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We discuss Paediatric COVID 19 with April Kam

April Kam, our Paediatric EM and Critical Care track lead, spent some time with us this week to discuss COVID 19 in the Paediatric population.

April is an Associate Professor in the Department of Pediatrics and the Director of Research and Quality for the division of PEM at McMaster University in Hamilton, Canada.

She has an interest in global health education and has worked around the world.

Check out her extensive CV here.

We are very lucky to have her expertise and energy devoted to DevelopingEM and in March she led a fantastic group of Paeds EM specialists for the 2020 conference in Cartagena, Colombia.

You can check out all the 2020 conference presentations from April and her team (Nate Kupperman from UC Davis, Viviana Pavlicich from Paraguay, Camilo Gutierrez from Kids National in DC, Tanya Solana from Sick Kids Toronto, Laura Galvis from Colombia and Suzanne Beno also from Sick Kids Toronto).

Today April gives us a Canadian and global perspective on how the COVID 19 Pandemic is playing out in Paediatric Emergency Medicine.

In this interview we discuss the prevalence of illness, some of the options for treating the respiratory form of the illness and also describe the evolving knowledge on the inflammatory and vascular forms of the illness in children.

We think you will agree that Paediatric COVID is a fascinating and evolving situation.

Check our all the references April mentioned here.

Interview Text.

Powerpoint Slides.

Children’s Hospital of Eastern Ontario (CHEO) PIMS Guideline.

European Centre for Disease Prevention and Control (ECDC) PIMS Rapid Risk Assessment.

Zhang et al, Science. COVID 19 contact patterns in China.

Ramcharan T et al, Pediatr Cardiol. PIMS UK.

Capone C et al, J Pediatr. MIS-C in New York.

Toubiana J et al, BMJ. KD France.

Feldstein L et al, NEJM. MSIS USA.

We really appreciate April’s time and hope to catch up with her in the next six months to see how the situation continues to evolve.

Stay tuned for more COVID focussed interviews with our global faculty.

DevelopingEM talks COVID 19 in Nicaragua with Hector Real

Today we talk to Dr Hector Real from Nicaragua.

Hector is an Emergency Physician working in critical care at the Hospital Vivian Pellas in Managua.

He is a spokesman for the Nicaraguan Association of Emergency Medicine (ANME) and the ACEP Liaison for Nicaragua.

Hector attended our DevelopingEM 2020 conference in Cartagena and presented on the development of emergency medicine in Nicaragua.

Over the years we have had many fascinating presentations on the struggles colleagues have faced in the development of our specialty, emergency medicine.

The challenges faced by practitioners in Nicaragua is multifactorial and intertwined with a complicated political situation in the country.

This context is something that few of us have to calculate when advancing the expertise of our workplace.

Hector’s presentation analysed the development of EM within this overall context.

You can see Hector’s DEM2020 presentation in Spanish here.

Our follow up interview discusses the challenges that COVID 19 has brought to this setting.

You can see that interview here.

Many of us have only a cursory understanding of Nicaragua and so here is some basic information on the country and its political situation.

Geography

Nicaragua is in Central America bordering Honduras to the north and Costa Rica to the South with both a Pacific and Caribbean coast.

Population

Nicaragua has a population of a little over 6 million with 87% of this population being under 55 years of age.

60% of the population are urbanised with 1 million people living in the capital Managua

Health statistics

Life expectancy at birth

74.2 years

(Australia 82.7 / USA 80.30 / Costa Rica 79.20 / Honduras 74.60)

Maternal mortality rate

198 deaths / 100,000 live births

(Australia 6 / USA 19 / Costa Rica 27 / Honduras 65)

Infant mortality rate

16.5 deaths / 1,000 live births

(Australia 3.1 / USA 5.3 / Costa Rica 7.5 / Honduras 14.6)

Current health spending

8.6% of GDP

(Australia 9.2% / USA 17.1% / Costa Rica 7.3% / Honduras 7.9%)

Physician density

1.01 physicians / 1,000 population

(Australia 3.59 / USA 2.59 / Costa Rica 1.15 / Honduras 0.31)

Hospital bed density

0.9 beds / 1,000 population

(Australia 3.8 / USA 2.9 / Costa Rica 1.1 / Honduras 0.7)

Major infectious diseases

degree of risk- high for food or water borne disease (including bacterial diarrhoea,  

                                                                                               Hepatitis A and Typhoid fever)     

                                                and vector borne disease (including dengue and malaria)

(Costa Rica- degree of risk- intermediate /  Honduras- degree of risk- high)

History

The Pacific coast of Nicaragua was settled as a Spanish colony from Panama in the early 16th century.

Independence from Spain was declared in 1821 and the country became a fully independent republic in 1838.

The dictatorship of General Zelaya began in 1893 but he was deposed with the help of United States (US) troops in 1909 marking the start of a prolonged period of US involvement in the affairs of the country.

Over the next decade the US established military bases in the country.

Guerrillas led by nationalist Augusto Sandino, after whom the Sandinista movement is named, campaign militarily against the US military presence and were part of the reason for a US withdrawal from the country in 1933.

Sandino was assassinated during peace talks in 1934 on the orders of National Guard commander General Anastasio Somoza Garcia.

General Somoza was elected president not long after in 1937, heralding a 44 yearlong rule by his family.

The Sandinista National Liberation Front (FSLN) is founded in 1961 and identified as a nationalist, socialist and anti-imperialist organisation, whose objective was the seizure of political power through the destruction of the bureaucratic and military apparatus of Somoza’s dictatorship.

In 1978 the assassination of the leader of the opposition parties triggered a general strike and brought together moderates and the FSLN in a united front to oust Somoza.

Violent opposition to governmental manipulation and corruption spread to all classes during 1978 and resulted in a civil war that brought a civil-military coalition, spearheaded by the Sandinista guerrillas, led by Daniel Ortega Saavedra, to power in 1979.

The FSLN government redistributed the vast Somoza family land holdings and promoted radical changes to education and healthcare.

However, it was their anti-imperialist, anti-capitalist and pro Cuban and Bolivarian identity that attracted the ire of the US which systematically commenced a program to remove the FSLN from government.

The Australian journalist John Pilger visited the country at this time and his insightful documentary can be seen here.

This US effort to unseat the FSLN was centred on military support for the anti-Sandinista contra guerrillas, but also involved the mining of Nicaraguan harbours and the enforcement of an economic embargo against the country.

These measures were responsible for enormous hardship and violence within the country and were a contributor to the FSLN losing free and fair elections in 1990 where they relinquished power to the democratically elected opposition coalition.

What followed was a difficult period that saw a gradual reduction in paramilitary violence but also increasing debt and corruption.

After losing further elections in 1996, and 2001, former Sandinista President Daniel Ortega was elected president in 2006, 2011, and most recently in 2016.

This new Sandinista period is a vastly different period to the 1980s with election wins coming at the cost of compromise for many of the FSLN core beliefs.

There have been coalitions with ex contras, rapprochement with the Catholic Church (including support for a ban on abortion by the FSLN), and new accords with the IMF.  

Whilst there have also been reintroduction of free education and literacy programs, as well as Zero Hunger programs, and corruption crackdowns, there has also been a reduction in public financial accountability, a freeze on the wages of teachers and health care workers (already the lowest in Central America) and suspect constitutional change allowing Ortega to continue as President beyond the usual two terms previously allowed.

Concerns about an increasing authoritarianism had been growing internally and were recognised by Amnesty International in 2018 when responses to protests against the government outlined Amnesty concerns.

These concerns are more expansively explained here but centre on the reduction of interaction with international agencies scrutinising human rights, an appreciable reduction in the freedoms of expression and assembly, the use of the legal system to prosecute political opponents, increased state sponsored violence and government targeting of journalists, human rights defenders and local NGOs.

In 2019 the FSLN was expelled from the Socialist International due to the same concerns.

In the last 2 years there have been mass protests over wages and social security changes that have morphed into general denunciations of the ruling party and system especially after the very violent responses to the original protests.

The political situation in that period has been a factor behind the nearly 90,000 Nicaraguans who have recently fled the country.

It is into this complicated and multifaceted situation that COVID 19 arrived in March.

Hector’s perspectives on the current situation are fascinating and we remain very grateful for his time and expertise.

If you would like to help in efforts to supply PPE and other equipment then please consider joining with DevelopingEM in donating to the efforts of FNE International.

DevelopingEM 2020 Presentations Now Available

An amazing time was had by all in beautiful Cartagena during DevelopingEM 2020 Colombia.

Apart from the wonderful attractions of this incredible place we actually had one of our best emergency medicine and critical care conferences ever with the latest evidence based material from some of the best presenters on the planet.

All this wonderful material is now freely available on our website as both powerpoint presentations and video recordings.

Check it out HERE.

Ben Wyler Talks COVID 19 with Mark

One of the best presentations at DEM2020 was delivered by Ben Wyler on COVID19.

It not only was a spur of the moment addition to the program but also delivered on the day the Global Pandemic was declared.

It was a sobering presentation and predicted much of what would happen in the last 2 months.

Check it out HERE.

We thought it would be interesting to follow up with Ben who has been working in one of the COVID 19 Epicentres- New York City- since he returned from Colombia.

Ben talks about what its been like in New York, about some of the emerging therapies and also what the future holds.

Check out the interview HERE

We had such a good time catching up with Ben that we thought why not chat with some of our other amazing global faculty to see what the last few months has been like for them.

So keep an eye on our social media pages as we catch up with people from around the world and get a different perspective on COVID 19.

In the meantime DevelopingEMers, Be safe, Stay well and Stay Tuned!!

Lee, Mark and Sanj

Post Conference Surveys and Our Future

DevelopingEM 2020 Colombia was an amazing conference but held in truly historic times.

The Pandemic was declared on the last day of the plenary sessions and our lives have changed forever.

In this very different world we have wondered about the future of DevelopingEM and since the conclusion of the conference we have conducted two delegate surveys related to the Pandemic to help us determine if we should proceed with our events.

Our first survey was a health related questionnaire in which our delegates were asked about Covid 19 symptoms and test results in the first 14 days after the conference.

In total we had 127 responses.

26 respondents described at least one potential COVID 19 symptom and 1 respondent tested positive in this 2 week period.

So the event was a low but not zero risk gathering.

We were extremely lucky and don’t seem to have created harm in the larger scheme of things.

Our second survey focussed on whether the current pandemic dynamic should change our approach as a conference organising agency.

The results were very encouraging for Lee, Sanj and myself.

97% of respondents said we have to continue with DevelopingEM and indeed 90% agreed with the decision to proceed with the 2020 event.

There were some amazing comments generated from the survey that have buoyed our spirits at this difficult time.

” DevelopingEM is an amazing and unique gathering of EM folks with similar interests and a strong desire to give back something greater than themselves.” 

” We must survive “

” DevelopingEM is a wonderfully compelling conference. Supporting international learning and bringing together the best and the brightest — its what we need to do, now more than ever. “

” Because this too shall pass and needs will continue. “

Our DevelopingEM family is truly amazing!

You have confirmed our thought that we should continue with DevelopingEM as a face to face international event. 

Many meetings could probably continue virtually but it is people meeting people face to face that is at the core of DevelopingEM.

So we have already started preparing for 2022 and our African partners are keen to collaborate- we will have more to tell you soon!!

STAY TUNED!!

Wrap up of DevelopingEM 2020 Colombia

DevelopingEM 2020 was held between March 7 and 11, 2020 at the Centro de Convenciones, Cartagena de Indias, Colombia

The conference included the attendance of emergency practitioner delegates from 22 different countries.

It was extremely well received with 65 local Colombian and 23 regional practitioners attending as well as nearly 150 other delegates from around the globe

83% of income came from international delegate registration fees and the breakdown of the distribution of these fees is as follows.

For a full delegate paying $AUD1800

  • $AUD1080 went towards venue costs
  • $AUD450 went to administrative costs including outsourced event management, insurance, legals, college fees and merchandise (there is no payment to the medical management team)
  • $AUD72 went towards planning meetings
  • $AUSD54 went towards marketing
  • $AUD18 went towards IT support
  • Most Importantly $AUD126 went to supported attendance of regional and local delegates at the conference and workshops (this is over and above the costs of covering the conference costs of each Colombian and regional delegate)

The other substantial financial contributors to the conference include

  • EMRAP who provided 9% of the total income stream funding some regional delegates, the nursing workshop and the regional development forum
  • ACEM who provided 3% of the income and this was channeled into regional delegate funding

Many ongoing relationships were forged during the conference and we hope this results, as previously, in multiple future projects being generated as a result of the conference.

The conference was held in a turbulent period for global emergency healthcare with declaration of the COVID 19 Pandemic on the final day of the event. Despite the permanent changes to our lives that COVID 19 will bring, the overwhelming feedback from our delegates is that the DevelopingEM concept should continue. We hope to continue to foster international emergency medicine and critical care collaboration now and into the future.

Lee and Mark chat with CODA’s Oli Flower about #DevEM2020

In September, 2019, DevelopingEM Co-Directors, Lee Fineberg and Mark Newcombe were interviewed my SMACC/CODA legend Oli Flower about the upcoming DevelopingEM 2020 Conference in beautiful Cartagena de Indias, Colombia.

A recording studio in CODA’s swanky new office space underneath the on ramp of the iconic Sydney Harbour Bridge was the setting for a discussion about

  • The wonders of Cartagena and Colombia
  • Supported Colombian and Regional Delegate Attendance at the conference
  • What to expect from the workshops and program at #DevEM2020

Check it out here

Thanks Oli and the entire CODA team for your support over the years.

Its definitely not too late to Register– we would love to have you join us.

190321 Poster with Web Address - AMG

 

Get Prepped for #DevEM2020

Hi DevelopingEMers

We know you’re coming to the best international EM conference of the year but are you fully prepped???

Here’s the essential steps:

  • Registered online
  • Make sure your passport is up to date
  • Buy your travel insurance
  • Complete your travel arrangements
  • Join the Whatsapp Social Group
  • Memorise the Hashtag and get Tweeting
  • Count down the next 50 sleeps until you’re in beautiful Cartagena

Registration

As an organisation, DevelopingEM takes no-profit from events.  Every cent from registration is used to cover the conference costs and sponsor local and regional EM clinicians to attend. As per previous conferences, Developing EM has been able to sponsor one local attendee for every two full fee registrations and this largely due to the generosity of our international delegates- YOU!

If you haven’t yet registered, please register now to confirm your attendance. 

  1. Choose your registration type
  2. Add in your preferred sessions (the Full Conference option includes all social events)
  3. Add in any optional workshops
  4. Check out and make your payment by credit card

We are very grateful for every registration dollar so thank you for your contribution!

Get that Passport sorted!!

You need to have at least 6 months until the expiry of your passport to enter and leave Colombia. Dont fall at the customs hurdle

 

Dont forget your Travel Insurance

Never travel without it

 

Accommodation and travel

Please review the Pre-Conference Travel Information – this will help guide you through your travel arrangements.

You can also check our previous blog article detailing our own experiences of travelling to Cartagena

If you would like support with making your travel arrangements, DevelopingEM has partnered with www.two.travel who have been briefed on our event and are very keen to assist you. Two Travel is a company based in Cartagena which can provide A to Z travel support for anyone coming to Colombia; from basic accommodation to full service concierge. Check out their website or email ray@two.travel. Alternatively, choose from a plethora of accommodation in Cartagena.

Join the Conference Whatsapp Social Group

Once again Joachim Unger from Berlin is taking care of your social arrangements

Use the following QR Code to connect to the group and help you get together in Cartagena

 

Memorise the conference Hashtag #DevEM2020 and get to tweeting!!

 

Count down the next 50 sleeps until you’re in beautiful Cartagena and we will see you there.

Travel Recommendations from the DevelopingEM team

We know you have already requested your leave to attend DevelopingEM but now its time to think about

  • Registering for the conference and workshops
  • Booking those flights
  • Getting your accommodation sorted
  • Planning your travel

Here are some tips and tricks from our our planning team who had the task of scoping out this amazing city prior to the conference.

Travel to Colombia

• When you book your ticket make sure the Colombian departure tax/airport fee is already

    included so you don’t have to bother with a cash payment whilst checking in at the

    airport

• GET TRAVEL INSURANCE!!!

   We cant stress this enough for all of our events

• Make sure you have your Yellow Fever immunisation documentation

   This is mainly to assist re-entry to Australia and other home countries after visiting

    the region

• For Aussies check and record your trip on the Smart Traveller website

Entry into Colombia (Cartagena)

• Check the following guide to the Rafael Nunez Cartagena Airport

• No visa is required for Australians visiting for < 90 days (check the situation in your own

   countries)

• Customs forms are handed out on the inbound flight

• There is a standard customs area beyond the arrival point

• Most customs officials will speak some English

• Past the customs area is a standard baggage claim area

• Past baggage claim is an area for any declarations

• Past declarations are two currency exchange booths

   Americambios

   Globocambio

   and both open from 7 am to 8pm

   It has been suggested that better exchange rates are obtained from ATM’s and there

   are ATM’s in the domestic arrival and departure area

• There is a taxi area on the street outside arrivals and there are usually taxis waiting

    Taxi rates are meant to be fixed but they often are not and can vary between 13000 and

     20000 COP depending on where you are going

    Most taxis will accept USD as well and $10 USD is enough

• Uber is also available with an average rate of 15000-30000 COP depending on the dropoff

• The drive time to the old city is 15 mins from the airport

Departure from Colombia (Cartagena)

• Check in for international flights is 2.5-3 hrs from time of flight

• Online check in is dependent on the airline but could speed the departure process if you

   don’t have bags to check

• Lines can be long at check in on the weekends and we suggest arriving early

• An Airport fee / departure tax is collected at the check in counter if it hasn’t been

   included in your ticket- it needs to be paid in cash (60,000 COP)

• There is a standard exit with customs and security

• The airport lounge is comfortable but basic with a couple of basic food options and a

   couple of souvenir stores

• The airport wifi is free

Accommodation options

• There are literally hundreds of room type and budgetary options

• There are 3 main accommodation areas

   Cielo Mar- near the airport

   Old Town (El Centro / San Diego)- the walled historic old city

   Getsemani- historic (now hipster) area outside the walled old city

   Bocagrande- Miami-like new area of multiple high rise apartments and hotels

• Hotel options that we have personally reviewed include

  Old Town

  – Sofitel Santa Clara

  Bocagrande

  – Hyatt

  – Estelar

  – Intercontinental

   Cielo Mar

   – Las Americas

• Air BnB options that we have personally reviewed

  – Edificio Centenario

• A Tour Company we have used previously and can Highly Recommend is

   Two Travel

Bars and Restaurants

• There are many options

  – the following can be recommended by the organising team

  Old City

  • El Baron

  • Alquimico

  • Cafe del Mar

  • KGB

  • Bar at the Sofitel- El Coro

  • Rooftop at the Movich- La Terraza

  Getsemani

  • Demente

  Bocagrande

  • Hyatt balcony- Amacagua

 

So now you have that you have booked your flights, accommodation and social schedule it’s time to Register for DevelopingEM 2020 and ACEM 2020.

March in Cartagena is going to be amazing- See you there!!

Global EM- an incredible conclusion to #DevEM2020

From Human Trafficking to Medicine in Immigration Facilities to Anthropology in EM this is sure to be a fantastic and thought provoking way to conclude DevelopingEM 2020.

Nat Thurtle has once again brought together an incredible faculty to speak on these important issues.

She has written the piece below further outlining the theme of the session, Global Emergency Medicine: Social Science and Narrative in Emergency.

Thank you Nat.

 

For those of us practicing in Emergency Care, we all know it to be a general specialty. 

Whether you practice in Colombia, in Australia, in Uganda, or in any other place where people come to hospital looking for help because they think they are having an emergency, you may see everything from psychosis to a nailbed injury, from neonatal sepsis to the palliation of an octogenarian, in just one day.

To borrow from the title of one of the session’s talks… ‘All of Life is Here’.

It’s almost 15 years since I first worked in an emergency department, and I still sometimes see things I’ve never seen before. 

I often see things that I know I cannot fix, or things that we can maybe put a bandaid on or give a placebo to, that in reality will do nothing, or nothing beyond short-term relief.

I’m sure you do too. 

And that can feel like a failing, not just of us as individual Emergency Care practitioners, but of the discipline of medicine itself.

 

If we broaden our ‘generalness’ to engage and integrate with other disciplines, including the Social Sciences such as psychology, anthropology, political science, we can perhaps understand more, not only about what might be offered to patients when there is no straightforward medical option for their presentation, but also about the determinants of their emergency, of their behaviour, and ours. 

We can weave these different inputs into a story, their story, our story, into a narrative.

Narrative Medicine encourages the recognition of patient experience and the psychological dimensions of physical illness so we can develop a more holistic approach.   

 

In the session this year, we welcome a broad array of incredible speakers with diverse experience.

Caitlin L. Chandler is an investigative journalist based in Berlin who covers migration, security and human rights and has worked extensively in advocacy.  She is going to talk to us about the concept of bearing witness in emergency. 

Dr Hanni Stoklosa is an Emergency Physician based in Boston who will share her expertise on the topic of identifying and managing the impact of human trafficking in the emergency department. 

I will then share some perspectives on the marginal space where Australian doctors are engaging with the health of the refugee population affected by Australia’s offshore processing policy. 

We welcome back Dr Kathleen Thomas, an intensive care doctor, who will share the challenges of attempting to build a grassroots medical advocacy campaign against the deliberate targeting of hospitals in war. 

Dr Darryl Stellmach is a former aid worker/manager who is now a medical anthropologist with MSF. He will talk about his work applying anthropology in humanitarian emergencies with MSF.

And finally we also welcome back MSF doctor and rural generalist Dr Amy Neilson to talk about narrative in humanitarian medicine, perhaps a way that we can thread it all together.

 

We will also have two panel sessions where we hope to get some discussion flowing and hear about your thoughts on how narrative medicine and the social sciences can feed into what we do in Emergency Care.

I’m super grateful to have the opportunity to curate what I hope will be another fantastic Global Emergency Care session at Developing EM and can’t wait to welcome you to participate in beautiful Cartagena.

Nat Thurtle