UK Global Health Projects, Programmes, and Research
Dr Jade Hanley / FY2 Doctor / University Hospitals Birmingham, UK
GECCo (Global Emergency Care Collaborative) have been hosting conferences for the last three years and they get more impressive each time. GECCo describe themselves as neither a who nor a what, but rather as a way of connecting those involved in emergency care with an interest in global health.
Who are GECCo?
GECCo is a network of emergency clinicians (doctors, nurses, ACPs and others) from the UK and beyond, who are actively pursuing global health projects and seeking ways to advance the quality of this work. They believe that striving to deliver excellent emergency care in the UK, and our projects to achieve the same on a global scale, needn’t be in competition, that, in fact, there are many synergies to be found and capitalised on. This is what makes GECCo so exciting. They represent a forward-thinking, problem-solving mentality, combined with an ethos of equity in global emergency care. Who wouldn’t want to join that party? I certainly did, so off I went to Edinburgh, for a dose of fresh ideas, inspiration and, I hoped, new connections. The theme of this event was UK global health projects, the who’s who and what’s what of an environment that can be difficult to navigate given the tangle of government bodies, international organisations, NGOs and others who operate in this space.
The day kicked off with an introduction by Dr Anisa Jaffar, a founding member of GECCo, Higher Emergency Medicine trainee, and NIHR Clinical Lecturer at the University of Manchester’s Humanitarian and Conflict Response Institute. I’ve met Anisa at previous GECCo events and her energy and presence encapsulate GECCo’s ‘ask-good-questions-and-get-stuff-done’ vibe. She’s sharp, practical, great with a crowd, and set the tone for a day packed full of fascinating people doing exciting and important things.
Dr Ram Vadi, Health Director of UK-Med, gave a brilliant talk on UK-Med’s response to the devastating earthquake affecting Turkey and Syria in February 2023. He shared UK-Med’s approach to mobilising a team, as well as some of the challenges presented by the (very necessary but at times cumbersome) legal structures which surround deploying an emergency medical team (EMT). Countries wishing to welcome the support of international EMTs are required to put out a formal invitation, to which interested EMTs respond with an offer of support which must be formally accepted by the host country before the EMT deploys. Following the Turkey-Syria earthquake, UK-Med felt that, based on their experience, provision for primary care, obstetrics and paediatrics would be a critical part of any response, due to the disruption to normal services and the evacuation of many local doctors from the area. However, the government officials who were coordinating the response were focused almost exclusively on emergency care. Working through this difference of opinion took time, and required clear and efficient communication to mount a timely and effective emergency response.
Next was an update on the Royal College of Emergency Medicine’s (RCEM) current global emergency medicine activity from Victoria De Witt, Senior International Officer at RCEM. Victoria introduced RCEM’s new Visiting Observer Fellowships, in which emergency medicine clinicians from low- and middle-income countries (LMICs) visit UK clinical centres with the aim of exchanging good practice and developing knowledge. RCEM are now also offering Global Health placement grants to RCEM members and fellows based in the UK. These grants provide the opportunity to spend time in LMICs to support the development of Emergency Medicine as a specialty in the host country. RCEM encourages applications from Emergency Medicine clinicians at all levels of experience, whether trainees or consultants. Projects or placements that are working towards sustainable goals are preferred. This year’s application round has closed but application forms for next year can be found on RCEM’s website.
Following a quick coffee break, GECCo introduced their new idea in conference organisation, the ‘concept carousel’. Think poster presentation meets speed dating. Eight presenters with their posters had two minutes each to share a headline summary of their research, followed by a further few minutes for questions. Given the varied and collectively vast global EM experience in the room, this made for some excellent discussions. Adventure Medic’s very own Dr Alex Taylor presented her recent work with the Tshemba Foundation in Mpumalanga, South Africa, where she worked with the local emergency department to further develop their systems. Another highlight was the work of Dr Eleanor Broad, Global Emergency Medicine Fellow based in Manchester, on what we can learn in the UK from international approaches to tackling inequality in child health services.
Next, attendees were treated to a keynote speech full of compassion and the insights of a long career, by Professor Tony Redmond, Professor Emeritus of International Emergency Medicine and founder of UK-Med. Professor Redmond shared what he has learnt from a career that has played a significant role in how International Emergency Medicine is practiced today. He stressed the importance of humility and the pursuit of true equity. International crises are not a time for honing skills or taking professional leaps, he reminded us. They are a time for expertise and the utmost professionalism. He also addressed one of the sticky areas of International Emergency Medicine, why do we do it? Is it because we are motivated by social justice? Or is it because it feels exciting? Probably a combination, he reflected. He encouraged us all to be honest with ourselves about our motivations. It is only in doing so that you can keep these motivations in check, and aligned to what must be the ultimate goal, providing the best possible medical care to those in need. It’s okay to find this work exciting, he said. But excitement must never be the goal. This was an important reminder and grounding principle for the day.
A second fantastic keynote was delivered by Dr Ellen Weber, San Francisco-based Emergency Medicine Consultant and EMJ Editor. Dr Weber focused on approaches to performing high-impact, low-cost research in resource-limited settings. She emphasised the need for pragmatic approaches. She gave the example of randomised controlled trials, which are often not possible due to limited funding and available resources. However, the need for an evidence base is still absolute, so how can we go about it? Dr Weber has a longstanding relationship with a number of emergency departments in Tanzania and has supported many clinicians in conducting valuable research. Methods such as prospective cohort stories, and descriptive cohort studies, that are relatively time and cost effective can be incredibly useful, and highlight areas that warrant further investigation. Such studies addressing the aetiologies and outcomes of patients presenting with abdominal pain, and the utility of point-of-care serum lactate in predicting serious adverse outcomes, have produced knowledge that can guide practice and the allocation of resources.
The rest of the afternoon was spent in interactive workshops, including ‘Urgent care of poisoning & envenomation in West Africa’ by Professor Michael Eddleston and ‘The cHALO programme for emergency care training in Pakistan’ led by Dr Taj Hassan. These small group workshops gave participants the opportunity to take a deep dive into these specific areas, as well as ask questions and exchange ideas with the projects’ leaders.
To round out the day, Kevin Miles, Senior Lead for Global Fellowships in NHS England, introduced the audience to the NHS Global Fellowship Volunteer Programme. The programme is open to all doctors in speciality training for General Practice, Paediatrics, and ACCS in English deaneries, and aims to make a contribution to the improvement of health outcomes in rural and resource-poor communities. The programme supports fellows to use their skills during a 4-6 month deployment to a low-resource medical facility in one of several African countries, including Kenya, Malawi and South Africa. As well as aiming to support teams in the host country, the programme aims to bring benefit to the NHS as fellows return with enhanced clinical, leadership and decision-making skills. More information on the programme is available here.
The last speaker of the day was Professor Justine Davies, Institute for Global Innovation at the University of Birmingham, who presented her team’s work on access to quality care for injuries in LMICs. She stressed the importance of seeking to identify the ‘unknown unknowns’ with respect to the causes of delay in accessing medical care following injury. Using the ‘process mapping method’ and ‘three delays framework’, the team identified the critical actions and decisions required to access emergency care in Northern Malawi, as well as the barriers to doing so. Barriers included logistical challenges such as long journey times, compounded in some cases by poor road conditions, but also included individuals personal choices, such as preferentially visiting traditional healers. It was fascinating to see the potential of creative approaches to research methods and data presentation to illuminate barriers that once known can be addressed.
Thoughts over a drink…
After a long day full of interesting people and exciting projects, many attendees headed out into Edinburgh to continue the conversation over a drink. I personally came away reinvigorated and reminded of the privilege that it is to do this work, as well as a couple of new projects busier. If you love emergency medicine but the idea of limiting the scope of your practice to the UK makes you want to run for the nearest exit, check out GECCo, you might find it is exactly what you’ve been looking for.