The need for continuing medical education

In the US, continuing medical education (CME) is required in every field of medicine in order to provide the highest possible level of patient care. Innovations impact how patients should be assessed, treated, and cared for. As a result, medical professionals have to continue their education and stay on top of these changes. Only by doing so can they confidently provide patients with the level of care they deserve. And while continuing medical education is ubiquitous in the US, no such infrastructure exists for emergency care practitioners in Uganda. 

As GEC enters our 11th year training Emergency Care Providers, we’re concentrating on CME to achieve sustainability and maintain the excellent outcomes for patients cared for by the ECPs. We’re defining CME in the broadest terms possible—striving not to just maintain skills, but to continually build new skills as the practice of emergency medicine in Africa evolves. This will take creativity on our part, as the continuing education infrastructure for emergency medicine in Africa is in its most nascent stages.

Ultrasound Machine Fundraiser for GEC
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines.

​Over the past 15 years I've worked in a variety of global health settings around the world; what GEC has been doing over the past 10 years is certainly unique.

Recognizing the huge physician shortage in Uganda and throughout Africa, GEC is training nurses and clinical officers to provide quality emergency care appropriate to the settings where they practice.

The students are trained as ECPs. In the US, they would be called nurse practitioners or physician assistants. ECPs can be trained in 2 years, whereas it would take nearly a decade and a much greater cost to train physicians to do the same tasks. Patients dying in Uganda do not have time to wait.

I've been in Uganda for nearly 3 months assisting the ECP trainers with teaching and curriculum development. I have been impressed with the knowledge and skill levels of the trainers and students. The students are energetic and eager to learn practical skills and put them to use.

For example, two weeks ago we had a simulation of a mass casualty incident where multiple critical patients come to the Emergency Department (ED) at the same time. The students were taught to triage and prioritize care, and to organize and lead others involved.

Approximately an hour after this teaching session, a student found me in the lecture room and hurriedly exclaimed “there’s a mass casualty.” I couldn’t believe it.

I walked to the ED and learned that a truck had turned over. Multiple patients were brought in at once. Just as had been simulated, the patients were kept close together with supplies in the middle. An entire team was working together with the group being coordinated by one of the ECP trainers, Alfunsi.

The students quickly and calmly assessed the patients in a stepwise approach and addressed their critical needs. The scenario went just as practiced and all the care was provided by the ECPs. I did not join in, because I did not need to.

Giving Ugandans the skills, the tools, and the knowledge to take care of Ugandans is what GEC does, and does well. I have seen it in action.

Randall Ellis, MD, MBA, MPH
GEC Global Health Fellow
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​Thanks to you, and other donors like you, hundreds of thousands of people living in remote communities now have access to lifesaving emergency care.

Deus started the exam with a view in the right upper quadrant of the abdomen that looks at the liver and kidney.  Almost immediately, he spotted the black stripe between those 2 organs and correctly interpreted this as free fluid (Blood!).  Already the team could tell that Deus had been right; that this was more than what it seemed. He next moved the ultrasound probe to her lower abdomen to look in the pelvis.  He was able to see the woman’s uterus which was empty. This is not the expected finding if it was a normal pregnancy. He moved the probe a little to the left and was able to see a gestational sac (the pregnancy)…but the sac was outside the uterus!!  There was more of the black free fluid in the pelvis as well. Now there was no question. This woman did indeed have a ruptured ectopic pregnancy that was the actual source of her bleeding and low blood pressure. This woman did not need to be admitted to the ward, and in fact would have likely died there had Deus not intervened.  The woman needed to go to the operating room right away. Deus knew this and called the surgeon who did just that.
We later learned that in the OR the surgeon confirmed the left sided ectopic pregnancy and bleeding.  They were able to remove the ectopic pregnancy and stop the bleeding. The woman lived and the next day was doing very well.  A life was saved thanks to the quick thinking of the ECP and his skillful application of ultrasound to confirm the diagnosis he suspected.
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I think this case is very special.  As someone new to volunteering with GEC it really highlighted what an incredible resource the ECPs are for Uganda.  It is amazing how much they have learned from their training and how well they apply it to patient care to save lives!  In this case, the ECP was better able to evaluate the patient than even the physician. What is troubling is that the ultrasound machine that was here at Masaka is currently broken.  The cost of fixing it is nearly that of a new machine. When Dr. Lori and I came, we were lucky to have the generous support of organizations back home that allowed us to borrow a few machines to teach the ECPs while we are here, but they are sadly coming back to the U.S. with us.  While we are here, we have been working on ways to obtain a new ultrasound machine for the ECPs. Please help us reach that goal with a donation. ​

Ultrasound Machine Fundraiser for GEC
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines.

Please consider a donation today. Your gift will ensure that more GEC's Ugandan team will have future opportunities to attend conferences and other professional development opportunities. Thank you!

By: Dr. Stacey Chamberlain, Development Director, Co-Founder

​It is so exciting to announce that in September 2017 GEC finally started the first class of Emergency Care Practitioners that will receive Diplomas upon completion of their training program from our partner university, Mbarara University of Science and Technology (MUST)! This is a landmark accomplishment that will greatly improve the sustainability of our programming as it truly integrates our training program into the local educational system. 
 
Imagine if you went to nursing or medical school, and at the end, you didn’t receive an actual diploma and a nationally recognized degree. You wouldn’t be able to use your life saving clinical skills because employers would not recognize your expertise without that piece of paper. So after many years of fine-tuning our curriculum and working with our Ugandan partners including Masaka Regional Referral Hospital, MUST, and the Uganda Ministry of Health, this roll-out is a big step in the creation of a workforce of Ugandan emergency practitioners that will have the skills to treat acutely sick and injured patients. 

We are thrilled to welcome our first class of Emergency Care Practitioner Diploma trainees: 
Joyce Nakajja
Winifred Auma
Mohammad Kyambadde 
Edward Kasiira
Henry Kagaba
Harriet Ijangolet
Jane Frances Birungi 
John Twesigye
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​Teddy truly captures what it means to be an Emergency Care Practitioner (ECP) and the positive impact it has on the community and herself. The program developed by Global Emergency Care gives Teddy the confidence and ability to quickly identify and treat patients with life threatening conditions. Before her training to be an ECP, she would have to wait for orders on what to do in such time critical medical situations that could’ve led to grave outcomes. Teddy now feels equipped to assess a patient and provide the right treatment. These skills go a long way in developing a relationship with a community and giving people the reassurance that their lives do matter, especially in time sensitive emergencies. Teddy’s most memorable case involved a 9-year boy who was involved in a road traffic accident. He came in short of breath and in distress. Teddy suspected pneumothorax (collapsed lung) after examination of the child, and performed a needle decompression. This allowed the child to stabilize and recover quickly. With her fast thinking and expert skills, the boy was released four days later. Ultimately, ECP’s are able to save lives by effectively working under the pressures of emergency medical situations. 

Teddy is proud of her work as an ECP. She emphasizes, "I have the knowledge, skills, and determination to take care of emergencies, not like most nurses who wait for orders on what to do. It’s also exciting because I know what to do, and a big thanks to the GECC board and all those who shared knowledge with us. I love being an ECP and I don’t regret taking the training".

Watch the short video below where Teddy tells about her most memorable case - saving the life of a 9 year old boy.

Written by: Rashidah Nambaziira, Masaka Program Director, GEC

​Recently, Global Emergency Care (GEC) was honored to collaborate with Imaging The World (ITW) on a 2-day emergency care training. Imaging The World’s mission is to bring accessible, affordable, high quality ultrasound imaging to remote and underserved communities. ITW has been doing similar work to GEC - seeking to create a sustainable educational intervention and incorporating it into the Uganda medical education system. In addition to research and outreach programs, ITW offers a Point-of-Care (POC) ultrasound curriculum that focuses on OBGYN ultrasound diagnostics, and maternal/fetal care.  Partnering with GEC, the ITW providers wished to expand their knowledge of general topics in emergency medicine in order to use POC Testing for acutely ill and injured patients.   
 
POC ultrasound has served to be one of the best additions to emergency rooms at hospitals where we operate because it is a fast, convenient, and inexpensive way to make an accurate diagnosis. These factors go a long way in resource-limited settings, like Masaka Hospital and rural health centers, where patients often can’t afford the cost (including travel) to town for a formal ultrasound. Additionally, acutely ill patients often need intensive resuscitation and monitoring. Thus, leaving the hospital to get an ultrasound at a clinic not only delays their care, but also can be dangerous as well. By identifying intra-abdominal bleeding from trauma or a ruptured ectopic pregnancy, a POC Focused Assessment with Sonography in Trauma (FAST) exam in the Emergency Department can mean the difference between life and death in Uganda. For these reasons, and evidence in improved patient care, POC ultrasound is a big part of the Global Emergency Care (GEC) curriculum. 

GEC-trained Emergency Care Practitioners (ECPs) conducted the training with the purpose of expanding the ultrasound skills of the ITW-trained staff to include applications of POC ultrasound in trauma (eFAST); assessment of fluid status in shock patients using IVC ultrasound; lung ultrasound to diagnose pneumonia; and pelvic ultrasound in suspected ectopic pregnancy.
 
It was a very successful training to both organizations, as both teams learned a lot from each other. “It was really fun, and helped boost my confidence,” said Elizabeth, one of the GEC trainers. ITW brought a diverse team composed of doctors, sonographers, nurses, and clinical officers. Our ECPs are used to teaching nurses, so, training mixed cadres presented a new exciting challenge for them, which boosted their confidence.
 
“It’s inspirational to work with people doing similar work, and really inspiring that they were actually taking the effort to learn, engage, and ask questions,” said Alfunsi, an ECP trainer from GEC. The ECPs felt that the ITW team was humble and a delight to teach, which made the training a success, and left them eager to work with ITW again in the future.   

In addition to the dissemination of clinical knowledge and ultrasound skills, the GEC team enjoyed the sessions. “We loved having them here,” Elizabeth exclaimed. The ITW team was very outgoing; the after-training meals were full of intellectual and inspirational conversations that left us exhilarated from interacting with similarly minded people with a similar goal of expanding quality patient care to Uganda. There was also a noticeable comradery between the two teams during and after the training sessions, and I believe the 2-day GEC-ITW training collaboration will have a positive lasting impact on us all.
 
This collaboration was the first of many, and we hope for many more with other similar NGOs, as we continue in our mission to reduce disparities in global health by collaborating to create access to quality emergency care in resource limited settings.

By: Hans Hurt, MD, GECC Volunteer Physician

Simulation has been a great addition to the standard lecture format of teaching the Emergency Care Practitioners (ECPs), and has provided an opportunity to observe the wide skill set they have developed. There are no high tech simulators in such a low resource setting, but the ECPs manage to get in the mindset with improvised bottles of bug repellent to mimic Ultrasound motions, a USB lanyard for an oxygen hose, and pens to represent needles for chest decompression. When there was down time in between patients, we had the opportunity to use the Emergency Department to use the normal equipment and run through the progressions of a trauma assessment and FAST ultrasound exams. It was great to see the ECPs’ thought processes and be able to help them refine parts of their physical exam and optimize their Ultrasound imaging.

Towards the end of the month we worked at transitioning some of the senior ECP’s into taking on the leadership role with the simulations. I was impressed by what they observed and the helpful feedback they were able to provide the Juniors. The ECP’s were excited to learn the new techniques and get the focused time to practice.