knowing and doing; negotiating resource constraints through research
TRANSCRIPT
African Journal of Emergency Medicine (2013) 3, 151
African Federation for Emergency Medicine
African Journal of Emergency Medicine
www.africanemergcare.ning.comwww.sciencedirect.com
Knowing and doing; negotiating resource constraints
through research
The importance of knowing what we do and how we are doingit is vital in a setting where standards of care are driven not by
best evidence, but by available resources. If we are going tonegotiate the hurdles of resource constraints in order toimprove those standards of care we will need to develop a body
of best evidence that addresses resource constraints. With mosthigh impact publications reporting on improving standardsthrough the latest resource heavy interventions (think Primary
Coronary Intervention and full body trauma ComputedTomography), African nations are left behind in a whirlwindof evidence that is of no use to them. As the emphasis onlow resource interventions starts to disappear (think streptoki-
nase for myocardial infarction, and clinical gestalt and serialexaminations for trauma; there are many more examples), cli-nicians in low income nations find it more and more difficult to
achieve the preferred standard of care for their patients. Theresult is a knowledge vacuum where clinicians know what is re-quired, but have to choose an uncertain care package as little is
known about what would be considered best evidence in a re-source poor setting.
The anthropologist Zora Neale Hurston described research
as ‘‘formalised curiosity. It is poking and prying with a purpose’’.African acute care research has to be aimed at establishing bestevidence in a resource poor setting in the first instance. Merelyreproducing results from high impact publications in the hand-
ful of centres in Africa that have comparable resources is of nohelp to the tens of millions who have very limited acute careaccess. Only resource optimised (or tailored) care can address
the rising tide of deaths attributable to communicable andnon-communicable diseases affecting the large majority of pa-tients requiring acute care (look at the WHO report on road
deaths in Africa summarised in Uchunguzi elsewhere in thisissue). The impact of lives lost due to the poor understandingof local resources (skill-mix, availability and access) and theirefficient application alone must cost African governments
millions. The impact of research in reducing mortality and
Peer review under responsibility of African Federation for Emergency
Medicine.
Production and hosting by Elsevier
2211-419X � 2013 Production and hosting by Elsevier on behalf of Africa
http://dx.doi.org/10.1016/j.afjem.2013.08.002
morbidity (and cost) has had a good track record in high in-come settings; research improves care options, which in turn
improves outcome, which in turn leads to more research. Thereis no reason why acute care research will not reproduce thistrend in Africa as well. The benefit to the public purse makes
this a no-brainer. Not only is it likely to save lives, it will alsosave money. We need a focus on the evidence and impact rel-evant to acute care in Africa.
This issue of AfJEM reports on various projects aimed atunderstanding acute care in its current form in several Africancountries. Little and colleagues describe the case and resource-mix at a small community emergency centre in Tanzania,
whilst Bosson and colleagues investigate the barriers to theuse of a pre-hospital service in Gabon. Cox and Chandra de-scribe the inclusion of emergency medicine in a formal under-
graduate training programme, and Tom Mallinson reports onthe use of a Shawl as an improvised pelvic binder for a patientwho suffered a pelvic fracture following trauma. These reports
are an optimistic start; however, similar but larger initiativesare required. To tackle road related deaths, African countriesneed to consider resourcing a trauma registry (as was done in
Karachi, Pakistan; also summarised in Uchunguzi); to manageacute care effectively, education from the ground (community)up is needed and best evidence for resource poor environmentsneed to be described. This will no doubt require health care
workers to invest time in research, but the lives saved as aresult will more than make it worthwhile. It was Leonardoda Vinci who said: ‘‘I have been impressed with the urgency
of doing. Knowing is not enough; we must apply. Being willingis not enough; we must do’’. We must apply and we must do.
Lee A. Wallis *
University of Cape Town and Stellenbosch University,Private Bag X24, Bellville 7535, South Africa
* Tel.: +27 21 948 9908; fax: +27 21 949 7925.
E-mail addresses: [email protected]
Available online 23 August 2013
n Federation for Emergency Medicine.