Emergency Medicine Uganda: Reflections of Mulago Hospital: a new EM perspective

Launch of aero med evac service by Acute Care & Emergency Response consortium

As healthcare providers we assume that every patient is entitled to high quality emergency care. No one knows when an emergency may happen to them, whether from a motor vehicle accident, heart attack, or severe infection. With modern medicine in the 21st century everyone should be able to access emergency care.

Elizabeth (final year student Makerere) leads a trauma
code simulation on patient (Dr.Bradley Dreifuss)

Emergency Medicine (EM) as a specialty is in its infancy in Uganda and much of Africa. A small group of dedicated healthcare providers have seen the vision and laid the ground work for starting the first EM training program at Mulago Hospital. EM in the USA went through a similar development over 30 years ago, and is now a respected and expected medical specialty in every hospital in America.

I was asked the question while I was at Mulago "Why do we need EM and how does it fit with medicine, surgery, critical care, and all of the other specialties". The simple answer is that every hospital needs emergency medicine specialists to be able to rapidly treat any medical condition that walks through the door 24/7. Especially, at a big, busy hospital such as Mulago, emergency physicians play a key role in providing high level care in a time sensitive manner to stabilize the trauma patient who is waiting to go to the operating theatre or the critically ill medical patient who is waiting for an ICU bed.

Josephine and Dr.Harries conducting introduction to emergency
medicine CME with nurse trainees at Mulago hospital.

During my two months in Uganda, I was given the opportunity to give EM lectures to various medical specialties and levels of healthcare providers. Additionally, I was able to provide bedside teaching in the medical and surgical A&E and ICU. Working together as a team, we proved to each other that emergency care can be provided despite limited resources. While treating both medical and trauma patients, we focused on addressing critical issues during the primary and secondary surveys and making timely, life saving interventions. For example, sepsis patients received time sensitive IV fluids and antibiotics, and occult shock trauma patients received appropriate emergent resuscitative interventions, as needed.

Dr.Harries conducting an ATLS simulation with medical students at College of Health Sciences Makerere

It is an exciting time for emergency medicine in Uganda with the reconstruction of the new A&E ward currently underway and hopefully soon the first class of emergency medicine specialists training at Mulago Hospital/Makerere University. I am grateful for the opportunity to have been able to work with all the great doctors, nurses, and staff at Mulago Hospital. A special thanks goes out to all those who supported me during my two months in Uganda.