Uganda Project
GECC trains midlevel emergency care providers in rural Uganda, a new cadre of health care worker called the Emergency Care Practitioner (ECP). Read on to see how we got to where we are now, and where we are going… expanding emergency care services nationally in Uganda, with the Emergency Care Practitioner on the forefront of this expansion.
The History of the Nyakibale Hospital Emergency Department
GECC’s flagship project results from our relationship with Karoli Lwanga Hospital (“Nyakibale Hospital”) in the Rukungiri District in the southwest of Uganda, Africa. This area of the country is rural, and the hospital is a seven-hour drive from Kampala, Uganda’s capital. The nearest major city, Mbarara, is located about two hours away. The countryside is mountainous and the hospital is situated at an altitude of approximately 5,000 ft (comparable to Denver).
Nyakibale Hospital has grown from a modest health center in the late 1950s into a referral center for the Rukungiri District. It serves over 300,000 people, more than half of whom are under age 18. The district is very poor; one third of the residents have no access to clean water. The Hospital is staffed by four Ugandan physicians, three clinical officers, forty-eight nurses, and twelve midwives. There is also a nursing & midwifery training school onsite with approximately 130 nurses-in-training.
The Hospital has made steady improvements recently to both the quality and the accessibility of the services it offers. But prior to GECC’s work, the Nyakibale Hospital Annual Report found that eight of the ten leading causes of death in the hospital’s patient population were treatable with quality emergency care and resuscitation. Among these causes of death were severe malaria, pneumonia, and trauma.
The Global Emergency Care Collaborative (GECC) was founded in 2007 to meet the need for quality emergency care at Nyakibale Hospital. After a thorough needs assessment and extensive fundraising, on June 2, 2008, Nyakibale Hospital proudly opened the first truly functional emergency department in Uganda (as opposed to a disaster or casualty unit). Since its opening, the Nyakibale Emergency Department (ED) continues to provide treatment and stabilization for critically ill patients. In only two years, the emergency staff has cared for over 10,000 patients with a variety of medical and traumatic illness and injuries, preventing an extraordinary number of potential deaths. It is projected that the ED will continue to treat over 7,000 patients per year.
To see a video about GECC’s Emergency Care Practitioner training program, click here: Uncage the Soul Production’s GECC video
To view a 2008 video of the Center for Emergency Care and learn more about Nyakibale Hospital click link below:
Nyakibale Hospital Emergency Department Tour
You can also view a video of the Nyakibale Hospital Tour in Uganda:
Training Uganda’s First Emergency Care Practitioners
In order for the Nyakibale emergency care to remain sustainable, GECC developed a training curriculum for local staff that launched in July 2009. Our Emergency Care Curriculum combines classroom and clinical work to train the local staff to effectively and independently manage the emergency department. The curriculum was developed by GECC affiliated physicians based on their experience working at Nyakibale Hospital. The implementation of the curriculum was carried out by GECC volunteers with strong support from other short-term volunteers. This training program is a two year graduated responsibility program, in the “train the trainer” model… so that education, clinical care, and administration are weaned from GECC to local staff over time.
Impressive Patient Care Results
In the fall of 2009, GECC began intensive data collection to monitor the care provided by its trainees. We believe that the preliminary data is very encouraging, with over 1,800 patients in the data base (including more than 400 children under five years old). Mortality rates for children under five cared for by GECC’s Ugandan trainees are significantly lower than any other rates reported in the literature for Sub-Saharan Africa. Additionally, the Ugandan Ministry of Health has a set a target to drop inpatient malaria mortality to 2% for children under five. Although this goal has been elusive at other hospitals in Uganda, the mortality of children in this age group receiving care in the Nyakibale Emergency Department and still requiring admission for malaria has recently been as low as 0.6%. These results are exceptional, since many centers in Sub-Saharan Africa report mortality rates of 7% or higher for malaria in children under five years.
The Next Wave of Emergency Care: Continuing the Emergency Care Training Program
With the graduation of the first class of Emergency Care Practitioners in March 2010, GECC has transitioned into the next phase of the project. This will entail continued mentoring of the first six Emergency Care graduates while they lead and replicate the program for the future classes of nurses selected to become Emergency Care providers. This will set the foundation to launch further editions of the training program and allow emergency care to expand to other Ugandan hospitals.
GECC’s Public-Private Partnerships in Uganda: The Path Toward National Emergency Care Services in Uganda
GECC is working collaboratively with Mbarara University of Science and Technology (MUST), a regional medical training school, to certify the Emergency Care training program for a graduate level Diploma. The graduates of this program would be independent Emergency Care Practitioners (ECPs), a new cadre of midlevel emergency care providers capable of providing emergency care services and life saving care. GECC has also been working collaborative with the Uganda Ministry of Health’s Health Service Planning office and Human Resource working groups to move forward with national recognition of this new Emergency Care Practitioner health worker class and with expansion of emergency care services nationally.
