Project Update: The Zambian Emergency First Aid Responder Program
Continuing her work in the U.S. Alumni TIES theme “The New Frontiers of Global Public Health,” Benjamin A. Gilman International Scholarship alumna Jennifer Pigoga reports on her health work in Zambia. Her project brings the issue of cultural relevance to the surface of emergency first-responder programs in southern Africa and aims to adapt their content to a Zambian context, building a stronger community of first responders in the country.
You can read more about Jennifer’s project and other U.S. Alumni TIES Small Grant winners in our previous post here.
“Developing a Context-Appropriate Model for the Zambian Emergency First Aid Responder Program (EFAR)”
Imagine that you were severely injured in a car accident.
Who would you call?
For those in the United States, the answer to the question above is obvious: 911. Either yourself or a bystander would recognize your situation as an emergency and immediately phone for help. Thanks to well-trained first responders, the treatment you would need to stay alive would begin on an ambulance, long before your arrival at an emergency room. In conjunction with the adequate care provided at the hospital, this functional pre-hospital response system might save your life.
What if, instead, you were injured while in a less-developed country? The reality is that your outcome would likely be drastically different. Due largely in part to a lack of resources and training, much of the lesser-developed world lacks access to life-saving emergency care. Many low- and middle-income countries face serious shortages of healthcare workers and supplies, and the problem is only worsened by high burdens of injury and illness. These healthcare systems as they stand are too resource-poor to manage the amount of patients attempting to seek emergency care. What this means is that you — a critically injured patient — might die before ever being seen by a provider.
Emergency care has been identified as a cost-effective means of decreasing morbidity and mortality from these conditions. Yet, despite clear benefits, these systems are slow to gain traction in developing regions. Perhaps the most obvious solution is to provide formal training programs for healthcare providers, but it will take decades to build up a substantial workforce of specialized emergency care providers. In the meantime, empowering community members to manage emergencies as they occur is a viable solution. Harnessing what she learned about capacity building in underserved communities from the U.S. Alumni TIES conference on “The New Frontiers of Global Public Health,” Jennifer Pigoga seeks to change this situation.
As most emergencies begin at home, the community plays an influential role in determining the severity, subsequent steps, and overall impact of a medical emergency. Community members are often the earliest responders to an emergency and, as such, must be included in the development of the overall emergency care system. Layperson first responder programs, which educate previously-untrained community members, are an effective method of involving the community in improving emergency care. Establishing emergency medical services at the community level not only ensures effective first-response to medical emergencies, but also creates a link between community-based providers and higher-trained pre-hospital and facility-based providers.
The Emergency First Aid Responder (EFAR) program was created in 2010 to address the emergency care needs of low resource areas in South Africa. EFAR is a five-day short course that emphasizes local participation and ownership to empower communities to manage their own emergencies. EFARs, as participants are referred to, are trained in two types of knowledge: life-preserving skills and emergency care systems awareness. Community members learn to provide life-saving care in the interim before an ambulance or other transport arrives, and are familiarized with the broader emergency care system so that they become an active and integrated part of this system. They take away from the course a wealth of practical knowledge and skills, such as how to stop bleeding using informal medical supplies like a t-shirt. EFAR relies upon community involvement, training a large number of community members to increase the likelihood that an EFAR is near to any emergency that occurs. It is a viable means of rapidly scaling up a workforce of emergency responders and building a foundation upon which a more formal system — such as an ambulance service — can be built.
In response to a series of highly-fatal car accidents, the Zambian Ministry of Health began to prioritize emergency care. One of the first steps towards the nation’s goal of increasing access to emergency services was to conduct a needs assessment. The African Federation for Emergency Medicine, an organization that aims to advocate for emergency care expansion across all of Africa, assisted with this assessment in 2014, identifying that a community first response program would be a critical element in a multipronged approach to emergency care expansion across the country. Over the next two years, forty EFARs were trained in two Zambian villages. While the course itself was successful, a follow-up study identified serious gaps in what the program was teaching. Results suggested that the curriculum, which was purpose-designed for a South African setting facing different disease and injury burdens, was in need of modification to reflect the emergencies seen by Zambians.
With the support of a small grant from the U.S. Department of State’s Alumni TIES program, Jennifer and her colleagues are tackling this issue. A team of emergency care providers from Africa and around the world are refining the Zambian EFAR program so it better reflects the emergency care needs of Zambia. They are also creating a two-day program that will train local leaders to run the course, so that reliance on external instructors is decreased. In tandem, local trainers facilitating a locally-appropriate course will translate into better care provided by EFARs and better outcomes.
During the coming month, Jennifer and her colleagues will travel to Zambia to pilot the new EFAR and associated Train the Trainer courses.
Written and contributed by Jennifer Pigoga.