Assisting the setting up of an emergency service in rural Africa

Abstract

There is increasing evidence that timely treatment not only reduces mortality from acute medical problems and trauma and reduces hospital length of stay but also that many patients who have traditionally been admitted for investigation and treatment can, if investigations are provided early, be treated as outpatients. So emergency medicine (EM) which for a number of years was largely confined to the English-speaking western world has come to be accepted as a specialty in many countries. In large African cities, it may be possible for emergency medicine to be provided based on a similar model to the USA or UK (albeit with many of the same difficulties that we describe below) and there are now EM specialists and residency programmes in South Africa, Ethiopia, Tanzania and other sub-Saharan African countries. However the majority of Africans live in poorly accessible rural areas and small towns where the provision of emergency care is more difficult. Nanyuki is a small, reasonably prosperous, town in Kenya with a population of approximately 40,000 about 3 h north of Nairobi, and its hospital serves a large surrounding rural area. It is staffed by nine consultants, one each in general medicine, surgery (including orthopaedics), paediatrics (the paediatrician is also Medical Superintendent), anaesthetics, radiology, pathology, ophthalmology, obstetrics and gynaecology and ENT (part time). There are also a number of medical officers (MOs) but the bulk of medical staffing is provided by clinical officers (COs) and interns. It is difficult to quantify the number of emergency patients as they present mixed in with patients who attend the hospital for primary care. There have been links between Nanyuki and Torbay Hospital, UK since 2011, and in 2012 Torbay was asked to send a team to advise on the setting up of an emergency department (ED). A team of ED doctors, nurses and paramedics has been visiting the hospital two or three times a year since then and this editorial is based on the visiting team's experience in trying to establish an ED and emergency service. Provision of all secondary health care in rural Africa is difficult. In many parts of Africa, healthcare as a whole may be given a lower priority than education or fighting terrorist threats.... Language: en