First-Responder Training Courses

For the past two months we have been planning for the trauma lay first-responder training courses that took place this week.

As discussed in a stakeholders meeting a month or so ago, we decided that since trainees are not being paid by their employers to take on this extra responsibility, that we should give each certified trainee a first-aid kit, ID card, course certificate, and reflective armband, in order to provide incentive and a sense of pride.

It seemed simple enough at the time.

Just to provide some perspective, here in Kampala even simple things like ordering at a restaurant or buying some groceries, are tasks which inevitably involve delay, detour, or debacle.

Having said that, one can imagine the comedy associated with bargaining at the local flea market for quantities of supplies that quite frankly would be difficult to obtain even at a Costco.

Kit assembly took about ten times longer than calculated, mostly because we decided to individually spray paint the course logo onto each kit ourselves. But after sorting forty-thousand pairs of gloves, individually diluting and pouring 350 one-liter bottles of bleach, cutting 700 square meters of tarp into 350 one by two meter stretchers, folding 350 pieces of cardboards for splinting, cutting 700 triangular bandages, and after folding 6000 pieces of gauze we can see that it was definitely worth it.

During the Uganda Taxi Operators and Drivers Association (UTODA) training days, we were joined Mr. Moses Dumba, UTODA Road Safety Officer, and Mr. John Ndyomugyenyi, UTODA National Chairman. Mr. Dumba provided an excellent talk on road safety that was well-received by the trainees and accessible via Prehospital Project web page. Numerous reporters from local TV, magazines and newspapers were present as well.

The trainees were exceptionally motivated and interactive throughout the training day.

After baseline surveys and a pre-test in the morning, Dr. Jackie Mabweijano, head of Mulago Casualty Department and GPAS Director, gave a 45-minute lecture on the course fundamentals (video accessible online). She eloquently gave and engaging lecture simultaneously in Luganda (the local dialect) and English.

The rest of the day was spent rotating in groups of 10 through each of 5 skills stations. The topics covered airway management (Dr. Cephas Mijumi – Mulago Anesthesia; Dr. Jim Suozzi - UCONN), hemorrhage control (Juliete Kiyimba, Yusuf Kimbowa – Kampala Red Cross, Dr. Michael Lipnick), fracture splinting (Daniel Nsubuga – Kampala Red Cross; Dr. Robert Wangoda, Consultant Surgeon Mulago Hospital), Scene Management (Dr. Jackie Mabweijano, Head of Mulago Casualty Department), and triage/transport (Robert Okuyat – Kampala Red Cross; Dr. Doruk Ozgediz, faculty surgeon UCSF).

Based on the enthusiasm of the trainees, we are optimistic and eager to begin the prospective phase of collecting data for this study.

We are hopeful that we will be able to obtain additional funding from local government and private donations to facilitate future courses.

Prehospital Study Planning

A glimpse into another side of healthcare in Kampala.



We are currently in the process of coordinating our prehospital study. You can read about it in detail on the "projects page." The general idea is that here in Kampala, there is no public ambulance system. There are a few private ambulances, but they are too expensive for the vast majority of the population to even think of using. As a result, most people with injuries are either not brought to the hospital at all, or are brought in by taxi drivers, police, or relatives... and no prehospital care is provided. We believe that as a consequence, many people with survivable injuries are dying because of a lack of extremely basic prehospital care (ie airway management – turning an unconscious patient on his side, or controlling bleeding before loading the patient into a taxi, just to name a couple). The other week I visited the city mortuary and not surprisingly of the ~1000 deaths that were brought there in the last 6 months, it seemed that about 90% were injury-related.



We are planning to train taxi drivers, police, and local council members in basic first-responder skills (~300 in the initial training courses in May 2008). We will also provide them with a basic first aid kit. This study is based on similar efforts in other countries. We hope to measure its impact in a small area of Kampala over the next year.



In order to collect some data for the study we have been traveling to the health clinics in Kampala. This has been an interesting and informative experience.



We have visited five health centers around Kampala that we hope to designate as potential health facilities for our first-responders. Most of our trips have involved a few common themes:



1. Traffic
A near accident or pedestrian collision seems to occur almost every few minutes. After each of these we look at each other and repeat the comment,"I hope the data collection doesn't start on this fieldtrip." Long-lasting "jams" are everywhere, and can occur at anytime of day. The few traffic lights around the city are rarely working and as for the condition of the roads - red dirt and gravel that is broken up by pothole-strewn, paved portions.



2. Understaffing/waiting
Despite appointments, the clinics are so badly understaffed that they understandably have trouble meeting with us – so far most of the clinicians we have talked to, report seeing about 150-300 patients between 8AM-5PM, as there is only one doctor, a few nurses and medical assistants in each clinic.



3. Inadequate facilities
Though many of these clinics, by definition of the ministry of health, are supposed to have basic instruments and supplies for first aid, we have found that many do not. Some do not have even gauze, more or less suturing instruments. And those with suturing instruments may not have a sterilizer... etc.



4. Traffic
Worthy one more mention.



5. Optimism
Despite the discouraging conditions that we found in the health clinics, we were consistently greeted with optimism by the health clinic staff. All have been in agreement that it is time to at least try for a change or attempt to learn what may or may not work for prehospital care in Kampala. We have been invited back to the clinics to provide a basic orientation course to the staff regarding the study forms – but per their request, we are using this opportunity to provide a brief course on basic first aid and the approach to an injured patient.