IEMH’s Peace Through Health
In an effort to foster sustainable improvements in emergency medicine through collaborative partnerships forged around the world, the International Emergency Medicine and Health (IEMH) in BWH’s Department of Emergency Medicine has clearly established initiatives, all of which stress local leadership and systems development.
IEMH’s director is Mark A. Davis, MD, MS, an attending physician in the BWH Emergency Department and Assistant Professor of Medicine (Emergency Medicine) at HMS. The IEMH has five key program areas:
International leadership forums.
The IEMH is creating alliances among medical, government and civil leaders worldwide. Together, they assess and improve emergency response systems, prepare for individual crises or large-scale disasters, and find ways to make the best of resources at hand. These forums — often held in areas of political unrest — also work to promote peace. For example, the IEMH’s Peace Through Health program, funded by the U.S. Department of State, is helping to improve emergency systems and health conditions for parties to the Middle East conflict while enhancing understanding and collaboration.
Train-the-trainer programs.
In countries worldwide, IEMH is helping to train medical staff and village health workers with limited education, who then train thousands of local physicians, nurses and “first responders.” This fosters exponential growth in capabilities to meet medical needs and crises most relevant to the local environment — mass starvation, dehydration, tuberculosis, injuries and trauma, primary care for cardiovascular events, or specialized care for women and children. For example, IEMH is assisting the many developing countries that have no ambulance system, expanding local capacity by teaching police and other first responders simple but lifesaving techniques. Also among recent IEMH successes is a partnership in Ethiopia, where the IEMH is collaborating with Addis Ababa Medical School and the World Health Organization to create a new training program and develop systems to help prevent unnecessary loss of life. In Romania, the U.S. Agency for International Development (USAID) supports IEMH efforts to improve trauma systems and hospital care.
Residency and fellowship programs.
Postgraduate physicians in Emergency Medicine are doing research in international public health and directly alleviating human suffering in populations in distress. Whereas the traditional approach to international medicine is structured vertically within a system of well-defined specialties, the IEMH is shaping a horizontal approach — integrating the basic principles of all specialties into front-line emergency and primary care, a model that best serves countries with scarce medical resources. “The need is so basic, and we can save lives through simple educational interventions for front-line village workers that are very inexpensive,” said Davis. For example, while on an assessment mission in rural Ethiopia, IEMH fellow Miriam Aschkenasy, MD, came across a child who had fallen from a tree and suffered a displace fracture of the femur. Using a scrap of wood, she taught a technique of reduction and splinting of the long-bone fracture, saving the child’s life and educating the village health worker. “How many children die unnecessarily due simply to a lack of knowledge?” Davis wonders. The IEMH operates a successful two-year fellowship in international emergency medicine and health, with collaboration from the Harvard School of Public Health.
Exchange programs.
Health care providers from around the world are coming to Boston for intensive training in emergency medicine. American physicians also are learning emergency techniques from physicians experienced in responding to terrorism.
Research.
Understanding the particular need of each area and measuring the outcomes of intervention are top priorities. The IEMH also undertakes non-field-based research, such as studying the performance of emergency communications systems in New York City during the World Trade Center disaster.
The IEMH is located within the Department of Emergency Medicine, whose chair, Ron M. Walls, MD, shares innovative airway-management techniques worldwide. Other faculty include J. Stephen Bohan, MD, executive vice chair, who is teaching responses to trauma and prevention of domestic violence and injury in Romania, and Hilarie Cranmer, MD, associate fellowship director. Richard Zane, MD, vice chair of the department, leads efforts at BWH and Partners HealthCare to prepare for potential disasters. At HSPH, Jennifer Leaning, MD, SMH, also an attending physician in Emergency Medicine at BWH, teaches disaster management and response to humanitarian crises.
The IEMH’s strength is derived from the participation of many health care professionals, including physicians in various medical and surgical subspecialties. BWH nurses also are actively involved. “Our approach is multidimensional and highly integrated,” said Davis. “Both here and abroad, good systems and broad collaboration save lives.”
Walls adds, “Mark Davis has done an extraordinary job in getting the IEMH up and running so quickly and so successfully. There is no question that IEMH programs have already had a very significant impact on the health of people around the world.”