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. Since then, our trainers have been able to conduct additional trainings and continue to roll out the plan to train physicians and nurses across the country.
After 2 years of supporting this project without significant in-country involvement, KHMH staff and the Belize Ministry of Health have expressed a desire for refreshing training with involvement from our US-based team. We also plan to take a new US-based trainer with us, for her to gain experience and be able to teach this course in the future.
The funding for the trip will assist in defraying travel costs associated with TCH faculty traveling in-country to assist in the new ETAT courses that will be delivered in 2026-27.
The target population is pediatric and adolescent patients presenting to emergency departments in Belize; particularly young children under 5. Significant discrepancies exist in under 5 mortality rate, with one factor being lack of specialized healthcare for children throughout the country, especially in regional hospitals and clinics. By training staff throughout the country in the ability to recognize and stabilize acutely/critically ill children, the goal is that we can reduce morbidity/mortality for these children when presenting to any healthcare facility in the country.
During this trip, we will train new staff and have meetings with KHMH and Ministry of Health leadership to continue planning on our involvement. The program has been fairly well sustained since my last in-country trip 2 years ago, so we have significant resources in place to continue this work. We will look at triage processes this trip and strategize ways to further incorporate ETAT principles into every day work flows within the emergency department.
During this trip, we were able to train 14 physicians and nurses on pediatric emergency treatment, assessment, and triage. We integrated the training into existing triage processes/ongoing initiatives. We were able to apply this training hands-on in the pediatric ICU.
