Emergency Medicine in Colombia

- Then we would like to share with you the experience from Colombia about emergency medicine. Next slide, please. We are going divide this presentation in two. I'm gonna share with you the progress of emergency medicine, and Luz is going to show you the challenges we have now. Next slide please. I think everyone knows how was Colombia in the 1980s and 1990s. This was a picture from Rolling Stone Magazine from 1989. This was our emergency department. One of the many departments where I was from like an emergency physician. And this is now. Next slide, please. This is now what we're doing in emergency medicine. Well, it's been more than 30 years, but emergency medicine grew up like in a difficult way. In the 1880s and 1890s, the emergency departments were managed by internist and general surgeons attending trauma. The emergency medicine was not recognized as a specialty, more or less until 1998 when some of the surgeons, one of them, Nando Rojas, broke from the United States the idea of founding the emergency medicine specialty. Next slide, please. From 1996 until now, this, our faculties, our emergency departments are managed right now by general practitioners, but in every department in main cities, the emergency physician plays an important role like a leader. And these are the four cities where is centralized the emergency medicine in Colombia. Right now, there are like three or four universities that are initiating this specialty. This is from a study. I think Dr. Andres Patino was one of the authors. Next slide, please. In education, we, in the past 10 years, have brought to residents, some of the initiatives like Pocus, Pocus is really young in Colombia. Resuscitation and other strategies that we learned from another countries like the United States, French, I'm sorry, France, United Kingdom, et cetera. Next slide, please. I'm sorry. I'm very, I'm really nervous. Some of our schools are now starting to work in innovative procedures like REBOA and ECMO. We have in our country, like five or six ECMO centers that have a great experience. And this is one of the main centers on the country. This is from hospital Valle del Lili in Cali. They are pioneers in REBOA in the country. Next slide please. Now Luz Adriana is going to share with you the challenges we have as country in emergency medicine. Thank you very much.

- Hi, next slide please. Next slide. Can you press please? Well, when I think about the challenges that emergency medicine has to face right now in Colombia, I think that in our country, that remote regions, that lack of economic resources has lack of access roads, sometimes they even have to cross in small boats to get by the river. They have poor governance, medial health system. They are really far away from the main cities. So the primary care over there, it's really, really bad. I think emergency medicine has to think about that sort of things right now because we have population that has, they live in some that has a lot of somatic places. They have chagas, malaria, dengue, a lot of diseases that cannot get the proper healthcare or medical care because of the lack of resources, the lack of infrastructure, all that kind of stuff. That makes our, there are these places in our country that has a year, they last eight years less. This slide is to show you some data that put us in context. Years of potential life lost by department compared to the city of Bogota. If you are in the capital city, you can live eight years more. That means that if our primary care in that other part of the nation, like I show here in the slide, so it's lower, a lot lower. Next slide please. Next slide. Okay. Part of the problem is that the human resources, like doctors, nurses, they are not going to that places because of security, low income salary has very bad. So we don't go there. We don't live there. Neither do general doctors. So there are, like I showed, in this slide, the number of doctors and nurses per 1000 inhabitants per department. It's really low in this area compared to Bogota that has 6.2 other places like Choco, it's just 1.2. So it's not enough personal medical care over there. Next slide. And in other countries they have a better, for example, Cuba has a lot of factors because of the faculties. But look, compared to other countries, Colombia is still there, given, like we say here, given the fight. But still we lack of these medical nurses and doctors and nurses in those places. So next slide. I think emergency medicine has to take care of the primary care. We are part of the primary care, the emergency department, all the consultants, all the patients that we have need primary care and we are responsible of improving that. So the idea is to consider the possibility that our residents go there and educate, train the doctors, train the nurses. Because of the places and the income, there's no way we go and live there. But if we spend some time, like lay the problem on the table and show that there's the need for improve the primary care in the emergency department, we right now have some strategies like the leading lab. And if the doctor has some doubts, he can call this program and he will put on telephone and emergency medic physician that will see the medical record and talk directly to the doctor that is attending the patient and can give them some advice and tell if the patient needs or not referral. Because it sometimes it means explain both that kind of stuff. So if it's necessary or not, that the patient is needed to be taken to them to another city to refer. So it helps, but I insist that it's very educate to solve them the problems. It's better than train them so that with the lack of resources, they do their best job giving this emergency primary care. Also, there's an infrastructure problem. We have not enough hospital beds. These slide shows that bed density per 1000 inhabitants, it's really low in some places like Vaupes, these are remote regions that has a lot of indigenous population. The lack of you know, vaccine, vaccination. The lack of, in healthcare. So this next slide please. This also, you know, put the thing very difficult for us. There are 347 municipalities that don't have adult hospitalization services. So what are they doing? I ask myself how they do with their sick patients. 183 municipalities do not have emergency services, don't have the services. Next slide. And 305 municipalities in the country do not have delivery room. So how do they care the mothers, take care of the mothers and the babies. So this social and economic and infrastructure makes the primary care a really, really big problem for us in this kind of region. And the presence of group outside the law makes everything even worse. Sometimes they cannot move because of the security and the risk that means going someplace to another in this, the lack of governance and the police presence is not enough. So sometimes they want to go, they need to go and they cannot because of security. So the access of them to the healthcare is pretty, pretty, pretty low. So I think as emergency physician, we should contribute to improve that primary care to train the doctors, to train the nurses, and to make our residents see the problem, go there, help use it as a practice of teaching and practicing of that other part our work. When we don't have what we need, we don't have all the resources. So that is really, really needs training also. So that's the proposal and that's what I think we should improve right now. Thank you.