, but for the most part the ECPs can effectively manage, diagnose, and treat the majority of patients that come through the Emergency Department. The people working at Nyakibale Hospital provide a level of care that is unavailable in most low resource settings and is driven by individuals that truly care about the livelihood of their community.
The high level of care that patients receive in the Emergency Department (ED) at Nyakibale Hospital is enough to reverse some of even the most severe cases. Although the resources do not exist to properly intubate and the closest brain and heart surgeons are more than two hours away, most patients that enter the ED either survive or are stabilized to the point where they can be transferred to Mbarara. Given the high number of traumatic road traffic accidents that occur (combined with the severe lack of adequate head protection) and the high rate of malarial infections, it is surprising how many patients recover because of the practiced care of the ECP’s. Importantly, most of the ECP’s are from the surrounding district or at least the same region. This lends itself to a medical culture that is an integral part of the community structure. They are involved in local weddings, know and interact with religious and political leaders, and are invested in the livelihood of their community. In turn, because of the level of care provided in the ED and Nyakibale Hospital as a whole, they are respected and thanked by the community. There is a sense of balance and trust between the community and hospital that builds an atmosphere that expects that the medical practitioners will do everything in their power to care for the sick and injured.
The ECPs and Emergency Department staff take supreme pride in their work. Deus, one of the junior ECPs, was excited earlier this week to put a backslab splint on a child with a broken tibia and fibula. He was driven to make sure that this cast would be his best one yet, and made sure to get x-rays and do a complete exam before reducing the fracture, holding traction, and applying the splint. The patient clearly appreciated the effort that Deus put in to alleviating pain in the leg and taking the time to get it right. This is true for the work that all of the ECPs put in to their patients, and people often go out of their way to say thank you.
It is clear that the success of the Emergency Department at Nyakibale Hospital is due to the health care practitioners who make the most out of what they have in order to make sure the community around them is healthy and safe. ECPs, nurses, and doctors alike are able to provide an extremely high level of care in a resource scarce environment, and patients are truly thankful for the care they receive. Hopefully, the success of this program can become an example to other facilities throughout the country and communities will recognize the powerful positive effect of thoughtful patient care.