Strengthening emergency care: experience in central Haiti

Marsh, Regan H.; Rouhani, Shada A.; Pierre, Paul; Farmer, Paul

doi:10.1016/s2214-109x(14)70378-x

Cited by 14 publications

(10 citation statements)

References 11 publications

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“…Haiti has few post-graduate medical training programs and, prior to October 2014, had no EM residency program or emergency physicians [ 16 ]. EM services in Haiti are limited and, when available, are often delivered by generalist or social service physicians with no emergency care training.…”

Section: Methodsmentioning

confidence: 99%

Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti

Rouhani¹,

Israel²,

Léandre³

et al. 2018

Int J Emerg Med

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BackgroundIn many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists.MethodsIn conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care.ResultsFourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful.Key components to our program’s success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels.ConclusionMedium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings.

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Section: Methodsmentioning

confidence: 99%

Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti

Rouhani¹,

Israel²,

Léandre³

et al. 2018

Int J Emerg Med

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“…While global health topics are expanding in North American undergraduate and graduate medical education, these topics also are increasingly important for postgraduate medical education in other high-income and middle/low-income regions [ 5 , 27 , 28 ]. Global health root cause analysis with an emphasis on social justice is already underway in Haiti [ 29 ]; however, continued education and widening the audience for this topic would be valuable.…”

Section: Discussionmentioning

confidence: 99%

The Haiti Medical Education Project: development and analysis of a competency based continuing medical education course in Haiti through distance learning

et al. 2016

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BackgroundRecent calls for reform in healthcare training emphasize using competency-based curricula and information technology-empowered learning. Continuing Medical Education programs are essential in maintaining physician accreditation. Haitian physicians have expressed a lack access to these activities. The Haiti Medical Education Project works in alliance with Haitian medical leadership, faculty and students to support the Country’s medical education system. We present the creation, delivery and evaluation of a competency-based continuing medical education curriculum for physicians in rural Haiti.MethodsReal time lectures from local and international institutions were teleconferenced to physicians in remote Haitian sites using VidyoConferencing™ technology. With American Academy of Family Physicians (AAFP) and College of Family Physicians Canada (CFPC) guidelines as references, a competency-derived syllabus was created for a Haitian continuing medical education program. The resulting educational goals were reviewed by a committee of Haitian and North American physician/medical education practitioners to reflect local needs. All authors reviewed lectures and then conferred to establish agreement on competencies presented for each lecture.ResultsSixty-seven lectures were delivered. Human immunodeficiency virus/Acquired Immunodeficiency Syndrome, ophthalmologic, infectious diseases, renal and endocrine competencies were well-represented, with more than 50 % of the joint AAFP and CFPC recommended competencies outlined. Areas under-represented included allergy and immunology, cardiology, surgery, pain management, gastroenterology, neurology, pulmonology, men’s health and rheumatology; these topics accounted for less than 25 % of AAFP/CFPC recommended competencies. Areas not covered included geriatrics, nutrition, occupational health and women’s health. Within practice-based lectures, only disaster medicine, health promotion and information management were included, but only partially covered.ConclusionsWe identified teaching goals covered and competencies that were missing from a CME program for rural Haitian physicians. We aim to use this analysis to provide a competency-based CME lecture series that proportionally meets local needs while following recommendations of recognized national family medicine organizations.

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“…Well-functioning emergency departments (EDs) can address the causes of 54% of deaths in low- and middle-income countries [ 6 ], including cerebrovascular disease. Despite these needs, emergency medicine (EM) remains underdeveloped in most LICs, including Haiti [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti

Rouhani

Marsh

Rimpel³

et al. 2020

African Journal of Emergency Medicine

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Introduction In many low-income countries, Emergency Medicine is underdeveloped and faces many operational challenges including emergency department (ED) overcrowding and prolonged patient length of stays (LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving care quality. EDOUs are untested in low-income countries. We evaluate the effect protocolized EDOU care for ischemic stroke on the quality and efficiency of care in Haiti. Methods We performed a prospective cohort study of protocolized observation care for ischemic stroke at a Haitian academic hospital between January 2014 and September 2015. We compared patients cared for in the EDOU using the ischemic stroke protocol (study group) to eligible patients cared for before protocol implementation (baseline group), as well as to eligible patients treated after protocol introduction but managed without the EDOU protocol (contemporary reference group). We analysed three quality of care measures: aspirin administration, physical therapy consultation, and swallow evaluation. We also analysed ED and hospital LOS as measures of efficiency. Results Patients receiving protocolized EDOU care achieved higher care quality compared to the baseline group, with higher rates of aspirin administration (91% v. 17%, p < 0.001), physical therapy consultation (50% v. 9.6%, p < 0.001), and swallow evaluation (36% v. 3.7%, p < 0.001). We observed similar improvements in the study group compared to the contemporary reference group. Most patients (92%) were managed entirely in the ED or EDOU. LOS for non-admitted patients was longer in the study group than the baseline group (28 v. 19 h, p = 0.023). Conclusion Protocolized EDOU care for patients with ischemic stroke in Haiti improved performance on key quality measures but increased LOS, likely due to more interventions. Future studies should examine the aspects of EDOU care are most effective at promoting higher care quality, and if similar results are achievable in patients with other conditions.

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Strengthening emergency care: experience in central Haiti

Cited by 14 publications

References 11 publications

Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti

Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti

The Haiti Medical Education Project: development and analysis of a competency based continuing medical education course in Haiti through distance learning

Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti

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