More great news from St Lucia as a result of DevelopingEM 2013

Amazing things keep happening in St Lucia as a result of connections made during DevelopingEM 2013. Here’s a letter from our friend and colleague Lisa Charles to explain the latest news.

Victoria Hospital in Castries St. Lucia hosted our first ever Basic PICU course, May 20th to 21st, under the leadership of Drs. Elena Cavazzoni and Bruce Lister. The course was a resounding success with participants expressing renewed commitment and energy as they returned to work driven to implement the new information and techniques which will change their practice.

It all began with a casual conversation during the Developing EM conference in Cuba less than one year ago where Elena asked Caribbean delegates what they thought of having the PICU course taught locally. The power of networking within international conferences such as Developing EM where people meet face to face to learn of and appreciate the challenges of EM in the developing world first hand can not be understated. Nor can the commitment of groups such as the Paeds Basic instructor group and Ultrasound Podcast who self finance these trips to make a difference.

A special thank you goes out from all twenty eight participants in St. Lucia and the many patients who will benefit from the information imparted to us through this most recent spin off of the Developing EM network.

Thanks to those instructors who travelled from around the world: Dr. Peter Skippen, Dr. Nga Pham, Dr. Bruce Lister, Dr. Elena Cavazzoni, Chris Barstow and our newly trained regional trainers Dr. Kandamaran Kishnamurthy, Dr. Joanne Bradford and Dr. Martin Plummer. Special thanks also to Dr. Michele Lashley, University of the West Indies, Barbados for all the work in pulling the course together.

Intracranial Catastrophe – Andrew Bezzina

The next presentation is by one of my personal mentors in Emergency Medicine, Andrew Bezzina.

Andrew is a senior staff specialist in emergency departments around NSW, Australia and he is heavily involved in medical education at all levels.

He remains one of the best emergency physicians I know.

His presentation on the management of intracranial catastrophes outlines some of the controversies and potential solutions for emergency physicians for a disease process that is frequently a frustrating dynamic.

Andrew has helped DevelopingEM from the start and whilst he won’t make it to Salvador he will be supporting us from back home in Oz.

Thanks Andrew for all your support and for another great presentation.

Click here for Audio Link.





Acute CT Interpretation in the ED – Why we shouldn’t always wait for the radiologist

The next in our series of presentation from Havana is Sanj Fernando’s presentation from the Adult ED and Critical Care session.

Sanj is an emergency and retrieval medicine physician from Sydney. He has an interest in education and has taught around the globe. During DevelopingEM 2013 he gave this presentation, organised a fantastic CT interpretation workshop and assisted with the Ultrasound Workshop. This year he is chairing our Trauma Program which is shaping up to be a standout component of the program in Salvador.

Sanj’s presentation was a great reminder that as critical care physicians we really have to own the CT so we can institute life saving therapies in a timely manner.

Listen to the audio file here.



Critical Care Ultrasound for the New Era – 2013 Presentation

Continuing with our presentations from Havana the next in our series from the Adult EM and Critical Care session is from Jorge Otero on Critical Care Ultrasound for the New Era.

Jorge joined our faculty from Connecticut and is the Ultrasound Director of the Emergency Department at Waterbury Hospital. He’s also heavily involved in ultrasound education at Yale School of Medicine.

Jorge is a fluent Spanish speaker and it was great to have him on board in Havana where his presentations in Espanol were a welcome relief from the Aussie drawl for our Cuban companeros.
Jorge was also a fantastic addition to the bilingual Ultrasound workshop.

His lecture outlined some of the basics of emergency ultrasound as well as describing some of the advanced applications.

Audio File – Soundcloud

St. Lucia to host first Paediatric Intensive Care Basic Course

Lisa Charles
Medical Director – Victoria Hospital

The goodwill from St. Lucia’s participation in the Developing EM Conference in Cuba continues to flow our way. This month through the hard work of Dr. Elena Cavazzoni – Paediatric Intensivist; Children’s Hospital at West mead, Australia, whom we met in Cuba and Dr. Bruce Lister – Lead Instructor; Paediatric Intensivist and Anaesthesiologist; Director of Training, Department of paediatric Critical Care Medicine, Mater Children’s Hospital , Queensland, Australia, St. Lucia will host its first ever Paediatric Intensive Care Basic Course!

We have thirty local nurses and doctors signed up for this fully sponsored course. Just over eight paediatric intensivists from as far away as New Zealand, Australia, Canada and the US and as close as Barbados will run the two day workshop – May 20th and 21st.

What is even more exciting is that our colleagues from the University of the West Indies in Barbados under the guidance of Dr. Michele Lashley together with Paeds Basic will run a train the trainer workshop so that we build capacity locally to continue training on our own.

photo (3)St. Lucia has a three bed ICU with the most basic equipment. The provision of ICU care to Paediatric patients is a challenge with the current equipment and absence of intensivists. This course is certainly a step in the right direction to elevating our ability to safely approach the initial management of critically ill paediatric patients.

We will send lots of pics and updates your way after the course.

Also update on our new portable sonosite from Matt and Mike of Ultrasound podcast is being put to great use in our ICU – the head nurse assures me that “it is being used all the time…great things are happening!”


Building global relationships with DevelopingEM

By Mark Newcombe- Co Director of DevelopingEM

As a co-director of DevelopingEM I have had a pretty realistic impression of what our little organisation is likely to achieve.

Lee and I hope, within the framework of a quality conference experience, to promote interactions between clinicians around the globe with the aspiration that these connections made will result in ongoing and long lasting benefit in the regions DevelopingEM visits.

These are fairly lofty aims which I must admit don’t always fit with my very realistic assessment of my own capabilities.

I was immensely proud of the experience Lee and I were able to organise in Havana but it is news just in the last week that has made me begin to realise that maybe we are doing something really memorable with DevelopingEM.

The news was from St Lucia.

In explanation, as part of our venture in Cuba we were able to support the attendance at DevelopingEM 2013 in Havana of three senior emergency clinicians from St Lucia, an island nation of 180,000 in the Windward Islands of the Eastern Caribbean.

We also facilitated a two day ultrasound workshop in St Lucia performed by Matt and Mike from the Ultrasound Podcast Team.

Dr Lisa Charles, an emergency physician who is also the medical director of Victoria Hospital in the capital of St Lucia, Castries, gave an amazing presentation during DevelopingEM 2013 on the development of emergency medicine in her homeland.

This presentation (powerpoint, audio, video) is available below.

So, a fruitful interaction on a small scale, and that I thought was that.

Then a few days ago we received the following update from Lisa.

Dear Mark and Lee,

St. Lucia continues to benefit from the allegiances made during your conference. We have managed to secure the donation of two additional ultrasound machines for Victoria Hospital in St. Lucia, one through ultrasound podcast (big up to Matt and Mike) and also from Meinhard Kritzinger (much love coming your way from St. Lucia).


When I read Lisa’s update I realised that we really have done something a little special.

With no financial support, beyond all of you as our registrants, we’ve facilitated something for Lisa and her team in St Lucia that will be long lasting and beneficial for multiple patients.

Four years feels too long to wait to head back to the Caribbean.

Hopefully when we’re back, with your help we can expand our impact even further.

I know you will enjoy Lisa’s presentation and I’d like to thank her on behalf of all of you and the DevelopingEM team.

Lisa, we hope one day to see those ultrasound machines in action in Castries.

Download Presentation


DEM 2013 hits the mark

In this article, rural emergency SMO Amy Neilson talks about her experience at the 2013 DevelopingEM conference, and why she was in “rural generalist heaven”. Thanks Amy for a great article! Lee + Mark.

During September 2013 the DevelopingEM conference welcomed a broad array of critical care, emergency and generalist doctors to Havana, Cuba.  The brainchild of Mark Newcombe and Lee Fineberg – FACEMs of Wollongong fame – DevelopingEM is “an Emergency Medicine conference with a difference”.  

I was attracted to the event by the sense that it was designed to export tertiary medical skill and training, with focus on the availability of information for all who benefit.  Funds generated were used to subsidise the attendance of local emergency medicine practitioners.  Slides and resources were made freely available.

A great deal of money, research, study, education, time and effort has gone into the ongoing development of the practice of Emergency Medicine in Australia.  As a Senior Medical Officer in a regional Emergency Department, a Rural Generalist and a registrar of ACRRM, I have seen the work of both ACEM and ACRRM colleges, trainees and consultants to improve the delivery of emergency care in Australia.  When gathering to up skill, to share and develop knowledge, I believe there is merit in doing so in settings that encourage broadening the reach of said continuing medical education.

Many Australians travelled via Sydney, Vancouver and Toronto, and on to Havana.  The circuitous route was a consequence of the persisting poor relations between the United States of America and Cuba.  I commenced this journey by looking at a map, thinking I could just pop over to Los Angeles, then on to Miami, then a mere hop skip and jump to Havana.  Not so.  I tried to order Euros online.  ‘Are you going to Cuba?’, the Commonwealth Bank and American Express online services asked me.  A tick in the box of ‘yes’ (a doomed moved, of course, but curiosity won) returned the reply that these services were therefore not for me.

In anticipation of the conference I read about Cuba’s impressive literacy and primary health care outcomes.  I maintain a belief that Primary Health Care in Australia has some serious obstacles and that looking well outside the box for ideas is a worthwhile exercise.  And so, as the Cuban and Caribbean doctors sought to learn about excellence in tertiary emergency care, I was curious to learn from them about robust primary health care systems.

DevelopingEM was attended primarily by FACEMs from Australia and their American equivalents.  However there were a smattering of Rural Generalists, and some Anaesthetics and Intensive Care colleagues.  The conference was accredited by ACEM, ACRRM, and AAEM for continuing medical education, and attracted the full three days of funding for the Rural Procedural Grants Program (Emergency Medicine). The conference was also supported by ACEP and IFEM.

The mood and conversation were open and convivial.  From junior Cuban doctors and ACRRM registrars (well, just me I think) to Joe Lex and Judith Tintinalli, health practitioners contributed, discussed, listened, and learned something new.

Professor of Emergency Medicine Joe Lex kicked off with a reminder of why and how we read medical literature.  Sanj Fernando detailed how important CT diagnoses can be made in ED pending radiology reports, and exhorted his listeners to be able to do so.  Peter Viccellio explained how to observe high intracranial pressure with simple bedside USS by measuring the diameter of the optic nerve.

Lisa Charles, in her disarmingly honest, positive and practical talk on the first afternoon, embodied the event.  Lisa fascinated the audience with the tale of returning from EM training in the United States to her home of St Lucia to essentially build an Emergency Department from the ground up.  She explained that Emergency Medicine is not a priority in developing countries.  Global health policy in St Lucia focuses on maternal and child health and infectious disease. However, the timely treatment of emergencies can mitigate burden of disease in low and middle income countries.

Judith Tintinalli reminded the audience of salient issues associated with trauma in pregnancy.  Simon Binks explained why reviewing the evidence means he no longer uses codeine in children and often prefers absorbable sutures for paediatric facial lacerations.  Marianne Gausche-Hill spoke of teaching ‘BLS plus’ in Iraq. Ricardo Hamilton covered finger or tube thoracostomy, tying of vessels, hysterotomy and lateral canthotomy.  Mike Abernathy explained his great loves as a flight physician –  the bougie, intra-osseous access, video laryngoscopy and capnography.

Jerome Hoffman reminded us that health outcomes are only marginally related to health care, and apologised for his own government as he rose to the mammoth task of following the Cuban speakers.  Sobering statistics were presented to explain the daily effect of archaic sanctions by the United States of America.  Ships with Cuban products cannot enter the States.  Banks in foreign countries cannot trade accounts with Cubans in US dollars.  $4 million of UN funds for AIDS and TB was stopped from coming to Cuba.  This is one of many, many examples.  Trade sanctions mean no access to alzheimer’s medications, or to some medications required by Cuban children with heart disease and leukaemia.  An old, old story with ongoing consequences.

Natalie Thurtle presented her experience of working in Emergency Medicine in Botswana and explained there are currently two funded FACEM posts available there.  (If interested email or  Bradley Dreifuss explained his experience working in Uganda.  The deleterious health impacts of climate change were discussed.

Judith Tintinalli greeted the final day’s audience with a discussion of emerging challenges of Emergency Medicine.  She explained Emergency Medicine as the only population-based specialty.  Any person, any age, any time of day, any condition.  As a Rural Generalist, I hold this definition dear.  We take all comers.  In planning for future needs Dr Tintinalli emphasised the importance of Public Health and Public Education in developing Emergency Departments that meet the needs of the population.

The 2013 Developing Emergency Medicine conference covered a lot of ground.  Emergency Medicine, Rural Generalism, and Public Health are inextricably entwined. My daily goal is see any patient that walks in the door, and to be able to act appropriately.  Achieving that goal requires extensive ongoing continuing medical education.  The DevelopingEM conference was an exceptionally worthwhile use of my professional development time and money.  Warm, intelligent and kind people.  A look at a health system vastly different to our own, yet notable for its own successes.  New knowledge, inspiring colleagues, an appreciation of the practice of medicine in various settings, and a challenging reminder of the ethics and politics of health.  I was in Rural Generalist Emergency Doctor heaven. I encourage Rural Generalists far and wide to consider meeting in Salvador, Brazil on September 12-18, 2014.


Letter to President Obama

As a result of the 2013 DevelopingEM conference in Havana, Cuba, a resolution was made to write to President Obama to end the embargo on Cuba. Here is what we sent.

President Barack Obama

The White House

1600 Pennsylvania Avenue NW

Washington, DC 20500

October 24, 2013

Dear President Obama,

We implore you to end the embargo of Cuba. It accomplishes nothing worthwhile, and is a humanitarian catastrophe for the Cuban people.

We are not a political party, or an organization; nor do we even have a shared social agenda. We are simply doctors who met in mid-September at the “DevelopingEM” medical conference in Havana, in order to share our clinical knowledge & experiences in emergency and critical care medicine. This letter stems from a resolution passed by the participants at the conference.

Approximately 185 doctors came to the conference from 18 countries, including the United States, Cuba, Australasia, Europe, and throughout the Caribbean. We heard talks by presenters from the US and other nations on clinical aspects of emergency care, as well as on related aspects of public health. One of the latter talks, given by Mr. Jorge Soberon, from the Cuban Health Ministry, addressed the impact of the US embargo on both health and healthcare in Cuba, and was extremely sobering. The following facts were presented:

The embargo, currently in its 55th year, severely limits Cuba’s ability to import medicines, medical equipment and new technologies, including some that are essential for treating life-threatening diseases and maintaining public health programs that are important for ordinary Cubans.

The embargo has prevented Cuba from purchasing, among other things, medicines to treat childhood leukemia, and enteric formula for children in danger of dying from treatable diarrheal diseases.

In addition to blocking direct purchases from U.S. companies, the embargo prohibits foreign companies from doing business with the U.S. if they also trade with Cuba. The Office of Foreign Assets of the U.S. Treasury Department stopped Cuba from receiving $4 million worth of drugs from France to combat AIDS and tuberculosis. Fines for doing business with Cuba have doubled under your administration compared to that of your predecessor, George W. Bush.

We believe that political considerations should not supersede the health needs of several million ordinary human beings. We are sure you know that many prominent individuals, including from the US, have expressed concern that the embargo violates both moral standards and international law (and even adversely impacts American business). By continuing to enforce this policy not only would you be counter to the expressed belief of the international community, but also of the majority of the American people (62% in one poll). You would also be abetting what continues to be a humanitarian catastrophe for the people of Cuba.

The embargo simply makes no sense. Flora Roca, a Cuban psychiatrist suggested that “the U.S. thinks the embargo will make Cubans rise up against the Cuban government, but it doesn’t work that way.” Fifty-five years have proven as much. What the embargo does cause is immense suffering, to people we claim to want to help. What value is there in denying medicine to a child with leukemia?

As physician specialists in emergency medicine, we may be fortunate enough in our careers to have a positive impact on our communities, helping to ease suffering and occasionally even saving a life. By ending this senseless embargo against Cuba you would ease the suffering of millions of people, and save thousands of lives. In 2009 you were awarded The Nobel Prize for Peace for your “extraordinary efforts to strengthen international diplomacy and cooperation between peoples.” Please extend this effort to include the people of Cuba. We call upon you please to put an end to this senseless and inhumane embargo.


S. Lee Fineberg, MD, FACEP, FACEM

Mark A. Newcombe BMed, FACEM

Jerome R. Hoffman, MA, MD, FACEP

Faculty & Delegates of DevelopingEM 2013 – Havana, Cuba
569 Lawrence Hargrave Drive
Wombarra, NSW 2515