Daily report
February 14, 2010
Kathleen Clem, MD, FACEP
Arrival to Ramallah, uneventful travel. Arrived to Royal Court Suites hotel without any adverse events. Waleed Abu-Gharbiyeh was our driver. He has an excellent sense of humor. He informed us he speaks 3 languages fluently – Hebrew, Russian, (but has never been to Russia), and English. He said Arabic doesn’t count. We were greeted by Dr. Jason Prystowsky and Orrine Singer – both from Loma Linda. Met with Flagship team members for debriefing evening meeting and beginning of orientation go Flagship project and key people I will be working with. A lot of manuals, assessments, and policies to review. I couldn’t get logged on to the computer, and jet lag overcame my determination to get through everything!
February 15, 2010
We were driven by taxi to the Flagship headquarters. The project is with USAID (US Agency of International Development) and the Palestinian Health Sector Reform. This is a 5-year initiative funded by USAID in close collaboration with the Palestinian Ministry of Health (MoH). I was introduced by Dr. Taroub Faramand the Chief of Party to the other team members and leadership.
We then went to visit to Nablus to one of the key hospitals – the surgical specialty Rafidia hospital. They have pockets of excellence with all of the latest in equipment, such as orthopedic joint replacement surgery, but the Emergency Department is too small, and is under-staffed. I was given a tour of areas specifically related to Emergency Medicine. The CEO of Rafidia Hospital, Samer Awantani led the tour. Issa Badnur served as interpretor and did an excellent job! Rafidia would be an excellent sight for a Palestinian emergency medicine residency-training program created and maintained in collaboration with LLU. PMC could be one of the key training sites for emergency medicine residents. Jason spent time in the ED observing directly while I met with hospital leadership to gain information for needs assessment to start emergency medicine training program and to learn more about emergency care at this hospital. There is obvious enthusiasm and understanding of the need for EM at Rafidia. They recognize the need and verbalize understanding of the positive impact this training would have for all of Palestine. Rafidia sees 4,000 ED patients/month. There is no boarding of inpatients in the ED. If there are no inpatient beds, they transfer the patient to another hospital. Triage is non-existant, as they do not have space. The patients come back to the main desk in the ED and are seen by a physician who decides what specialists need to see the patient and then consults them. Radiology read of CTs must be requested as a consult. Anesthesia does critical care transport for patients requiring medical care, as Rafedia is a surgical hospital. Rafedia Hospital leadership states the biggest problems for emergency care are space, triage, physicians and nurses trained for emergency care, and dedicated staff. They also feel that key equipment is not available. We were served a fabulous dessert made from sheep's milk cheese and honey – then made crisp on the outside – similar to creme’ brule- I’m guessing 500 cal/serving. Good thing that was all I had for lunch and breakfast!
We then went back to Flagship headquarters to prepare a report on triage for the MoH to be instituted at the newly built Palestinian Medical Complex (PMC) new Emergency Hospital. I have not yet been to this hospital and there is some confusion as to where the USAID should focus efforts. I am willing to work with whatever is proposed, but need clear guidance. It seems that so far the PMC is not yet ready to support a new training program and that partnering with Rafidia seems a more productive road for residency training.
We hired a driver to become real tourists today since today is my day off. We saw the garden of Gethsemane and where Jesus prayed, we saw where Jesus is believe to have ascended into heaven. We attempted to go to the Temple Mount, but it was closed to non-Muslims. Walking the Via Delarosa (sp) would have seemed like a more sacrad experience if we had not been bombarded most of the way by people trying to sell things to us. It was very crowded and people were pushing up against us most ofthe way. Taking a little rest now, then hope to see the Old City this afternoon.
ReplyDeleteI am continuing to concentrate on what is most needed in my role as technical consultant. My understanding is that the more generally applicable my recommendations are across Palestine, the more useful they will be to emergency care. We will work together as a team on the format and the recommendations and plan to put this together next before next Thursday when I leave. I spent the rest of the working day creating reports and documents.
ReplyDeleteSunday February 21, 2010
I worked on the internet and writing documents for the establishment of an EM residency, Train-the-trainer,Job descriptions, had a several hour meetings to consolidate plans and generate combined documents as he will be staying on after I leave and will need to implement much of what we are generating.
Monday February 22, 2010
In the morning Dr. Harry Gunkel and Medical Director of Rafidia Hospital and Director of Rafidia Hospital, Nablus for briefing on the functions of Medical Staff as it relates to the Emergency Department, residency training programs, and nursing. I then spent time consulting in the emergency department - seeing patients with the goal of better understanding the current practice of emergency medicine and the interactions between departments. We expanded differential on pediatric patients presenting with specific symptoms. Had conference call in the evening with Loma Linda Global Health leadership and Jason.
Tuesday, February 23, 2010
Had very important series of meetings with influential Palestinian healthcare leaders - all with a focus on starting the specialty of Emergency Medicine in Palestine. The first meeting was with the Head of the Palestinian Medical Council. He voices very strong enthusiasm for establishing the specialty of Emergency Medicine and he will be instrumental in approving the first emergency medicine faculty, leadership, and initial EM residents. Gathered detailed data that will be used to create the Master Plan for Emergency Medicine in Palestine. Next met with the Dean of the School of Medicine An-Najah National University. He explained the planned relationship with Lille University in France in establishing the EM training program. We then met with the Directoctorate for General Hospital served by the MoH.