I Iulai 9, 2020, MUa hana ʻo Akerere University, School of Public Health i kahi loiloi kūikawā i ka mokuʻāina o EMS a me ka mālama maʻi olakino mālama olakino ma Uganda. ʻIke lākou i ka pae paeʻāina, aia ka hapa o nā mea hoʻomaʻamaʻa ambulance, e like me nā ambulance eʻe ana, nā papa spinal, a me ka nele o nā kaukau loea.

ʻO 16 (30.8%) wale nō o 52 mau mea hoʻolako mua ma ka haukapila i loiloi i loaʻa nā kaʻa pilikia maʻamau me nā kaʻa kaʻa kaʻa e pono ai pono, nā lāʻau, a me nā limahana e pane pololei i kahi hanana pilikia. ʻO kēia ka mea a ke Kulanui ʻo Makerere i hoʻomaopopo ai ma hope o kāna ana ʻana ma Uganda a puni. ʻO ke kumu kēia kokoke i 70% o nā hiʻona ma Uganda ʻaʻohe ona hiki no ka mālama olakino ʻana ma nā wahi ma mua o ka haukapila.

Ma ke kua o ka loiloi, ua hōʻike lākou no ka Ministry of Health (MoH) i ka pono e hoʻomaikaʻi i nā lawelawe ambulance. Ke aʻo nei kēia noiʻi e hoʻokumu i ke kūlana o nā lawelawe olakino kūwaho (EMS) a me ka mālama ola olakino mālama kino ma Uganda. Hana lākou i ka loiloi e pili ana i ka paeʻāina a i nā paeʻāina, e noʻonoʻo ana i ka mana EMS ma ka hale o mua a me ka pae hoʻokele e hoʻohana ana i ka World Health Organization Systems (WHO) Emergency Care Systems Assessment (ECSSA).

ʻOiai ua hana ʻia kekahi mau noiʻi e loiloi ai i ka mālama mua o ka haukapila ma Kampala [7,8,9], ʻaʻohe mea i ʻike ʻia i hana ʻia no ka nānā ʻana i ke kūlana o EMS a me ka mālama ola olakino mālama kino ma Uganda ma ka pae lahui.

 

ʻO ka pahuhopu o ke aʻo ʻana a me nā kumu: nā kuleana o nā poʻe loea a me nā lako ambul ma Uganda EMS

Ma kahi ʻoihana loea e lawelawe ai (EMS), pono nō hoʻi nā lawelawe ambulance ma Uganda e hoʻonohonoho i nā mea āpau o ka mālama i hāʻawi ʻia i nā mea maʻi i mua o ka hale haukapila a i waho paha o nā haukapila [1] ʻO ka Paramedics a me nā EMT (ma ke ʻano o nā mea kūʻai kaʻa ambulance), e hoʻokele i nā mea maʻi me nā mea hana ambulance kūikawā. ʻO ka pahuhopu ka pono o ka hoʻomaikaʻi ʻana i nā hopena o nā mea maʻi me nā kūlana koʻikoʻi, e like me ka obstetric, ke kūlana olakino, nā hōʻeha hōʻeha, a me nā maʻi maʻi ʻē aʻe.

ʻO ka mālama mua ʻana i ka haukapila ʻaʻole ia he kahua i kaupalena wale ʻia i ka ʻoihana olakino, ʻoiai hiki ke komo i nā ʻāpana ʻē aʻe e like me ka mākaʻi a me ke keʻena ahi. Ma waho aʻe o ka mālama mua-hospital, hoʻopilikia nui ʻia nā hopena maʻi e ka mālama koʻikoʻi i hāʻawi ʻia ma ke keʻena olakino e loaʻa ai [4]. ʻO ke ola o ka poʻe maʻi a me ka hoʻihoʻi ʻana e hilinaʻi ʻia ma ke alo o nā limahana lapaʻau i hoʻomaʻamaʻa kūpono ʻia, a me ka loaʻa ʻana o nā mea pono ambulance, e like me nā stretchers, spinal nā papa, ka ʻōnaehana oxygen a pēlā aku, nā lāʻau lapaʻau, a me nā lako i nā minuke a me nā hola ma hope o ka hōʻea ʻana o kahi maʻi maʻi maʻi ma kahi keʻena mālama ola [5].

 

EMS ma Uganda: nele nā ​​lakohana kaʻa kaʻa a me nā ʻoihana hoʻomaʻamaʻa - Ka laʻana o ka laʻana a me nā ʻano hana hoʻohālike

ʻO ka ʻōnaehana olakino Uganda i hoʻonohonoho ʻia i ʻekolu pae nui:

• hale haukapila ʻōiwi
• nā haukapila pili ʻāina
• halemai (apana)

I loko o ka moku, aia nā wahi olakino me nā ʻano like ʻole:

Ke kikowaena olakino I a me II: ke keʻena olakino ʻoi loa. ʻAʻole kūpono i nā kūlana olakino koʻikoʻi [11];

ʻO kahi kikowaena olakino II a me IV: nā lawelawe olakino piha loa.

Ua loaʻa i ke Kulanui ʻo Makerere kahi laʻana o nā pono olakino āpau ma Uganda mai MoH a stratified i ka papa inoa e nā wahi olakino. Ua hōʻuluʻulu hou ʻia nā wahi olakino i 4 mau ʻāpana geo-hoʻokele o Uganda [12] (ʻo ia hoʻi, ʻAkau, Hikina, Komohana, a me Central) e hōʻoia i kēlā me kēia wahi geo-administration i hōʻike ʻia i ka laʻana. Ma loko o kēlā me kēia wahi geo-administrative, ua koho koho ʻia ka hui noiʻi i hoʻokahi ʻāpana olakino (Fig 1 - ma lalo).

 

Ua noʻonoʻo lākou i ʻekolu mau wahi olakino olakino: ʻĀina Arua ma West Nile no ka mea he nui o ka heluna nui o ka poʻe holo aku, a hiki paha i nā EMS. ʻO kekahi ʻoi ke kāla olakino ʻo Karamoja mai ka wā i loaʻa ai ka mōʻaukala a me ka hanana i ka wā i hoʻopilikia ʻia me ka komo ʻole o nā lawelawe kaiāulu. ʻO ke kolu ʻo ka ʻāpana ʻo Kalangala i hoʻokumu ʻia i ka mokupuni he 84 a no laila ke loaʻa i kahi paʻakikī o ke kaʻi ʻana aku.

Ua hōʻuluʻulu ka hui o ka Pūnaewele University ʻo Makerere i nā HC āpau i koho ʻia i loko o nā wahi olakino i koho ʻia e ka waiwai (ʻo ia hoʻi, aupuni, ʻona a ʻoihana pono ʻole a i ʻole hana aupuni (PNFP / NGO), a me nā pilikino pilikino for HCs). No kēlā me kēia wahi olakino, ua koho pono lākou i 2 mau keʻena olakino no ka pono o ka maikaʻi (ʻo ia hoʻi, 1 HC IV a me 1 HC III), ʻUlena keʻena ololi a PNFP / NGO (ʻo ia hoʻi, 4 HC IV a me 2 HC III) mau kino olakino (ʻo ia hoʻi, 2 HC IV a me 4 HC III). Ma kahi i noho ʻole ai kahi pilikino-no-profit or PNFP / NGO HC III a i ʻole ka HC IV i loko o nā wahi olakino i koho ʻia, hoʻopiha lākou i ka pihi (me) a ka HC III a aupuni a i ʻole ʻo HC IV.

ʻO kā lākou hoʻolālā sampling i hopena i ka nui no ka hānai hoʻohālike e pili ana i nā haukapila referral rehiyon 7, 24 mau halemai ākea (apana), 30 HC IV a 30 HC III Eia kekahi, ua manaʻo ʻia ʻo ka Apana ʻo Kampala ma kahi ʻāpana kūikawā ma muli o kona kūlana ma ke kaona ʻona nui me ka neʻe nui o nā pono olakino. Ma waho o nā RRH ʻekolu (ʻo ia, ʻo Rubaga, Nsambya, a me Naguru) i loko o ke kūlanakauhale, ua hoʻohui pū kekahi ʻo RRH (Naguru) i ka ʻano noiʻi.

Eia nō naʻe, ua hoʻohui lākou i nā mākaʻi i ka mea mālama mua ma ka haukapila no ka mea ʻo lākou ka mea mua i pane mua ʻia i nā hanana pōpilikia a hoʻolako i ka halihali i nā poʻe kōkua. ʻO ka loiloi he hōʻike ʻāpana ʻāpana ʻāina nona ka 7 mau ʻāina olakino, 38 mau moku (Fig. 2) [13], he mau keʻena olakino 111, a me 52 mau kahu maʻi hānai. Mai kēlā me kēia 38 mau wahi, noiʻi nā mea noiʻi i kahi luna āpana o nā kalana, ʻo ka pinepine, ʻo ka luna o ka Apana Oihana Apana ka mea e hoʻoholo ai i ka helu o ka moku, a he 202 mau limahana koʻikoʻi i komo pū me EMS a me kahi mālama ola olakino.

 

ʻO ka hemahema o nā ʻenekia a me nā ʻoihana loea i Uganda: hōʻiliʻili ʻikepili

Ua hoʻoponopono nā mea noiʻi mai ke Kulanui ʻo Makerere i ka loiloi hoʻonaʻauao ʻo WHO Emergency Care Systems [14] i hoʻomohala ʻia e Teri Reynolds a me nā mea ʻē aʻe [10]. Ua kōkua kēia iā lākou e hōʻiliʻili i ka ʻikepili ma EMS ma ka pae o ka haukapila a me nā pae olakino. Hōʻailona ka mea kākau i nā hōkeo a me nā nīnau nīnau, kahi i hoʻopaʻa ʻia ai i nā pou o ke ola kino ʻeono: alakaʻi a me ke aupuni; kālā kālā; ʻikepili; ola hana olakino; nā huahana olakino; a me ka lawelawe lawelawe. Ua nānā pū lākou i nā hōʻike mai nā haʻawina mua EMS ma Uganda [7,8,9] a hoʻopihapiha i nā ʻikepili i hoʻomaikaʻi ʻia i kahi makaʻala kumu nui e alo ai i ka kūkākūkā me kahi luna ʻelele ʻo MOH.

 

 

EMS ma Uganda: Hōʻike nā hualoaʻa i nā pono ambulance a me nā mea hoʻomaʻamaʻa hoʻomaʻamaʻa hemahema

Kuhi i ka papa e hōʻike nei i nā hopena i loaʻa i loko o nā kīʻaha like ʻole a me nā pae ʻāina a me nā ʻāpanaʻāina. Nā huaʻōlelo hou loa i nā loulou ma ka hopena o ka moʻolelo.

 

ʻIkepili ma EMS ma Uganda: kūkākūkā

Ua ʻike ʻo Uganda i ka nele o ke kulekele aupuni, nā alakaʻi, a me nā kūlana i ke kula olakino maʻi. Hōʻike kēia nele i nā māhele o ke kula olakino: kālā; nā huahana olakino, a me ka hoʻonohonoho ʻana.

Loaʻa i nā wahi ulia i nā ʻoihana olakino nā mea hoʻohana pono ʻole a me nā lāʻau lapaʻau e nānā ai a me ka mālama ʻana i nā kūlana olakino āpau. Loaʻa ʻia kēia hemahema o nā lako a me nā lāʻau lapaʻau i nā pae āpau o ke olakino. ʻOiai, ʻoi aku ka maikaʻi o nā ʻoihana pilikino a me nā ambulances ma mua o nā mea aupuni. Loaʻa ka hemahema a me ka hana o nā mea ambulance no ka pane ʻana i nā kūlana olakino e manaʻo nei e hele nā ​​mea maʻi ma ka mālama mua i ka wā ma mua o ka haukapila, a laila halihali ʻia i nā wahi olakino e hoʻomaʻamaʻa maikaʻi ʻia ana e hoʻokele i kā lākou hanana hanana.

Ua kāwili ʻia nā lawelawe ambulance e nā ʻenehana maikaʻi ʻole, ka hoʻonohonoho ʻana a me ka kamaʻilio ʻana. Ma kahi o 50% o nā mea hoʻolako EMS i ninaninau i hōʻike ʻia ʻaʻole lākou e haʻi i nā wahi olakino ma mua o ka hoʻoili ʻana i nā pōpilikia ma laila. ʻO kēlā mau keʻena hau, me nā haukapila referral rehiyon, ʻaʻole i loaʻa i ka EMS ma 24 lā o ka lā. ʻOiaʻiʻo, nā mea kūleʻa a me nā hoahānau pili wale i nā mea lapaʻau e kōkua i nā mea maʻi. A ʻo nā kaʻa kiaʻi mākaʻi i mau kaʻa ka mea maʻamau (no ka 36 o nā mea hoʻolimalima he 52 no ke halihali ʻana i nā mea maʻi e pono ai ka mālama ola.

ʻO ka noiʻi ua wehewehe i kahi ambulance ma ke ʻano he kaʻa huakaʻi ʻo ia e hoʻolako nei i ka lele a me ka mālama ʻoiai ma ka hale o ke haukapila ma mua, i ka manaʻo o ka hapanui o nā hāʻawi ma mua o ka haukapila he mau ʻulima, akā he mea hoʻolako lākou i ka lawe huakaʻi. Eia nō naʻe, i kēlā me kēia pae, ʻike ʻia ka lawa ʻole kālā no EMS.

ʻO nā palena o kēia noi ʻana he ana hewa mai ka hilinaʻi ʻana i nā hōʻike ponoʻī no kekahi o nā hopena (e laʻa me ka hoʻohana ʻana o ka ʻikepili no ka hoʻolālā). Eia naʻe, ʻo ka hapanui o nā hopena nui (loaʻa a me nā hana o nā huahana olakino) i ke ana ʻana i ana ʻia ma o ka nānā pololei ʻana. Ua hōʻoia nā mea noiʻi i nā mea mai nā noiʻi ʻē aʻe e hoʻohana ana i kahi ʻano hana like i loaʻa ka nele o ke alakaʻi ʻana, ke kānāwai a me ke kālā ma ke ʻano he mau pale nui i ka hoʻomohala ʻana o EMS i nā ʻāina kūkulu.

ʻO ka mea i hōʻike ʻia ma kēia ʻatikala he loiloi aupuni a no laila e hiki ke hoʻonui ʻia nā mea ʻike i ka holoʻokoʻa ma Uganda. Ua hiki nō ke hoʻonui ʻia nā mea i ʻike i nā ʻāina haʻahaʻa a me ka hapa waena i loko o ʻAulikaʻaila ʻaʻohe o nā ʻōnaehana EMS [1] a hiki ke hoʻohana ʻia no ke alakaʻi ʻana i nā hana e pili ana i ka hoʻomaikaʻi ʻana i nā ʻōnaehana EMS i loko o kēia mau papa.

 

I ka hopena…

ʻO Uganda kahi pūnaehana multi-tiered o nā pono olakino e hiki ai i nā mea maʻi ke hele no ka mālama olakino. Eia nō naʻe, mai nā mea i ʻike ʻia ma luna o nā mea he nui e nīnau 'ʻO Uganda anei kahi EMS?'. Pono mākou e kuhikuhi a ua hana ʻia kēia noiʻi ʻana i ka manawa i ʻike ʻole ai nā kulekele EMS, ʻaʻohe kumu, a maikaʻi ʻole koʻi hoʻonohonoho ʻana ma nā paeʻāina a me nā pae ʻāina.

Wahi a nā mākaʻi o Makana Makahiki, no laila he mea hoʻonaninani loa ia i ka manaʻo, aia nō, ʻaʻohe EMS, akā he nui o nā mea nui i kahi e hiki ai ke hana hou ʻia ma ke ʻano he hoʻomaka no ka hoʻokumu ʻana i ka ʻōnaehana. Na ka mea i wehewehe i ke kumu no nā lako ambulance a me ka nele o nā limahana hoʻomaʻamaʻa maikaʻi. Eia naʻe, aia kahi kaʻina hana e hoʻomohala ai i nā kulekele a me nā alakaʻi no ka hoʻokumu ʻana o ka EMS.

 

E hoʻomaopopo '

1. Mistovich JJ, Hafen BQ, Karren KJ, Werman HA, Hafen B. Prehospital emergency care: Brady prentice health health; 2004.
2. Mold-Millman NK, Dixon JM, Sefa N, Yancey A, Hollong BG, Hagahmed M, et al. ʻO ka moku'āina ʻoihana lawelawe olakino (EMS) i loko o ʻApelika. Prehosp Disaster Med. 2017; 32 (3): 273–83.
3. ʻO Plummer V, ʻo Boyle M. EMS nā'ōnaehana i nā ʻāina haʻahaʻa haʻahaʻa haʻahaʻa: ʻo ka nānā ʻana ma ka palapala. Prehosp Disaster Med. 2017; 32 (1): 64-70.
4. Hirshon JM, Risko N, Calvello EJ, SSd R, Narayan M, Theodosis C, et al. Nā ʻōnaehana olakino a me nā lawelawe: ka hana o ka mālama mālama pono. Pūleʻa Pūnaewele o ka Pūnaewele. 2013; 91: 386–8.
5. Mock C, Lormand JD, Goosen J, Joshipura M, Nā Kūlana Peden M. no ka mālama pono trauma. Geneva: World Health Organization; 2004.
6. Kobusingye OC, Hyder AA, Bishai D, Joshipura M, Hicks ER, Mock C. ʻOihana lawelawe lapaʻau. Hoʻomaʻamaʻa i nā ʻoi aku nā moʻomeheu Pūnaewele. 2006; 2 (68): 626–8.
7. Bayiga Zziwa E, Muhumuza C, Muni KM, Atuyambe L, Bachani AM, Kobusingye OC. Ua hōʻeha ʻia nā hōʻeha alanui ma Uganda: ʻo ka wā mālama mua ma mua o ka haukapila mai ka pahu hoʻokipa a i nā haukapila a me nā mea pili e nā mākaʻi o Uganda. Int J Inj Contr Saf Hoʻolālā. 2019; 26 (2): 170-5.
8. Mehmood A, Paichadze N, Bayiga E, et al. 594 Hoʻokele a me ka hoʻomaikaʻi-hoʻokolohua i ka paahana wikiwiki no ka mālama mua ʻana i ka haukapila ma Kampala, Uganda. ʻVentionlelo hōʻeha. 2016; 22: A213.
9. Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Raza O. Ke nāwaliwali a me nā hikiwawe e hoʻopiʻi i ka mālama ulia ʻo Prehospital no nā mea i hōʻeha ʻia e ka huina alanui ma nā wahi nui ʻo Kampala metropolitan. Mele Kalikimaka BMC. 2017; 17 (1): 29.
10. Reynolds TA, Sawe H, Rubiano AM, Do Shin S, Wallis L, Mock CN. ʻO ka hoʻoikaika ʻana i nā ʻōnaehana olakino e hoʻolako i ka mālama no ka pilikia. Nā hana i nā maʻi ma mua: ke hoʻomaikaʻi ʻana i ke olakino a me ka hōʻemi ʻana i ka pōpoki 3rd edition: ʻO ke Bank International no ke kūkulu hou ʻana a me ka hoʻomohala / ʻO ke kālā honua; 2017.
11. Acup C, Bardosh KL, Picozzi K, Waiswa C, Welburn SC. Nā mea kūpono e hoʻopiʻi ana i nā mākaʻi pasila no T. b. rhodesiense kanaka African trypanosomiasis ma Uganda. Kaukini Acta. 2017; 165: 230–9.
12. Wang H, Kilmartin L. Ke hoʻohālikelike nei i ka ʻano hana ma waena o ke kaiāulu a me ke kūlanakauhale a me ka hoʻokele ʻana ma Uganda: nā ʻike mai ka hoʻohana ʻana i ka lawelawe lawelawe leo. J Urban Technol. 2014; 21 (2): 61–89.
13. Ka Hoʻohui Hoʻokele QGIS. QGIS Hōʻikeʻike Geographic System 2018. Loaʻa mai: http://qgis.osgeo.org.
14. World Health Organization. Hoʻopilikia ka mālama a me nā trauma iā Geneva, Switzerland. 2018. Loaʻa mai: https://www.who.int/emergencycare/activities/en/.
15. ʻO Hartung C, Lerer A, Anokwa Y, Tseng C, Brunette W, Borriello G. E wehe i nā ʻikepili: nā pono hana e kūkulu ai i nā lawelawe ʻike no ka hoʻomohala ʻana i nā wahi. I: Nā kaʻina hana o ka hālāwai ACM / IEEE International e pili ana i ka ʻikepili a me nā ʻenehana ʻenehana a me nā Hoʻohui. London: ACM; 4. p. 2010–1.
16. Nielsen K, Mock C, Joshipura M, Rubiano AM, Zakariah A, ʻo Rivara F. ʻO ka loiloi o ke ʻano o ka mālama prehospital ma nā ʻāina o ka hapa haʻahaʻa a me ka hapa waena. ʻO ka mālama pīhoihoi Prehosp. 13; 2012 (16): 3–381.

 

AUTHORS

ʻO Albert Ningwa: Ke Oihana o ka maʻi ʻeha a me ke olakino o ke olakino, Makeere University School of Public Health, Kampala, Uganda

ʻO Kennedy Muni: Keʻena ʻOihana Epidemiology, University of Washington, Seattle, WA, USA

ʻO Frederick Oporia: Ke Oihana o ka maʻi ʻeha a me ke olakino o ke olakino, Makeere University School of Public Health, Kampala, Uganda

ʻO Joseph Kalanzi: Keena Oihana Kauka ʻoihana, nā Kuhina o ke Ola, Kampala, Uganda

ʻO Esther Bayiga Zziwa: Ke Oihana o ka maʻi ʻeha a me ke olakino o ke olakino, Makeere University School of Public Health, Kampala, Uganda

ʻO Claire Biribawa: Ke Oihana Oihana Oihana a me na Oihana Aina o ke Kaiapula, Makerere University of Public Health, Kampala, Uganda

ʻO Olive Kobusingye: Ke Oihana o ka maʻi ʻeha a me ke olakino o ke olakino, Makeere University School of Public Health, Kampala, Uganda

 

 

E LEʻI ALSO

EMS Ma Uganda - Ke lawelawe nei ʻo Ambulance ʻo Uganda: Ke makemake nei ʻo Passion i ka ʻālana

ʻO Uganda No Ka Hana Kānāwai me Boda-Boda, ʻO nā ʻauhau ʻĀkana i hoʻohana ʻia ma ke ʻano he kaʻa holo kaʻa

Uganda: 38 mau kamaʻilio hou no ke kipa ʻana o Pope Francis

 

 

KANAKA

BMS: BioMed Central - Ke kūlana o nā lawelawe olakino pōpilikia a me kahi mālama olakino olakino ma Uganda: nā hopena i loaʻa mai kahi National Cross-Sectional Survey

Nā hōʻike a nā hoa: Ke ala o nā lawelawe olakino e pili ana i nā lawelawe olakino a me ka mālama kino olakino ma Uganda: nā loaʻa mai kahi National Cross-Sectional Survey

Kula o ke Kula o ka Pūnaewele Manaʻo o nā Health Health, ʻO Ke Kulanui ʻo Makerere

 

ʻO ka WHO: mālama mālama