Emergency Medicine in sub-Saharan Africa is an under-represented medical entity, particularly in rural areas, but has recently been identified as an expertise of high clinical relevance. The Emergency Department (ED) of the St. Francis Referral Hospital (SFRH) was established in 2015 as one of the first emergency services in Tanzania. The major aims of the ER project are to ensure a 24-hour emergency medicine service, train medical personnel in triage, emergency medicine, point-of-care sonography and incorporation of clinical research.
The SFRH serves a population of more than 1 million people of the Kilombero, Ulanga, and Malinyi districts in Tanzania. Before the start of the project in September 2015, no emergency department was in place. Within the newly built facilities financed by the Swiss Agency for Development Cooperation (SDC), the former outpatient clinic was reorganized to an ED by integrating a new emergency room for patients with serious conditions. A total of seven clinical officers, six to 10 rotating intern doctors, and 13 nurses work at the ED. Triage of all patients is performed using the South African triage score to classify patients into three severity categories and prioritize medical evaluation and treatment of those most in need. The ED operates in three shifts 24 hours a day.
Emergency drugs, fluids, and other consumables are always available. Patients are diagnosed using clinical skills, ultrasound, electrocardiogram (ECG), and point of care tests (malaria rapid tests, urine dipstick, urine pregnancy test, blood glucose and HIV tests). In March 2020, the iSTAT point of care system (Abbott, Chicago, USA) was introduced: Laboratory markers such as haemoglobin, electrolytes, liver enzymes, creatinine and blood gas analysis are measured at the ED with results made available within 5 minutes. Diagnosis, stabilization and treatment of patients is completed within the emergency room including treatment recommendations for the first 24 hours on the wards.
In 2021, an oxygen plant was installed at the SFRH, including pipelines delivering oxygen to the emergency department, theatres, and wards. This oxygen plant was financed by the Rudolf Geigy Foundation, Basel, Switzerland. Moreover, the oxygen cylinders can be refilled for other health centers in the district.