By Dr. Morgan Broccoli, MD, EM PGY2
To say that I learn something new every time I travel is an understatement. Wherever I go, I take away salient experiences and interactions that change my perspective in the future. In September, I traveled to Zambia to teach the World Health Organization’s Basic Emergency Care (BEC) Course to nurses and physicians at two hospitals. The WHO’s BEC Course is a clinical course aimed at frontline providers (doctors, nurses, clinical officers) who by necessity provide emergency care at their facilities, but have received little or no formal training in the field. I have a particular attachment to the BEC Course because I helped with its development while working at the WHO.
Zambia, like many low- and middle-income countries, has a high burden of acute illness and injury but is lacking an emergency care system capable of meeting this need. The Zambian Ministry of Health (MoH) have prioritized developing and strengthening their emergency care system, and we collaborated with them on this project. The MoH chose Kafue General Hospital and Choma General Hospital as the training sites based on their high burden of acute illness and injury.
Kafue General Hospital is the only hospital in the town of Kafue, a town of over 200,000 residents and over 130,000 surrounding rural residents that is located about 50 km from the capital of Lusaka. The town is uniquely situated on both the Great North Road, a busy highway that runs to Lusaka, and the southern highway that runs to Livingstone. There are many road traffic accidents that occur on this road, and the providers at the hospital are charged with caring for the injured.
When we were preparing for this course, the MoH connected us with clinical heads at each of the hospitals who were tasked with finding participants for the course. In email communication, our MoH contact stated that they “usually invite a heterogeneous group of health workers that attend to emergencies in some way [including] nurses, clinical officers, doctors, radiographers, lab technologists, porters etc.” When I read this email, I felt slightly annoyed and figured that he had misread our course description. The BEC course was designed for those with medical training, specifically junior doctors, clinical officers, and nurses. We had not planned on teaching those without a medical background, and I was afraid that having such a heterogeneous course would detract from the learning of the target audience. I wanted to reply and specify that the course was for healthcare providers only, but I decided to wait and see who would come to the course.
On day 1 of the course in Kafue we arrived to a classroom of 35 participants. Most participants were nurses, plus a few clinical officers and doctors. There were also a medical equipment technician and a registry clerk present as well. During introductions, they voiced their concerns that they did not have a medical background, but stated that they were very eager to learn about medical emergencies in case they were asked to help. The medical equipment technician and the registry clerk were very eager, active participants of the course, and they engaged in all practical activities. On the last day of the course, after the final exam, the medical equipment technician approached us and thanked us. She told us that she had learned a lot from the course, and felt that all employees of the hospital should be trained in BEC. She did fail the final exam, but not by much. Most impressively, she improved her exam scores from 36% prior to the course, to 64% after.
So what did I learn from my time in Kafue? I learned that all employees of healthcare facilities may want to learn about basic emergency care, and that they may be called upon to actually use this information. On our hospital tour, we learned that junior doctors were supposed to be staffing and overseeing the outpatient department (where emergencies present), but they had all been pulled to work in the wards as there were not enough doctors. The outpatient department was currently being covered by a few clinical officers and nurses. In understaffed hospitals, task shifting takes place by necessity all the time, and you never know who may be asked to provide medical care. I also learned that I shouldn’t form judgements, as the medical equipment technician and the registry clerk did learn a lot from the course. In fact, two of the best students were a dentist and a medical scientist.
This experience was a good segue into the next part of my teaching experience in Zambia. After teaching the BEC course at two hospitals, we spent a week teaching basic first aid to community members in Choma. The goal of this course is to provide education and empowerment to community members, so they can recognize acutely ill and injured patients, provide basic stabilization, and transport them safely to a medical facility. We trained 20 community members in Choma, who will then act as a link between the community and the hospital. While it is important to tailor an educational curriculum to the experience level and needs of participants, I also believe that all people should be trained in basic emergency care – from community members, to medical equipment technicians, to doctors. This way, we are all prepared to help when we encounter a medical emergency.