Training, the Beginning of Change (Ojalá)

Finally, after hours of waiting for ambulances to collect information, getting sick, struggling through Spanish, multiple attempts with the Ministry of Health to get the correct permission, and months of trying to make the correct contacts, we were able to see some of the payoffs for our research. I am not saying our research is done by any means, but on Monday, we taught our first class of EMS professionals...and it felt great. We were actually a little taken back by how eager most of them seemed to be at the training. As a seasoned paramedic told us, he had never previously received instruction regarding standardized communication when transferring a patient to the hospital. In fact, many people we spoke to during the training commented that they wished for more training opportunities like this. Looking back on the mandatory trainings I have attended (e.g. HIPAA), I have never really been eager to go, let alone ask for more. I was impressed by their general interest and passion for their field. For the first time in Ecuador, it finally felt like what we were doing could make a positive, long-lasting impact. It might actually stick.

For the next week, we (Dr. Martinez, Dr. Salamea, LATE students, and VCU students) taught two hour-long sessions a day about MIVT, while the class (about 35 people in each) stayed for another two hours to learn about proper radio protocol, and how to organize a trauma scene. As the Ministry of Health posted on their Facebook page, the training consisted of "337 participants of the MSP, Red Cross, Firemen, IESS and Sis-ECU 911." Essentially, the training included all of the pre-hospital providers in the third largest city, and medical Mecca, of Ecuador. Our presentation included the pathway of communication in the Ecuadorian pre-hospital system, stressed the importance of their role in transferring the patient using MIVT, presented our data from the previous weeks, ran through assigning a Glasgow score, provided a real example of poor communication, and finished with an exercise that allowed the class to use their newly approved MIVT cards to present to a partner as if at the hospital.

MIVT, or IMLST in Spanish, approved by the Ecuadorian Ministry of Health. We designed the card based on MIVT protocol and information requested by receiving hospitals as determined by a previous ITSDP project. The card was designed to fit in with their ID cards--to be readily available. 

The class using their new MIVT cards to work through the exercise.

Now for a bit for the pessimist inside me. I have been wary of that "special summer project" where that ambitious, naive person travels to a developing nation to build a well for a community in need, when in a year, the machinery breaks and the project is rendered useless. The person leaves the village that year with some amazing photos, a fun experience, but in the end, did nothing to help the community in the long-run. That is exactly how I did NOT want this project to go. Working with Dr. Martinez and the LATE students has calmed that fear regarding this project. Pepe, Emmy, Caro and Fernando, the LATE students, taught so well and have proved their commitment to the project (even during their finals). Dr. Martinez was incredible. He drove home many of the points as we taught, and with years of experience with emergency medicine, he related well with the EMS personnel. Some doctors in South America (or anywhere for that matter) may come off at times as haughty and hard to work with, but he was just the opposite of that. His humble character allowed for open discussion, yet commanded respect from the listeners. It was clear that he is motivated to improve his community...even without proper compensation for his efforts (he is not getting any special bonuses for helping with the research and training). On the other hand, it appeared that the majority of the classes truly appreciated the training and took it seriously. I am sure more training will be due in the future, but I feel it is a great start for change. I think the future of this work is in good hands. 

Caro and Emmy introducing MIVT.

 Instruction by Dr. Martinez with Mark and Pepe. 

As my travels throughout the world have taught, you can find people everywhere that are intelligent, competent, and motivated to improve their own communities. I am grateful for the people of Cuenca for allowing me to experience their health system first-hand, for the many lessons learned, for the friendships made, and for the hope that my short time there performing this research may have lasting implications for good (even if it was just a small mark). 

I will never forget the ambulance ride-along with Leonardo and Victor to the "top" of the Andes. It was great to run into many familiar faces at the training.