GLOBAL EMERGENCY MEDICINE

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OUR
MISSION

The Mission of the Division of Global Emergency Medicine is to collaborate with international partners to extend the department's vision of discovering, teaching, and delivering patient centered emergency care to low and middle income countries through the development of locally sustainable emergency medical systems.

Emergency Medicine Development in Guyana:

A sustainable partnership for education leads to the birth of a system.

Since Vanderbilt Emergency Medicine’s first visit to Guyana in late 2002 led by then Chief Resident John Paul Rohde who grew up in Georgetown in the 1980s, a robust Vanderbilt collaboration with the Guyanese public health sector and the Georgetown Public Hospital Corporation (GPHC) has made significant contributions to the development of Emergency Medicine in Guyana.

The modern history of global health engagement in low-and-middle income countries by developed country institutions is marred by echoes of neocolonialism, white supremacy, and harmful medical tourism. However well intended, major philanthropists and governmental agencies have funded shortsighted and misguided projects that have commonly failed to result in sustainable local systems development and have often impaired lasting local progress by fostering dependency on foreign resources and by misaligning incentives. By contrast even as early as 2002, Vanderbilt’s initial conversations with GPHC’s then Director of Medical and Professional Services Dr. Madan Rambaran were infused with his vision of founding durable graduate medical education programs in all major specialties in Guyana as a key sustainable development objective.

Prior to 2009 Guyanese physicians could obtain their initial medical degree either from the University of Guyana or in Cuba through an agreement between the Cuban and Guyanese governments---but no post-graduate residency training programs were locally available. The post-graduate path to the practice of medicine was based on simply assigning junior doctors to a hospital department and putting them to work as informal apprentices to more experienced clinicians. In order to obtain bona fide specialty training Guyanese physicians and surgeons had to leave the country to attend programs in the United States, Canada, Russia, Cuba, Great Britain, or the West Indies. While some of these foreign trained specialists did return home and become medical leaders in Guyana, many were lost to the system because of the portability of foreign training and more attractive practice markets elsewhere.

In 2009 Vanderbilt’s Division of Global Emergency Medicine became the grateful recipient of a grant from Project D.A.W.N., a non-profit devoted to improving the health of the Guyanese people founded in 1985 by Dr. Carmen Gannon. Dr. Gannon, also known as Sister Mary Carmen Gannon of the Sisters of Mercy, was a U.S. American Internal Medicine physician and Nun originally from Baltimore who had developed a deep connection to the people of then British Guiana as she worked in the Mahaica Hospital as a nurse caring for patients with leprosy. After completing her medical degree at George Washington and her residency at MUSC in Charleston, she returned to Guyana and founded Project Donors and Workers Now, leveraging international resources to provide locally unavailable surgical care for Guyanese patients.

The Project D.A.W.N. gift allowed Vanderbilt to recruit Dr. Nicolas Forget, the first fellowship trained Global Emergency Medicine faculty member at Vanderbilt, who would eventually become known as the “Father of Emergency Medicine” in Guyana. In 2010---just 4 months before Dr. Gannon’s death from complications of a stroke---Vanderbilt, the Georgetown Public Hospital, and the University of Guyana collaborated to launch the Masters in Emergency Medicine residency program, the first degree conferring residency program for physicians in the country. Nico and his wife Dr. Ruth Derkenne, herself a family physician and obstetrician who contributed monumentally to the local development of her own specialties, moved their family which would eventually include 2 young children to live in Guyana for the 3 years that it would take to get the new residency program up and running.

In the decade that followed this collaboration has become a sustainable partnership that has produced 18 fully trained Emergency Medicine physicians so far. 16 graduates have remained in Guyana and are actively involved as teachers in the residency, including Dr. Zelda Luke from the class of 2014 who now serves as the Program Director.

Two graduates have returned to their home countries to become the first residency trained Emergency Medicine physicians in Grenada and Antigua. The Georgetown Public Hospital and the University of Guyana now offer residency training in Emergency Medicine, Surgery, Internal Medicine, Pediatrics, Family Medicine, Obstetrics and Gynecology, Anesthesiology, Radiology, and Psychiatry in collaboration with numerous international partners. The vision of sustainable graduate medical education in Guyana is actively being realized.

The development of Emergency Medicine residency training in Guyana has paid dividends and fostered progress on many levels:

The Accident and Emergency Department at GPHC has been elevated to full department status within the institution and the residency program’s 1st graduate, Dr. Zulfikar Bux, serves as Head of Department and National Director of Emergency Medical Services.
With seed funding from the Morris Family Foundation the National EMS Service was launched in 2012. With 911 style public access, centralized dispatch, and online medical control by trained emergency physicians at GPHC, it has grown to over 80 basic EMTs in service and is adding advanced EMT training early next year.
Alongside the Emergency Medicine residency program for physicians, Vanderbilt, GPHC, and the University of Guyana now offer a bachelor’s degree conferring 2-year residency in Emergency Nursing lead by Vanderbilt’s Jessica VanMeter---believed to be the first of its kind. With 5 classes and 42 graduates to date it is revolutionizing emergency nursing care in Guyana.
Introduction of the American Heart Association life support courses (ACLS, BLS, PALS), and the creation of the GPHC’s own life support training center accredited by the Caribbean Heart Foundation.
Facilitation of a new and ongoing partnership between GPHC and Project Dawn Ltd. which secured the use at cost of Project Dawn’s thirty-thousand square foot facility near the University of Guyana for GPHC’s growing medical education needs. This facility houses the office of Guyana National Emergency Medical Services, accommodates visiting faculty, and serves as a training site. Since the start of the Covid-19 pandemic it has provided isolation housing for providers assigned to the Covid-19 specialty hospital at Ocean View.
Development of additional specialized fellowship training programs for residency graduates in Emergency Ultrasonography and Emergency Department Administration, with plans to add EMS, Simulation Education, and Global Emergency Medicine in the near future.
Consultation by request of the GPHC board of directors on the redesign of the GPHC A&E Department by Vanderbilt chief architect Mr. Donald Blair, who donated his time and created a blueprint and recommendations for a new physical plant.
Creation of GPHC’s Trauma Registry database program, to collect epidemiologic data on accident and injury cases, to guide the future development of the program based on real data and patient outcomes.
When the Covid-19 pandemic struck Guyana, the government created an Infectious Diseases Specialty Hospital for Covid-19 patients and named a 2014 graduate of the GPHC EM residency, Dr. Tracey Bovell to become its Chief Medical Officer based on her reputation as a leader in disaster preparedness.

This progress has been the work of a cast of characters from Vanderbilt, Guyana and beyond:

John Paul Rohde - grew up in Guyana in the 1980s and will always consider Guyana to be home. Led the first Vanderbilt visit to Guyana in 2002 and worked with Project Dawn, GPHC, the Guyana Ministry of Health, and the University of Guyana to create the platform for ongoing collaboration. Core faculty member in the Emergency Medicine residency at GPHC.

Nicolas Forget – the inaugural Director of the Masters in Emergency Medicine program at GPHC and the “Father of Emergency Medicine” in Guyana. Nico and his wife Dr Ruth Derkenne (Family Medicine and Obstetrics) have had an incalculable impact on the development of graduate medical education in Guyana. Their legacy in the development of Emergency Medicine, Family Medicine, and Obstetrics is monumental.

Jeff McKinzie - first Division Head of Global Emergency Medicine at Vanderbilt and early pioneer of the Vanderbilt partnership with GPHC

Les Wooldridge – world class resuscitation guru and American Heart Association content expert who brought resuscitation training to Guyana as an early educational initiative. His personal style and teaching talent created the credible foundation of resuscitation education on which the EM residency at GPHC was later built.

Seth Wright – second Division Head of Global Emergency Medicine at Vanderbilt and founder of the Fellowship program who mentored JP Rohde and 6 Fellows, recruited and mentored Nico Forget, and built the Division of Global EM into what it is today.

Keith Wrenn – Legendary teacher of Emergency Medicine who gave generously of his time and tirelessly of his effort to provide critical training to the early residency classes.

Corey Slovis – Legendary teacher of Emergency Medicine and retired Chair of Vanderbilt Emergency Medicine under whose tenure the Guyana partnership was started, nurtured, and developed with his generous support.

Ian Jones – Strategic advisor on program development, early residency class educator, and constant supporter of the program.

Larry Stack – Legendary medical photographer and teacher of visual diagnosis who was an important educator of early residency classes.

Kristen Dettorre – first Vanderbilt Global EM fellow and now Fellowship Director who created the first GPHC residency curriculum and remains a major contributor to the residency. One of the creators of the VUMC Global Health Equity training program available to all VUMC residents and fellows. Core faculty of the EM residency at GPHC.

Shannon Melvin Langston – international man of mystery, former paramedic of 13 years, and second Vanderbilt Global EM fellowship graduate who leads the Guyana National EMS System project with Dr. Zulfikar Bux. Core faculty of the EM residency at GPHC.

Tiffany Alexander – Filled Nico Forget’s gigantic shoes to become the 2nd GPHC EM residency Program Director, laboring tirelessly on behalf of the residency with an inspirational commitment to excellence and an unparalleled personal humility.

Jordan Rupp – Vanderbilt Global EM and Ultrasound fellowship trained co-founder with Brian Bales of the GPHC Emergency Ultrasound fellowship and the global ultrasound non-profit Global Sounds. Core faculty of the EM residency at GPHC. (Jordan may almost rival Tiffany in the personal humility department.)

Brian Bales – Vanderbilt Global EM and Ultrasound fellowship trained co-founder with Jordan Rupp of the GPHC Emergency Ultrasound fellowship and the global ultrasound non-profit Global Sounds. Core faculty of the EM residency at GPHC.

Jaime Cirbus – Vanderbilt Global EM fellowship graduate and now Director of International Education, managing Vanderbilt’s evolving role in support of the GPHC EM residency. Worked innovatively with Dr. Zelda Luke, the GPHC EM Program Director, to rapidly adapt the curriculum to Covid-19 pandemic constraints. Core faculty of the EM residency at GPHC.

Ken Iserson – Veteran academic emergency physician, author, educator, and wilderness medicine expert from the University of Arizona who serves as a core faculty member of the EM residency at GPHC.

Lacey MenkinSmith – Director of the Global Emergency Medicine fellowship at the Medical University of South Carolina who serves as a core faculty member of the EM residency at GPHC.

Joe Reardon – Vanderbilt Global EM fellowship graduate whose ambitious fellowship project successfully reviewed and updated the GPHC Masters in EM residency curriculum.

Catherine Burger – long-time recurring contributor to EM resident education in Guyana and now Peds EM specialist with a vision for enhancing Peds EM training in Guyana.

Stephan Russ – long-time recurring contributor to EM education in Guyana and master facilitator and collaborator on big ideas. Closely involved and heavily engaged since the earliest days of the partnership. Key contributor to National EMS System, Masters in EM program, Emergency Nurse Residency program, and GPHC A&E architectural redesign projects among others.

John Morris – Master creator of systems of care and invaluable mentor who has given abundantly of his time and unequaled expertise to make the Guyana National EMS System project possible.

Jessica VanMeter – If Nico Forget is the Father of Emergency Medicine in Guyana, then Jessica is the “Mother of Emergency Nursing”, serving as the inaugural Director of the Bachelor’s Program in Emergency Nursing at GPHC

Sally Dye – VUMC trauma program educator and long-time recurring contributor to Emergency Nursing education in Guyana and Associate Director of the Emergency Nurse Residency program.

Ali Grubbs – VUMC nurse leader and former emergency nurse involved from the beginning of the Vanderbilt/GPHC partnership in Emergency Nursing education. Key contributor to the creation of the Emergency Nurse Residency curriculum.

Morgan Vero Rohde – VUMC cardiothoracic CRNA and former emergency nurse involved from the beginning of the Vanderbilt/GPHC partnership in Emergency Nursing education. Key contributor to the creation of the residency curriculum. Recently facilitated a new partnership between Middle Tennessee School of Anesthesia and GPHC in support of nurse anesthesia education.

Emily McBride – VUMC nurse leader and former emergency nurse involved from the beginning of the Vanderbilt/GPHC partnership in Emergency Nursing education. Key contributor to the creation of the residency curriculum

Jan Dahlke – VUMC emergency nurse case manager and key contributor to the creation of the Emergency Nursing residency program.

Jason Reed – VUMC Lifeflight nurse and former emergency nurse who was a key contributor to the creation of the Emergency Nursing residency curriculum

Emily Evans – VUMC critical care/emergency nurse practitioner and key contributor as an educator in the Emergency Nursing residency program.

Shannon Elrich - VUMC critical care nurse practitioner and key contributor as an educator in the Emergency Nursing residency program

Kevin High – Master educator in airway management and trauma team resuscitation who has provided valuable airway and resuscitation training for GPHC physicians and nurses

Jeff Gray – Vanderbilt EMS communications guru who helped design and implement the communications platform for the Guyana National EMS System.

Donald Blair – Vanderbilt Medical Center’s chief architect who donated his time and expertise to generate blueprints for a redesign of the Accident and Emergency Department facility at GPHC.

And now the cast of characters is changing as the residency program has retained 100% of its Guyanese graduates in Emergency Medicine practice in Guyana:

Zulfikar Bux – Inaugural graduate of the GPHC/Vanderbilt/University of Guyana Masters in Emergency Medicine in 2013, first promoted to rank of Consultant, now Head of GPHC Accident & Emergency Department, and Guyana National Director of Emergency Medical Services

Tracey Bovell – Class of 2014 graduate and 2nd promoted to rank of Consultant. Leader in Trauma education and Disaster Preparedness. Chief Medical Officer of the Guyana Covid-19 Specialty Hospital.

Zelda Luke – Class of 2015 graduate and now Program Director of the Masters in Emergency Medicine residency program.

Balram Doodnauth – Class of 2015 graduate and now Assistant Director for A&E Operations and current Fellow in A&E Administration.

Batukhan Wilson – Class of 2015 graduate with clinical focus in critical care medicine. Leader in the national Covid ICU.

Sri Devi Jagjit – Class of 2015 graduate and first to complete the Vanderbilt/GPHC Emergency Ultrasound Fellowship. Now director of ED Ultrasound at GPHC and US fellowship director. Internationally acclaimed US research in publication.

Esan Reid – Class of 2015 graduate and active duty Guyana Defense Force Medical Corps Officer. GPHC staff Emergency Medicine physician and leader in remote/hinterland search and rescue operations.

Priscilla Joseph – Class of 2016 graduate and GPHC staff Emergency Medicine physician.

Rajiv Singh – Class of 2017 graduate, GPHC staff Emergency Medicine physician and current Ultrasound Fellow.

Hemchand Jhagru – Class of 2017 graduate and now Chief Oral Boards Examiner for the GPHC Masters in Emergency Medicine program and Head of Accident & Emergency Department, New Amsterdam Hospital, serving Guyana’s second largest city.

Dwayne Kellman – Class of 2018 graduate, GPHC staff Emergency Medicine physician, and Assistant Medical Director of Guyana National EMS.

Rayal Jhagru – Class of 2018 graduate, GPHC staff Emergency Medicine physician, current Ultrasound Fellow, and Director of Simulation Education.

Andy Walcott – Class of 2019 graduate and GPHC staff Emergency Medicine physician.

Melissa RIcket – Class of 2019 graduate and GPHC staff Emergency Medicine physician.

Dellon Durga – Class of 2020 graduate, GPHC staff Emergency Medicine physician, and soon to be future Global Emergency Medicine Fellow.

Vedprakash Etwaria – Class of 2021 graduate with impressive performance on Masters written and oral exams despite 2 years of training in pandemic context with hybrid remote/in-person learning platform.