A becoming specialty – EM in Tanzania

We all pass through milestones of growth and every stage is a hurdle to the next, how we choose to view it is our own choosing. Imagine seeing it from a child’s perspective; a five-month-old wobbly reaching for a shiny new toy that seems just a grasp away, falls flat on his face cries then realises; ooh wait there is that shiny new toy again. Picks up from where he left off and with every advance sitting transforms to crawling.

Joshua Yonazi 2014
Currently doing her Paediatric Cardiology Fellowship

As a medical student, I had no exposure to Emergency Medicine as a specialty. We had an OPD that was functional 24 hours. Paediatrics was what I set my mind to do, and Dr. Stella Mongella, who remains a role model to date influenced a lot of what I am today in my timeliness and responsibilities. It was a see admire and try to become not her but myself in the best way I could. 

After completing my medical school, which is a five-year program, the next step was to go for my one-year internship training. I moved from a mostly public health facility to a private health facility. It was until 2014 when I was employed as a Resident Medical Officer at the Accidents and Emergency Department of the Aga Khan Hospital Dar es Salaam when I met Dr. Yash Dubal, an Emergency Physician who had just joined the hospital that same year. He had graduated from Muhimbili University of Health and Allied Sciences (MUHAS) and working with him is what made me realise what a becoming speciality Emergency Medicine is and in less than a year I decided to join the same residency program he had graduated from.

This three-year residency program is a core competency-based training in research, trauma, paediatric care, leadership skills, bedside ultrasound, recognition and treatment of toxicological, obstetric and medical emergencies. Offers elective exchange opportunities for residents to go abroad for observership as well as those from abroad coming to Tanzania. Muhimbili National Hospital first and the only hospital to date to have an Emergency Medicine Residency Program in Tanzania and first to have initiated an Undergraduate Emergency Medicine Rotation in 2014. Since the presence of this fully capacitated Emergency Medicine department, there has been great change in the delivery of services and outcome within the hospital and its graduates are part of regionalisation of emergency care in Tanzania.

To date there are nine health facilities with fully functional 24 hours emergency departments with Emergency Physicians available at; Muhimbili National Hospital, Bugando Medical Center, Kilimanjaro Christian Medical Center, Arusha Lutheran Medical Center, Mount Meru Hospital, Mbeya Zonal Referral Hospital, Bombo Hospital, Benjamin Mkapa Hospital and The Aga Khan Hospital. Development of EMS is in progress with basic ambulance providers, attendants and dispatch training complete.

Muhimbili National Hospital
Mbeya Zonal Referral Hospital
Benjamin Mkapa Hospital
Kilimanjaro Christian Medical Center
Emergency Medical Services
The Aga Khan Hospital Dar es salaam

Emergency Medicine is a Becoming Specialty with core values to safely deliver those critically ill and injured from the community to the acute care units for resuscitation, stabilization and transfer to specific units for definitive care.

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ICON360: Tracy Sanson – Full Interview – Audio

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

In this episode, we shared the full interview of Dr. Tracy Sanson. 

Who is Dr. Sanson?

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal. A frequent speaker for Emergency Medicine programs, Dr. Sanson also serves as a core faculty member for the American College of Emergency Physicians. Dr. Sanson has consulted and lectured nationally and internationally on administrative and management issues, leadership, professionalism, communication, patient safety, brand development, personal development, womenäó»s issues and emergency medical clinical topics for a wide range of health care organizations. Dr. Sanson’s experience spans 20 + years in Emergency Medicine Education and ED management and leadership development. She has held director positions in the US Air Force, University of South Florida and TeamHealth for the past 15 + years. Dr. Sanson trained at the University of Illinois at Chicago for medical school and her emergency medicine residency. She is well versed in leadership, patient safety and medical management issues having served on TeamHealth’s Medical Advisory Board, Patient Safety Office Division Director and faculty in their Leadership Courses. (resource: https://feminem.org/author/tracy-sanson-md/)

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

What every Med Student/Intern should know about EM

james-holliman

Rob Rogers

Joe Lex

C. James Holliman

Learn the secrets of Emergency Medicine from the fabulous four chapters prepared by three worldwide experts. Listen or read, but know these stuff as early as possible in your medicine/emergency medicine career.

iEM Weekly Feed 3

iEM world

Welcome to iEM Weekly Feed!

With this feed, you do not miss anything. You will find all published blog posts during this week. Click the “title” or “read more” to open each page you interested in.

Pulmonary Embolism

by Elif Dilek Cakal Case Presentation A 45-year-old female with no prior medical history presented to the emergency department (ED) with three days of constant shortness

Read More »

My Leg Is Swollen!

A New Chapter Is Just Uploaded To The Website! An 85-year-old woman, with a history of congestive heart failure, presented with right leg pain and

Read More »

Fall From Bicycle!

In case you didn’t encounter a child fallen from a bicycle today! Read “Multiple Trauma” Chapter Listen “Multiple Trauma” Chapter iEM Education Project Team uploads

Read More »

Left Flank Pain

In case you didn’t encounter flank pain today! iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images

Read More »

iEM Image and Video Albums

Uploading Image and Video Archive More than 350 images and videos are uploaded into iEM Flickr channel. Thousands to come… Uploading Image and Video Archive

Read More »

Is Troponin Enough?

You are the emergency doc working in a rural ED. It is the Saturday night at 23:25 and you have three patients with chest pain.

Read More »

Acute Heart Failure (AHF)

by Walid Hammad – USA Case Presentation An ambulance crew rushes into your emergency department (ED) with a 56-year-old man. He is severely short of

Read More »

I…can’t…breathe!

A New Chapter Is Just Uploaded To The Website! An ambulance crew rushes into your emergency department with a 56-year-old man. He is severely short

Read More »

A kid with wrist pain!

In case you didn’t encounter a kid with wrist pain today! Pediatric fractures affecting growth plate are classified with Salter-Harris classification. It is from I

Read More »

Managing Psychosis In The ED

Case 1.  It is a quiet Wednesday night in the emergency department when you suddenly hear someone coming down the hall continuously spouting out a string of profanities.  You leave the comfort of your chair to see what the commotion is all about only to find a 37-year-old female brought in by police for altered mental status.  She is acutely agitated on presentation, spouting obscenities non-stop, refusing to answer questions and uncooperative with a physical exam.

Case 2.  As you are pondering your next step, you see the paramedics wheeled an older gentleman past you and into the next room.  You step into the next room to get a report.  The family is at the bedside and states the patient is an 82-year-old male with a history of hypertension and BPH who has been increasingly confused and aggressive over the past two days.  You note that he is mildly tachycardic when you hear the PA system announce, “Security is needed in the critical care hallway.”

Case 3.  A nurse pops her head into the room and requests your immediate assistance.  You follow him down the hall and see your charge nurse along with three security officers trying to hold down a male patient.  The patient, who appears to be in his late twenties, is actively kicking and trying to bite and spit at the medical staff.  He appears flushed and diaphoretic.

by Michelle Chan, Nidal Moukaddam, and Veronica Tucci from USA.

A Kid With Wrist Pain!

In case you didn’t encounter a wrist pain today!

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

Happy week with tons of education!

Being A Woman In Emergency Medicine

being a women in EM

Gül Pamukçu Günaydın

Turkey

Watching the famous TV series “ER” in my 3rd year of medical school I decided to be an “ER doctor.” I started my Emergency Medicine residency in 2003. So this is my 15th year in Emergency Medicine. I have not regretted my choice yet, and I cannot imagine myself being anything else but an Emergency Physician.

Emergency medicine is indeed a fulfilling career choice for a variety of reasons: first of all, we are cool, we never panic over an emergency. Secondly, emergency medicine is never boring, every shift in the Emergency Department is filled with diverse cases waiting to be solved, like a puzzle. We treat patients in every age group with all kinds of chief complaints, and we hear all sorts of exciting stories. We are there for people who need us most, 24/7, on one of the worst days of their lives, regardless of their background and financial status. We bring patients who are near death back to life, and in every shift, we feel that we make a real difference.

Having said all this, I admit that the life of an Emergency Medicine physician is not a perfect fit for everyone. For example, although shift work is flexible by its nature and you have control over your schedule, shift work is not desirable to everyone. If you plan ahead shift work will allow you to take more vacations any time during the year but if something comes up last minute, there is a pretty good chance that you will miss it. Night shifts may easily disrupt your body cycle even if you follow the recommendations for sleep and it gets harder with age. Working weekends and holidays will mean missing some family gatherings or events at your children’s school and may make your social life difficult. On the bright side, you will always have free weekdays to run errands or catch up with friends on their lunch breaks. Although you do not bring work to your home, (when your shift is over you just pass your patients to another doctor, leave emergency department, and you are not on call) sometimes your shift is so physically exhausting and emotionally draining that you have little energy left for home.

If you are living in a culture where child raising, housework or care of the elderly is seen primarily as women’s duty, or you choose a partner that thinks so, you may have a harder time in life regardless of the specialty you choose as a woman. You may solve some of this issue by willing to accept all help you are offered from close ones and purchase help when necessary to share some of these duties. You may find fewer role models in Emergency Medicine compared to your male peers, but if you look carefully, you will recognize female or male leaders close to you, who understand the difficulties you face and offer you their mentorship.

When choosing any specialty, think about not just now but try to imagine what would make you happy in 10-20-30 years. Yes, being an Emergency Medicine specialist has its challenges and is harder in some aspects compared to other specialties, but I think most of the challenges are there regardless of being men or women. I also believe that with a little flexibility and creativity you can overcome the difficulties, so join us who find joy and feel content in the vibrant and exciting environment of emergency medicine.

Suggested Chapters

Choosing the Emergency Medicine As A Career

C. James Holliman

Emergency Medicine: A Unique Specialty

Will Sanderson, Danny Cuevas, Rob Rogers

Unbearable Attraction of Emergency Medicine

Where This Attraction Come From?

Emergency Medicine! It is maybe the most desired specialty all around the world. Countries are rapidly changing their systems to modern emergency medical care. Residency trained emergency physicians are the cornerstone of this change across the globe. Today, more than 65 countries have recognized Emergency Medicine specialty. The demand is still so big, and all systems are facing to Emergency Physician shortage. However, it is not the reason why thousands of students/interns apply for a single position every year. 

This summer many new Emergency Medicine residents will start their new career. They are the winners! They chose the best specialty ever. They chose to be the advocate for their patients. They chose the challenge themselves to save a life, many lives. 

Want to understand more “why?” We have 3 chapter to share with you. You may prefer to read or listen. Every medical student and intern should know these facts; the facts that make our specialty unique. 

Emergency Medicine: A Unique Specialty

Will Sanderson, Danny Cuevas,
and Rob Rogers

Imagine walking into the hospital to start your day – ambulances are blaring, the waiting room is clamoring, babies are crying…

Choosing the Emergency Medicine As A Career

C. James Holliman

The specialty of Emergency Medicine (EM) is a great career choice for medical students and interns. In August 2013, I celebrated my 30th year in full-time EM clinical practice…

Thinking Like an Emergency Physician

Joe Lex

Why are we different? How do we differentiate ourselves from other specialties of medicine? We work in a different environment in different hours and with different patients more than any other specialty. Our motto is “Anyone, anything, anytime.”