The many challenges of working in an Ethiopian ER
Finally I got to spend the day in Black Lion ER. Ryan and Mike spent the day teaching the first class in the new training center, which had been opened the day before. They were teaching an Ethiopian Trauma class. This was the first time this class had ever been taught in Ethiopia. I headed over to the ER.
On the previous trip I had walked though the ER several times but I had never spent a long period of time there. I was somewhat nervous about what to expect.
Would the staff want nothing to do with me? Would the patients be offended? Would I be horrified by what I saw? Lots of questions that would not be answered until I walked in. It was time to really get out of my comfort zone.
First some background on Black Lion’s ER. It moved into their current location about 2 years ago, it is broken in to 3 large rooms (Triage, resuscitation room, and stabilization room) with several small exam rooms, a procedure room and a very small CPR room.
They currently use a model of multiple providers, which is very uncommon in the US, but will be moving to the single provider model, which is what we have at the UW and most American ER’s use. The multiple provider model splits patients into two different categories at triage, medical (which means they will be seen by a internal medicine resident and the problem is medical related or surgical which means they will be seen by the surgical resident and their problem may potentially require surgery.
The ER is typically staffed by 6 nurse, several residents and interns. It has 23 beds but can quickly expand to 50 or more. In a typical day they triage about 120-150 patients and see about 80 of them. The ones that are not seen in the ER are referred to a clinic.
I spent the day shadowing Bahilu, a CRNA who basically acted as the charge nurse, walking around trouble shooting problems and helping out as needed. My first impression of the ER was that it appeared chaotic, patients were in stretchers or in chairs everywhere, and it seemed that every patient had 5 or 10 family members with them.
I was later to learn that family members play a big and important role at Black Lion. Nurses and ancillary staff are very limited and many of the task that would be done by hospital staff in the US fall on the families shoulders, examples are taking patients to x-ray, lab, buying medications, taking them to the bathroom, getting them food and many, many more task.
I also quickly noted that they are disorganized, and then remembered that this way of running an ER was new, only about 2 years old and it was a work in progress. There were also many inefficiencies in how they practiced. There registration system barely works, patients are given a card when they first come to the hospital, which has their medical record number. Any future visits they need to bring the card with them to get their medical record. Most patients do not bring the card with them, and since the system is entirely on paper there is no way to search for their number. Patients end up have many, many different numbers and their medical records are then not kept together. Finding past medical documentation for patients is very difficult.
There also is no track board showing where patients are in the ER or even how many patients there where in the ER. Walking around I could assume that the people in the beds were patients but had no idea of the people sitting in chairs, if there were patients or not. I am still not sure how they did it.
The nurses were for the most part very young, typically in their 20’s, with a 2 year nursing degree. I sent a good of time watching in the procedure room, where trauma patients were put or any one need a minor procedure or even just needing a wound irrigated. This was also the only room I saw with any type of supply cabinet. There was not a whole lot in it. Black Lion hospital and the ER is short of every type of material needed, and this is at the hospital that is considered a tertiary care center, and brings in patients from all over Ethiopia.
Patients were have been evaluated and require admission are then typically placed in the stabilization room were they wait for a room in the hospital to become open. Sometimes this be a very long wait, sometimes it can be weeks. Their was one patient I noticed with two full leg cast who had been waiting 2 weeks for a bed. There is also no bed control, no one single person in charge of determine were patients were to be placed.
I spent about 6 hours shadowing today and it was a wonderful, experience. The staff was very receptive and the patients did no seem to mind my presence. I learned a lot on how they treated patients with significantly less resources then I used to practicing with. They also informed that the day was “cool” meaning it was not very busy, they invited my to come on a “hot” day.
|5/06/2010||The Ethiopian Project|
|2/20/2010||The Last Day|
|2/19/2010||An African Adventure|
|2/18/2010||Teaching Ethiopian Nurse/Medics Day 2|
|2/17/2010||Teaching Ethiopian Nurse/Medics Day 1|
|2/16/2010||The many challenges of working in an Ethiopian ER|
|2/15/2010||Talking about Emergency Medicine|
|2/14/2010||Arrived safe and sound|
|2/14/2010||Exploring the city and countryside|
Date Published: 02/16/2010