Interview by Ryan Radecki – Associate Professor of Emergency Medicine The University of Texas Medical School at Houston.
This article was originally published on the BMJ website. It has been republished with their permission.
Today, we virtually interview Lee Fineberg and Mark Newcombe, the hearts and brains behind DevelopingEM. They are emergency physicians who have returned from Havana, Cuba, after the second edition of their conference concept providing resources and support to medical education in the developing world.
Tell us a little bit about visiting Cuba, a place that’s traditionally been closed off to many in the Western world.
Mark: Cuba is an absolutely fascinating country. A combination of Madrid and Moscow in the middle of the Caribbean.
Crumbling colonial buildings, 1950s American cars, revolutionary murals, rum and cigars, with an integrated multicultural population which makes Cuba an incredibly romantic place to visit.
Lee: Yes its certainly an amazing place. Scenically incredible as Mark says but also culturally impressive. With a rich history and a revolutionary ideology that continues to infuse through peoples’ values, it is a welcoming, fair and safe place for visitors. We were both certainly made to feel welcome by both medical and non medical Cubanos.
What challenges did you witness in the delivery of medical care in Cuba?
Mark: As you probably know Cuba has a healthcare system that provides its citizens with healthcare indices equivalent to the United States. This healthcare is free for all Cubanos and is achieved despite a 50 year old economic embargo that prevents delivery of advanced pharmaceuticals and medical devices to Cuba. We have called upon President Obama in an open letter to end this embargo, an immoral policy whose stated goal is to “bring about hunger, desperation and the overthrow of government”.
Lee: Yes, Cuba despite having limited economic resources has made health care a priority and as Mark has said despite spending 1/25 the spending per capita of the USA on health Cuba has approximately the same figues regarding overall life expectancy, as well as infant and maternal mortality. Cuba also has an impressive and largely unheralded program of international medical education, through the Latin American School Of Medicine(ELAM), and international medical aid. ELAM has been described as the largest medical school in the world with approximately 15,000 students from 50 countries. Cuba’s medical internationalism currently also sees 20,000 doctors working in multiple countries around the world.
Mark: So whilst there are challenges Cuba has an impressive national and international healthcare system that has many lessons for our own systems.
How is emergency care supported – or neglected – in their healthcare system?
Lee: Cuba has a different model of critical care delivery than the Anglo-American model we are used to. The core of the health care system in Cuba has revolved around the community based polyclinic with more advanced investigation and management occurring in specialty based hospitals. Critical care has been delivered primarily from an intensive care setting.
Mark: Yes emergency departments have increasingly become integrated into both the polyclinic and hospital setting with the realization that unwell patients can present to either setting. The bulk of critical care continues however to be centred in the intensive care. Whilst a different system it works well within the Cuban setting.
Many folks may not have heard enough about DevelopingEM. In a nutshell, what’s your core mission?
Lee: DevelopingEM is a new direction in medical education, combining cutting edge training in critical care medicine, with a focus on providing a meaningful contribution to medical professionals in developing regions through an inclusive and philanthropic approach.
Mark: We’re a not-for-profit conference organising agency specialising in providing a practical clinical approach to the delivery of emergency medicine and critical care education to senior practitioners in the fields of emergency medicine, intensive and critical care medicine, anaesthetics, and prehospital and retrieval medicine.
Lee: With short sharp, polished presentations focusing on evidence based best practice we hope to provide a clinically relevant educational experience aimed at the senior critical care practitioner.
Mark: Yes in fact this year we’re looking at 20 minute, 20 slide presentations, more audience participation, panel discussions and demonstrative scenarios.
Lee: As with the past two conferences in Sydney andHavana the core topics will include adult critical care medicine, pediatric critical care medicine, and trauma medicine, with optional sessions covering the Brazilian experience of emergency medicine, global health and emergency medicine, prehospital medicine and ultrasonography.
Mark: As well as the education provided during the conference we also aim to follow up on our efforts in Cuba and the Caribbean by hosting satellite workshops in the region and also donating computer workstations preloaded withFOAMed resources to centres in the region
Lee: Yes in 2013 we hosted an ultrasound course in St Lucia performed by the Ultrasound Podcast guys, and also an ATLS course in the Bahamas.
Mark: And we provided 4 Mac mini based computer workstations for health centres in the region. These were preloaded with EM courses and resources. We’re hoping to repeat the effort in Brazil.
Lee: As Mark mentioned earlier central to the philosophy of our concept is the not for profit model. We have avoided industry sponsorship in order to prevent content conflict of interest.
Mark: Yes conference registration fees and donations alone will be used to fund the ongoing costs of the annual conference and utilised to subsidise the attendance of regional delegates, the establishment of future conferences, and ongoing continuing education projects.
Lee: This model has been a successful financial model for the last two conferences with costs covered and enough credit to cover start up costs of the subsequent conference.
Mark: Our annual conference this year will be held in Salvador da Bahia, Brazil between September 8th and 12th and as with our model in Cuba, DevelopingEM is forging ties with local Brazilian critical care specialists and organizations in order to secure Brazilian involvement in both attending and presenting at the conference.
Lee: As well as Central America and the Caribbean, and South America, DevelopingEM hopes to take its educational concept to Sub Saharan Africa and South East Asia. Possible conference settings to follow Salvador include Gaborone in Botswana and Siem Reap in Cambodia.
What inspired you to initiate this program?
Lee: Primarily the inspiration grew from a desire for us to share in the experiences of our colleagues working in under resourced regions around the globe.
Mark: Yes we’ve met some truly inspiring people doing incredible work around the world. Unfortunately they often have a very limited ability to attend international meetings and interact with multi national critical care colleagues.
Lee: So I guess within a conference format we hoped to introduce our delegates and faculty to amazing clinicians from developing regions so that we can learn from each other.
Mark: And I think in Cuba we really were able to achieve this goal, and hopefully we’ll be able to repeat the process in Brazil.
How can interested folks support the initiative or become involved?
Mark: Registrations are the key for DevelopingEM. Without our delegates the whole concept doesn’t work. So we’d encourage everyone to take a look at the evolving program on our website and if it appeals join us in Salvador.
Lee: They can find us online, on Facebook, on Twitter, and on Instagram and spread the word to their colleagues. Not only will we be advertising the conference through these sources but also hosting an educational blog based around the presentations from Havana.
Mark: Even if your readers can’t make it to Brazil there will be options for virtual registration and delegate sponsorship to allow anyone to contribute.