Emergency Medicine Education Intervention in Rwanda,☆☆,

https://doi.org/10.1016/S0196-0644(96)70088-4Get rights and content

Abstract

Study objective: To describe the effectiveness of an emergency medical education program in a postwar developing country. Methods: A prospective, nonrandomized interrupted time-series study was conducted in an emergency department at a national referral hospital in Rwanda immediately after the 1994 civil war. Participants included 11 medical personnel staffing the ED comprising physicians, nurses, and medical assistants. International medical relief workers in the ED identified deficiencies by directly observing routine clinical practices. On the basis of this assessment, formal training programs in trauma resuscitation, airway management, wound care, and blood/fluid precautions were conducted. Subjects were then observed 1 week and 2 months after the educational programs and scored on a standardized data-collection form. Scores before and after intervention were compared with the use of Fisher's exact test to determine program effectiveness. Results: Educational interventions with statistically significantly longer term effects included wound management principles and blood/fluid precautions (before versus after intervention, P<.05). Interventions with the least sustained effect included advanced airway interventions and procedures related to trauma resuscitation. Conclusion: Educational seminars proved to have the greatest sustained effect on those behaviors requiring minimal equipment and noncomplex medical decisionmaking. [Erickson TB, VanRooyen MJ, Werbiski P, Mycyk M, Levy P: Emergency medicine education intervention in Rwanda. Ann Emerg Med December 1996;28:648-651.]

Section snippets

INTRODUCTION

The civil war in Rwanda began on April 6, 1994, and caused the deaths of more than 500,000 people.1, 2 Kigali, the capital of Rwanda, was at the center of the conflict. The Central Hospital of Kigali is a 600-bed tertiary care facility that was fully functional until the onset of the war. Before the war, the hospital was the primary national referral and training hospital for Rwanda. During the first 3 months of the conflict, the facility, including the emergency department, was inoperable as a

MATERIALS AND METHODS

After the initial reestablishment of the Central Hospital of Kigali, the ED was reopened under the guidance of an international emergency medicine relief team. The relief team comprised two board-certified emergency physicians and one emergency medicine nurse. During October and November 1994 (the 2-month intervention period), the team supervised the structural rehabilitation of the ED and subsequently developed educational objectives to standardize the medical care rendered by the ED staff.

RESULTS

A site survey conducted in February 1995 (posttest 2) demonstrated sustained improvements in wound management and compliance with blood/fluid precautions compared with pretest results (Table 1). Specific areas of statistically sustained improvement (P<.05) included disposal of sharps/ waste, wound irrigation, and sterile suture technique. Airway management and trauma management remained relatively unimproved after the 2-month washout period (posttest 2) despite the improvement immediately after

DISCUSSION

Despite the substantial increase in medical relief and educational interventions in developing countries in the last 25 years, interpretation of their efficacy is incomplete. Few of these interventions have ever been properly researched or shown to be effective. Most studies are descriptive and based on incomplete or nonobjective data.3 This is particularly true in the setting of international relief. One of the fundamental difficulties in assessing the effectiveness of these interventions has

Acknowledgements

The authors acknowledge the contribution of Paul Jones, MD; Gene Rudd, MD; Don Mullens, MD; and Ken Isaacs of Samaritan's Purse International Relief.

References (13)

There are more references available in the full text version of this article.

Cited by (24)

  • Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis

    2023, Journal of Pediatric Surgery
    Citation Excerpt :

    Injury prevention programs in India could reduce the impact of trauma by targeting high-impact mechanisms among children, particularly for burn and road traffic injuries [51]. In addition to primary prevention, efforts to improve pediatric injury outcomes can target system level gaps in trauma training [52–57], protocols and checklists for triage, evaluation and resuscitation [58–64], trauma quality improvement and systematic data collection for performance monitoring [25,65–67]. There are population, generalizability, methodological, and data limitations to this study.

  • A Framework for Standardizing Emergency Nursing Education and Training Across a Regional Health Care System: Programming, Planning, and Development via International Collaboration

    2022, Journal of Emergency Nursing
    Citation Excerpt :

    The use of the train-the-trainers model for international emergency medicine projects has been discussed in the literature as being a scalable and instrumental component to program success and long-term sustainability.22 In fact, train-the-trainers programs have been used to develop physician, nurse, and prehospital emergency medicine education throughout the world in many countries,23 including China,24,25 Turkey,22 India,22 Italy,22,26-28 Poland,29 Armenia,30 Ethiopia,31 Costa Rica,32,33 Rwanda,34 Ghana,35 Estonia, Armenia, Kazakhstan, Russia, Moldova, Georgia, Ukraine, Turkmenistan, Uzbekistan, Belarus, Tajikistan, and Albania.36 Backed by strong evidence, a train-the-trainers session was scheduled, in which each trainer received 22 hours of training (see Figure 7) as follows: first, a 7-hour training workshop, facilitated by the US nurse educators, was held for the entire regional trainer group.

  • Effective teaching and feedback skills for international emergency medicine "train the trainers" programs

    2013, Journal of Emergency Medicine
    Citation Excerpt :

    Finally, working with their hosts to develop curricula allows the idiosyncrasies of local emergency practice to be incorporated into the curriculum. As a result, “train the trainers” programs have been launched throughout the world to foster the development of EM (5–15). Other specialties have also used this model to good effect.

  • Developing and implementing emergency medicine programs globally

    2005, Emergency Medicine Clinics of North America
    Citation Excerpt :

    This course was divided between lectures and hands-on training and emphasized Israeli instructors learning about the local system before lecturing and receiving input for changes throughout the course [43]. Curriculum for non–United States–based physicians has been published for visiting postgraduate fellowships or externships to assist in faculty development for international EM programs [45]. Emergency-based educational seminars in postwar Rwanda prospectively showed that greater sustained effects were seen in behaviors requiring minimal equipment and noncomplex medical decision making, such as wound management principles and blood/bodily fluid precautions.

  • Lessons learned from international emergency medicine development

    2005, Emergency Medicine Clinics of North America
    Citation Excerpt :

    International EM development programs and projects should produce one or more “deliverable.” In international EM, deliverables usually include needs assessments, capacity assessments, specific plans, program evaluations, educational curricula, training courses, and on-site teaching [6,15–21]. Less often, they include specific materials, such as facilities, vehicles, equipment, supplies, and pharmaceuticals.

View all citing articles on Scopus

From the Department of Emergency Medicine Office of International Studies* and the School of Public Health, University of Illinois, and the Toxikon Consortium, Cook County Hospital/University of Illinois§, Chicago, Illinois; and the Samatiran's Purse International Relief Central Hospital, Kigali, Rwanda.

☆☆

Address for reprints: Timothy Erickson, MD, Department of Emergency Medicine, University of Illinois, CMW Room 618 (M/C 724), 1819 West Polk Street, Chicago, Illinois 60612

Reprint no. 47/1/77652

View full text