The State of Emergency Medicine in Ecuador

Ecuador is fast approaching its 30th anniversary of recognizing emergency medicine as a specialty. Within these three short decades, the country has achieved significant milestones in advancing the field of emergency medicine, including the development of a national EM society and implementation of post-graduate training programs. However, there is still much work to be done.  I was lucky enough to have a conversation with the ACEP Liaison to Ecuador, Augusto Maldonado, to learn of recent advancements of emergency medicine in the country. 

“Igual que todos los países del mundo, el rol los que responden inicialmente y la organización de los servicios de emergencia frente a esta emergencia de salud ha sido muy especial.”

The COVID-19 pandemic certainly affected the specialty in the scope of medical practice, as well as highlighted some of the limitations of the medical system that were already present. Following the global trend, emergency care providers came to the forefront of medical attention with the manifestation of the pandemic. Dr. AM says that many emergency departments were forced to adapt in the face of the pandemic, as some hospitals became designated ‘COVID hospitals’ requiring emergency departments to coordinate care for the remaining patients. For example, some emergency physicians suddenly found themselves providing postoperative care when patients would be transferred directly from surgery back to the emergency department. In other places, emergency departments were transformed into intensive care units, staffed by emergency physicians. Dr. AM explains that the COVID-19 pandemic has given the specialty the push it needs, stating “ . . regarding the issue of the pandemic, it really has given us a very big boost as a specialty and I believe that to the authorities it is now very clear the importance of emergency medicine as a specialty to face this type of complex situation”. 
This increased visibility of the specialty is mirrored by the substantial popularity of the country’s national emergency medicine society, Sociedad Ecuatoriana de Medicina de Emergencias, which has increased in number by over 500%! 
The country has also seen an increase in the number of residency training programs over the last year.  In addition to the two already running in Quito, a third and fourth have been established in the city of Cuenca, and a fifth is set to open in Guayaquil. Furthermore, a critical care fellowship is in the works at Universidad San Francisco de Quito. This project stems from a recent study which identified a high demand for a critical care fellowship in Ecuador. 
A distribution of the five emergency medicine residency programs found in Ecuador
The impact of COVID on trainees’ education has, thankfully, not been substantial. Unfortunately, the pandemic did result in residents not being recruited to the Quito programs for 2020, but the programs in Cuenca did start a new class of trainees last year. As with many training institutions across the world, the residents were initially barred by the health authorities from treating COVID patients. However, the creation of ‘COVID’ and ‘mixed’ hospitals has resulted in an increased workload for residents serving the non-COVID population – “I believe that the residents have more work than before . . . and have more procedures because of the overhang generated by the creation of ‘mixed’ hospitals. There’s a lot to do.” He states that residents are on-track for completion of their programs, with ample procedures logged to graduate.
Another aspect of residency training is the required completion of a scholarly project. Research has been slowed across the country as a result of the pandemic. Interest in COVID investigations sparked the Ministry of Health to establish an ADHOC committee explicitly tasked with expediting the review of research proposals. The committee was mandated to review proposals within five days of submission, but in reality, approvals are taking upwards of three to four months. La Universidad San Francisco de Quito explored this roadblock and revealed that some twenty studies had been published through alternative review processes due to the lengthy process of gaining official approval. Dr. AM views COVID as a potential kick-start for encouraging providers to do research, saying “I see it as a great opportunity to better focus [on] research, which is one of the things that we have been looking to do for a long time . . . with the pandemic, [we see] the importance of doing clinical research [in being] able to give adequate treatment to our patients.” 

Looking forward, Dr. AM says that there are many remaining opportunities for growth in the field of emergency medicine, much of which he hopes can be better addressed once the economic situation in Ecuador recovers. He says there is much desire for innovation within the field, but many EM providers are having to work two to three jobs to have a sufficient income to live, leaving little time for research, teaching, or collaboration. There are many lessons to be learned world-wide from the pandemic, but Dr. AM says that in order to address future issues international cooperation is key.

Cite this article as: Global EM Student Leadership Program, "The State of Emergency Medicine in Ecuador," in International Emergency Medicine Education Project, September 18, 2021, https://iem-student.org/2021/09/18/the-state-of-emergency-medicine-in-ecuador/, date accessed: October 18, 2021
Halley J. Alberts, MD
Halley J. Alberts, MD

Halley is a first year resident training in Emergency Medicine at Prisma Health - Midlands at the University of South Carolina. She was a GEMS LP mentee for the class of 20-21 and has now joined the leadership team by managing the new GEMS LP blog page and assisting with journal club.

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