Global Emergency Medicine Initiative

Training Prepares Nepali Physicians for Earthquake Response

October 20th, 2015
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IN 2010, when Vancouver-based mining company Teck Resources gave $2.5 million to help St. Paul’s renovate its Emergency Department, the company may never have thought that its gift would have an impact five years later and ten thousand kilometers away.

The global reach and long life of the Teck donation lies in the fact that in addition to its funding of a redesign and renovation of the now-named Teck Emergency Centre at St. Paul’s, a portion of the gift was earmarked to support research, education and innovation in emergency medicine, which led to the establishment of the Teck Emergency Centre Innovation Fund.

One of those Teck Innovation Fund grant recipients was Dr. Andrew Kestler, an emergency medicine physician at St. Paul’s and Chair of the Global Emergency Medicine Initiative (GEMI). GEMI was founded by UBC emergency medicine specialists to establish training partnerships with medical institutions in low- and middle-income countries to help improve emergency care.

With his Teck innovation grant, Dr. Kestler developed a partnership between GEMI, the University of Alberta, the University of Calgary, and an emergency medicine training program established in September 2013 at the Patan Academy of Health Sciences in Lalitpur, a historic city in Nepal’s Kathmandu Valley.

Innovation in the emergency department — from bedside technology to life-saving research — is revolutionizing the way we provide emergency care.
The Global Emergency Medicine Initiative (GEMI), is establishing long-term partnerships with low-and middle-income country institutions that are leading in-country efforts to improve emergency care.
The field of emergency medicine is growing in urban Nepal. Large urban hospitals have triage systems and dedicated GP emergency physicians.
Developing the discipline of emergency medicine is one step in evolving the care at Patan Hospital and the education at Patan Academy of Health Sciences.

From late 2013 to early 2015, GEMI arranged to have several St. Paul’s and UBC emergency medicine specialists travel to Nepal on a volunteer basis for one month each. As international guest faculty, they worked at the bedside and in the classroom to teach the trainees (Fellows) of the new Emergency Medicine Fellowship Program at the Patan Academy in a number of areas of emergency medicine including pre-hospital care, disaster preparedness, triage and emergency medicine education. These Fellows would come to represent Nepal’s first generation of formally trained emergency medicine physicians.

On April 25, 2015, however, six weeks after St. Paul’s physicians had helped administer the Fellowship’s final exams and returned home, disaster struck Nepal in the form of a major earthquake. More than 9,000 lives were lost, 23,000 people were injured and hundreds of thousands were left homeless. It was the worst earthquake to strike Nepal in eighty years.

The epicentre of the quake was located just 100 kilometers northwest of Patan. The earthquake killed more than 9,000 in Nepal and injured more than twice as many.

Patan the third largest city of Nepal, received extensive damage as centuries-old buildings were destroyed at UNESCO World Heritage sites including the Patan Durbar Square.

By Davide Mauro (CC BY 2.0) via Flickr

A largely volunteer ambulance service struggles to tend to both urban and rural patients in and around Patan. Ambulances take patients to the Patan Hospital, which receives 32,000 people annually through its emergency department.

By Asian Development Bank (CC BY 2.0) via Flickr

The people of Patan and Nepal have shown incredible strength and resilience in the weeks and months that followed the earthquake in April 2015.

By mebrett (CC BY 2.0) via Flickr

A key part of the Fellowship program had in fact involved an elaborate Disaster Drill that took a full month to plan and involved the Nepali military, which had been called upon to set up a 40-bed field hospital for the exercise.

“British Columbians should be proud of what these physicians are doing in a country where this kind of knowledge sharing and training has such profound benefits.”
— Dr. Andrew Kestler, St. Paul's

Amidst the chaos of the earthquake’s aftermath, the Fellows were able to play key roles as the medical team at Patan Hospital, themselves included, began to take control. The Fellows were able to help assemble teams to meet incoming victims, establish a triage post and field disaster areas, and engage patient identification, record keeping and crowd control. The fellows would later speak to how much better prepared they had been thanks to the training they had received.

“British Columbians should be proud of what these physicians are doing in a country where this kind of knowledge sharing and training has such profound benefits. To hear the stories of how these Fellows were able to help in the wake of such a disaster is an inspiration for us all. These efforts benefit patients here at St. Paul’s, too, as our physicians come back inspired and refreshed from such a teaching experience,” says Dr. Andrew Kestler, St. Paul’s emergency medicine physician and GEMI Chair. “Most rewarding is watching skilled local physicians rapidly incorporate new knowledge and immediately apply it in a setting where emergency care needs have so far outstripped its supply. This is one of those special endeavors where all parties benefit: our doctors and patients here at home; and of course, the caregivers and citizens of Nepal.”

An 18-month program, the Fellowship in Emergency Medicine at the Patan Academy of Health Sciences is helping to transform health care in Nepal. BC emergency physicians are encouraged to join GEMI and participate, especially in the program’s early years when support is so critical to success. Additional information may be found by downloading the International EM Faculty for Nepal document and by contacting GEMI executive committee members Dr. Andrew Kestler, Dr.Simon Pulfrey and Dr. Sophie Low-Beer.

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