Growing Emergency Medicine in Tanzania

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Investigator: Ellen J. Weber, MD

Location(s): Tanzania; Congo (Kinshasa); Congo (Brazzaville)

Description

Background

Despite their very high burden of acute illness and trauma, limited income countries are in the initial stages of establishing the specialty of Emergency Medicine.. In 2011, Muhimbili National Hospital (MNH) in Dar es Salaam started the first, and to this date, only residency training program in emergency medicine in the country. Under a grant from Abbott Labs, Emergency Medicine specialists from a consortium of US medical schools, led by UCSF, rotated through the emergency department (ED) at MNH, providing on the ground training, In 2015, the residency training program was successfully transitioned to the initial graduates of the program and the grant supporting the work of international faculty ended.

However, there remains a need for faculty from countries where EM is more established. The acceptance of emergency medicine as a specialty in Tanzania will depend on two things: 1) the successful growth of emergency medicine practice (and research) beyond Dar es Salaam and, 2) development of research capacity among those practicing emergency medicine in Tanzania. The latter aim is important not only in establishing emergency medicine as an academic discipline, but will fill critical gaps in knowledge; current understanding of disease processes and treatments are based on evidence high income countries, which may not apply to populations that haven’t been as well as studied. As an example, the dissertation from a graduate of the Muhimbili training program, demonstrated that the Broselow tape, used in all US emergency departments for dosing medications in pediatric cardiac arrest, misjudged the weights of children at MNH, potentially resulting in the wrong dosages of medicines being administered.

Since my initial rotation providing clinical teaching and supervision at MNH in 2013, I have returned on a volunteer basis twice a year to mentor the residents in research, which is a requirement for their graduation.  I spent about a month to five weeks and provide research lectures (based on UCSF’s TICR curriculum and the Designing Clinical Research book by Hulley et al and the curriculum that UCSF developed with the BMJ). I meet several times with each resident to discuss research ideas, and then work step by step to develop aims, problem statement, and methods. Between trips, the residents send me their work via email which I review. The list of work undertaken to ensure their sucess is very long.

Aim of this Project

Graduates of Muhimbili’s residency have now returned to their homes in other parts of the country, (as well as Congo) and have been tasked with developing emergency medicine departments in their hospitals. I will be visiting for several weeks at each site, providing clinical teaching and supervision, and research mentoring.