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Launching the continuing education & Leadership Program

6/14/2019

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​Emergency Medicine is a vast field, encompassing a knowledge base of essentially every other discipline in medicine and a wide array of procedural skills; practitioners need to constantly stay up to date. This can be a daunting task and one that requires significant support to be achievable.

To support our graduates after they finish their two-year Emergency Care Practitioner training, we are launching the Continuing Education & Leadership (exCEL) Program. The exCEL Program will provide graduates with continuing medical education opportunities to review higher level content, learn new skills, and receive additional mentorship after they graduate. Furthermore, it will enable ECPs to attend regional retreats and larger scale conferences, take emergency care training courses, and access online resources. Once back at their home hospitals, we're working to set up visits to work with administration on integrating emergency care into their facilities and regular phone calls to support ECPs in their new environment.
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.
Supporting our ECPs beyond the program

Since 2010, we've been funding ECPs to attend regional conferences. These conferences, while a high cost for us as an organization, are invaluable to trainees. ECPs use conferences to present GEC's work and make connections with providers in other countries and benefit from the high-level continuing education offered at each conference. 

Furthermore, ECPs serve as ambassadors of the ECP model, and the concept of non-physician emergency care providers is now recognized as a critical and successful component of emergency medicine development in Africa. 
"AFCEM inspired me to return home and continue moving emergency care forward in Uganda. It was very impactful to have our work, as ECPs in Uganda, acknowledged by important speakers from other African countries and to hear that, because of our success, similar programs are being started in other countries."
—Kizza Hilary, GEC’s Nyakibale Program Coordinator & ECP
While these conferences are valuable, they’re relatively infrequent. Thus, we deploy emergency medicine volunteers to provide CME opportunities for ECPs to review higher level content, teach new skills, and provide additional mentorship. This has been a highly successful part of our approach, but is insufficient as a stand alone method of continuing education, especially since the ECPs face challenges in their practice that are unimaginable to most doctors practicing in high income countries. 

​East African conferences on emergency medicine are being organized, large international organizations, such as the World Health Organization are offering training courses in aspects of emergency care, and more online resources are becoming available for ECPs. 


All of this continuing medical education comes with a cost

Our extensive volunteer network continually enhances the education we offer our trainees, we want to emphasize how critical it is for us to be able to offer them additional resources to further their education and training. 

The educational experiences we are providing the ECPs as they graduate and enter practice are building on the solid foundation we build over their two years of training. 

Please support ECPs to walk the path of lifelong learning and provide truly amazing care to those vulnerable patients they care for every day by donating to GEC. Together, we can continue to make lifesaving emergency medical care available to all Ugandans.​
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Ultrasound Chronicles: Mass Casualty Case

1/14/2019

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"Within one day, I’d seen the training and careful preparation in the morning and practical application of the same knowledge in the afternoon.
​A great day of Global Emergency Care at work."
By: Dr. Michael Schick, GEC Ultrasound Director

As a second year Emergency Care Practitioner (ECP), Friday mornings are spent learning through simulation. On my recent trip to Uganda one of the morning simulations was a mass casualty event. In the simulation, a pregnant mother with her two children were riding on a boda when it crashed. Four patients, two with life threatening emergencies and two who were injured but less severely. The ECP running the case is tasked with rapidly assessing each patient, triaging them, quickly deciding who needs immediate intervention and assigning tasks to other ECPs. Each ECP is assigned to one of the patients with priorities set.

It was a fun and engaging morning of learning and I was impressed with the skills demonstrated and questions generated by the ECPs. We discussed prior mass casualty events that have come through the ED at Masaka and how the ECPs divided tasks during those events. With road traffic accidents being so common and so deadly in Uganda, this is something the ECPs had witnessed many times. Entire buses that have rolled over, two bodas with several passengers each colliding, open trucks with several people in the back that veered off the road. Each event is challenging, intellectually and emotionally, and the ECPs shared what they had learned from these events.


That afternoon, we joined the other ECP trainers in the emergency department seeing patients. The ED was busy that afternoon and the ECPs were busing seeing several patients; one with a piece of wood stuck in the bottom of the foot, another with a large laceration of the hand, a patient with pneumonia, another with abdominal pain, another with malaria. A truck pulled up outside and Alfunsi went to assess the situation. When came back in, he announced that we had a mass casualty. The truck was loaded up with several injured men, all from the same accident, some walking, some unable to walk. A truck had rolled over on the road outside of town. We were about to do what they’d just trained for.

The ECPs began putting on personal protective equipment (gloves and gowns) and taking stretchers outside and making space in the crowded department. Alfunsi assumed the role of leader, directing the others who were doing primary and secondary surveys of each patient. One of the ECPs went bed by bed with the ultrasound machine doing EFAST exams.

Having working in U.S. EDs and witnessed similar large scale trauma events over many years, I must say, the ease and rapidity with which the ECPs assessed and managed these patients was SMOOTH. What can seem like chaos for someone watching for the first time, is in fact well-orchestrated prioritization through systematic evaluation and when done right, it is a beautiful thing. When done poorly, patients can die. A true emergency provider looks past screaming and blood and fearful patients to see the problems that need an immediate intervention: abnormal vital signs, a positive FAST, or pneumothorax. This is the difference between good training and poor preparation. The ECPs were completely unfazed. Alfunsi had prioritized two of the patients as critical within five minutes. The ECPs managed each injury from large to small. One was sent to the OR and another needed transfer for a spinal fracture. The remaining patients were lower acuity and though some would be admitted, there were no further critical procedures needed.

Within one day, I’d seen the training and careful preparation in the morning and practical application of the same knowledge in the afternoon. A great day of Global Emergency Care at work.
Ultrasound Machine Fundraiser for GEC - 100% Match
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. 
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Ultrasound Chronicles: Umbilical Hernia

1/8/2019

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"As our primary diagnostic tool, ultrasound can provide a fabulous amount of confirmatory and ancillary information."
By: Dr. Michael Schick, Director of Ultrasound

While working in the emergency department at Nyakibale Hospital in Rukingiri, Uganda a two-year-old boy arrives with his mother for persistent vomiting. He appears ill, has an elevated heart rate, but no obvious fever. Gastrointestinal illnesses are extremely common in this region of the world and account for a large proportion of childhood deaths, related to dehydration.

While most children presenting with vomiting, will also have diarrhea from either invasive of non-invasive intestinal infections this child was not suffering from diarrhea. Vomiting in isolation in a young child can indicate a benign illness like common childhood viruses, food toxicity, but can often indicate life threatening intra-abdominal emergencies or intra-cranial emergencies such as meningitis.

The child was listless, tired and not fighting against our Emergency Care Practitioners (as many toddlers normally do); he was dehydrated, but other than that the patient had no signs of meningitis. As we undressed the child, our astute Emergency Care Practitioner found the patient’s abdomen to be distended, tympanic, and with an obvious umbilical hernia. If you have never seen an umbilical hernia, it is a large protrusion from the belly button.

​One risk of any hernia is that bowel or intestine can get stuck inside it and twist, which cuts off blood flow to the intestine. Like all things, without blood flow the intestine will die. Bowel will become obstructed, necrotic, and release stool contents inside the abdomen. Life threatening infection ensues and in this region, certainly death.

As our primary diagnostic tool, ultrasound can provide a fabulous amount of confirmatory and ancillary information. We first image the four quadrants of the abdomen, which in the upper abdomen demonstrates large, dilated loops of bowel with anterograde and retrograde peristalsis. This indicated the patient has a bowel obstruction.
In the lower abdomen, his bowel appears normal, which indicates the obstruction is higher than the bowel imaged. When we place the probe on the umbilicus we see intestine within it and adjacent free fluid. We have difficulty acquiring reliable color flow from the intestine.

We consult surgery immediately and t
he patient is taken to the operating theater. The surgeon successfully released the strangulated umbilical hernia. Even though we had feared intestinal necrosis and perforation, the surgeon found the bowel to be well perfused. The patient had an uneventful post-surgical course.
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.
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Timely Training - Mass Casualty Event

12/27/2018

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"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."

​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
​
​Thanks to you, and other donors like you, hundreds of thousands of people living in remote communities now have access to lifesaving emergency care.
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Ultrasound Chronicles: RUPTURED ECTOPIC PREGNANCY

12/6/2018

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By: Lori Stolz, MD, GEC Ultrasound Director & Alexa Sabedra, MD, GEC Volunteer
​
On our first day in Masaka, while sitting in on the chest pain lecture being given to the ECP 1s, Deus (an ECP 2 who was working in the ED at the time) quietly walked in and asked if Dr. Lori could bring the ultrasound to the ED.  On the way there he explained that a young woman in her early 20s had presented to the ED complaining of bloody stools and had low blood pressure. She had been seen by one of the intern physicians who was also working that day. The doctor thought that she had bleeding inside her intestines and was planning to admit her to the ward.  Deus heard about the patient and had noted that she had a positive pregnancy test. Knowing this information, he was concerned that something more was going on.


On arrival at the bedside the team found an unwell appearing young woman. She was pale, another ECP was repeating a blood pressure and having trouble getting a reading.  Deus wanted to perform an ultrasound exam to look for internal bleeding, a FAST exam. In a pregnant patient who is having abdominal pain or vaginal bleeding, a ruptured ectopic pregnancy could be the cause.  An ectopic pregnancy is when a pregnancy implants outside of the uterus, usually in the tubes. This is a life-threatening condition which is the leading cause of death in women in the first trimester worldwide.
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.
​

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.
Donate Today
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Breaking barriers in emergency medicine education

11/21/2018

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Our team was thrilled to participate in the 4th African Conference on Emergency Medicine this month in Kigali, Rwanda. Thanks to the conference’s close proximity to Uganda, 18 GEC team members were able to attend the three-day event, from Emergency Care Practitioners, researchers and students, in addition to U.S.-based board members, staff, and volunteers. 

Nyakibale Research Coordinator, Adrine Kusasira, and Research Associate, Charles Ndyamwijuka, did an excellent job in their first presentation. They worked with GEC volunteer, Ashley Pickering, to present on factors contributing to delays in emergency medical care at Nyakibale Hospital in rural Uganda.

GEC board member, Mark Bisanzo, presented on management of acute heart failure in low-resource settings, while Stacey Chamberlain, also a board member, presented on global partnerships in emergency care. GEC volunteer, Greg Gaskin, presented his paper on Information Technology Supporting Emergency Care in Sub-Saharan Africa: A Scoping Review and Commentary.

Our team also participated in a full day stakeholder meeting with the Emergency Medicine Uganda community. It’s an exciting time for emergency medicine in Uganda as partners continue to develop relationships and build coalitions that drive the growth of emergency medicine by Ugandans for Ugandans.

We’re newly energized from learning about other innovative programs and models in emergency medicine across Africa. The GEC team returned to Uganda excited to implement new ideas, foster relationships with new friends, all the while working hard to move emergency medicine development forward across Uganda.

GEC Presentations

  • Building It so They Will Come: Factors Contributing to Delays in Seeking Available Emergency Medical Care in Rural Uganda and Surrounding Countries
    • A Systematic Literature Review
      Ashley Pickering, GEC Volunteer
    • ED Patient Case Studies
      Kusasira Adrine, Nyakibale Research Coordinator
    • Community Focus Groups
      Ndyamwijuka Charles, Nyakibale Research Associate

  • Global Partnerships in Emergency Care
    Stacey Chamberlain, GEC Co-founder and Development Director

  • Management of Acute Heart Failure in low Resource Settings
    Mark Bisanzo, GEC Co-founder and Director of Programs

  • Information Technology Supporting Emergency Care in Sub-Saharan Africa: A Scoping Review and Commentary
    Greg Gaskin, GEC Volunteer

  • Derivation and Validation of a Chief Complaint Shortlist for Unscheduled Acute and Emergency Care in Uganda
    Brian Rice, GEC Research Director

  • Sepsis Outcomes in a Ugandan ED Staffed by Non-physician Clinicians
    Sal Calo, GEC Volunteer
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!
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First-Ever ECP Diploma class

12/6/2017

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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
​
TO RECRUIT & TRAIN THE 2018 CLASS OF ECP DIPLOMA STUDENTS, WE NEED YOUR SUPPORT

Now more than ever, your gift will make a huge impact. It allows us to train even more Emergency Care Practitioners who transform health outcomes and save lives in some of Uganda’s most underserved communities.
Donate Today
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Kiire TeddY - Emergency Care Practitioner

5/30/2017

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"I love being an ECP because I am able to handle all emergencies by identifying and stabilizing life threatening conditions, and consult where necessary.
This makes me love what I do - saving lives." 
​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.
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ECPs teach ultrasound to Imaging the world

4/25/2017

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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. 

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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.   

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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.

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Sedation and Trauma Simulation

12/12/2016

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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.

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Copyright 2015-2019. All Rights Reserved. P.O Box 4404 Shrewsbury, MA 01545. GEC is a 501(c)3 non-profit organization. All donations are tax-deductible. Thank you for your support and generosity.