John B. Sampson, MD Johns Hopkins Hospital Baltimore, Maryland, USA
	Haile Mezghebe, MD Howard University Hospital Washington, D.C., USA
	Mark Walker, MD Surgical Health Collective Atlanta, Georgia, USA

This summer, the Society of Critical Care Medicine (SCCM) took additional steps in its growth as a worldwide organization by collaborating with Doctors for United Medical Missions (DrUMM) to hold its first Fundamental Critical Care Support (FCCS) course in East Africa. Through contributions from SCCM members, the Society’s Critical Care Education and Research Foundation (CCERF) provided funding for the project, which took place in June.

In Sub-Saharan Africa, the need for improved critical care services is often overshadowed by the need for basic primary and preventive medical care. Western healthcare professionals often maintain the perception that critical care does not exist and is not needed in African countries. However, most healthcare providers would agree that basic fundamental concepts in fluid resuscitation, shock management, and the treatment of life-threatening infections are paramount to any primary care or emergency care practitioner.

In Eritrea, East Africa, the continent’s newest country, there is a progressive Ministry of Health who is addressing the healthcare challenges faced by his country. Saleh Meky was trained as a nurse anesthetist in the United States and has efficiently worked toward equitably distributing Eritrea’s limited healthcare resources to both the rural and urban areas of this emerging democracy. He has received assistance from benevolent countries, such as the People’s Republic of China, which constructed Orotta Hospital, a new state-of-the-art facility in Eritrea’s capital of Asmara. The beautiful and utilitarian facility includes medical/surgical wards, an intensive care unit (ICU), an emergency department, four operating rooms, recovery room, and conference center. China’s generous gift to Eritrea is inclusive of such equipment as three new mechanical ventilators, monitors, infusion pumps, and defibrillators.

This modern equipment is of little use without accurate operating knowledge, however. The lack of previous knowledge of such equipment, as well as untranslated Chinese instructions has inhibited Eritrean healthcare professionals from effectively utilizing this equipment for the improvement of quality healthcare.

Right: Critical care nurses teach EKG, monitoring and defibrillation skills during an FCCS skill station in Eritrea.

The Ministry of Health sought the help of DrUMM, a nonprofit, humanitarian organization, to address this challenge. The organization identified SCCM’s FCCS course as the best-suited tool for improving critical care knowledge in Eritrea. Many of DrUMM’s members,

including the president, are active critical care practitioners and SCCM members. The original plan was to host a class of 26 FCCS participants. After reviewing the curriculum, the Ministry of Health strongly felt that physicians and nurses working in rural hospitals needed a critical care knowledge base almost as much as those who actually worked in Eritrea’s only tertiary intensive care unit. The Ministry of Health disseminated information about the FCCS course to hospital directors throughout the country and allowed 13 hospitals to choose two individuals to attend the course.

Even with such national representation, DrUMM volunteers were inundated with requests asking to expand the number of people permitted to attend the course. The desire for knowledge was strong and after discussing the matter with the Ministry of Health, the duration of the course was increased from two days to three days to allow for greater hands-on experience, question/answer periods and in-depth explanation. The total number of attendees increased to 45. Others were also allowed to audit the lectures, but not participate in the skill stations.

The first day’s response was overwhelming. The American Ambassador, the director of the U.S. Agency for International Development (USAID), and the Eritrean news media officially recognized the course. Participants took the pre-test with such intensity that it set a very serious tone for the course to follow. States and has efficiently worked Dr. John Sampson (Left) engages participants in an intense ventilator management case discussion during the mechanical ventilation skill station.

At the conclusion of the three days, everyone relaxed and expressed deep appreciation for the FCCS course. One of the participants felt that this was the most organized course ever held in Eritrea. Many participants excitedly explained that they could not wait to return to their institutions to pass on the information they had received. And others stressed the need for another FCCS course in Eritrea for those who were not chosen to attend or who needed reinforcement.

Course participant Dr. Goitom Berhane wrote, “I am one of the participants of the seminar that you gave on critical care medicine at Orotta Hospital in Eritrea and one of the surgeons assisting you at the Halibet Hospital. This is to give my words of appreciation and to thank all of the members who have participated in teaching the Eritrean medical community such important concepts regarding the care of critically sick patients. The knowledge and skills that your group provided us will help to improve the quality of care that we provide to our patients.” The FCCS course offered the tools for improving the quality of care provided to the sickest patients in Eritrea. Both DrUMM and SCCM plan to continue their collaboration and are planning additional FCCS courses in Ghana and Nigeria.

We extend our gratitude to the SCCM members who made donations to the CCERF to help fund this FCCS course. This course would also not have been possible without the individual sacrifice of the physicians and nurses who dedicated their time to travel to East Africa at their own expense. We would like to send a special thanks to all members of the DrUMM team, including Ingrid White, BS; Tsion Sergot-Michaels, RN; Celia Hightower, RN; Pam Copeland, RN, Esq; and Femi Akinnagbe.

Society Members John B. Sampson, MD, was the course director for the FCCS course held in Eritrea, and president of DrUMM; Mark Walker, MD, was the FCCS Course Consultant; and Haile Mezghebe, MD, served as the liaison to the Eritrea Ministry of Health.