An empathic deep-rooted connection to our global community is how Emergency Medicine Global (EM-Global) was founded. This grassroots NPO is a collaborative initiative between Tanzanian, Canadian, and American physicians. These physicians share a passion to invest in the capacity development of physicians local to in resource-scarce, high-needs areas.
We are about investing in people, specifically those who are the protagonists of development in their locale and who work daily to serve their own communities. We work to support, to motivate, and to empower; We seek not to take leadership roles nor to tell local physicians how things should be done, but rather to remove barriers to their training so that they, themselves, can lead.
We are just getting started but are excited to share what has been achieved so far. In one packed year, we have completed a needs analysis, formed partnerships across four universities, and trained 25 Tanzanian physicians and nurses in both community and tertiary centres in the use of portable ultrasound for trauma.
The technology of portable ultrasound is even more useful in settings where CT scanners don’t exist or aren’t reliable. For example, two buses collided just outside of Moshi, in Killimanjaro region, Tanzania, during the last day of EM-Global’s first training course. The passengers came to a small community hospital which had no CT scanner and, in fact, no emergency department. Immediately local Tanzanian physicians were able to implement the skills they had learned in portable ultrasound to identify whose injuries were most severe and triage the civilians who needed to be transferred to a trauma centre.
Through partnerships with portable ultrasound companies, Sonosite and Clarius (so far and looking for more!), we secured rental machines for bedside teaching and have been able to donate a portable ultrasound device. This gave a community hospital their first portable ultrasound device which continues to be used and supported through remote education.
Collaboration extends to colleagues at Duke University who are working on developing technologies that allow real time feedback inPoCUS, which would then enable teachers overseas to remain connected and provide clinical guidance.
EM-Global also provides sponsorship for local Tanzanian physicians to obtain residency programs in emergency medicine at Muhimbili Teaching Hospital in Dar Es Salaam. Currently, through fundraising, we have sponsored a Tanzanian physician to go through residency training. He will become the 31st physician to achieve residency in emergency medicine in a country of 59 million. We are working with the Tanzanian Ministry of Health to develop greater levels of access to training.
A common idea in modern global health discourse is that capacity building with the ‘bottom up’ approach is the most sustainable way to achieve change. There are many terms used to express this idea, but the founding principle is the same — if you seek to help a population in need, those once termed “beneficiaries” should more accurately be viewed as collaborators.
It is not about forcing ideas and ways of doing things upon another group, but rather meeting our international colleagues where they are. Unfortunately, many global health projects, which claim to empower, may, unintentionally and paradoxically disempower.
So how can we ensure our initiatives foster empowerment rather than disempowerment? The group of physicians involved have compiled research in the area of participatory global health and summarized the learning. We have created three EM-Global critical appraisal questions that can be used to evaluate whether a global health initiative addresses its mandate of being participatory and empowering. These questions came down to the following:
Attitudes: What sorts of attitudes do the initiators of this project have about those whom they seek to serve? Attitudes may be observed in how people speak about another, in the assumptions that we make, and in the tone and spirit in which the organizers conduct themselves. Attitudes of superiority can stifle any initiative, no matter how well planned or funded the project may be.
Level of Collaboration: Who has defined the goal of the project — was this a goal articulated at the grassroots level, or identified by those external to the community? What role do those who live and practice in the high-needs area have in the project?
Plans for Sustainability: At the outset of the project, how do the project organizers envision the results to be sustained? Is there a goal for the initial project organizers to become less integral to the project overtime, encouraging local leaders to have the greater roles?
Many readers may already be involved in a social action project or global health initiative. Others may be skeptical about getting involved and question what will sustain the effort when constantly being pulled in many directions. It is our experience that there is something profoundly uplifting about exercising the empathy that is within all of us, so much so that in giving our time and energy, we are energized rather than burnt-out.
The question of what is meaningful social action, however, can be a challenging one and it is the hope of EM Global that the critical appraisal questions may help you choose an initiative that is useful and sustainable.