Evaluating emergency physicians’ knowledge, attitudes, and experiences of FARC ex-combatants : a pilot study of Colombia’s emergency medicine teaching hospitals

Objectives: In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex-combatants into the healthcare system. However, FARC ex-combatants have faced significant challenges in receiving healthcare, and little is known about physicians' abilities to address this population's healthcare needs. Methods: An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians' knowledge, attitudes, and experiences with the FARC ex-combatant reincorporation process. Results: Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two-thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex-combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty-two participants (41.5%) had identified a patient as an ex-combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex-combatants (r = 0.356, n = 47, P = 0.014). Conclusion: Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex-combatants, and cared for these patients when they self-identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex-combatant healthcare reintegration.Revista Internacional - Indexad

Love in the Time of COVID-19: Negligence in the Nicaraguan Response

The response of the Nicaraguan government to the coronavirus disease 2019 (COVID-19) pandemic has been perhaps the most erratic of any country in the world to date. Directly contradicting mitigation strategies recommended by WHO, President Daniel Ortega has refused to encourage any physical distancing measures. Vice President Rosario Murillo (Daniel Ortega\u27s wife) instead called on thousands of sympathisers to congregate in street marches under the slogan \u27love in the time of COVID-19\u27. By downplaying the danger of the pandemic and increasing the risk of community transmission in the second-poorest country in the western hemisphere, the Nicaraguan government is violating the human rights of its citizens

Attitudes of US emergency medicine program directors towards the integration of climate change and sustainability in emergency medicine residency curricula

Background: Climate change affects hospital operations and the conditions and rates at which people seek treatment. Emergency physicians are relied upon to treat climate-related conditions and meet surges in demand. Educators have called for integrated education on climate change to better prepare physicians. However, the attitudes of United States (US) emergency medicine (EM) residency educators on climate change in the curriculum remains unknown. Methods: An initial pilot survey was developed and validated to assess US EM program directors’ attitudes towards the inclusion of sustainability and climate change in resident education. Likert scales were analyzed as a psychometric response to specific domains of residency directors’ attitudes towards climate change and sustainability importance and their inclusion in EM residency training. Concordance of Likert scores for questions on sustainability versus climate change were compared via Wilcoxon matched pairs signed rank test. Scores were compared across demographics, geographic location, political affiliation and self-reported knowledge of sustainability and climate change with one-way ANOVA analyses. Results: Seventy-five survey responses were received, with greatest representation from the Northeast and Great Plains/Midwest. Most participant's self-identified political leanings were liberal (43%). Respondents indicated that most programs do not include climate change education (90.3%). The median level of agreement with “climate change is an important issue for EM physicians” on the 9-point Likert scale was 6 (IQR= 1, 8) and for sustainability was 7 (IQR = 6, 9). The median level of agreement for “climate change should be included in EM curriculum” was 3 (IQR = 1, 6) and for sustainability was 6 (IQR = 5, 8). Responses were statistically different across political leanings and gender. Conclusion: While most program directors sampled believe that climate change and sustainability are important to EM, agreement with the importance of the inclusion of climate change in EM curricula was lower. Currently, climate change is not discussed in the majority of EM training programs across the United States. While low response rates limited generalizability, hypotheses were generated including potential differences in receptivity by educator age and gender

Supporting healthcare workers caring for excombatants: incentives among Colombian providers with FARC ex-combatants

Q2Q1Fuerzas Armadas Revolucionarias de Colombia (FARC)With the Peace Agreement between Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised healthcare to 13,000 ‘reincorporating’ FARC ex-combatants. Shortages of healthcare workers in reincorporation camps means this promise is in danger of going unfulfilled. More information is needed to determine incentives, disincentives, and recruitment of healthcare providers to address this shortage. Semi-structured interviews were conducted with healthcare providers across FARC reincorporation camps, and a multidisciplinary team conducted analysis in NVivo12 using a team-based coding method. Twenty-four healthcare professionals from 15 camps participated, of which 75% were female. Incentives to work with FARC included improved clinical skills, professional advancement, increased comfort with FARC, and contributing to the peace process. Disincentives included poor living conditions, lack of support, biases, familial commitments, and sacrificing career opportunities. Threefourths of the sample recommended working with FARC, and 92% reported a shortage of healthcare workers. Recruitment strategies included improved resources and specialised career development for healthcare workers, facilitating interactions between FARC and healthcare professionals outside clinical scenarios, and integrating medicine for vulnerable populations into health education. This study shows the impact that working with FARC ex-combatants can have on healthcare providers and tangible suggestions for increasing provider participation to address the healthcare worker shortage.https://orcid.org/0000-0002-1982-6799https://orcid.org/0000-0002-9013-5384https://orcid.org/0000-0002-5372-2459Revista Internacional - IndexadaA2N