Rwandan fellowship project gives insight into the value for reliable data and the need for experienced local partners
Rwandan fellowship project gives insight into the value for reliable data and the need for experienced local partners.
Around the world, International Emergency Medicine (IEM) Fellowship programs provide unique opportunities for research and evaluation of emergency care systems. Last year, EP Craig Spencer, an IEM fellow from Columbia University in New York City, completed multiple projects in East Africa including a teaching curriculum and a patient monitoring program. The work gave Spencer an inside look at the importance of gathering reliable data, and of working with knowledgeable local partners.
A large part of Spencer’s work in Burundi was the routine care of sick patients, which was as eye-opening as it was frustrating. He was presented with a patient population where malnutrition caused daily complications and seemingly routine health concerns turned into emergencies because of a lack of supplies and follow-up. Spencer worked alongside NGO ‘Village Health Works’ (VHW) founded by another of Columbia’s 2013 IEM fellows, Dziwe Ntaba. The VHW clinic was one of the few places in South Burundi with access to oxygen. As a result it was often inundated with patents, forcing physicians to prioritize patient care.
“Many clinics would send their patients with pneumonia or anemia to the VHW clinic for oxygen. We only had a few canisters, so in the US five patients would have been given oxygen, a facemask or even intubated or on life support. In Burundi you had to choose which two of the same five patients needed it most. In one case we gave oxygen to a child with pneumonia over a woman who was very anemic from malaria.”
Spencer learned that in such difficult cases it was the experience of the Burundian and Congolese doctors that made all the difference.
“The physicians in Burundi are some of the best I’ve ever come across, I couldn’t have triaged and treated patients as well,” he says. “I don’t think I would have had the same success in deciding who needed oxygen to survive and who didn’t. But they had experience. They’d seen it before.”