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Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study

Published online by Cambridge University Press:  21 October 2015

Annelies De Wulf ,
Adam R. Aluisio ,
Dana Muhlfelder  and
Christina Bloem
Annelies De Wulf*
Affiliation:
Section of Emergency Medicine, Division of International Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LouisianaUSA
Adam R. Aluisio
Affiliation:
Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New YorkUSA
Dana Muhlfelder
Affiliation:
Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New YorkUSA
Christina Bloem
Affiliation:
Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New YorkUSA
*
Correspondence: Annelies De Wulf, MD, MPH LSU Emergency Medicine Division of International Emergency Medicine 2000 Canal Street D and T Building Suite 2720 New Orleans, Louisiana 70112 USA E-mail: annelies_de_wulf@hotmail.com
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Abstract

Introduction

The North East Department is a resource-limited region of Haiti. Health care is provided by hospitals and community clinics, with no formal Emergency Medical System and undefined emergency services. As a paucity of information exists on available emergency services in the North East Department of Haiti, the objective of this study was to assess systematically the existing emergency care resources in the region.

Methods

This cross-sectional observational study was carried out at all Ministry of Public Health and Population (MSPP)-affiliated hospitals in the North East Department and all clinics within the Fort Liberté district. A modified version of the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care and Generic Essential Emergency Equipment Lists were completed for each facility.

Results

Three MSPP hospitals and five clinics were assessed. Among hospitals, all had a designated emergency ward with 24 hour staffing by a medical doctor. All hospitals had electricity with backup generators and access to running water; however, none had potable water. All hospitals had x-ray and ultrasound capabilities. No computed tomography scanners existed in the region. Invasive airway equipment and associated medications were not present consistently in the hospitals’ emergency care areas, but they were available in the operating rooms. Pulse oximetry was unavailable uniformly. One hospital had intermittently functioning defibrillation equipment, and two hospitals had epinephrine. Basic supplies for managing obstetrical and traumatic emergencies were available at all hospitals. Surgical services were accessible at two hospitals. No critical care services were available in the region. Clinics varied widely in terms of equipment availability. They uniformly had limited emergency medical equipment. The clinics also had inconsistent access to basic assessment tools (sphygmomanometers 20% and stethoscopes 60%). A protocol for transferring patients requiring a higher level of care was present in most (80%) clinics and one of the hospitals. However, no facility had a written protocol for transferring patients to other facilities. One hospital reported intermittent access to an ambulance for transfers.

Conclusions

Deficits in the supply of emergency equipment and limited protocols for inter-facility transfers exist in North East Department of Haiti. These essential areas represent appropriate targets for interventions aimed at improving access to emergency care within the North East region of Haiti.

De WulfA, AluisioAR, MuhlfelderD, BloemC. Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study. Prehosp Disaster Med. 2015;30(6):553–559.

Keywords

developing countriesemergency treatmentHaitineeds assessmentWorld Health Organization
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Supplement 6 , December 2015 , pp. 553 - 559
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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References

1. Central Intelligence Agency. World Factbook: Haiti. CIA Web site. https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html. Accessed September 9, 2013.Google Scholar
2. The United Nations Children’s Fund. Under-five mortality rankings. UNICEF Web site. http://www.unicef.org/sowc2012/pdfs/UNDER-FIVE-MORTALITY-RANKINGS.pdf. Accessed November 2, 2013.Google Scholar
3. United States Agency for International Development. Global Health: Haiti. USAID Web site. http://www.usaid.gov/haiti/global-health. Accessed April 2, 2014.Google Scholar
4. Pan American Health Organization. Fact Sheets of the HAITI- PAHO/WHO Technical Cooperation in Haiti 2010-2011. PAHO Web site. new.paho.org/disasters/dmdocuments/HealthResponseHaitiEarthq.pdf. Accessed September 15, 2013.Google Scholar
5. Geohive. Haiti: general information. Geohive Web site. http://www.geohive.com/cntry/haiti.aspx. Accessed April 2, 2014.Google Scholar
6. Sletten, P, Egset, W. Poverty in Haiti. Fafo-paper 2004:31. Fafo Web site. http://www.fafo.no/pub/rapp/755/755.pdf. Accessed November 2, 2013.Google Scholar
7. Aluisio, A, Gore, R, Decome, I, De Wulf, A, Bloem, C. Prehospital characteristics in the North East Department of Haiti: a cross sectional study from a low-income setting without prehospital systems. Prehosp Disaster Med. 2014;29(3):230-236.Google Scholar
8. Hirshon, J, Risko, N. Health systems and services: the role of acute care. Bull of the World Health Organ. 2013;5(91):386-388.Google Scholar
9. World Health Organization. WHO generic essential emergency equipment list. WHO Web site. http://www.who.int/surgery/publications/EEEGenericListFormatted%2006.pdf. Accessed September 1, 2014.Google Scholar
10. World Health Organization. Needs assessment and evaluation form for resource limited health care facility. WHO Web site. http://apps.who.int/medicinedocs/documents/s15330e/s15330e.pdf. Accessed September 1, 2012.Google Scholar
11. Mock, C, Nguyen, S, Quansah, R, Arreola-Risa, C, Viradia, R, Joshipura, M. Evaluation of trauma care capabilities in four countries using the WHO-IATSIC Guidelines for Essential Trauma Care. World Journal of Surgery. 2006;30(6):946-956.Google Scholar
12. The World Bank. Mortality rate, infant (per 100,000 live births). World Bank Web site. http://data.worldbank.org/indicator/SP.DYN.IMRT.IN. Accessed April 3, 2014.Google Scholar
13. The World Bank. Maternal mortality ratio (modeled estimate, per 100,000 live births). World Bank Web site. http://data.worldbank.org/indicator/SH.STA.MMRT. Accessed April 3, 2014.Google Scholar
14. The United Nations. We can end poverty: the millennium development goals and beyond 2015. UN Web site. http://www.un.org/millenniumgoals/maternal.shtml. Accessed April 3, 2014.Google Scholar
15. Wilson, A, Hillman, S, Rosato, M, et al. A systematic review and thematic synthesis of qualitative studies on maternal emergency transport in low- and middle-income countries. Int J Gynaecol Obstet. 2013;122(3):192-201.Google Scholar
16. Hundley, VA, Avan, BI, Braunholtz, D, Graham, WJ. Are birth kits a good idea? A systematic review of the evidence. Midwifery. 2012;28(2):204-215.Google Scholar
17. Ouma, MN, Chemwolo, BT, Pastakia, S, Christoffersen-Deb, A, Washington, S. Pilot study of single-use obstetric emergency medical kits to reduce maternal mortality. Int J Gynaecol Obstet. 2012;119(1):49-52.Google Scholar
18. Raza, SA, Avan, BI. Disposable clean delivery kits and prevention of neonatal tetanus in the presence of skilled birth attendants. Int J Gynaecol Obstet. 2013;120(2):148-151.Google Scholar
19. Wall, SN, Lee, AC, Niermeyer, S, et al. Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet. 2009;107(Suppl 1):S47-S62, S3-4.Google Scholar
20. Agyeman-Duah, JN, Theurer, A, Munthali, C, Alide, N, Neuhann, F. Understanding the barriers to setting up a health care quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi. BMC Health Serv Res. 2014;14:1.Google Scholar
21. Wong, EG, Gupta, S, Deckelbaum, DL, et al. The International Assessment of Capacity for Trauma (INTACT): an index for trauma capacity in low-income countries. J Surgical Res. 2014;190(2):522-527.CrossRefGoogle ScholarPubMed
22. Penfold, S, Shamba, D, Hanson, C, et al. Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues. BMC Health Serv Res. 2013;13:61.Google Scholar
23. Penoyar, T, Cohen, H, Kibatala, P, et al. Emergency and surgery services of primary hospitals in the United Republic of Tanzania. BMJ open. 2012;2(1):e000369.Google Scholar
24. Kingham, TP, Kamara, TB, Cherian, MN, et al. Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg. 2009;144(2):122-127; discussion 128.Google Scholar
25. Parati, G, Kilama, MO, Faini, A, et al. A new solar-powered blood pressure measuring device for low-resource settings. Hypertension. 2010;56(6):1047-1053.Google Scholar
26. Baker, EC, Hezelgrave, N, Magesa, SM, Edmonds, S, de Greeff, A, Shennan, A. Introduction of automated blood pressure devices intended for a low resource setting in rural Tanzania. Trop Doct. 2012;42(2):101-103.Google Scholar
27. Prasarn, ML, Conrad, B, Small, J, Horodyski, M, Rechtine, JR. Comparison of circumferential pelvic sheeting vs the T-POD on unstable pelvic injuries: a cadaveric study of stability. Injury. 2013;44(12):1756-1759.Google Scholar
28. Littman-Quinn, R, Mibenge, C, Antwi, C, Chandra, A, Kovarik, CL. Implementation of m-health applications in Botswana: telemedicine and education on mobile devices in a low resource setting. J Telemed Telecare. 2013;19(2):120-125.Google Scholar
29. Lewis, T, Synowiec, C, Lagomarsino, G, Schweitzer, J. E-health in low- and middle-income countries: findings from the Center for Health Market Innovations. Bull World Health Organ. 2012;90(5):332-340.Google Scholar
30. Chanda, KL, Shaw, JG. The development of telehealth as a strategy to improve health care services in Zambia. Health Info Libraries J. 2010;27(2):133-139.CrossRefGoogle ScholarPubMed
31. Firth, P, Ttendo, S. Intensive care in low-income countries--a critical need. N Engl J Med. 2012;367(21):1974-1976.CrossRefGoogle ScholarPubMed
32. Aufderheide, TP, Nolan, JP, Jacobs, IJ, van Belle, G, Bobrow, BJ, Marshall, J. Global health and emergency care: a resuscitation research agenda- part 1. Acad Emerg Med. 2013;20(12):1289-1296.Google Scholar
33. Notrica, MR, Evans, FM, Knowlton, LM, Kelly McQueen, KA. Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg. 2011;35(8):1770-1780.CrossRefGoogle ScholarPubMed
34. Kwon, S, Groen, RS, Kamara, TB, et al. Nationally representative household survey of surgery and mortality in Sierra Leone. World J Surg. 2013;37(8):1829-1835.CrossRefGoogle ScholarPubMed
35. Zafar, SN, Fatmi, Z, Iqbal, A, Channa, R, Haider, AH. Disparities in access to surgical care within a lower income country: an alarming inequity. World J Surg. 2013;37(7):1470-1477.Google Scholar
36. Linden, AF, Sekkide, SF, Galukande, M, Knowlton, LM, Chackungal, S, McQueen, KA. Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg. 2012;36(5):1055-1065.Google Scholar
37. Chu, KM, Ford, NP, Trelles, M. Providing surgical care in Somalia: a model of task shifting. Confl Health. 2011;5:12.Google Scholar
38. Beard, JH, Oresanya, LB, Akoko, L, Mwanga, A, Mkony, CA, Dicker, RA. Surgical task-shifting in a low-resource setting: outcomes after major surgery performed by non-physician clinicians in Tanzania. World J Surg. 2014;38(6):1398-1404.Google Scholar
39. Hsia, RY, Mbembati, NA, Macfarlane, S, Kruk, ME. Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap. Health Policy Plan. 2012;27(3):234-244.Google Scholar
40. Yang, A, Farmer, PE, McGahan, AM. “Sustainability” in global health. Glob Public Health. 2010;5(2):129-135.Google Scholar
41. Sixtieth World Health Assembly. WHA60.22. Health Systems: emergency care systems. http://www.wpro.who.int/mnh/A60_R22-en.pdf. Published May 23, 2007. Accessed April 4, 2014.Google Scholar
42. Sethi, D, Subramanian, S. When place and time matter: how to conduct safe inter-hospital transfer of patients. Saudi J Anesth. 2014;8(1):104-113.Google Scholar
43. Mock, C, Lormand, JD, Goosen, J, Joshipura, M, Peden, M. Guidelines for essential trauma care. Geneva: World Health Organization Web Site. http://whqlibdoc.who.int/publications/2004/9241546409.pdf?ua=1. Published 2004. Accessed April 4, 2014.Google Scholar
44. World Health Organization. Tool for situational analysis to assess emergency and essential surgical care. WHO Web site. http://www.who.int/surgery/publications/QuickSitAnalysisEESCsurvey.pdf. Published 2009. Accessed April 4, 2014.Google Scholar
45. Solis, C, Leon, P, Sanchez, N, et al. Nicaraguan surgical and anesthesia infrastructure: survey of Ministry of Health hospitals. World J Surg. 2013;37(9):2109-2121.Google Scholar
46. Kwon, S, Kingham, TP, Kamara, TB, et al. Development of a surgical capacity index: opportunities for assessment and improvement. World J Surg. 2012;36(2):232-239.Google Scholar
47. Taira, BR, Cherian, MN, Yakandawala, H, Kesavan, R, Samarage, SM, DeSilva, M. Survey of emergency and surgical capacity in the conflict-affected regions of Sri Lanka. World J Surg. 2010;34(3):428-432.Google Scholar
48. Osen, H, Chang, D, Choo, S, et al. Validation of the World Health Organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World J Surg. 2011;35(3):500-504.Google Scholar
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