Written by Lindsay Doucette, Program Director

While speaking about the extensive need for trained emergency medical technicians in the department of Chuquisaca, Dr. Alberto Aviles said, “Our advice to people living in the rural areas is simply don’t get a head injury!”

This quote from Dr. Aviles, the Director of Emergency Medical Services at the Hospital Santa Bárbara, came during a two-day Bolivian American Neurotrauma Symposium held last week in Sucre, Bolivia. The Symposium was organized through a collaboration among the Hospital Santa Bárbara, the Medical College of Sucre, the Chuquisaca Society of Neurosurgery, Puente de Solidaridad (PdS), and the Neurosurgery & Neurology Institute (NNI) of Solidarity Bridge.

While this comment made people laugh, everyone in attendance knew the need for an efficient and effective response to traumatic brain injury (TBI) is a serious matter. Anyone who has witnessed the devastating impact of a TBI on a patient, friend, or loved one knows that in addition to the suffering of the injured person, it also involves the entire community needed to support their rehabilitation and reintegration.

For many years, the Solidarity Bridge neurosurgery program has focused on the care of TBI patients almost exclusively within the context of the neurosurgery service. But in 2019, neurosurgeon and NNI president, Dr. Richard Moser, began to dream bigger. He had a vision to expand our focus to encompass the entire spectrum of care for the TBI patient. As you can see in the figure below, this includes dispatch at the site of the accident, emergency medical service, hospital admission, hospital care, rehabilitation, and community reintegration.

Many service areas must coordinate to provide the full spectrum of care needed for patients with a traumatic brain injury.

According to a recent article in the Lancet Neurology journal, “people in LMICs [Low- or Middle Income Countries] are disproportionately affected by TBI, with most injuries caused by road traffic incidents. There are substantial disparities in care, with little infrastructure for emergency pre-hospital care and very little access to post-acute care.” Through collaboration with our hosts at the Hospital Santa Bárbara (HSB), the NNI organized an integrated neurotrauma trip that included both clinical and theoretical exchange between U.S. and Bolivian healthcare professionals.

Dr. Victoria Harding discusses the nuances of neurological rehabilitation with the physical therapy team at Hospital Santa Bárbara.

On the first day, we divided into service groups focused on emergency, nursing, neurosurgery, neuro-anesthesia, neuro critical care, and neuro rehabilitation. With bilingual medical students and recently-graduated doctors serving as interpreters, the teams were immersed in the realities of HSB, a large public hospital that serves as the primary trauma center for most of the southern third of Bolivia. Each group discussed what works well, areas for strengthening, and opportunities for collaboration. These notes will be used to identify shared goals for partnership with the participating services and the hospital as a whole.

ICU staff transport a patient across the street to access a CT Scan

Back at our hotel each night, the teams debriefed on what they had seen, experienced, learned, and shared with their Bolivian counterparts throughout the day. Many commented on how impressed they were with the commitment and hard work of the hospital staff. As pictured, for example, the ICU team found a way to urgently access a CT scan for a patient. The CT scanner at HSB was broken, so the doctors arranged to obtain the images at a private imaging center nearby. However, no ambulances or transport staff were available, and the imaging center was closing soon. Refusing to give up, the ICU team transported the patient themselves, down the street and across traffic. This was just one example we witnessed of the incredible commitment of HSB staff to overcome any obstacle and provide the best care possible for each of their patients.

In addition to our work in service groups, we also advanced a dialogue about the implementation of the Latin American Registry for Cranial Neurotrauma at HSB. The registry was developed by the MEDITECH Foundation in Colombia with support from the University of Cambridge, the National Institute for Health Research, the Global Health Research Group, and UK Aid. During our week in Sucre, we identified partners to assist with the implementation of this registry and held several meetings with emergency personnel, hospital social workers, and the HSB statistics department. There is currently very little data on the incidence, prevalence, and mortality rates of TBI in Bolivia. Initiating standardized data capture will be an important step to identify opportunities and measure change in death and disability related to TBI over time. It is one more way that the HSB staff are going above and beyond to improve the health and wellbeing of the people of their region.

At the end of our time in the hospital, all of the Bolivian and US participants gathered for a closing dinner overlooking Sucre’s historic Plaza 25 de Mayo. It was a warm and collegial event that included anesthesiologists, physical therapists, nurses, emergency physicians, and neurosurgeons. The dinner was symbolic of the incredible teamwork that is required to provide integrated care for patients with neurotrauma. While it was sad to leave Sucre and return home to winter weather in the U.S., we know that we’ve made many new friends and we look forward to continuing to work together to improve care for patients and families affected by neurotrauma in Bolivia.

Through partnerships and collaborative actions that are measurable and sustainable, the Neurosurgery & Neurology Institute works to build capacity and expertise in Bolivia and Paraguay in order to increase access to safe, affordable and timely health care. As a program of Solidarity Bridge, we are committed to alleviating the suffering, death and disability from neurological disorders and injuries that disproportionately impact patients in the countries where we serve.

We are grateful for the participants from the following institutions and others supporting our neurotrauma work this week in Sucre, Bolivia:

NeuroRestorative
Neurosurgery & Spine Group
Penn State Health Milton Hershey Medical Center
Penn State Health St. Joseph Medical Center
Providence-Swedish
Stanford University School of Medicine
UMass Chan Medical School
University of Washington Medicine - Harborview Medical Center

An Integrated Approach to Traumatic Brain Injury Care in Bolivia