Zachary Foughty, MD
Zachary Foughty, MD
Pediatrics · Houston, TX

Belize ETAT Training

March 21st
Belize City, Belize

Project Description

Baylor College of Medicine (BCM) and Texas Children's Hospital (TCH) have partnered with Karl Heusner Memorial Hospital Authority (KHMH) in Belize City, Belize since 2015 offering continuing medical education training to nursing and physician staffing focused on pediatric emergencies. The World Health Organization (WHO)'s Emergency Triage Assessment and Treatment (ETAT) course is a short course focused on pediatric triage and immediate stabilization. This was first implemented in Belize in 2016 with a sustainable train-the-trainer (ToT) program and, prior to Covid, nearly 400 healthcare staff had completed trainings. Given the covid pandemic, training had been halted for the past several years due to other clinical demands and the need for social distancing. Due to staff attrition, the number of staff trained in ETAT dropped significantly during Covid.

In May 2022, we restarted this program and trained a new cadre of 14 trainers. Since then, these trainers have held monthly trainings to train and refresh 82 staff members, including 65 medical officers. The goal of this trip is to train a new cadre of trainers and increase the uptake of ETAT.

Population Served

We expect this project to benefit children throughout Belize. Although Belize has made great strides over the past 20 years in reducing under-5 child mortality rates, the 2020 rate of 11.7 annual deaths for every 1000 children under the age of 5, the country still lags behind the highest performing countries in their region.

Expected Impact

By training a new cohort of trainers (and refreshing concepts with previously trained trainers), this will allow ETAT courses to be reinstituted in Belize with continued remote support from BCM/TCH. While outcomes have not been studied specifically in Belize, we know from previous work in Guatemala that ETAT systems are able to be successfully implemented in resource-limited settings and may lead to decreased length of stay and mortality rates of critically ill children. If this ETAT training model is implemented successfully, we would expect the dissemination of this training countrywide would lead to similar outcomes in Belize.
We also know that, prior to the Covid pandemic, there was sustainable uptake of ETAT training, as mentioned above. Our group studied participant attitudes toward training through qualitative interviews previously, finding that the participants believed that triage education and process implementation was essential to improve communication and pediatric emergency care. We have had good success already since our first post-Covid trip in May 2022 and have been able to provide technical support in the interim. Based on this, we believe that the uptake of this training and ability to disseminate ETAT courses with Belizean trainers will have similar success as in the pre-Covid era.

Trip Photos & Recap

We were able to a group of 16 trainers for ETAT, who will take charge of training the western region of Belize in pediatric emergency triage, assessment, and treatment. This group included pediatricians, general practitioners, surgeons, and nurses. At the end of the week, we facilitated a meeting with the trainers and Ministry of Health leadership to strategize for roll-out of these trainings across the region.