By Dr. Lisa Puchalski Ritchie
As an emergency physician in Toronto, Canada's largest city, I am privileged to have access to the latest research evidence, medical tools and technology. I also have access to a network of professional colleagues who I can call on for advice and assistance.
However, caring for patients in the context of a fast-paced urban emergency department, I still face the challenge of keeping up with and using evidence in making clinical decisions.
Imagine how challenging it must be in low-income countries where healthcare resources are scarce and trained health professionals are in short supply.
As one of the founding members of Global Health Emergency Medicine (GHEM), a group of emergency physicians at the University of Toronto dedicated to improving access to emergency health care in low-resource health settings, and a knowledge translation scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, I have had the opportunity to work in Ethiopia and other countries in Africa.
Like other low-income countries, Ethiopia struggles with a lack of healthcare infrastructure and healthcare professionals. There are some 3,000 physicians in Ethiopia, serving a population of 100 million.
In the area of emergency care, however, the Ethiopian ministry of health is taking action. In fact, Ethiopia has become a leader in emergency medicine in Africa.
My colleagues and I in GHEM are contributing to this effort through the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). TAAAC-EM is a program that involves the University of Toronto and the Addis Ababa University, whose goal is to foster the development of the country's first Emergency Medicine Residency Program and support the growth of the specialty.
Launched in 2010, the collaboration aims to assist in the development of emergency medicine leaders at Addis Ababa University who will train future generations of Ethiopians, spread emergency medicine expertise throughout Ethiopia and share lessons learned to other low- and middle-income countries.
Through the TAAAC-EM project, we help with training, curriculum development and mentorship. We also carry out research to identify priority conditions for interventions to help improve care and patient outcomes.
We recently published a baseline study on emergency care in Ethiopia. The study produced essential data on the causes of early death among patients in emergency care. It was carried out at the Tikur Anbessa Specialized Hospital, the largest publicly funded teaching hospital in Ethiopia, which receives 18,000 patient visits per year, with the majority of patients critically ill or traumatized and requiring urgent intervention.
We found that the major causes of early death (within 6 to 72 hours) were traumatic injuries and sepsis, an illness caused by the body's overwhelming response to infection.
Through this study, we were able to identify some ways to improve emergency care. These included reorganizing emergency care so that patients are transferred to the care of an inpatient physician while they may be still in the emergency department waiting for a bed in the hospital.
We found that most patients travelled to the emergency care in taxis, suggesting a need for better pre-hospital care and ambulance service.
We also identified the need for the development and implementation of standardized trauma and stroke care protocols. The study also highlighted an urgent need for public health interventions to reduce the incidence of severe traumatic injuries in Ethiopia, namely traffic injuries.
With this data in hand, we are now in a position to look at how we can implement interventions to reduce early mortality in partnership with our academic partners and hospital administrators and the ministry of health.
One such intervention is the use of evidence-based clinical algorithms in emergency care, a common practice in Toronto emergency departments. Algorithms provide a step by step approach to patient evaluation and management.
In talking to clinicians and managers in the emergency department at Tikur Anbessa Specialized Hospital, my colleagues and I identified a need for context appropriate evidence-based clinical algorithms to standardize care for common illness such as trauma, sepsis, heart failure and diabetic emergencies and to improve patient outcomes.
We also conducted interviews to identify barriers and facilitators to the use of these tools. The biggest barrier, of course, will be to tailor these tools to match the healthcare setting and available resources. By introducing these tools in our training programs, we can facilitate their uptake and use by emergency physicians and other health professionals.
This work shows how, as clinicians and researchers in Canada, we can make a difference in improving health care in low-income countries. I am privileged to have the opportunity to work with a group of professionals and medical trainees here in Canada and in Africa who are so dedicated to providing the best possible care for patients.
Dr. Lisa Puchalski Ritchie is an emergency physician with the University Health Network and a founding member of the Global Health Emergency Medicine network. Dr. Puchalski Ritchie is also a lecturer in the Faculty of Medicine at the University of Toronto and a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital.
This blog is part of the series: "Resilient and Responsive Health Systems for a Changing World" by the Canadian Society for International Health and Health Systems Global, to share the central issues explored at the 4th Global Symposium on Health Systems Research in Vancouver, 14-18 November 2016.
The views expressed are those of the authors and do not necessarily reflect the views of CCIC or its members.
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