How one doctor’s education can drive up survival rates 

In Somalia, the average life expectancy is 54 years old. The reasons for such a low age are multifaceted, but one contributing factor is the fact that, up until recently, there were no doctors trained in emergency medicine in the country. That meant – and often still means – that very few within a Somali hospital have the expertise to handle an incoming trauma. This ultimately contributes to higher mortality rates.

The situation is the same elsewhere in East Africa; there are estimated to be only a few hundred trained emergency physicians in the whole region. That isn’t, however, due to lack of interest. “In low- and middle-income countries, it’s a speciality people aren’t aware of,” explained Irene Atuhairwe Duhaga, Uganda’s country director for Seed Global Health. Most doctors gain a bachelor’s degree in medicine but should they be aware of the opportunity to study further, they can then struggle to find, access, and fund a master’s degree in emergency medicine.

That was certainly the case for Dr. Abdirahman Hassan Hersi, who, after completing his medical training in China, became starkly aware of the limitations of his abilities upon return to Somalia. “You receive a patient, you are the only doctor around and maybe that patient has trauma, multiple injuries, severe dehydration or is hypertensive. It was hard to make a decision on what to do… And there was no Internet to find the knowledge,” he shared. He recognized that he could benefit from further training, but initially struggled to find a viable course.

That, however, changed in 2019 when he heard of a newly launched Master of Medicine in Emergency Medicine at the Mbarara University of Science and Technology (MUST) in Uganda. Launched the year prior, the course was borne out of a desire by Seed Global Health to improve access to emergency medicine and train health professionals in the region, and is part of a partnership with Uganda’s Ministry of Health and Ministry of Education. Both MUST and Makerere University, also in Uganda and offering a Master of Emergency Medicine, have since accepted a cohort of around five students from the region each year. The idea is that by taking students from neighboring countries, the program is not only strengthening access to health care in Uganda but in the entire region. Trained physicians can then take their skill set back and share what they have learned amongst more doctors.

Much closer to home than other options in China or Russia, this seemed more viable and so Dr. Hersi applied and was accepted. Thus began three years away from his family and hard work that would see him rotate around different hospital departments, gaining hands-on experience led by professors from around the world.

In the three-year program, the emphasis is on enabling doctors to make quick decisions on whether a patient needs resuscitating or intubating, where a central line is needed and whether the response should be surgical or medical, explained Dr. Hersi. “We rotated in anesthesia, surgery, pediatrics, internal medicine and other departments where we learned how to handle emergency cases and important procedures.”

The depth and breadth of this program differs to what would have been on offer to doctors prior, explained Dr. Daniel Olinga, head of the Department of Emergency Medicine at MUST.  “Before this program, there was only small, basic training, for instance in advanced life support, advanced cardiac life support or provision of first aid,” he said. “The detailed continuum of actually knowing how to refer the patient, stabilize them, resuscitate them and finally discharge them to their primary doctors is what was missing.” All of this is vital in saving lives; something Dr. Hersi had acknowledged in Somalia and aimed to rectify.

The three years were tough though, Dr. Hersi shared, especially being so far away from home; but it was worth it. “There are so many things I do now that I wasn’t able to do before, whether it is clinical work, stabilizing patients, making decisions or diagnosing those specialties,” he said, adding that every day he now sees a patient he may not have been able to help, even save, in the same way before.

Such was Dr. Hersi’s dedication to bettering his medical practice that Dr. Olinga and other professors still recall his time as a student today. “He is one of the most improved students and now an emergency physician I can proudly talk about who harnessed the skills that we gave to him,” said Dr. Olinga, recalling his particular talent for emergency ultrasound. “He impressed his colleagues and residents in that he was the go-to person for every procedure.”

Beyond the classroom

In the time since Dr. Hersi graduated in 2022, he has returned to Somalia, determined not only to provide better care himself but to improve the care provided by all physicians around him. He is Head of the Emergency Department at Kalkaal Hospital in Mogadishu and spends a lot of his time not only administering emergency medicine but sharing what he learned at MUST with more junior doctors. “I didn’t know I was a good teacher until I joined this course,” he shared. He has produced department guidelines on triage procedures and designed systems for how nurses can best support in the ward.

Dr. Hersi’s story is not unique. Of the 25 plus doctors that have so far gone through a Seed-supported master’s program in emergency medicine in Uganda, the majority are locals and have gained employment in facilities across the country, bolstering the care Ugandans now have access to. Duhaga said the accessibility of the course may have contributed to a 34% reduction in mortality for patients between 2023 and 2024 in the country.

Of the students who enrolled from neighboring countries, most have returned to those countries, intent on improving access to care for their communities in the likes of Kenya and Somalia, said Dr. Olinga, explaining that this was always the aim. This, he believes, is contributing to a decline in deaths and improved patient outcomes across the region.

“The doctors have established emergency departments, are developing protocols and helping run the whole hospitals. This cannot just be by any chance. It is something that is taught in the program; residents adopt the act of leadership,” said Dr. Olinga.

The next step is to expand the program to allow for more than a handful of doctors to train each year. Seed is aiming, said Duhaga, to train 120 emergency medicine doctors in Uganda by 2030. This would help contribute to building a robust health workforce by 2030 and mitigate the number of deaths in emergency wards. It is part of Seed’s Strategic Plan 2030 to strengthen human resources for health. Dr. Hersi believes offering more doctors like him the chance to upskill is key to saving more lives across the region.

“Each hospital should have one or two emergency physicians,” he said, adding that this helps entire communities receive the care they deserve. “People have better health when they have good emergency care.”