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.
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.
By training a new cohort of trainers (and refreshing concepts with previously trained trainers), this will allow ETAT courses to be re-instituted 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. 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.
Our team worked with the Ministry of Health to train trainers for the WHO ETAT course. Just weeks prior, providers from around the country and taken the course and from there, participants were selected for their aptitude and interest to become trainers themselves. This group came to a central location where we reviewed the material and then spent time teaching this group best practices for adult learning theory and providing them the opportunity to practice both in didactic teaching and in small group skills stations and case series.