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 to date 387 healthcare staff have 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. While Covid numbers have improved, there has been significant turnover of staff and there is a need for further training, including a new ETAT refresher course for existing trainers and a new ToT course to incorporate new ETAT trainers. 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 in May 2022.
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 reinstitute 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 was able to train a wonderful group of about 14 trainers, who are now delivering ETAT training in their hospital on a weekly basis. The training is intended to better equip healthcare providers to quick triage, assess, and treat critically-ill infants, children, and adolescent, so we hope that continuing this training will help with patient care and outcomes in the emergency department.