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.

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