Traffic accidents kill more than a million people every year worldwide and injure or permanently disable millions more. The Middle East region ranks second highest in terms of road fatalities, according to the WHO, with Egypt alone suffering more than 7,000 deaths annually.
Photo by Deborah S. Doyle,
courtesy of Photoshare
The Middle East region ranks
second highest in terms of
road fatalities. Egypt alone
reports more than 7,000
That's why Fogarty grantee Dr. Jon Mark Hirshon of the University of Maryland, Baltimore, chose to launch a trauma research training effort there.
Hirshon, a leader in public health and emergency medicine, has designed trauma training programs domestically and in the Middle East. He works primarily in Egypt where he's trained nearly 400 health professionals in initial assessment and management of trauma patients, and injury epidemiology. He's extended his research and training team and expertise to Iraqis (see the related article Fogarty project provided emergency trauma training to Iraqis), Iranians, Afghans and Sudanese as well.
His current projects in Egypt are supported by a five-year International Collaborative Trauma and Injury Research Training grant from Fogarty. The main thrust of his research involves assessment of injury-related death and disability in Cairo. This information is helping public health officials plan and implement appropriate and cost-effective prevention strategies.
Research collaboration studies trauma issues
Hirshon's team studies practical matters such as how long it takes to get to the hospital by different modes of transportation, the delays in reaching the hospital and factors related to delays for trauma patients admitted to Ain Shams University Hospital in Cairo. In collaboration with the WHO, Ain Shams is a key research partner that serves as a growing regional resource for the study of causes, dynamics, treatments and outcomes of traumatic injury.
Data about the effect of under-triage on trauma patients at this hospital is currently being analyzed. Other studies focus on risk factors for violence among patients admitted to the hospital and how to decrease return emergency department visits. Data collection is ongoing for epidemiology of moderate and severe traumatic brain injury at another facility, Alexandria University Hospital.
Photo by P. Virot, courtesy of WHO
Fogarty-supported studies include
assessments of injury-related death and
disability in Cairo.
Fatalistic beliefs contribute to accident rates
Vehicular collisions account for 45% of injury deaths in Egypt. Research done by Hirshon's team analyzes human factors related to car crashes on the roads that encircle Cairo. Attitudes about traffic accidents affect behavior on the street and behind the wheel of a car. In one study, researchers interviewed Egyptian adolescents about their knowledge and attitudes about injuries and fatalism.
Despite a low belief in the preventability of injuries and a high belief in fate, surveys and focus groups revealed that young, educated Egyptians are ready for and would benefit from injury prevention programs.
"As in much of the Middle East," says Hirshon, "there is work underway in Egypt to create a shift in thinking of accidents as random and unavoidable to preventable, predicable and avoidable."
Pedestrians suffer 75% of traffic collision deaths in Egypt. A study of Cairo University students examined the relationship between risk-taking behavior and road traffic collisions. Although the risky behavior was nothing out of the ordinary, the study concluded that education on safe street crossings would likely decrease the rate of pedestrian injury.
Cultural differences impact research and training
One of Hirshon's areas of interest is providing education in cross-cultural settings and addressing the challenges that come with language barriers, educational customs and evaluations.
As in many countries, substance abuse is a problem in Egypt and a factor in trauma-related injury and death. Because of the stigma associated with drug and alcohol use among Egyptian Muslims, it has been a difficult topic to study. Hirshon is launching an effort to do so, employing the more experienced members of his team.
Trainees become trainers, capacity increases
Hirshon's five-day training course covering initial assessment and management of trauma patients plus injury epidemiology is so successful, it's now included in Alexandria University's master's curriculum and trauma training has been made a requirement for board certification in emergency medicine in Egypt.
Another lasting impact of Hirshon's efforts is the 25 or so Egyptians he's trained in trauma and injury research who are now training others, further expanding Egypt's ability to address this critical health problem.
"With so many Egyptian nationals trained and with valuable information drawn from many research studies," says Hirshon, "the work of this Fogarty grant has increased Egyptian health professionals' knowledge and understanding of human trauma and injury prevention and helped them build up injury prevention and trauma response mechanisms in their country."