2 Responses

  1. Georgina Phillips
    Georgina Phillips October 13, 2015 at 4:38 pm

    Thanks Belinda for highlighting this critical but undervalued aspect of global health.

    One of the key errors people make when thinking about emergency care in LMICs is to imagine their local emergency department, or something they’ve seen on television transposed into a low resource environment. People imagine rooms full of expensive equipment and high technology interventions when they think about emergency care. But the most valuable and important aspects of safe and effective emergency care are not expensive and not complicated.

    Elizabeth Molyneux and colleagues illustrated this so well in their study on transforming a busy and poor-functioning children’s outpatients clinic in Malawi. Molyneux showed that by training staff in emergency care skills, introducing some emergency care systems (such as a simple 3-scale triage system) and re-designing and renovating the environment, mortality can be substantially reduced. This is the ‘staff’, ‘systems’, ‘space (and ‘stuff’) that Paul Farmer also talks about in his terrific article in the London Review of Books earlier this year.

    None of these components are high cost or high technology. But they do require some investment in clinicians and their hospitals; neither of which have received much interest or attention in the global health discourse so far. People in poor countries need both public health interventions (sanitation, immunisations etc.) and safe and effective clinical care. A hospital or clinic that can be trusted to provide emergency care inculcates public confidence that is crucial for times of increased need. The importance of accessible and trustworthy hospitals (or lack of them) to an effective Ebola response in West Africa illustrates how critical clinical care is to a functional health system.

    As you have illustrated, Belinda, there is hope and movement for a more integrated approach ahead. Those of us working in the field of global emergency care welcome your article and the opportunity to discuss these critical issues with policy and thought-leaders in our region.

    Great work!

    Dr Georgina Phillips, FACEM

  2. Chris Curry
    Chris Curry October 9, 2015 at 3:06 pm

    Thanks Belinda,
    Re. The emergence of emergency care: You may like to see the ACEM International Emergency Medicine Network News of September 2015: https://www.acem.org.au/getattachment/f58d278a-6b1a-493e-b929-3e24d535bcb6/IEMNET-News-Vol-1-Issue-1-(1).aspx
    Chris Curry

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