Texas Children's Global Health Emergency Medicine

MALAWI

The Republic of Malawi ranks among the world’s most densely populated and underdeveloped countries with 67% of the country’s nearly 19 million people under the age of 24. Kamuzu Central Hospital (KCH) is the national referral hospital in the capital city of Lilongwe serving the central region of Malawi.  The pediatric ward admits more than 27,000 patients per year and manages all medical emergencies with very few Malawian pediatric healthcare workers.

Pachimake means “at the heart of the matter” in Chichewa, a Bantu language spoken in parts of Malawi—and Texas Children’s in partnership with Baylor College of Medicine Children’s Foundation-Malawi intends to get at the heart of the matter to address pediatric emergency care challenges at KCH. A recently established initiative bringing together KCH and the Malawi College of Medicine with 4 U.S.-based pediatric hospitals (BCM Children’s Foundation and Center of Excellence Malawi, Texas Children’s Hospital / Baylor College of Medicine, Cincinnati Children’s Hospital Medical Center, University of North Carolina Chapel Hill / Project Malawi, University of Utah / Primary Children’s Hospital) — the Pediatric Alliance for Child Health Improvement in Malawi at KCH and Environs (PACHIMAKE)—aims to improve the care of acutely ill children through implementation of high quality and sustainable clinical, educational, and research initiatives and partnership. Goals focus on improving access to high quality emergency care, building capacity for pediatric providers to care for acutely ill children at KCH, strengthening partnerships and improving infrastructure including development of care processes, improvement of facilities and ensuring access to medication, equipment, and supplies. We anticipate this consortium can serve as a model of collaboration for institutions striving to improve pediatric healthcare systems in other Low- and Middle-Income Countries (LMICs).

LATIN AMERICA

The Emergency Triage Assessment and Treatment (ETAT) guidelines and training program were developed by the World Health Organization (WHO) as part of the Integrated Management of Childhood Illnesses (IMCI) strategy to promote improved assessment, triage, and initial management / stabilization of acutely ill children in resource-limited hospital-based settings, which has been shown to decrease pediatric mortality. Global PEM faculty members developed locally-relevant supplemental ETAT train-the-trainer curricula in English and Spanish and have implemented high-quality, sustainable training programs and triage processes for pediatric healthcare workers in Africa and throughout Latin America including Guatemala, El Salvador, Nicaragua, Panama and Belize, in collaboration with PAHO and local Ministries of Health. Successes to date: Program rollout to 7 countries; integration of the curriculum into the national norms of 2 countries; training of 135 facilitators who have subsequently trained over 1200 participants in their respective countries; evaluated and collaboratively published results of both the training program and triage process implementation.

BELIZE

Belize is a middle-income country of 375,000 inhabitants bridging both the Caribbean and Central America. Due to its size, it does not have a medical school or residency programs, and most providers are general practitioners that lack formal emergency medicine knowledge or skill sets. The healthcare capacity of the nation has not kept up with its growing local and tourist populations, with 0.7 physicians per 1,000 inhabitants and 39.7 healthcare providers per 1,000 inhabitants. Increasing and strengthening healthcare capacity is a strategic priority for the country and its regional partners, as noted in the World Health Organization’s (WHO) 2017 Country Cooperation Strategic Agenda Strategic Priority 2 for Belize. Despite its size, Belize has a high burden of emergency service use. The main and only government-funded tertiary referral center in the country, Karl Heusner Memorial Hospital Authority (KHMHA), sees ~25,000 patients annually in the ED. Twenty-two percent (22%) of these are trauma cases, with a significant mortality rate of 19%. There is a need and a desire to improve emergency service care that is provided nationwide.

Since 2015 Global PEM has partnered with Baylor College of Medicine Department of Emergency Medicine, the Belizean Ministry of Health and KHMHA to train local healthcare providers in pediatric emergency care. 884 healthcare providers have been trained in locally-relevant PEM topics, ETAT, Point-Of-Care-Ultrasound (POCUS) and the WHO’s Basic Emergency Care course. These educational trainings have utilized train-the-trainer approaches and have been linked with process improvement in setting which take care of emergently ill and injured children.

UNITED STATES

An important part of our work starts at home. The Baylor Pediatric Emergency Medicine - Global Health (PEM-GH) Fellowship was established in 2005 in response to growing interest in global health among trainees.  As the first pediatric global health fellowship in the U.S., our combined program is the largest in the country and is recognized as a model of excellence.  Since 2005, 16 fellows have enrolled in the combined PEM-GH fellowship, 11 have graduated from the program and an additional 8 standard track PEM fellows have participated in components of the global health track.

These 24 PEM-GH fellows have received 18 grants/scholarships, presented 59 platform/poster conference presentations, and published 28 manuscripts. Nearly all of our graduates pursue academic careers, and many are leading global health programs around the country. Our fellows have provided care to emergently ill and injured children in 23 countries with an increasing focus on sustainability and integration with existing global health programs. They are the future leaders in global PEM.