The practice of austere critical care in rural Africa and resource limited areas

1. The Practice of Austere Critical Care in Rural
Africa and Resource Limited Areas
Introduction:
SOF me dics are currently deployed throughout Africa. They are treating casualties with limited me dical kit and prolonged MEDEVAC times. This study was conducted to
determine if medics were able to get clinical experience in Africa prior to deployment, would they be more proficient when providing medical care in resource poor environments.
Method:
This study was conducted using online surveys. 37
participants were selected based on their clinical
placement experience and location on the African
continent. The study period ranged from 2015 to 2018
and used the Delphi method for data collection.
Results:
We conclude that acquiring clinical experience in rural
Africa enhances the capabilities of the deployed medic.
Discussion:
There were significant increases in skills confidence from all participants
after experiencing clinical placements in Africa.
There were far more trauma cases seen in larger cities throughout
Africa. For the rural hospital placements the majority of medical cases
followed the pathology of Disease and Non-Battle Injuries (DNBI)
Acknowledgements:
There are no corporate sponsorships for this study other
than financial and administrative support from the not-for-
profit College of Remote and Offshore Medicine
Foundation.
The Kilimanjaro Experience
Kilimanjaro Christian Medical Centre is located at the base of
Mount Kilimanjaro. It is the largest hospital in northern Tanzania.
It was selected due to English as an official language, it is a safe,
predominantly Christian population with direct flights on EU airlines.
A. O’Kelly, D. Stephens, W. de Mello, in cooperation with and supported by the College of Remote and Offshore Medicine Foundation
The College of Remote and Offshore Medicine Foundation
is a not-for-profit academic institution based in the EU that provides degrees and austere medical courses that focus on the practice of healthcare in resource poor environments.
www.CoROM.org
Minor Trauma
22%
Major Trauma
16%
Cardiovascular
14%
Respiratory
13%
GI & Diarrhoea
9%
Malaria etc
8%
Other: Burns,
Dehydration,
Shock, UTI &
Skin Problems
18%
MedicalIssues seen inrural Africa
Skills before clinical placement Not
confident
Slightly
confident Average Confident
Very
Confident
Treating a critically ill patient (unstable) 5 5 12 10 2
Assessing and treating a medical patient 2 6 14 9 3
Assessing and treating a trauma patient 2 5 12 12 3
Advanced airways including intubation 5 4 13 11 1
Cardiac patients 1 8 10 11 4
Ventilator management 8 11 9 4 2
Suturing and minor surgery 7 5 9 8 5
Orthopaedic injuries 4 4 15 10 1
Respiratory illness & emergencies 1 4 12 15 2
Infectious diseases 6 14 6 7 1
Ob/Gyn 7 8 12 5 2
Environmental Emergencies 4 2 14 12 2
Altitude Illnesses 7 10 11 4 2
Shock and Haemodynamic Emergencies 2 3 12 13 4
Skills after clinicalplacement Not
confident
Slightly
confident Average Confident
Very
Confident
Treating a critically ill patient (unstable) 0 0 8 19 7
Assessing and treating a medical patient 0 0 9 17 8
Assessing and treating a trauma patient 0 0 8 15 11
Advanced airways including intubation 0 5 7 18 4
Cardiac patients 0 2 7 18 7
Ventilator management 2 6 11 10 5
Suturing and minor surgery 2 3 10 7 12
Orthopaedic injuries 0 2 10 18 4
Respiratory illness & emergencies 0 1 6 20 7
Infectious diseases 1 3 15 12 3
Ob/Gyn 5 2 14 10 3
Environmental Emergencies 0 3 8 17 6
Altitude Illnesses 4 5 14 8 3
Shock and Haemodynamic Emergencies 0 1 7 17 9
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