In April, I had the wonderful opportunity to participate in and complete a 4-week international ED rotation in Arusha, Tanzania, at Arusha Lutheran Medical Center.
The primary purpose of my elective was to conduct a prospective observational study titled, “Use of Point-of-Care (POC) Hepatitis B Virus (HBV) Testing and Ultrasound to Screen for Hepatocellular Carcinoma (HCC) in a Tanzanian Emergency Department (ED).” This project was funded by the Emergency Medicine Foundation (EMF)/Emergency Medicine Residents’ Association (EMRA) Resident Research Grant. My travel was graciously funded by the EMRA International EM Rotation Scholarship Award.
The purpose of this rotation/study was to pilot a novel approach to community infectious diseases and liver cancer screening by employing rapid HBV POC testing and POC ultrasonography in the ED. HBV is the most common risk factor underlying the development of HCC, which is the second leading cause of cancer-related death in the world. The largest epidemiologic burden of HBV and HCC occurs in low- and middle-income countries, and sub-Saharan Africa is one of the most disproportionately affected regions. In Tanzania, the primary care infrastructure is underdeveloped. Thus, many patients do not seek medical attention unless they are ill and do not have access to routine infectious disease screening.
To bridge this gap in healthcare access, this program will capitalize on a patient’s presentation to the ED and offer him or her important medical screening. Initiatives aimed at increasing HBV and HCC awareness and screening in Tanzania and other parts of Africa have the potential to save millions of lives. This pilot study, which places the ED at the center of the public health system, could serve as a model for the delivery of public health services in the region and will help extend the potential impact and growth of emergency medicine in Africa.
During my short time there, we were able to screen more than 700 patients for HBV. Patients who were positive had POCUS performed to assess for HCC and were referred to the clinic for treatment. The study will continue to enroll patients, under the guidance of local co-investigators, and we hope to screen more than 2,000 patients over the next two months.
One goal of this rotation was to train local co-investigators in how to perform research so that they might independently conduct their own methodologically robust studies. I also had the opportunity to work with emergency medicine and intensive care providers and provide bedside POCUS teaching. During my time shadowing local ED providers, I learned an immense amount about what it is like to practice EM in a resource-limited setting. I am humbled by the resiliency and resourcefulness of my Tanzanian colleagues.
In summary, I believe my experience will be transformative in helping me become a more well-rounded clinician and researcher. My cultural immersion and exposure to the Swahili language gave me a glimpse into a new way of life. I will forever cherish the memories made with my new Tanzanian friends and colleagues.
Hakuna Matata.
— James Ford, MD