Because crying rooms should not exist!

The Problem

An estimated 80% of injured persons in low-resourced settings receive inadequate or no pain treatment due to poverty, poor healthcare systems, international regulation of opioid analgesics, and discriminatory attitudes. In conflict settings, it is even worse. New approaches to pain management are needed.
The Solution
ICZ determined that ultrasound regional anesthesia (USRA) was a viable low cost, safe & pragmatic pain management solution and developed programs to demonstrate proof-of-concept, skill transferability, and sustainability.

Methodology

A 5-year pilot program was developed in Goma, Eastern Democratic Republic of Congo using a training course and clinical mentoring format, Later, we expanded to 3 large urban referral trauma centers in DRC and Ethiopia. The locations had orthopedic or emergency medicine educational programs and represented a diverse spectrum of resource limits as well as a disparate scale of sophistication of personnel and infrastructure. 

Through grants, we provided ultrasound machines to trainees in exchange for their commitment to protocols and procedures. Inexpensive single-use kits were constructed with needed equipment for safe & sterile technique.  A one page chart was developed for thorough patient documentation

Over 5 years, ICZ trained 102 providers in Democratic Republic of Congo and 60 in Ethiopia, yielding 3,853 procedures. Participating doctors and patients reported dramatic decreases in injury-related pain. The cost per procedure for consumable supplies was negligible at less than $1. A 5-year follow-up showed USRA adopted into routine patient care. 

Next Steps

All courses are now taught by Congolese teaching teams.  Recent student testing (GRS and Chesklist) show Congolese orthopedic techs scoring the same as Ontario Canada anesthesia residents when graduating from the course.

We plan to build regional networks to share instructors, establish maintenance cooperatives, and control data acquisition to allow this skill to be developed safely

Link to our publication here  

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