Medical screenings and care of expatriate workers As part of the planning process before a corporation selects a project site in the developing world, Rescue Medicine can conduct a Medical Site Assessment. This report would include an evaluation of the physical, political, and medical conditions in the local area, with recommendations for reducing health and safety risks to both expatriate and domestic workers if the site is chosen.
The majority of international MEDEVACs involve preventable medical conditions such as:
Rescue Medicine’s Global House Call is a 6-month mandatory comprehensive physical medicine screening, exam, interview and dental check-up for long-term expatriates living in extreme environments.
Unlike primary care programs in the US, House Call metrics assume that emergency medical care will be delayed 1 week instead of 1 hour. House Call requires that the best of US medical training and knowledge be adapted for maximum health advantage. For example, extremely aggressive cardiac screening is performed on all deployed personnel under 28 years of age; all personnel are pre-challenged for foreign manufactured antimalarials; prescription drugs are pre-screened for interactions with emergency medications used by non-US hospitals; secure, non-counterfeit local medication providers are identified; and local US boarded trauma surgeons are retained for 24/7 coverage of expatriate and local employee communities.
Occupational and accidental death are primary causes of under 50 mortality in developing Africa and Asia. Up to 45% of these deaths occur at industrial construction projects, routinely in regions without advanced medical care. In 1988 Rescue Medicine adapted the U.S. Wilderness First Responder training and an industrial health and safety program for the oil industry to produce the Industrial First Responder (IFR) training program. Since then, the IFR program has been taught to over 3500 care providers in 6 African nations and 300 care providers in Indonesia.
The IFR program provides employees with no medical training with objective-oriented training that can be adapted from the job site to the roadway to the home village. In 1995, the IFR program became the training curriculum of the Ghanaian Fire Academy and in 1996 the IFR was adopted by the Nigerian oil industry as a minimum standard for workplace emergency medical care.
In 1999 the IFR curriculum returned to its origins in wilderness medicine when it was used as the basis for the Zambian Bush Medical Responder program, a training curriculum for safari guides in Zambia and Angola. The IFR has been widely adapted throughout Africa to meet the different needs of local and national prehospital requirements of different nations.
Rescue Medicine’s Medical Ambassador Program adapts peer-reviewed medical standards for the management of acute and chronic diseases to resource-constrained environments. Medical Ambassador Programs first identify leading medical interventions associated with maximum improvement in Activities of Daily Living (ADLs) and adapt these interventions for use in austere environments far from convenient medical care. Medical Ambassador starts with on-site medical screening and primary care management of industrial worker communities. In 1991 the annual cost of screening and 12 months of care for a 40 year old male was $22.00 per individual per year.
In 1996 the Medical Ambassador Program was recognized for launching the world’s first occupational Directly Observed Anti-Retroviral Therapy (DOART) program to treat HIV/AIDS at three heavy utility construction projects in Nigeria and DRC. The DOART program was initiated using best-in-class HIV treatment and was implemented three years before any other program in Africa. Medical Ambassador also played a critical role in preserving relations between the U.S. Government and the World Bank and foreign national labor unions that provided skilled employees.
In Nigeria, expansion of Medical Ambassador services were used to resolve a dispute among Christian and Muslim employees at a major construction project. In Republic of Congo, Medical Ambassador physicians and RNs were first to respond to a Ebola outbreak that occurred among villages supporting a local mining operation, and in Western Congo, Medical Ambassador medical teams were first to respond to the tragic Bukavu Massacre in Goma.
The Medical Ambassador Program has demonstrated that the humanitarian and ethical benefits of delivering quality medical care to domestic workers yields extraordinary dividends in worker and community health, transparent, trusting relationships, and improvements in project performance.
Global House Call and Medical Ambassador programs have allowed Rescue Medicine physicians to gain patient admission privileges to the best foreign hospitals, a major achievement in improving patient survival in the first 24 hours and a major strategy for preventing inefficient use of Rescue Medicine’s busy MEDEVAC aircraft.