When 911 doesn’t answer
If a motorist is hurt in a car crash in Mozambique, it is likely that the first person to tend to his or her injuries will be a bystander or a taxi cab driver.
EMS systems like those that exist in the United States to aid accident victims are “far beyond the reach of most low-income countries,” says Assistant Professor Scott Sasser, director of international programs in the Department of Emergency Medicine. “What they need are simple and sustainable strategies for improving pre-hospital care.”
While much of the attention in global health assistance is geared toward disease prevention and treatment, the World Health Organization (WHO) estimates that about five million people worldwide die from injuries each year—largely in developing nations.
In Africa, the leading causes of injuries are traffic accidents, burns, drowning, and interpersonal violence (including war and domestic conflicts).
Sasser and his colleagues, Assistant Professor of Emergency Medicine David Wright and Assistant Professor of Surgery Jana MacLeod, have received a $675,000 grant from the Fogarty International Center of the National Institutes of Health to establish an injury control program in Mozambique—a country of eighteen million on the southeastern coast of Africa.
“When I did ward rounds at the Central Hospital Maputo, I discovered that 60 percent of the patients we saw that morning were admitted with an injury-related diagnosis,” says MacLeod. “For the general surgeon in such an environment, up-to-date knowledge about trauma care is essential.”
WHO technical officer Kidist Bartolomeos 96MPH is stationed in Maputo, where she coordinates injury surveillance and epidemiology training.
“The largest need, as far as minimizing morbidity and disability, is access to care both at the scene of injury and at health facilities,” says Bartolomeos, a native of Ethiopia.
Through a partnership between Emory and Mozambique’s University Eduardo Mondlane, with support from the University of South Africa, medical faculty will be trained in public health, research methods, ethical principles, and safety promotion.
Sasser also is working with WHO and the City Council of Maputo to improve pre-hospital care within the city.
“Instead of buying fifty new ambulances that can’t be maintained, or providing advanced training that existing technology can’t support, we look at what can be done,” he says, such as teaching basic first aid to interested community members.
The Fogarty grant will support the training of ten fellows from Mozambique in trauma and injury control. Senior Associate Faculty Laurie Click 82N 89MPH, who teaches epidemiology at Rollins, is coordinating the fellows’ education activities and will be teaching distance courses in epidemiology and basic biostatistics.
“It’s a technological challenge,” says Click, who just returned from a trip to Mozambique to make sure the computers are set up. “I was humbled by their lack of resources contrasted with their enthusiasm to learn.”
Ultimately, the team will work with Mozambicans to develop a research center for injury control similar to Emory’s.
Sasser, who has been to Mozambique three times since June, says the key is “to be there. It takes a long-term relationship and building credibility, not going over there and saying, ’This is the way we do it in the U.S. and this is the way you should do it.’ ”—M.J.L.