Bringing emergency care to Bolivia

Swaroop and her team teach local police and firefighters safe ways to roll, evaluate and transport patients

Swaroop and her team teach local police and firefighters safe ways to roll, evaluate and transport patients

It is easy to take for granted in the United States the advanced system of trauma care, especially here in Chicago.

If your were the victim of a serious car accident along Lake Shore Drive, for example, it is likely you would talk to a trained emergency medical dispatcher at 911, be quickly treated by professional paramedics, and rushed by ambulance to one of several Level 1 Trauma Centers (one that has trained staff ready 24 hours per day, specific medical equipment, specialists at hand, and other qualifications) within an hour. Once there, you would receive treatment in an emergency room, and, depending on your needs, have the option of surgery or a stay in the intensive care unit. A swath of nurses would attend to your needs, and, once stabilized, you would be privy to post-hospitalization and rehabilitative care. From beginning to end, you would be surrounded by a team of trained professionals and high-tech resources to guide you through your recovery.

This system of care does not exist in many countries, including Bolivia, which is home to a staggering number of fatal road traffic accidents each year due to its mountainous terrain and poor road conditions. In the country home to the Camino de las Yungas, the “world’s most dangerous road,” the trauma care system is severely underdeveloped and understaffed, with hospitals ill-equipped to handle serious accidents and limited trauma training for professionals

Accident victims in remote areas often have to wait hours for firemen to arrive from the city

Accident victims in remote areas often have to wait hours for firemen to arrive from the city

This is a problem trauma surgeon Dr. Mamta Swaroop of Northwestern Memorial Hospital wants to solve. Building from the ground up, Swaroop and her team have been working in conjunction with her students and the Bolivian Ministry of Health to develop a comprehensive trauma care system in the country. It’s no small task, but Swaroop focuses on the incremental steps that will lead to her eventual goal of developing such a pervasive system.

“You have to be able to get a big picture and see the forest for the trees,” said Swaroop, who is also an assistant professor at the Feinberg School of Medicine. “But without the trees, there is no forest.”

The first tree in Bolivia was the lack of prehospital care. Many injured patients cannot access an ambulance due to financial constraints or distance, even in areas where access is feasible. Instead, they often rely on taxi cabs, volunteer firefighters or simply Good Samaritans– most of whom do not have any medical training, including basic first aid– for transport to a hospital. By the time a patient arrives, it is often too late.

With this in mind, Swaroop and her team have been delivering first responder training at the local clinic and hospital level in villages that see the highest number of traumas, with the goal of eventually spreading such standardized training to the entire country. Since the course began in March of 2013, Swaroop, her colleagues and local health care providers have educated more than 700 nurses, hospital workers, firefighters, and even average citizens on how to best treat patients before they arrive at a hospital.

A view from the entrance of Hospital Arco Iris, including the hospital’s two ambulances parked outside the Emergency Department

A view from the entrance of Hospital Arco Iris, including the hospital’s two ambulances parked outside the Emergency Department

“If the current reality is that laypersons – taxi cab drivers, people in the village – first come to help out injured victims, it’s worthwhile to teach these laypersons the basics of trauma first aid,” says Dr. Christopher Richards, Associate EMS Medical Director at Northwestern Memorial Hospital’s Department of Emergency Medicine. Richards was brought onto the project by Swaroop for his expertise in prehospital care.

Determining these on-the-ground nuances, such as who responds to trauma and how trauma is perceived by citizens, is a vitally important prerequisite to any intervention, according to Richards. A 911 system, for example, doesn’t work if no one thinks to call it for medical care.  “It’s not something we take from here and impose there,” he said. “We can’t put the Chicago Fire Department’s trauma response structure into Bolivia and expect it to work like it does here.”

Instead, the team is working with the local population and government to thoughtfully develop reliable trauma care that holistically integrates prehospital, emergency, hospital care, and post-hospital care for patients.

“Ultimately, the end game is to make sure that trauma patients get the best care they can,” Richards said. “If that works, we’re saving lives and I think that’s a success.”

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