The Queen Elizabeth Central Teaching Hospital in Malawi needs an Adult Emergency and Trauma Centre to address overcrowding in its emergency department and lack of facilities to treat adult patients. A proposal was drafted to build a new purpose-built centre with capacity for 500-1000 patients and facilities for triage, resuscitation, evaluation, treatment initiation, and data collection. Funding has been pledged by the Malawi-Liverpool-Wellcome Trust and support is sought from the Scottish government and NHS Tayside to provide additional funding, equipment, training, and expertise from Scottish emergency physicians.

1. Adult Emergency & Trauma Centre QECTH Blantyre Malawi Barry Klaassen Emergency Medicine NHS Tayside

3. NHS Tayside Numerous individual projects Formation of Tayside Malawi Group Strong Health Board and Executive support

4. Tayside Malawi Group Aim bring together projects and share knowledge and expertise potential for collaboration/co-operation Chair Prof Frank Carey( Pathology) Now NHS Tayside Int. Heath Links Group

5. NHS Tayside Group Anaesthesia General Practice Obstetrics and Gynaecology Pathology/laboratory Science Plastic Surgery Emergency Medicine also PAMS and St.Andrews/Dundee Medical Schools

6. Emergency project Anaesthetic/critical care training led by Dr Catriona Connelly Oct 2007 Part of that team Consulted on feasibility of Adult ED by Prof Malcolm Molyneux and Prof Rob Heyderman Director of Malawi Wellcome Trust

8. Queen Elizabeth Central Teaching Hospital Malawi’s largest 1,120 beds for local population approx 1 million Teaching hosp for single Medical School

9. Problems for QECTH 3 fold population increase urbanization HIV epidemic ALL increase GREATLY clinical workload

10. QECTH in 2006 400,167 attendances A&E/OP… 1500+/day on average 302 Paeds emergencies/day with 70 admissions/day 530 adult emergencies/day max1010/day with 70 med /20 surg admissions bed occupancy in med admissions 252%

11. Problems with existing A&E facility Makeshift access few small rooms/confined space no triage facility/triage non-existent no resuscitation facility no capacity for major incident no capacity to stabilise patients prior to admit to wards

15. Establishment of Paediatric A&E Unit ( PAEU) 2001 New build for rapid registration immediate triage on site immediate care resuscitation facility records and data store senior clinical supervision ability to deliver 1st treatments rapidly

19. Impact of PAEU DRAMATIC…. Reduction death rate among admissions from 19% to 9% improved research on acute conditions improved teaching/support of staff and Med/Nurse students improve morale of all on-site staff

21. THERE IS NO EQUIVELENT PROVISION FOR……. Adult acute Medical Adult Surgical Adult Orthopaedic and Trauma or Gynaecological Conditions

22. Proposal Purpose built Adult Emergency & Trauma Centre QECTH/COM heads of Dept agree need for such appointed steering group identified site at Hospital Architects appointed / drafted initial plan

24. Requirements of Centre Capacity for 500-1000 immediate reg/triage separate minor/majors resuscitation facility specialist evaluation ability to isolate I.D Short stay facility ability to initiate 1st treatment Capacity for data store open plan waiting area optimise flow to treat minor/major theatres & plaster areas lab facilities x-ray facilities dispensing pharmacy

25. Further requirements Suitable to senior supervision all areas teaching/training facilities/seminar room amenities for staff rest/refreshment Adequate toilet/wash facilities for patients max air flow & natural light throughout unit ready access for Amb.

26. Funding Malawi- Liverpool-Wellcome Trust pledged excess of £500,000 THIS REMAINS CONFIDENTIAL BUT IS CONFIRMED. This covers new build costs

27. Require further funding for .. Initial key set up personnel Equipment costs Training Costs

28. Scottish support Recruit Experienced Scottish EM Consultant to oversee initial operation Support re equipment purchase support re training Malawian clinical staff

29. Tayside EM dept involvement Support project and provide a link for new dept akin to Twinning arrangement share good practice and equipment allow senior Malawian Clinical staff to come and observe our EM practice

30. Tayside EM Benefits Opportunity to share some of our expertise with others contribute collectively as a unit in framework of Scottish Gov policy to Malawi opportunity to use the link to generate research and audit collaboratively Develop improved understanding of EM as practised in other country

31. Funding Scottish Gov. International Development Fund NHS Tayside funds with Malawi support group Local Fund raising Others…

32. Scottish Gov IDF Grant Not payable to individual need to be organisation NHS Tayside Director of Finance very supportive Have created NHS Tayside Malawi-EM project endowment fund

33. Additional Expenditure Recruit a Clinical Lead for Unit -College of Medicine responsibility Recruit Nursing Staff , New Clinical Officers and Eventually Medical Staff - Ministry of Health responsibility

34. SOMEONE CANNOT DO EVERYTHING… …BUT EVERYONE CAN DO SOMETHING.

35. ANY QUESTIONS?