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 cadre of in-country trainers. In February 2024, we will return to teach alongside our trainers in a new area of the country. This will allow us to provide feedback to trainers on their delivery of material as well as extend the reach of the ETAT program to a new hospital.
The staff who will participate in this training are from Belize's Northern Health Region (NHR), which serves two districts with a total estimated population of 77,964. The NHR is composed of two public Health Institutions (Northern Regional Hospital and Corozal Community Hospital), eleven Health Centers and sixteen Health Posts. The Regional Hospital has 57 beds and Corozal Community Hospital (CCH) has 30 beds.
Most ill pediatric patients will be transferred out of NHR to KHMH, where pediatric subspecialty resources are available. However, there is a need at Belize's regional hospitals, including Northern Regional and Corolla Community Hospitals, to recognize critically ill children in the emergency department and stabilize them for transport.
The ETAT program in Belize has been widely successful in the hospitals that have had trainings so far. Our cadre of trainers continue to deliver care in their own regions, with US-based trainers now going 1-2 times a year to provide technical support and train new trainers. We expect in the long term that providing this training will increase pediatric readiness for these centers and reduce mortality/morbidity prior to transfer to KHMH, As most children in Belize will have first contact at a health post, health center, or regional hospital where pediatric subspecialty typically isn't available.
Our work so far in Belize was selected for a platform presentation at the American College of Emergency Physicians Scientific Assembly 2023, and we expect to have similar results as we continue to expand this throughout Belize.
Through this trip, we were able to train a new cadre of 16 nurses and doctors on emergency care of acutely and critically ill children. We will have continued follow up with this site remotely and in person, and we will continue to monitor the impact this has on acutely and critically ill children in the Northern Region of Belize.
