The COVID-19 pandemic is magnifying the limitations of African health systems – increasing the burden on frontline health workers and posing challenges for patients needing care.
In many locations across Africa, emergency care facilities are limited to nonexistent. Africa averages less than one intensive care bed per 100,000 people, compared with more than 20 beds per 100,000 people in the U.S., according to a recent assessment by Reuters. And equipment like oxygen and ventilators are in short supply.
Trained staff is limited as well. Africa only has a small number of emergency physicians, many of whom are both providing day-to-day patient care and playing leading roles in developing local-country COVID-19 response plans. Working alongside them are nurses and junior doctors managing emergencies every day, without access to dedicated COVID-19 training or modern equipment to address key patient needs.
Without reliable access to these vital resources, healthcare workers rely more than ever on their experience and knowledge to meet patient needs during the pandemic.
To help these dedicated experts fight the virus as it spreads across the continent, Abbott and the Abbott Fund are supporting the vital work of the African Federation for Emergency Medicine (AFEM) to reach 2,000 emergency care professionals who are on the front lines in 26 African countries. AFEM is using technology to broadly reach, educate and share solutions on COVID-19 care with these emergency experts — who will in turn share their knowledge with other healthcare providers operating in their local countries.
"Our main challenge with COVID-19 is the lack of clear and concise information that is appropriate for our settings, where patient numbers are high but staff numbers and resources are scarce," said Professor Lee Wallis, founder of AFEM. "Our goal is to address the most critical topics for our frontline workers, so they are better armed with tools and knowledge to treat patients when working with limited resources."
Emergency Education in a Digital Age
Through a grant to AFEM, Abbott is sponsoring a series of virtual training webinars scheduled weekly from April through November in multiple languages. Local specialists, WHO representatives, frontline providers and health leaders are volunteering their time to support the training, with Abbott employees providing technical support to host and coordinate the webinars.
During each webinar, AFEM and guest speakers share best practices and information about critical topics, such as testing protocols, personal protective equipment, triaging and treating patients, and maximizing limited resources.
Participants also gain important and timely insights from each other. Each week, a frontline provider shares the knowledge and lessons learned from their country's COVID-19 response, which may help colleagues whose health systems are at different stages of the pandemic. So far, providers from Ghana, Kenya, Namibia and South Africa have shared details of their COVID-19 response initiatives. And healthcare providers in the Democratic Republic of the Congo, who recently faced Ebola and measles outbreaks, are sharing their learnings with other countries.
"When equipment, staff and resources are in short supply, information and knowledge-sharing becomes even more vital," said Dr. Heike Geduld, AFEM Immediate Past-President, Head of Emergency Medicine at Stellenbosch University, and President of the College of Emergency Medicine of South Africa. "Ideas matter. Health workers across Africa are resilient and have tremendous experience in coming up with novel ways to adapt and overcome local challenges, and doing more with less. Our work at AFEM aims to empower the ingenuity of our colleagues, share their ideas across the continent via the AFEM network, and provide them with effective tools to cascade these learnings to other health workers at the local-country level."
Advancing Clinical Guidance
AFEM also is collaborating with the WHO and other leading emergency medicine societies to create targeted guidelines for COVID-19 emergency management, including clinical guidance on screening patients for the virus, and triaging patients to determine the appropriate interventions needed. By accessing its extensive network of African emergency care providers – physicians, nurses and other emergency personnel – AFEM will implement the WHO technical guidance and training materials across multiple countries.
Abbott's grant also will help fund the translation of these materials to ensure reach to English, French and Arabic speakers; the production of short instructional videos related to issues of COVID-19 care; and a technical support line that will be shared through social media channels, mailing lists and WhatsApp groups.
In addition, AFEM also is undertaking a 10-hospital pilot in Sudan, utilizing its strong implementation network there, to implement the COVID-19 guidelines and protocols to generate real-world data and experience. Based on learnings from this effort, AFEM will then scale up implementation across the AFEM network through remote training.
So far, the impact of Abbott and AFEM's collaboration has been very positive.
"The webinars and other resources are giving our workers critical knowledge they need to treat the daily influx of patients during this pandemic. And the pilot we're implementing here in Sudan holds great promise to further advance the COVID-19 response here and elsewhere," said Dr. Yasein Omer, an emergency medicine resident in Sudan.
Longstanding Work to Strengthen Emergency Medicine
Abbott's work with AFEM to help address COVID-19 builds on earlier work to advance emergency medicine.
For two decades, Abbott and the Abbott Fund have worked closely with the government of Tanzania to strengthen the country's healthcare system, including creating the first dedicated emergency medical facilities and residency program in Tanzania. The partnership designed and constructed an Emergency Medicine Department and equipped it with modern technology and supplies. Beyond infrastructure, a primary focus has been to empower a new generation of physicians, nurses and staff trained in providing best-in-class emergency care.
Today, the emergency room at Muhimbili provides critically needed care, regardless of ability to pay, for more than 60,000 people each year. The number of deaths at the hospital decreased by 40 percent within two years after the emergency department opened, saving thousands of lives every year.
In 2013, the Abbott Fund also supported the creation of the "AFEM Handbook of Acute and Emergency Care," which details strategies for emergency disease management in African clinical settings. The Abbott Fund supported the printing and distribution of more than 9,000 copies of the handbook, which were donated to clinical sites in 33 African countries. A second edition was released in early 2019.
Now, thanks to AFEM, emergency care workers are receiving COVID-19 resources and training specifically suited to their knowledge levels, local experience and access to treatment tools.
Abbott's work with AFEM is an example of how existing partnerships can help to provide a rapid, targeted response in times of crisis, filling critical gaps and providing essential support in resource-limited settings.
See the following examples for more details about how Abbott and the Abbott Fund are helping strengthen health systems in Africa:
Expanding Health Access in Rwanda
Elevating Healthcare in Tanzania
Pioneering Emergency Medicine in Tanzania