“We don’t expect that every patient who needs emergency care will be seen by Emergency physician specialists…. they are not the solution to the emergency care problem…. the system is completely dependent on community-based first aid responders, clinics and low-level hospitals like district hospitals, nurses, clinical officers mid-level workers and generalist doctors who go from seeing emergencies with no training to dealing with emergencies properly trained. That is the transition we need to make”
“Our job is to save lives. It is therefore important to provide quality emergency care to all. Emergency care systems are the bedrock of good healthcare. For instance, if there was better emergency care at the scenes of traffic accidents, we could potentially save five hundred thousand lives in Africa annually.”
Access to emergency medical care should not be for the privileged few who can afford private evacuation by road, sea or air. It should be available to all. A robust medical emergency response service should be a priority for our Ministry of Health. All our medical facilities must have the necessary infrastructure to support emergency care and we must train and continuously impart skills to our emergency medicine specialists of every cadre, to run these emergency rooms.
Access to emergency care can be improved by better delivery at health facilities and the creation of new policies at a national level. Specifically, Kenya needs to recognise emergency services as an integral component of the healthcare system.
Access to quality emergency services is an essential component of the human right to health, but barriers to emergency care are found throughout Africa and the wider world. Data to support the development of emergency care are essential to improve access to care and further infrastructure development. We undertook this study to understand the community’s emergency care needs and the barriers they face when trying to access care and to engage community members in developing high impact solutions to expand access to essential emergency services.
To accomplish this, we used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated, and analysed using the content analysis approach. Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley, and Western), with equal rural and urban community representation.
We found that socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care: a lack of a structured system, resources, transportation, trained healthcare providers, and initial care on scene.
The results of this study indicate the need for specific interventions to reduce barriers to access essential emergency services in Kenya. Access to emergency care can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the prehospital care system, improving emergency care delivery at health facilities, nd creating new policies at both county and national levels.
Practical top tips for managing challenging consultations:
Control your own emotions
Don’t get angry
Verbalise the difficulty
Validate your patient
Don’t be afraid of silence
Try to find some common ground
Know when to call it a day
As a doctor, if all has failed, take time to reflect on the consultation at a later point. Perhaps review the notes and discuss with colleagues. Be the type of doctor where calling it a day with an unhappy patient is a rare event and something that you feel is worth reflecting on.