For this trip I will be part of a team teaching the WHO Basic Emergency Care (BEC) course followed by a train the trainer course to healthcare providers in Zambia and a community first aid responder (CFAR) course. The first BEC course will be at the University of Zambia school of nursing with participants from the first class of emergency medicine and critical care nurses. The second BEC course will be at University Teaching hospital in Lusaka, University Teaching hospital is the tertiary referral center for Zambia. The 3-day CFR course will be held in the village of Chiawa in partnership with the local health post and school.
The WHO’s Basic Emergency Care (BEC) course is clinical training aimed at frontline providers (doctors, nurses, clinical officers) who by necessity provide emergency care at their facilities, but have received little or no formal training in the field. The BEC course is taught over four days and covers five major modules: ABCDE approach, Trauma, Difficulty in Breathing, Shock, and Altered Mental Status. Each core component re-emphasizes the ABCDE approach and corresponding skills as it relates to the management of varied emergency conditions.
The train-the-trainer course will be a one day course for the top BEC participants to learn teaching principles including how to give a lecture, how to teach a skill and practical tips for teaching BEC. In future visits members of the organization will co-teach additional BEC courses with ToT participants at district hospitals throughout Zambia.
Chiawa is a rural community about 2 hours outside the capital of Lusaka, where access to emergency care is limited to the health clinic. The CFAR course includes content on scene safety, personal protection and bleeding control including a large component of skills practice.
I have prior experience teaching the WHO BEC course as well as experience teaching healthcare providers in Zambia and other low-income countries.
The population directly served by the WHO BEC course are the health care providers completing the course. The nurses currently enrolled at the school of nursing are the first cohort of specialized emergency and critical care nurses. After completing the one year nursing program they will return to their home hospitals throughout Zambia and be the most experienced emergency medicine providers in their hospital. Future expectations will include training their peers and responding to emergencies in their facilities. The providers at University Teaching Hospital currently do not have any specialized emergency training. There is currently only one emergency medicine specialist in Zambia who practices at Ndola teaching hospital, and there is no emergency medicine residency program in the country.
More importantly, the patients the participating providers will care for have the most benefit from the BEC and CFAR courses. University Teaching Hospital is located in the capital, Lusaka. In Zambia, relatively few people have access to private medical care and most residents of Lusaka rely on government run hospitals. The rural community of Chiawa is along the Zambezi river, in additional to typical road traffic injuries, HIV/AIDS and Malaria there is also a significant number of drowning and injuries from large game. These critically ill patients stand to benefit from basic first aid and rapid transport to a health facility.
Emergencies occur everywhere, everyday, a person cannot control when or how an emergency may happen. It is imperative that all people in Zambia have access to high quality emergency care, one critical piece to ensuring this, is education of healthcare providers. Our organization is currently working with the Zambian Ministry of Health to strategically conduct WHO BEC and train-the-trainer courses throughout Zambia. To date over a dozen courses with over 200 participants have occurred.
This project will have a long term impact on a large number of potential patients. Participants in the courses will be able to use the knowledge gained in their regular clinical practice. Additionally, the WHO BEC courses will include a train-the-trainer course so they can continue to educate their peers. Past WHO BEC courses in Zambia have resulted in participants doing small training sessions with their peers after completing the course. In Chiawa, the CFAR course will train participants to provide first aid in their community. Our organization plans to continue partnering with the community of Chiawa clinic to provide additional CFAR courses including a train-the-trainer course.
Our organization is also currently developing skills training videos with corresponding case scenarios that will be distributed electronically via WhatApps and Facebook to past BEC and CFAR course participants in Zambia.
This trip was not my first time traveling to Zambia, I was excited to go back and help teach several emergency medicine and first aid courses. The first training was a community first aid training with health workers and safari camp staff near the rural village of Chiawa. The health workers staff clinics that are responsible for deliveries, emergencies and chronic disease management. We were a little bit surprised when the response to our question of what types of injuries do you see the most, they answered elephant trampling and alligator bites. Thankfully, improvised tourniquets are part of the course and participants loved practicing on each other. When it was time to go, the participants all asked when we would be back for the next training. The appreciation for the training also highlighted the need for health training in the area.
The second course was the one I was most looking forward to, as it was with the first class of emergency and critical care specialty trained nurses. Much of health care in low resource settings is delivered and driven by the nursing staff. Zambia, interestingly, will have trained nurses before physicians which will likely help with EM sustainability when the trained physicians have dedicated and functioning Emergency units to work in. The nurses were excellent students and trained to become BEC trainers so that when they graduate from their nursing program they can continue to education and lead their peers at their home hospitals. The nursing school had selected orange as the uniform shoulder piece, which is the WHO color for Emergency Care! They especially enjoyed the Mass Casualty Drill, they students were great actors!
The third course I participated in was another BEC course with staff at a district hospital in the Lusaka area. Patient’s are essentially required to present to the district hospitals first and receive a referral to the main teaching hospital. If they are not critically ill upon arrival to the teaching hospital they must pay a fee in order to receive care, vs the care is free if they go to the district hospital.
We were joined by two senior medical officers who had recently completed the BEC training and trainer course and they provided invaluable local expertise and enthusiasm. I look forward to the day when we can call them EM residents, as their excitement and dedication to the field is admirable. The growth in emergency care is exciting, but there is still a ton of work to do.