Improving access to healthcare is a primary element of GE’s healthymagination strategy. In 14 countries across the developing world, GE’s signature program, Developing Health Globally™ (DHG), is doing just that for some of the world’s most vulnerable people. This philanthropic effort combines the best of GE’s people, processes and technology to improve care delivery at district-level hospitals (WHO level IV facilities) in partnership with national ministries of health.
The case for emergency medicine
In underserved areas across the developing world, community health awareness is low and preventive primary care is virtually nonexistent. When illness or injury strikes, it is only after local home remedies and traditional medicines are exhausted that rural villagers venture to seek care at a health facility. Assuming transport is available, the costly and tiring journey takes its toll on the sick patient. Tragically, the treatment available at district-level facilities is often less than what’s needed to avert permanent disability or death.
The most common types of care administered at rural district hospitals are treatment of maternity cases, acute illness and trauma. As road infrastructure improves and motorized transport spreads through rural landscapes, trauma casualties caused by road accidents, in particular, rise. It’s no surprise, then, that the casualty ward is often the busiest place in these facilities. However, more often than not, this access point in the health system isn’t capable of delivering effective triage and treatment.
Historically, global public health efforts have focused on selective programs to address priority diseases or care areas, largely ignoring the need to develop and strengthen underlying national healthcare delivery systems. As a result, the basic elements of emergency care have yet to be addressed in a comprehensive way by many developing countries. The DHG program has addressed this issue by focusing on upgrading technology and skills, especially in the area of emergency medicine, at district-level facilities.
In Ghana, GE has a long-standing partnership with the Ministry of Health. Through the DHG program, this has yielded upgrades in medical equipment and infrastructure for 10 district-level facilities. Basic medical equipment was introduced—patient monitors, ultrasound, ventilators, suction and oxygen-production units—to make the casualty wards functional. Training and coaching was provided for clinical staff, to ensure the new equipment was used productively and to build staff confidence with the new technology.
To further drive focus on triage and emergency care in Ghana, DHG added Columbia University’s medical and public health expertise to the partnership, and championed the creation of triage and treatment protocols, processes and supporting tools appropriate for the local casualty ward context. Simple procedures—like capturing vital signs to identify critical cases—were combined with better access to medicines and a formalized triage protocol that empowered the staff to prioritize and treat urgent cases before addressing routine needs. One year after implementation at Kintampo District Hospital in northern Ghana, the selected demonstration site, patient wait time had dropped by more than 50%—nearly 3.5 hours less than originally observed—enabling critically ill patients to get faster treatment. Overall impact on patient outcomes continues to be monitored.
In 2011, the Kintampo District Hopsital was formally recognized as Ghana’s center of excellence for emergency care by its peer facilities across the country. A second demonstration site has been created in Ashanti-Mampong Hospital in central Ghana, and the Ministry of Health is actively seeking to implement emergency medicine protocols and training across the national health system.
Acute respiratory illness in children
As progress was taking place in Kintampo’s casualty ward, a troubling observation emerged. Frequent cases of pediatric acute respiratory distress were commonplace, the result of severe pneumonia, malaria or sepsis. Combined, these three diseases account for 37% of deaths in children under the age of five globally. The district lacked the means for successful treatment, meaning young patients often succumbed to respiratory fatigue and, ultimately, death, while medical staff stood by, helpless to intervene.
One modern medical treatment, intubation and ventilation, required more skill and technology than was readily available, and greatly increased infection risk for young patients. Taking an alternate approach, the DHG program funded the evaluation of a less-invasive treatment method using n-CPAP (nasal continuous positive air pressure) for children in respiratory distress. N-CPAP opens the lungs with constant air pressure, reducing the work of breathing and improving blood-gas transfer. It provides breathing support while the underlying disease is being treated, effectively acting as a “bridge to therapy.” The 12-month study, conducted by Columbia University, showed the treatment to be so effective in reducing respiratory depress rates that the trial was stopped midway and the therapy was applied universally.
The local intervention yielded significant immediate benefit: 17 casualty-ward nurses across four sites received training and successfully applied n-CPAP to pediatric patients. Simple technologies (n-CPAP and vital-signs monitoring) appropriate for a district-level hospital were successfully implemented in place of invasive ventilation. Healthcare providers have gained new skills and now effectively recognize and manage pediatric patients with respiratory distress, using these tools. Most important, casualty-ward nurses are confident in their new capacity to help struggling young patients survive.
Moving forward to influence practice
In the n-CPAP study, the treatment was effective regardless of the underlying cause of respiratory distress (pneumonia, malaria or sepsis). This was an unexpected discovery, and holds promise if the treatment can be linked to a reduction in the under-five mortality rate. GE has recently partnered with Columbia University and Ghana Health Services to determine whether the use of n-CPAP decreases the number of deaths in children who receive it. Building on the prior findings, the n-CPAP mortality study has the potential to achieve a sustainable solution for the technology and treatment gap that persists in rural Ghanaian hospitals and across much of the developing world. By empowering local healthcare providers with the right combination of technology, clinical training and education, there is great potential to dramatically improve the quality of patient care in rural Africa.
Learn more about Developing Health Globally.