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Emergency Medical Education and the Worlds Largest Refugee Crisis

Support to the development of Human Resources (SDHR) project of Enabel- the Belgian development Agency

Midigo in Northern Uganda is experiencing the worlds largest refugee crisis as famine, economic catastrophe and years of fighting continue to force people out of South Sudan faster than from any other nation on the planet. Current figures show an influx of circa 1.6 million people seeking refuge. Following the closure of the main hospital in Yumbe, Midigo has become the central referral centre for the region.

The regions that we attended are incredibly poor and although some healthcare facilities do exist, they are entirely overwhelmed, not just by poverty and the incredible volume of patients but also by epidemics; HIV/AIDS, Malaria, COPD, Hepatitis and Trauma are prolific. The conditions that patients live in are hard, probably some of the hardest on the planet. The doctors and nurses live in equally harsh conditions but in addition, they are struggling to provide emergency medicine with limited resources, little ongoing training and at constant risk of contracting disease or suffering trauma either by accident or due to violence.

Our aim was to provide doctors and nurses with emergency medical courses, they needed to be culturally and educationally appropriate, be deliverable in a shed with unreliable power, inside a clinic with very limited space. All necessary resources would need to be transported overland. In addition, The 625 tutors would be called upon to attend emergencies during surge periods. The course needed to include both medical and trauma emergencies and required a focus on the prevention of infectious disease transmission.

The staff at 625 are used to working in difficult and complex environments but preparation is made much easier when you can draw on a mix of local and clinical expert knowledge. Our partners at The Global Health Collaborative (Plymouth University Medical School) have a wealth of experience delivering healthcare education in this part of the world and provided some great insights.  Other trusted partners like MDT Global Solutions helped us to put together training resources that could be transported easily across difficult terrain. In Uganda, our guiding lights were our resident GIS and mapping expert along with some local clinicians who had real-time access to information about the prevailing circumstances in Midigo.

To lead this kind of medical education project in complex and hostile environments demands a quite unique set of skills.  Resources in these kinds of locations are limited at best but most often, non-existent, it’s not possible to just take a course off the shelf and deliver it, getting the content right means seeing what’s available to the clinicians in their daily practice, assessing the capability of the staff and then dynamically building course around what is available. Improvisation is essential.

To choose the team members the person specification headlines were – academically proven specialist practitioners, with at least 10 years of clinical practice in hazardous environments, substantial and relevant humanitarian action experience in an international setting, a wealth of community healthcare delivery experience and with appropriate teaching qualifications and experience. They would also need to be able to lead small teams through difficult and high-risk topography with little or no access to operational support. In our view was only one group of clinicians that truly fitted the specification, paramedics with a combination of NHS, special operations and hazardous area response team experience.

The courses were a a resounding success and the feedback was borderline perfect.  The collaboration between Enabel and The 625 has armed the clinicians of Midigo with an enhanced ability to prevent death and reduce disability, additional victories were achieved when The 625 team got involved in treating patients.

Enabel and The 625 have a common understanding that courses alone are not enough and that turning lessons into sustainable practice is key. Moving forwards, Enabel  are investing in a coaching and mentorship program that involves not just practical training but also online support, the generation of clinical guidelines, procedures and protocols and an online repository for clinical training resources. This is genuine sustainable development and we are incredibly pleased to have been contracted to provide this additional level of support.

Our teams love working in Uganda and we enjoy a brilliant relationship with Enabel. We are lucky to do what we do, and every day we are blown away by the capability, commitment and fortitude of the clinicians we meet. It’s a privilege.