Evaluation of the Rwandan Emergency Medicine Clinical Guidelines: A Quantitative and Qualitative Review Open Access

Braxley, Nicole Marie (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/rj430529p?locale=en
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Abstract

Rwanda is a small, landlocked country in East Africa devastated by genocide in 1999 where nearly one third of its inhabitants were killed. Over the past twenty years, with the help of significant foreign aid, the country has shown tremendous progress in reducing poverty, increasing the life expectancy of its people, advancing technology and growing and developing its healthcare infrastructure. With the initiation of the Human Resources for Health (HRH) program in 2012, Rwanda seeks to "meet the health needs of its citizens by 2020" by partnering with 23 US Institutions of medicine, dentistry, and health management to bring full-time foreign faculty to Rwanda on an annual basis to work on a transfer of knowledge to Rwandan physicians.

Emergency Medicine (EM) specialists are included among the invited participants with the goal of introducing and advancing emergency care to Rwanda by establishing the country's first EM residency program and implementing emergency and critical care concepts in the capital teaching hospital.

Individual training in emergency care is not available to every Rwandan physician. As a side project, the author edited a new handbook for Rwandan general practioners called Emergency Medicine Clinical Guidelines. Because there are no Rwandan EM specialists, the handbook was authored by foreigners who practiced emergency medicine in Rwanda.

This thesis offers the results of a quantitative and qualitative analysis of the new guideline text, as tested and reviewed by Rwandan physicians. Participants gathered for a pre- and post-test analysis and stayed to participate in a focus group interview.

Quantitative results showed a significant improvement in post-test scores using the new guidelines as a tool to answer clinical questions. Themes that arose from the focus group interview session offered an overall positive review of the guidelines with recommendations on how to make it more accessible for the Rwandan general practitioner who is not trained in emergency medicine but cares for critically ill patients on a daily basis.

The Rwandan Ministry of Health recently approved the final draft of the guidelines for publication. The quantitative and qualitative data gathered here demonstrates the usefulness of the text to the Rwandan clinician.

Table of Contents

Introduction 8

Statement of the Problem

Rwanda, The Country

Rwanda, The Genocide

Rwanda, The Healthcare System, Then and Now

Human Resources for Health Program

Emergency Medicine in Rwanda, Then

Emergency Medicine, SidHARTe

Emergency Medicine Clinical Guidelines

Research Question 18

Goals and Objectives

Review of the Literature 20

Methodology 26

Setting and Selection of Participants

Intervention

Outcome Measures

Primary Data Analysis

Limitations and Delimitations

Results 32

Characteristics of Study Participants

Quantitative Results

Qualitative Results

Limitations of Study 39

Conclusions, Implications, and Recommendations 43

References 47

Appendix 48

Copy of application to Rwanda Council of Medicine and Dentistry

for CPD Accreditation

Focus Interview Questions

Focus Interview Transcript

Focus Interview Notes

Copy of Consent for Participation in Study

About this Master's Thesis

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