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A Novel Partnership & Approach to Strengthen Pediatric Emergency & Trauma Care In Ethiopia

Saturday, October 20, 2012: 9:52 AM
Room 346-347 (Morial Convention Center)
Sabrina Butteris, MD1, Tigist Bacha, MD, MPH2, Muluwork Dinerbu, MD2, Scott Hagen, MD1, Joshua Ross, MD3, James Svenson, MD3, Peter Rankin, RN, BSN4, Getachew Teshome, MD, MPH, FAAP5, Heidi Busse, MPH6 and Girma Tefera, MD6, (1)Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, (2)Department of Pediatrics, Addis Ababa University, Addis Ababa, Ethiopia, (3)Department of Medicine, Divison of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, (4)University of Wisconsin Hospital & Clinics, Madison, WI, (5)Pediatrics/ Emergency Medicine, Univ of Maryland Hospital for Children, Baltimore, MD, (6)Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI

Introduction: As the second most populous country in sub-Saharan Africa, the need for health care services in Ethiopia is substantial. With 46% of the over 93 million people in the country accounted for by children 0-14 years of age, the need for pediatric emergency care is immense. Population growth coupled with increased urbanization, inadequate sanitation, underlying malnutrition, infrastructure challenges, limited access to preventative care and high rates of road traffic accidents result in an ever increasing need for emergency pediatric care. Despite the substantial need, minimal infrastructure to support pediatric emergency care exists in Ethiopia currently.

Program Evaluation: In the fall of 2010, a partnership to strengthen pediatric emergency & trauma care in Ethiopia was formed between two tertiary care academic institutions, one in the US and one in Ethiopia, an Ethiopian diaspora organization and a US-based non-profit organization. The goal of the partnership was to enhance and strengthen pediatric emergency & trauma care by building institutional and human resource capacity. Partnership activities have included work planning meetings, bidirectional exchange of pediatric faculty & nurses, the development of a competency-based pediatric emergency medicine fellowship training program (with elements implemented in both the US and Ethiopia), quality improvement (QI) & leadership training, implementation of QI projects and short-courses in pediatric emergency & trauma care.

Results: Four pediatric nurses and two pediatricians from Ethiopia have participated in the exchange program. All participants have developed QI projects that are in various stages of implementation. The physician retention rate has been 100% and nurse retention 75%. Graduation of the first cohort of pediatric emergency medicine providers in Ethiopia is anticipated to occur in October 2012. Multiple short courses have been taught utilizing the train-the-trainer model with participation from across multiple regions in Ethiopia. Within the first year of the partnership there was recognition of the need for increased training in pediatric critical care, which was subsequently augmented in the curriculum. Locally identified priorities have included triage and registration, teamwork and leadership, pain management and sedation, bed management, and infection control. Challenges that have been identified include equipment limitations and consistent and reliable communication strategies, both of which have improved over the course of the partnership.

Discussion: A cornerstone of this partnership has been the development of a 2-year pediatric emergency medicine fellowship program for Ethiopian pediatricians. Given the local context, the fellowship blends the skillsets of emergency medicine & critical care with a focus on leadership and quality improvement. This model has been effective in this environment and may warrant translating to similar environments. An additional unique aspect of the partnership that warrants particular attention is the role of the Ethiopian diaspora community, a perhaps underutilized resource in conventional global health partnerships.