Fall 2012: Expanding Emergency Medicine in Bolivia Douglas Char, MD, FACEP
Fall 2012: Expanding Emergency Medicine in Bolivia Douglas Char, MD, FACEP
POSTED: September 5th, 2013
POSTED IN: Fall 2012,
Take six emergency physicians; add two ED nurses and a seasoned paramedic instructor. Mix with 300, interns, residents and a few “specialists” (attendings). Add in 100 nurses and scores of firefighters and police from the two largest cities in Bolivia all eager to learn about the latest in emergency medical care and what do you get? The 3rd Annual, Bolivian Emergency and Acute Care Medical Education trip. The 12 person team spent a week teaching in Bolivia’s two largest cities – Cochabamba and LaPaz. Our hosts were physicians from the Hospital Manuel Ascencio Villarroel and Collegio Medico Provincial Del Valle Alto-Punata (the largest teaching hospital in Cochabamba and a level two referral hospital outside the metropolitan area) and Hospital Joseph Viedma, a large tertiary medical center that is likely the most sophisticated hospital in the country. The differences between the two facilities were surprising (think county facility versus private hospital) but even the best hospital in Bolivia lacks many of the common resources that we often take for granted.
The Bolivian medical education system is such that it is easy to get into medical school and your first year of internship almost assured, but gaining specialty training (residency) is very difficult. Only the very brightest are able to pursue additional training. Many doctors can be found working as generalists in rural settings or another profession (even after having completed an internship). The residents (cream of the crop of their medical schools) we met were bright, energetic and very appreciative of the information we shared. There are no such things as work hour rules in Bolivia. One of our facilitators – Dr. Edwin Antezana worked all day translating for us then had to cover an overnight shift. 36 hour shifts and 140 hour weeks are common place – it’s like the “bad old days in the US”.
In both cities we organized 2-day, multi-track sessions. The physician’s sessions were led by faculty and fellows from Washington University; Barnes-Jewish and St. Louis Children’s hospitals. Emergency medicine doesn’t exist as a specialty in Bolivia but their physicians were eager to learn about how we handle emergencies and mass casualties. Our “curriculum” included an Acute Care/ Approach to Trauma track (Drs. Mark Levine, Brian Wessman, Sue lin Hilbert) and a combined OB/GYN and pediatrics track (Drs. Douglas Char, Melanie Kennedy and Tina Lee). Our team’s nurses, Julie Dalechek (St. Elizabeth’s in Belleville, IL) and Lori Winkler (Cardinal Glennon) reached out to the hospitals’ nursing staff – teaching BLS, PALS and basic emergency nursing. Deputy Chief, Donna Lowe – St. Louis Fire/EMS, along with Dr. Mark Levine (St. Louis Fire Medical Director) introduced a basic prehospital curriculum to over 150 firefighters and police officers. The highlight of each course was the hands-on skill stations; CPR – pediatric and adult, airway- pediatric and adult, spine immobilization, IO access and use of field tourniquets. Each of the first responders (a position that doesn’t really exist in Bolivia) was given a pocket rescue mask.
On day two in Cochabamba we were invited to evaluate a mass casualty drill on the outskirts of the city. Two buses had collided; there were 70 “injured patients”. We expected simple moulage and simulated extrications. What we saw impressed the heck out of us. Patients with real blood and guts (cow) littered the accident scene. Police and fire extricated the wounded using real tools – real time. A cadre of ambulances from around the region responded, carrying the injured to the local hospital, sirens screaming. Scores of medical personnel (mostly our students from the day prior) attended to the wounded. We all agreed, these Bolivians could teach our US peers a whole lot about how to plan and run a “real” disaster. They may lack equipment but they more than made up for it in terms of team work, passion and can-do attitude. We finished the drill and offered our humble feedback.
Besides putting on education sessions, MVP (Macedonian Volunteer Project) has donated thousands of dollars worth of equipment to help outfit Bolivian ambulances and field medical personnel. This trip we were raising money to help purchase more sturdy back boards. MVP lead by Ms. Julie Dalechek has provided numerous cardiac monitors, oxygen tanks and tubing, nebulizers, cervical collars, thermal temperature probes, splints and some surgical equipment over the past 5 years. They also raised money to pay for basic medications.
As with every trip to a developing country the key operational word is “flexibility” – we probably changed the list of lectures, stations 3-4 times in each city, trying our best to meet the needs of our students. Running lecture in 4 tracks simultaneously and via interpreters required a sense of humor and humility. Team members came home richer for having been able to share our knowledge and skills with the amazing people of Bolivia, South America’s poorest country. Our hosts have already asked when (not if) we will come back. While the US and Bolivian medical education systems may be very different at heart, this trip was about physicians sharing ideas with peers – each learning from the other. What an awesome experience!!