Global emergency medicine initiative: Advancing emergency medical care in the developing nation of Honduras

Abstract

Study objectives: Honduras is a Spanish-speaking country located in Central America, with a population of approximately 6.5 million. It is one of the poorest countries in the western hemisphere and was severely affected by Hurricane Mitch in 1998, which killed approximately 5,600 people and cost $1 billion in damage. Shortly thereafter, Global Emergency Medicine Initiative (GEMINI), sponsored by Rotary International, developed a program to advance emergency medicine and disaster response in Honduras. I describe 3 years of emergency medical training experience in the developing nation of Honduras. Methods: A team of 10 US health care providers and support staff traveled to Tocoa, Honduras, and surrounding communities on 3 occasions during 2002 to 2004 to provide basic health education and emergency medicine training to all levels of health care providers during a 3-day period. Course participants included physicians, nurses, midwives, first responders, administrative staff, and community health workers. Each year, a written survey was conducted to ascertain the health concerns and needs of the community. Subsequent curricula were adjusted according to the survey results. Topics included triage, splinting and immobilization, cardiopulmonary resuscitation, prenatal care and childbirth, cardiovascular emergencies, respiratory illnesses, hypertension, diabetes, HIV, malaria, and preventative medicine. Hands-on sessions for physicians included ECG training, intubation skills, and intravenous access. A woodworker taught the local firefighters how to make their own backboards. Geographically isolated community health workers were provided with Where There Is No Doctor books and instruction in basic health care. Results: Approximately 750 participants were trained during a 3-year period. They were provided with resources to others in their community with the hope of instituting a train the trainer program. The major health concerns in the communities include HIV (especially among the Afro-Honduran Garifuna population), malaria, diabetes, hypertension, diarrhea, and respiratory illnesses. Conclusion: Emergency medicine skills can be taught in developing nations incorporating out-of-community and local educators and resources.