Move Over, George Clooney

Young ER Docs on the Frontline of Health Care in Tanzania
A woman suffering from severe burns is carried on a stretcher into the Emergency Medical Department of the main hospital in Dar es Salaam, Tanzania. The patient had a live electric cable fall across her chest and her chances for survival are low.

Few ERs in Africa could deal with such a case but Muhimbili National Hospital’s ER is different. Staff are well-trained and resuscitation rooms are equipped with life-saving equipment. A command center has rows of computers to monitor the activities. There’s a top-notch ER director and specialists from the US provide new ideas and coaching, all courtesy of the Abbott Fund, the philanthropic arm of Abbott Labs. But the real miracles here are the young ER resident and registrar doctors who provide the manpower, passion, and optimism to deal with 200 patients a day. On a larger scale, they are the clearest hope for Africa’s health care challenges.

I’ve just returned from an eye-opening week at Muhimbili National Hospital, the home of the country’s only Emergency Medical Department. Along with three other FSGers, we’ve just kicked off a project to help the Abbott Fund chart its next five years of support to the hospital. The ER and the young residents and registrars who staff it quickly grab our attention.

Unlike in the US, where large numbers of patients use ER for sore throats and stubbed toes, Muhimbili’ s ER patients suffer from ectopic pregnancies, car accident wounds, severe malaria, or domestic violence. Patients make their way to the hospital in taxis or join other patients in crowded ambulances that are more buses than emergency vehicles. Patients are often held at a regional hospital, waiting days, until they fill an ambulance.

Amidst the scenes of multiple, daily trauma, I meet Drs. Hendry Robert, Upendo George, Faith Ringo, Juma Mfinanga, and Philip Michael. Their responsibilities are extraordinary – 12 hour shifts, often at night, where they make life-and-death decisions without senior doctor support. During the rest of the day, they study and squeeze in sleep. But these young ER docs are some of the most confident and happy health care workers I’ve seen on the continent. They’re assertive, questioning, and unwilling to accept the cynicism that pervades public hospitals. What drives them?

They answer the question: Autonomy for high-stakes decision-making, technology, international connections, and trust in their colleagues. It’s a great combination and, in the context of the nearly $80 million that Abbott Labs and the Abbott Fund have invested in Tanzanian health care system strengthening, the drive of these young ER docs is perhaps the best return.

I’ve spent the last 20 years focused on health prevention and treatment in Africa, particularly around the big diseases. Emergency care hasn’t been a priority for me or, frankly, the global health field. Perhaps that should change as the learnings are rich here:

  1. Motivated, young health care workers are a critical part of the health care solution in Africa. ER departments offer a particularly fast-paced learning lab for the next generation of health care practitioners in terms of leadership, growth, and accountability.

  2. Upgraded ER care acts as a catalyst for improvement in other parts of a hospital. ER departments are linked to radiology, labs, surgical services, etc. Higher expectations in the ER flows throughout the rest of the hospital care system.

  3. ER care may be a source of revenue generation for hospitals as other, private facilities lack the vital mix of high patient volumes and specialists.

Muhimbili ER – I couldn’t find a better set of stars to watch!

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