As an emergency physician, it’s easy to get caught up in the daily grind of reimbursement challenges, changing health care laws, and overflowing waiting rooms. Do you ever have the opportunity to take a step back and reflect on the underlying reason why you chose emergency medicine in the first place? How often do you get to the heart of emergency medicine?

Many ACEP members have found those answers by working thousands of miles away, at Tanzania’s Muhimbili National Hospital (MNH). However, prior to 2009, no modern emergency medicine facilities or emergency medicine education program existed in the resource-challenged East African country.

That’s when the Tanzania Ministry of Health asked the Abbott Fund to create the country’s first emergency medicine department at MNH. For more than a decade, Abbott and its foundation, the Abbott Fund, have invested more than $100 million to improve health care and treatment across Tanzania.

“We needed to create an impactful and cost-effective system to teach emergency medicine to Tanzanian doctors and nurses,” said Andy Wilson, vice president, Abbott Fund in Tanzania. “Abbott Fund and the Ministry of Health had a long history of working together to successfully build health systems but we had no knowledge of emergency medicine. So we asked ACEP members for help.”

In early 2010, Wilson met with emergency medicine faculty at the University of California, San Francisco (UCSF), Carolinas Medical Center, University of Chicago, and University of Maryland. “From that trip sprung relationships with ACEP physicians with whom Abbott Fund contracted to develop East Africa’s first emergency medicine residency, and provide both didactic instruction and clinical mentoring for residents,” said Mr. Wilson.

Today, these ACEP physicians, led by Dr. Teri Reynolds, UCSF’s director of global health and Abbott-Fund supported emergency medicine residency program director at MNH, along with their counterparts from University of Cape Town, South Africa, and Dalhousie University, Halifax, Nova Scotia, Canada, have collectively spent more than 30,000 hours training local physicians and nurses in MNH’s emergency department. The emergency department has provided life-saving care to more than 135,000 patients in its first three years. The first eight emergency medicine residency program residents graduated in late 2013 and six have their permanent government contracts to stay with the department.

“While the project’s initial scope was to open an emergency department, we knew its long-term sustainability depended on training local doctors in emergency medicine,” said Dr. Michael Runyon, director of research and global emergency medicine at Carolinas Medical Center. As part of an Abbott Fund–contracted team led by Dr. Steve Justus, Dr. Runyon helped provide the initial clinical, operational, logistical, and educational support for the new emergency department.

‘Village by village or hospital by hospital, these efforts by ACEP physicians and physicians from other developed countries have improved health care in Tanzania and around the world.’

“Because the specialty of emergency medicine didn’t previously exist in Tanzania, continued on-site support and teaching by emergency physicians from established academic emergency medicine programs is an important stop-gap measure during the residency program’s first years,” said Dr. Runyon.

“These patients face exponentially more hardship, and the amount of effort it takes them to physically get to the emergency department (no emergency medical services are available), as well as their degree of illness, is much more extreme than anything I’ve seen in the U.S.,” said Dr. Reynolds.

By the time patients arrive, they are usually incredibly sick. Approximately 80% of evaluated patients are admitted. “I rarely see a patient who doesn’t need to be here,” said Dr. Reynolds.

Dr. Vivek Tayal, director, division of emergency ultrasound, department of emergency medicine, Carolinas Medical Center, who spent a month teaching ultrasound at MNH in early 2013, added: “Even though I was in a supervisory role, the patients saw me as an ally and an asset to their doctors who were providing the direct care, and I experienced nothing but incredibly warm relationships,” he said.

“Working on this project has been incredibly rewarding,” said Dr. Runyon. “I’ve been able to work with, teach, and learn from some truly incredible Tanzanian doctors and nurses. I’ve forged friendships that will last a lifetime.”

For those who feel that their time won’t make a difference, Dr. Tayal said this: “Village by village or hospital by hospital, these efforts by ACEP physicians and physicians from other developed countries have improved health care in Tanzania and around the world. This is truly worthwhile, and it’s time well spent.”

It has certainly changed the life of Dr. Ghaniya Mbarouk, a third-year emergency medicine resident at MNH: “My life has really changed because of this program, and I can see a better future for my career and for all my patients in Tanzania.”

ACEP physicians have found the challenge of working within a limited infrastructure, often with only the most basic supplies, both challenging and rewarding.

In many ways, working as an emergency physician in Tanzania is similar to practicing anywhere – there will always be something you can’t predict. But you work to solve the problem with whatever is at your disposal. “Working in Tanzania is a more extreme version of that,” said Dr. Reynolds. “In some ways it is the purest form of emergency medicine I’ve ever had the chance to practice.”