Capacity Building in EMS

Integrating EMS into the Developing World: Botswana

Dumelang bomma le borra! Ke bidiwa… Tshireletso Kgamane, ke moithaopi

wa Peace Corps! Le tsogile jang? I also go by Marshall

Pele ga Peace Corps…

Work Paramedic for 10 years “Street Science” author for JEMS.com EMS research

Education Certificate in Public Health (U of M) B.A.S. – Emergency Health Services (U of

M) A.S. – Emergency Health Services (IHCC)

Ke itumetse go go bona! A re ithuta ka Botswana… akere? A little bit about

Botswana: Home to the Tswana

people:▪ One person: Motswana▪ Two or more: Batswana

Population: ~ 2 million Located in Sub-Saharan

Africa - about the size of Texas

Capital: Gaborone Major languages: English

(official), Setswana (official), iKalanga, Sekgalagadi, and a few others

Attractions: Kgalagadi Desert, Okavango Delta, Chobe National Park

Ka Mahalapye

Large village of ~45,000 Located on the A1 highway District Hospital with an EMS

attachment 18 EMS staff members▪ 2 Nurses▪ 3 EMTs (Training in South Africa)▪ 13 First Responders

2 Ambulances

So what’s it like in Bots?

A little more of Bots…

So where does EMS fit in?

• Trauma:• Road traffic accidents• Burns• Assaults – including stabbings

• ~ 18,000 kilometres of road• ~ 6,000 paved• ~2,000 unpaved

• ~9,000 kilometres of District Council Road

https://www.cia.gov/library/publications/the-world-factbook/fields/2085.html

The RTA… a major pain in the neck

2007 2008 2009 2010 20110

5000

10000

15000

20000

25000

Motor Vehicle Crashes and Injuries - 2007 to 2011

AccidentsCasualties

Alright… now you’re killing me

2007 2008 2009 2010 20110

100

200

300

400

500

600

Immediate Death Due to Motor Vehicle Crash - 2007 to 2011

Immediate Death

The rubber hits the road…

Botswana Road Traffic Statistics

2007 2008 2009 2010 2011Fatalities per 100,000 population 24.85 22.75 23.75 19.85 24.15

U.S. Road Traffic Statistics

2007 2008 2009 2010 2011Fatalities per 100,000 population - 12.31 11.05 10.67 10.42

Why all the wrecks?

Contributing factors to the RTA: Roaming animals Driving under the influence High rates of speed

Quick – call an ambulance!

Ok… so they aren’t all that bad.

Alright – EMS comes to Bots 2013 – National EMS is rolled out in

three pilot sites Gaborone Mahalapye Francistown

2014 – Six more sites are being introduced

But there are problems… Frameworks

Legislative Operational Medical

Lack of training 1 institution provides

the training Continuing education

Infrastructure Communication

systems Roads

Leadership Government officials

from the Ministry of Health

Experienced EMS professionals

Understanding Stakeholders Health care workers The public

Whoa – where do you start!? Grassroots capacity building

Give people the tools to do their job▪ Information Technology▪ Organizational skills▪ Critical thinking exercises

Education Health care workers Public safety workers The public

Give a man a fish and feed him for a day. Teach a man to fish and feed him for a lifetime.

Lending a helping hand

Once a week lectures on various topics Including simulation

Data analysis Providing consultation on service

improvement

Still… challenges exist

Lack of resources Training only occurs one day a week Understaffing

Trained staff Experienced staff

The future…

Working to help develop and influence: National policy Operational frameworks Medical guidelines Monitoring and Evaluation

Think Peace Corps is for you? Then it probably is…

Either a bachelor degree or 10 years experience in your field

Be committed to 27 months of service Have an open mind Resiliency… but that’s no problem