Mar 30, 2020
CPAR’s ongoing work to strengthen and improve the care offered at Fitche Hospital in Ethiopia took a new and exciting turn in March 2020, with a field trip to two high-calibre hospitals in Addis Ababa. Fitche Hospital is located in a rural area about four hours outside of Addis. The staff do a wonderful job with what they have, but conditions and resources are sub-optimal, to say the least.
CPAR has been working since 2016 to strengthen the Fitche emergency room (ER), seeing it as an entry point to full health system strengthening. We regularly send Canadian volunteers to work with and train the Fitche staff, but there is natural tendency for things to go back to the way they were once the volunteer leaves and the staff became overwhelmed with day-to-day demands.
Dr. Steve Ferracuti, CPAR’s board chair, is an ER physician in Haliburton, Ontario. He volunteers once a year at Fitche and wanted to do more to create lasting change. He came up with the idea of taking a group of Fitche staff on a knowledge exchange visit to AaBET and St. Peter’s hospitals in Addis Ababa. These high-functioning organizations specialize in emergency and critical care management and are among the best public hospitals in the city. He saw this as a tangible way to help the Fitche staff envision what their hospital could become. The results of the visit were inspiring, and CPAR considers it to be one of our most significant actions in supporting sustainable change at Fitche Hospital.
Early on March 13, eleven Fitche Hospital staff as well as Dr. Ferracuti and Sandra Abeje, CPAR’s senior program officer, gathered at AaBET Hospital. They toured the ER, the nursing stations, the triage and the procedure areas, the pharmacy, and the lab, among others. They saw how the crash carts are set up and observed several triage scenarios as protocols were put into practice.
Taking it all in at the AaBET Hospital nursing station
Observing the crash cart and medical equipment in the ER of the AaBET Hospital
The visit to St. Peter’s Hospital in the afternoon was equally instructive. The group was interested in the red, yellow, and green triage areas in the ER: red for the most severe and at-risk patients, yellow for those who are emergent, and green for those who do not need immediate assistance. They also were interested in the differences between the pediatric and adult ERs.
Learning more about triage at the St. Peter's ER
Observing the red, yellow and green corners in the St. Peter's ER
The AaBET and St. Peter’s staff provided useful feedback about the Fitche Hospital referral process and the fact that often patients are sent without appropriate first management. The Fitche staff agreed that there are some gaps and committed to improving the process.
Throughout the tours, the group had many opportunities to speak with and learn from various health professionals about how to improve protocols and efficiency. Staff at both hospitals were unfailingly generous with their time and open to providing information about their protocols, techniques, and orientation and training. We extend our sincere thanks to all of them for being part of this innovative exchange, and for their willingness to continue these valuable discussions.
At the end of the day, the Fitche staff held a round table discussion to determine what they could out into practice when they got home. There as a clear realization that even though Fitche Hospital lacks resources and equipment, some of the protocols they had seen could still be implemented.
Putting lessons from the field visit into action
They discussed ways to establish an adult intensive care unit and an advanced care unit. The biomedical engineering team committed to fixing machines that are in disrepair. Sister Bethel, the ER head nurse, will work with her team to improve cleanliness and ensure equipment is kept in good condition. And Dr. Kirubel will develop protocols and organize seminars and discussions on specific conditions so as to boost the knowledge and efficiency of the entire ER.
Finally, the importance of good protocols and practices was thrown into sharp focus in light of the growing urgency of the spread of the COVID-19 global pandemic. Just a few days later, Dr. Ferracuti had to cut his trip short to return to his ER duties in Canada.
The Fitche Hospital staff are excited about what they learned and how they can put it to use. Dr. Ferracuti’s “vision to inspire a vision” continues to benefit them and the patients they serve, and they have more confidence in their ability to cope with the coming COVID-19 storm. We at CPAR will do our best to support them through the pandemic and, when the time is right, we will continue to provide opportunities for them to learn from others and build their capacity to implement real and sustainable change at this small but mighty rural hospital.