Embedded into all of CPAR’s programming is the concept that “Everything is connected”.
So, the question arises, how is CPAR’s new direction connected?
Canadian Physicians for Aid and Relief is a Canadian NGO with country offices in Ethiopia, Malawi and Tanzania. For most of its 34 year history, it has garnered a well deserved reputation for delivering community based programming in east Africa. This has always been done with an ear to our communities and country staff and an eye towards sustainability. Most programs over the last decades have been in what would be generalized as food security, income security, water, sanitation and hygiene and the like. That is, on themes that are broadly thought of as social determinants of health.
Our approach has always been one of capacity building.
However, not everyone remembers that in its infancy CPAR brought nurses and doctors to east Africa, built health centres, trained midwives and community heath workers and other health care based activities.
In 2014, Dr. André Lalonde and myself were invited to make a site visit to Fitche Hospital, a zonal hospital (parallel to a Canadian regional hospital) in the North Shoa zone of Ethiopia. Fitche Hospital has a catchment of approximately 1.5 million people. CPAR has worked for years in the zone helping these same people with agriculture training and other activities geared towards addressing determinants of health.
The minute that Dr. Lalonde and I walked into the emergency department at Fitche Hospital it was quite clear that here was another area that could benefit from capacity building.
The Ethiopian medical system differs from the Canadian system in a number of ways. In Ethiopia, and in many parts of Africa in fact, emergency medicine as a discipline and as a systematic approach to illness is very much in its infancy. The only emergency medicine residency training program in Ethiopia has only graduated a small number of physicians over the last few years. This program was developed and is assisted in part by the University of Toronto through their Toronto Addis Ababa Academic Collaboration. Therefore, virtually all emergency departments outside of Addis Ababa are staffed by GPs, who are all on 1-5 year placements at their hospitals as they provide their obligatory service to the state. These GPs are almost without exception awaiting entry into specialty training programs. They generally have very good theoretical knowledge, a good knowledge and facility with local diseases but some approach and skill gaps when it comes to emergencies.
In a parallel fashion the nursing staff, while quite skilled in many areas, have not had exposure to a nursing approach to emergencies.
CPAR is currently working alongside our Ethiopian colleagues at Fitche Hospital to help build up a culture and skill set in a regional hospital ER. Physicians and nurses spend approximately a month at Fitche working alongside our colleagues to treat patients and leave behind knowledge and systems with respect to emergency care. General approaches to critical care, the assessment of the undifferentiated sick patients, principles of triage, vital sign taking and reassessment are all emphasized. At the same time we are provided an opportunity to learn about local diseases, local culture, what one can achieve with fewer resources than we are accustomed to and an opportunity to develop new friendships.
There are a many scenarios that are illustrative. In one such scenario, Fitche Hospital was presented with a multiple trauma situation resultant from a mini-bus accident. The patients arrived en masse without warning. One victim was being assessed on a bench in the waiting area. A GP was assessing his clearly deformed leg. One of the local nurses who had spent some time with us recognized that there were other priorities and did identify the patient as being in shock. The patient was then appropriately resuscitated.
There are challenges. The resources are poor but it is clear that one can do much with little with a different approach. Maintaining continuity and momentum is a challenge, but a consistent roster of Canadians and efforts to improve consistent clinical leadership in Fitche will start to address this. A medical system which emphasizes specialist versus generalist care is a challenge.
Nonetheless we are hopeful that our teaching and capacity building will leave Fitche Hospital and the North Shoa zone with a higher standard of care and improved outcomes and hopes for the people of the community.
If you are interested in participating or learning more please check us out at www.cpar.ca.
Dr. Steve Ferracuti is a general practitioner who has lived and worked in Haliburton, Ontario for 26 years. He has been a longstanding member of the board for Canadian Physicians for Aid and Relief and is currently the Chair of the Board and the Chair of the Physicians Advisory Committee for CPAR. He has been a volunteer at Fitche Hospital in Ethiopia.