Written by Rachel Fletcher
On the 5th of July 2024, GECCo held its ‘5 Years of GECCO: One Big EM and Global Health Discussion’ event at the Sands End Community Centre in Fulham. The award-winning building, with its emphasis on being community-centred and sustainable, was a fitting location, and it was refreshing being able to see outside and experience a bit of greenery at a conference, let alone in central London! 50 people attended what was my first time attending a GECCo event, having had some time out of emergency medicine (EM), and it was inspiring to meet and hear from so many like-minded people interested in global health. All of GECCo’s events are driven by feedback from its community in terms of topics and approaches they wish to explore. This was no different, it had been designed to maximise interaction with and hear the voice of as many delegates as possible, whilst homing in on some key topic areas. All of this had been fed back following previous events as something delegates were keen to experience.
The day started in the beautiful main hall with a welcome and introduction from Dr Anisa Jafar. This was followed by the first keynote lecture – a captivating talk from some of the team from Nanyuki Hospital in Laikipia County (Kenya), supported by the global EM partnership they have with the Bristol Royal Infirmary. Several of the clinical team from Nanyuki Hospital were able to join us for the conference, and Rose Sikote and Titus Guchu (EM nurses and simulation leads) presented their work: ‘Nanyuki and Dharura Partnership & our simulation journey: the past 6 years.’ They spoke of developing a simulation teaching programme in Nanyuki and how they had incorporated triage into their department after experiencing it in Bristol.
It was interesting to see a worked example of an international partnership and something other emergency departments (EDs) could aspire to achieve. Through a rolling fellowship scheme, UK staff are able to spend around 2-3 months in Nanyuki – training and working with local staff to build a teaching and simulation programme relevant to the local needs of the department. Staff from Nanyuki are also able to spend time at Bristol Royal Infirmary to experience the differences in a UK ED. Rose and Titus highlighted how successful the partnership had been in fostering relationships and promoting collaborative learning between the two sites both in person and via online engagement. One thing which was particularly noticeable to the Nanyuki team was how much bureaucracy and paperwork there was in the UK ED – something I am sure those of us who have worked in the NHS are all too familiar with! The confidence with which the Nanyuki team spoke, perfectly comfortably highlighting the challenges which result from higher to lower-income country partnerships, is a testament to bilateral respect and an authentic drive to achieving balance within the partnership.
Following from this we were straight into breakout workshops. We rotated around the building into smaller groups- a great opportunity to meet people early on in the day and discuss the important role of partnerships in global health. There were some great ideas as to what makes an ideal partnership. There was plenty of time to hear first-hand of some successful and not-so-successful partnerships people had been involved in. Whilst we discussed some theoretical models and ideas of how partnerships should look, the main takeaway was the importance of communication and relationship-building to forge mutually positive sustainability.
After a coffee break, we continued with the breakout workshops. The team had deliberately – and quite painstakingly – allocated groups such that for each session, different people were brought together over and over, maximising the opportunity to meet everyone. In the first session, we learnt about each other’s global health experience and how people had managed to weave into their careers. This is something I have often wondered about- so it was great to hear from others regarding their challenges and successes. It seemed most of the medics had taken time out of training to enable this – whether that be after foundation training, acute care common stem or as an out-of-programme experience. The wealth of experience in the room was truly inspiring.
The next breakout room focussed on ethics. In smaller groups, we discussed the experience of ethical dilemmas in the context of global health. We discussed how people had felt at the time and how they worked through the challenges they had faced. In our group, one person mentioned they had been asked to do something that they were not comfortable with and would not be within their scope of practice in the UK and how that had left them feeling. We talked about working within your remit and own experience level, recognising your limits and capabilities. We discussed how to address potentially difficult discussions with teams when outside of your usual clinical environment and feeling empowered to say no when appropriate. In other groups, the ethical challenges faced within humanitarian settings were compared to the day-to-day decision-making which very often requires some level of ethical consideration. Although it was acknowledged that there is no “right” answer in any ethical scenario, there are some tools and frameworks which might help in, for example, a humanitarian setting, within more public health oriented challenges or when considering research.
It was then time for lunch, and we were all tasked with a social networking challenge for a bit of fun and to keep creating new conversations: to see how many people we could each meet, learn about their involvement in global health and share on whichever social media we preferred using #GECCoLondon2024 #GECCoUK.
Again it was amazing meeting people in the field of EM wanting to pursue and incorporate global health in their work and especially to hear of projects people were involved in within the UK. This challenge was won by Naomi Richardson……. – well done!
After a lovely lunch, we stayed in the main hall for the second keynote speaker – a truly captivating presentation by Dr Omar Gabriel Torres Valencia, a GP and policy advisor for the Kings Global Health Partnership. He spoke with passion about his vast career in global health and the importance of long term partnerships, advancing health equity and health system strengthening. He spoke about the vital role that partnerships have in collaborative efforts. The benefit of pooling resources and expertise to help strengthen institutions. Dr Valencia consolidated many of the earlier discussions in the partnership breakout session and spoke of his work with the Kings partnership in Somaliland, Sierra Leone, the Democratic Republic of Congo and Zambia all of which have offered fellowships for UK volunteers, connecting them with health professionals in -country.
The first of the afternoon’s breakout sessions covered advocacy, which involved an interesting and somewhat lively debate between the group. The statement for debate was:
“Emergency care practitioners working in access, resource and/or context limited settings have a duty to advocate for and be accountable to communities they work with”
At first glance this was an easy-win for the defending debate side, however, as the opposition discovered, there is more nuance and challenge to be understood and this pressed both sides to dig deep. We ended the debate with a blind vote for the winning debating team – nothing like a bit of competition to awaken the soul!
The last two breakout rooms covered research and the next 5 years for GECCo. As someone who has shied away from research during my career I felt in awe of the breadth of work delegates had been involved with. It was enlightening to hear of the various pitfalls and successes people had experienced in their various projects. A recurrent issue many people had faced was the impact of COVID-19, its effects on fieldwork and how a move to video calls had really changed the way in which international projects were able to run. It was also reassuring to hear that many people were involved in research into health inequalities in UK Emergency Departments.
With respect to the next 5 years of GECCo, the breakout groups were full of ideas. Everyone was keen on more face-to-face events and to further develop GECCo into the platform it has become within the EM global health space. Themes of mentorship and targeted exchange of education and ideas with colleagues in LMICs were especially prevalent. I look forward to the next few months, when the team will really invest some time in picking out the key areas GECCo can develop in response to this and the overall event feedback.
Finally, the last keynote speaker of the day was Dr James Smith an emergency physician who has spent most of his career working, volunteering and lecturing in humanitarian response. Hearing about some of his experiences, especially the challenges with the logistics of providing humanitarian aid, was fascinating. He spoke candidly of his work in Gaza and other areas and talked about the moral demands and systemic and structural injustices in providing care, how clinical limitations add to this demand, and the notion of medical versus political neutrality. He argued that ‘ global emergency medicine has a critical role to play by channelling a value-driven, justice-orientated and decidedly political response to these global challenges.’ After final questions and a group photo, it was sadly the end of #GECCoLondon2024 and a wonderfully informative day. Lots of attendees caught up over pizza after the event, furthering the discussion on global health. Unfortunately, I had to catch a train back to Manchester, but I look forward to the next GECCo event and meeting more of the team in the future.
