Project Update #2: The Zambian Emergency First Aid Responder Program

Jenn Pigoga’s first Emergency First Aid Responder (EFAR) program in Choma, Zambia concluded this September, providing vital skills training in the small community with rising rates of traffic injury. Her calculated approach included a seven-module program for community members to respond to a variety of emergency situations, from breathing difficulty to serious trauma, and resulted in all 22 participants passing a follow-on test of their skills.

You can see Jenn’s previous work on her EFAR program here, and follow other U.S. Alumni TIES Small Grant winners projects here.

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THE ZAMBIAN EMERGENCY FIRST AID RESPONDER PROGRAM

“Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes.” -Olive Kobusingye

Emergency care is that delivered to patients with sudden, severe conditions that need to be treated immediately to avoid death or disability. The emergency care system extends from care at the scene of illness or injury (often a home or public space), through transport and emergency department care, and then to critical care in the hospital. Emergency care is the first point of contact with the health system for many people, given their barriers to accessing primary and preventative care services. Building strong emergency care systems allows limited resources to be targeted towards those at highest risk of death and disability, who have the best chance of benefitting from those resources. Despite clear benefits, emergency care only recently began gaining traction across low-income countries, including those in sub-Saharan Africa. Efforts to introduce formal emergency departments and healthcare provider training programs are resource heavy, take a long time to produce change, and are futile if patients are unable to reach the doors of the emergency unit. It is clear that emergency care, although a newly recognized frontier in global public health, is one that can improve the lives of all citizens, regardless of socio-economic status. Which begs the question: How do we not only develop emergency care systems, but ensure that patients are able to access these services?

In response to this dilemma, the African Federation for Emergency Medicine (AFEM) developed the Emergency First Aid Responder (EFAR) program. The program is based on a five-day course that targets community members, training them to both provide basic first aid on the scenes of emergencies and to connect emergency patients with the formal healthcare system. Patients tended to by EFARs benefit directly from this, but the program has the potential to improve the healthcare system at-large over time. Creating a sustainable EFAR program in Zambia will not only yield better health outcomes; it will also reduce reliance on external aid and lay the foundation for formal EMS systems in years to come.

Choma, a Southern province town along the access road between two of Zambia’s major cities (Lusaka and Livingstone), is faced with a high burden of injuries due to increased vehicle traffic. This compounds the baseline burden of disease, meaning that both medical and traumatic emergencies are increasing at an alarming rate. Given this knowledge, the Zambian Ministry of Health has prioritized the development of emergency care services in this region. They are training hospital providers using the World Health Organization’s Basic Emergency Care course; however, there remains no formal response system outside of hospitals. As such, they requested that the EFAR course be piloted in this area, so that community members can begin to build the foundation of a prehospital response system. Thanks in part to funding from the U.S. Department of State’s Alumni TIES program, AFEM was able to implement the EFAR program in Choma.

Planning for the course was challenging, as much of the logistics could not be determined until the AFEM team was on the ground. Three AFEM EFAR course facilitators travelled to Lusaka, where they met with Ministry of Health officials, and then on to Choma to secure the details of the course.

The EFAR course ran in Choma, Zambia from September 25–29, 2017. It was held at Choma General Hospital, where 22 participants were trained in the basics of emergency first response. Through seven modules (introduction, safety considerations, patient assessment, trauma, difficulty in breathing, shock, and altered mental status), EFARs learned the knowledge and practical skills to manage a wide variety of emergencies that they are likely to face in their own communities.

Overall, the course was a success: 19 of 22 participants passed the post-course assessment, with the remaining three participants able to pass after verbal revision with a course facilitator. Written English seemed to be a minor barrier for these three participants. When talked through the questions, the participants were able to correctly answer enough questions to pass the course.

This lesson — that the course’s language may need to be simplified — was one of many that AFEM gained from implementation. EFARs also completed forms to provide feedback about the pros and cons of each course module, including the content and facilitator. This feedback is particularly useful fin identifying how materials can be further refined for the Zambian context. At the end of the five-day course, participants were given the opportunity to write their thoughts anonymously on post-it notes. They each provided one comment detailing their favorite part of the course, and a second outlining something that they believed could be improved. Many suggested that the course could be longer, and that, perhaps, it could include additional content on pregnant patients and emergency childbirth. Positive comments included “I learned that I can be useful during an emergency, even as a community member,” “the lessons were wonderful,” and “I like the role of the EFAR providing basic emergency care for ill patients before they are taken to the hospital.” EFAR participants themselves also took the opportunity to speak in front of the group at the end of the course, providing consensus from their classmates on the course and what their hopes were for next steps in the program (such as the need for identification badges, refresher courses, collaborations with public services, and additional community outreach).

So, what is next? Particularly in global health projects, longitudinal engagement with local stakeholders is the key to success. As such, the AFEM team has planned a return visit to Zambia in six months. After meeting again with key Ministry of Health stakeholders in Lusaka, the team will travel down to Choma, where they will hold discussions and a short, one-day refresher training for current EFARs. After this, a two-day “Train-the-Trainer” course will be held, to train those who have emerged as leaders in the EFAR program in facilitating future courses themselves. They will learn about the course from an instructor’s perspective, and be taught educational skills so that they can effectively teach the course. These new trainers will then lead a second EFAR training with another cohort of 20 to 25 Choma community members, assisted by the AFEM team.

Although there is much work to be done moving forward, the project thus far has been a great success. The implementation team would like to extend their gratitude to the following organizations, without whom this project would not have been possible: the U.S. Department of State’s U.S. Alumni TIES program, the African Federation for Emergency Medicine, and the Zambian Ministry of Health.

Written and contributed by Jenn Pigoga.

Alumni Thematic International Exchange Seminars (Alumni TIES) are regionally focused seminars for alumni of U.S. government-sponsored exchange programs.