Dr Lisa Charles shares her story of life as an emergency medicine physician in Saint Lucia

As a small island in the Caribbean with a population of just 175,000, Saint Lucia faces unique emergency medicine challenges. From the day Lisa stepped off the island to further her studies she knew she would return, and in 1999 she did as a qualified emergency medicine physician.

From that point on Lisa has dedicated her life to improving emergency medical care and systems on the island. Lisa has been instrumental in the implementation of effective resuscitation and changing the relaxed emergency medicine culture to one of urgency and by doing so improving the quality of care and saving lives.

What are the main emergency medicine challenges you face in Saint Lucia?
The challenge I find most exhausting is having the right resources consistently and readily available. Managing the ebb and flow of resources is almost more challenging than if we remained prepared to always manage within a low resource setting. As a small island developing state funding for programs is a constant challenge.  One of the challenges for example is that you can’t maintain a huge spare parts inventory. So if a piece of equipment breaks down, or you run out of a medication the lead time to getting things up and running again is sometimes weeks to months.

Another challenge is that our hospitals aren’t linked to a university so there are no recognized training programs for our doctors who tend to do short stints and then leave to pursue training. There are also very low salaries for senior doctors, so it’s very difficult to convince consultants to stay. Sometimes we have enough doctors, and sometimes we don’t.

It’s very challenging knowing that one week you can provide a high level of emergency medical care, and then the following week you lose a patient because resources for critical care delivery in particular are limited. The constant resource management means I am spending a significant amount of time on non-clinical activities trying to maintain a consistent high-quality emergency medicine service.

What has been your greatest emergency medicine achievement?
Developing and seeing the growth of resuscitation, implementing emergency cardiac care courses and bringing a sense of urgency to emergency medicine in a country where the culture is a very relaxed one. People have the perception of the Caribbean being very laid back, which is great for tourism, but not so much for emergency medicine. I needed to change the culture of emergency medicine to get nurses and physicians to move with urgency and see the significant improvements it makes to patient outcome. I am always so proud when I see an ambulance arrive in the ER and our staff respond to the patient quickly, utilizing their training and saving a patient’s life. It is very gratifying.

What are you hoping to achieve over the next few years?
Five years ago we were gifted a state of the art hospital by the EU, but unfortunately due to challenges ranging from maintenance of the sophisticated technology, equipment and MEP systems to staffing and funding limitations, we weren’t able to immediately move in. We are working very hard now to recommission the complex systems to fit in with our current capacities and I am hoping that this year we can safely occupy the new hospital moving from our current hospital some buildings of which are century old army barracks.

Building regional and international support for the Emergency Medicine program is another area I am hoping to see grow. As a small developing island you occasionally need to look externally for resources and skill sets as you’ll never find everything you need in a population of just 175,000.

Only about 5% of our doctors return to the island post training – partly because the salary points are so low, but also because there are better opportunities for careers and families in developed countries. I would like to see the creation of a sustainable opportunity for the specialization of physicians here in St Lucia, to encourage physicians to stay and give service back to the island for a period of time. The country is too small to develop its own emergency medicine training program but possibly connecting with a regional or international training program that allows St Lucians to do part of their specialization at home and so increase the likelihood of them remaining here.

Why did you become an emergency medicine physician?
Emergency medicine was the right fit for me on many levels. Our system is Saint Lucia when I was training two decades ago was very primary care based so I knew I had to be knowledgeable in all areas, but I also wanted to handle the sickest of patients. So emergency medicine was the perfect fit for the skills I wanted and needed in the Saint Lucia emergency medicine environment. I love reaching out to young people just starting out in medicine to let them know that if they want maximal impact in the field of medicine then pick emergency medicine.

What is the best thing about being an emergency medicine physician?
That you’re able to take care of anything that comes through those swinging doors. Emergency medicine physicians are often seen as adrenaline junkies and there is definitely a component of that, that instant gratification from turning around a critical patient. There is also a great appreciation that things could have gone very differently if you hadn’t been there at that particular point in time. Being there in that moment with your skills to save a life is really the reason to keep pushing through.

What is the best way IFEM can assist the advancement of global emergency medicine?
Taking networking to the next level – connecting and working with emergency care teams from countries with similar resources and systems. Assistance with implementing low cost high yield interventions – protocol courses, resuscitation, point of care ultrasound etc.

A better way of classifying and determining emergency medicine needs within specific settings. Often volunteer doctors who come to Saint Lucia come with the expectation that our needs are more basic than they are. There are a growing number of countries that need more than the basics in emergency medicine system development while still not ready for the advanced systems of highly resourced countries. Finding that in between place.  You may also have similarly resourced settings which because of one or two slight resource differences such as availability of an emergency medicine trained physician, can have very different levels of care. It may be more beneficial to provide an emergency medicine trained doctor to input appropriate systems than to give a hospital funding without that emergency medicine expertise to enable improvements. What a single trained emergency medicine doctor armed with an understanding of critical emergency systems can do with limited resources, especially one familiar with the local setting, can be very impactful.