Introduction of WHO BEC course for nurses at Bugando Medical Center in Mwanza, Tanzania.

Introduction: The Basic Emergency Care (BEC) course is an open-access training designed for frontline providers in low resource settings which focuses on recognizing and managing emergent conditions. This study describes the implementation of the BEC course for nurses at Bugando Medical Center (BMC) in Mwanza, Tanzania in March 2020 as part of an educational initiative to improve nurses' knowledge and confidence in providing emergency care. Methods: This is a 2-week educational intervention with pre-post measurements. 12 nurses (cohort 1) received BEC training from in-country facilitators over the course of 4 days. A training-of-trainers (ToT) course followed immediately and the 5 newly trained facilitators then taught the BEC course to 12 additional nurses (cohort 2). Pre- and post-BEC knowledge was assessed with a standardized 25-question multiple choice (MCQ) exam; confidence levels were evaluated using a 4-point Likert scale survey; and qualitative feedback obtained was examined by thematic analysis. Results: 24 participants completed the BEC course, 5 of which completed a ToT to become BEC facilitators. For the combined group, knowledge assessment scores improved significantly from 63.8% to 85.2% with a mean difference of 21.5% (t(24)= 9.3, p<0.0001). Similar improvements were seen when cohort 1 and cohort 2 were analyzed separately. Analysis comparing the results across different demographic groups demonstrated a significant improvement in post-course score for each group. Confidence levels increased significantly across all domains. Main qualitative feedback themes were: quality of teaching; method of teaching; applicability of training to daily nursing practice; more time allotment; and the need to expand the course to other healthcare providers and to rural sites. Conclusion: Implementation of the BEC course at BMC led to an improvement in nursing emergency care knowledge and self-confidence. The course was well received and the ToT model was successful, giving the nurses the ability to train additional local nurses.

Risk factors for physician burnout: a perspective from Tanzania.

Introduction: while physician burnout has been studied in high-income countries, more research is necessary on burnout in lesser-income regions such as Tanzania. This study aimed to determine levels of burnout in Tanzanian physicians and to understand the contributing risk factors for burnout in this region. Methods: the Maslach Burnout Inventory (MBI-HSS) was adapted to assess burnout in Tanzanian physicians. Utilizing a cross-sectional design, we studied two distinct cohorts: 1) Emergency Medicine (EM) trained physicians in Tanzania and; 2) specialists at Bugando Medical Centre. We surveyed demographic, personal, and workplace data to identify risk factors for burnout. Results: seventy-seven percent (30/39) of Tanzanian EM providers and 39% (37/94) of Bugando specialists completed the survey. We identified burnout in 67% of Tanzanian EM providers and in 70% of specialists at Bugando. Burnout risk factors in EM physicians included dissatisfaction with career choice, considering switching institutions, working in an urban setting, inadequate coverage for emergencies/leave, and financial housing responsibilities. In Bugando specialists, risk factors were unnecessary administrative paperwork, working overnight shifts, pressure to achieve patient satisfaction or decrease length of stay, meaningful mentorship, and not having a close friend/family member die. Conclusion: this study reports a high prevalence of burnout in Tanzanian physicians. Risk factors for burnout were multifactorial but mainly related to institutional and workplace constituents. Targeting these risk factors provides opportunities to boost physician wellness and guides important areas for future research in this African region.

Recognition and Management of Pediatric Sepsis in a Resource-Limited Emergency Department in Mwanza, Tanzania: A Qualitative Study.

OBJECTIVE: The World Health Organization aims to reduce worldwide under-five mortality rates (U5MR), with a focus on resource-limited settings (RLS). Tanzania reports a mean U5MR of 54 per 1000 live births, largely due to treatable infectious diseases that may lead to sepsis, accounting for 40% of the under-five deaths. Bugando Medical Centre in Mwanza, Tanzania represents a resource-limited setting in Sub-Saharan Africa and estimates a 14% pediatric mortality rate. We sought to better understand provider experience in recognizing and managing pediatric sepsis in the emergency department (ED) at Bugando Medical Centre in Mwanza, Tanzania. METHODS: We conducted a qualitative study with a purposive sampling of 14 Bugando Medical Centre ED providers from January to February 2019, via minimally structured interviews, to identify factors influencing the recognition and management of children presenting to the ED with concern for sepsis. Interviews were conducted in English, audio recorded, and transcribed. Data saturation determined the sample size. Three primary coders independently coded all transcripts and developed an initial coding list. Consensus among all authors generated a final coding scheme. A grounded theory approach guided data analysis. RESULTS: We achieved thematic saturation after 13 interviews. Responses identified patient-, provider-, and health care system-related factors influencing sepsis recognition and management in children presenting to the ED. Patient-related factors include the use of traditional healers, limited parent health literacy, and geographic factors impacting access to medical care. Provider-related factors include limited knowledge of pediatric sepsis, lack of a standard communication process among providers, and insufficient experience with procedural skills on children. Health care system-related factors include limited personnel and resources, delayed transfers from referral hospitals, and lack of standard antibiotic-use guidelines. CONCLUSIONS: This qualitative study identified patient, provider, and health care system-related factors that influence the emergency care of children with suspected sepsis in a quaternary hospital in Mwanza, Tanzania. These factors may serve as a framework for educational opportunities to improve the early recognition and management of pediatric sepsis in a resource-limited setting.

An International Virtual Classroom: The Emergency Department Experience at Weill Cornell Medicine and Weill Bugando Medical Center in Tanzania.

Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers.We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration.The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.