#ICEM2025 May 27th Plenary Sessions

🌟 Plenary Session One: Defining and Delivering EM in Developing Countries

Speakers: Dr. Yeisey Yadkinnie Cruaz, Dr. Olita Shilpakar, Dr. Lise Mumporeze, moderated by Dr. Aisha Terry

Emergency Medicine (EM) in developing countries continues to grow in strength and sophistication, despite deep-rooted challenges. This morning’s powerful plenary session focused on how EM is being defined and delivered in three diverse nations: Belize, Nepal, and Rwanda. Each speaker brought forward a story of resilience, innovation, and community, reminding us that emergency care is both a clinical and social mission.

Common Struggles, Unique Paths

Across all three countries, speakers highlighted several common challenges:

• Limited resources and infrastructure

• Scarcity of formal training programs

• Overcrowding and strained prehospital systems

• Lack of recognition of EM as a distinct specialty

Yet each country is carving its own pathway forward, adapting to local context and creating opportunity through partnership, innovation, and national leadership

Belize: Pioneering a Specialty from Scratch

Speaker: Dr. Yenisey Yadkinnie Cruaz

Belize offers a striking example of EM leadership emerging from personal commitment. Dr. Cruaz is the first residency-trained emergency physician in Belize, returning home after training in Mexico to build capacity from the ground up. Belize currently has no in-country residency programs, so its EM development depends on returning clinicians like her who bring global training experiences back to local practice.

Key themes from Belize:

• English-speaking Caribbean context, but not an island

• No formal training structures, with care driven by externally trained physicians

• Strength through team-based care, as protocols and infrastructure slowly develop

“An emergency medicine specialist cannot be one without a team, and I love my team.”

Nepal: Adapting to the Harsh Realities

Speaker: Dr. Olita Shilpakar

Nepal’s journey is grounded in regional partnerships and adaptive training models. EM began taking shape in 2011 with support from the Australasian College of Emergency Medicine, leading to Nepal’s own fellowship program. Dr. Shilpakar highlighted creative community solutions, including training firefighters and airport staff in first aid, and illustrated stark realities such as patients being carried to hospital on lumber-carrying nets.

Key initiatives:

• First EM training program launched in 2011

• Community-based education to expand access

• Severe prehospital care gaps—“human ambulances” reflect EMS strain

• Focus on capacity building and partnerships to grow EM visibility

“The way forward is through capacity building, strengthening partnerships, and increasing the visibility of emergency medicine internationally.”

Rwanda: Building a Pyramid of Care

Speaker: Dr. Lise Mumporeze

Rwanda’s model reflects a nationally coordinated approach to rebuilding healthcare after the 1994 genocide. EM development is tightly integrated into the country’s health pyramid, with community care at the base, district-level support in the middle, and specialist care at the top. The government’s recognition of EM’s impact led to the launch of a four-year residency program, graduating its first cohort in 2018.

Distinct strengths:

• EM formally prioritized at the national level

• Prehospital care available in all districts since 2007

• Women empowered in EM leadership

• Structured progression from diploma to residency training

Challenges persist, however, with only 28 EM physicians nationally, leaving the system vulnerable when individuals travel or leave for further training. Yet Rwanda is actively addressing these gaps through PoCUS training, process improvement, and government advocacy.

“In Rwanda, women are thought of as the heart of the home—the foundation of the family. This strength translates into the leadership of our emergency departments.”

Key Takeaways for Global EM Providers

Country	Key Success	Ongoing Challenge
Belize	Physician-led grassroots EM development	No local residency programs
Nepal	Regional partnerships and community outreach	Critical EMS limitations, lack of academic infrastructure
Rwanda	Government recognition, formal EM training	Very small EM workforce, systemic overcrowding

For many of us attending ICEM from well-resourced settings, these stories are more than informative—they’re humbling. They highlight the adaptability and ingenuity required to deliver emergency care where the system isn’t built for it yet. More importantly, they remind us that EM is a global movement, driven by passionate providers who build something from nothing.

This plenary was not just about struggles, but about hope, vision, and community. Emergency medicine is growing in every corner of the world—and as global citizens of this specialty, we have a responsibility to support its evolution everywhere.

🌟 Plenary Session Two: Defining and Delivering EM in Developing Countries

Speakers: Dr. Don Melady

The George Podgorny Lecture is one of ICEM’s most prestigious sessions, named after a foundational figure in international emergency medicine. It celebrates visionary ideas and the power of global collaboration.

This year, Dr. Don Melady, a leading voice in geriatric emergency medicine, delivered a heartfelt and practical reflection on how emergency departments must evolve to better serve our aging population.

The Most Important Population

Older adults are the fastest-growing demographic worldwide—not just in high-income countries, but globally, thanks to public health, education, and chronic disease management. Emergency medicine has long adapted to crises: trauma, HIV, pediatrics, pandemics. Now, it must rise to meet the needs of older patients, who often present with complexity, polypharmacy, cognitive change, and functional decline.

These are not the “easy” problems our systems were built for—but they are the problems of our time.

A Global Geriatric EM Movement

Dr. Melady shared his personal journey, including a pivotal moment at ICEM Dublin 2012, where a group of passionate providers (and a bit of FOAMed-fueled energy) began shaping a research and educational agenda for geriatrics in EM. Since then, geriatric EM has grown rapidly, but much work remains.

“Older adults come to our EDs because we’re doing a lot of things right. But once they arrive, we need to keep doing everything right.”

From Ageism to Aspiration

Dr. Melady challenged attendees to examine their implicit biases toward aging. Emergency physicians must move beyond valuing speed and acuity alone. We must value autonomy, independence, and shared decision-making, because aging isn’t something that happens to others; it’s a shared human experience.

The 3 Ps of Geriatric Emergency Departments

Implementing a “geriatric ED” doesn’t require a complete system overhaul. It involves three key areas of change:

1. People

• Physicians and nurses with expanded skills and attitudes toward aging

• Training that moves beyond resuscitation to encompass complex, multi-system care

• Recognition and reflection on ageist assumptions in our clinical culture

• Interdisciplinary teams to prevent unnecessary admissions

2. Process

• Standardized cognitive screening (delirium vs dementia)

• Frailty assessment tools

• Better connections to community-based resources

• Volunteers or staff to support patients during long ED stays

3. Place

• Simple, low-cost environmental changes: hearing aids, mobility devices, food/water access, eye masks, ear plugs

• A physical space designed to support the comfort and dignity of older patients

Why Us? Why the ED?

Because we see everyone. And we’ve always stepped up.

Dr. Melady closed with a moving reflection on a concept attributed to anthropologist Margaret Mead: the first sign of civilization was not a tool or weapon, but a healed femur—evidence that someone had been cared for long enough to recover from a disabling injury. That care, that compassion, that commitment to the vulnerable—that’s what makes us human.

Final Thoughts

Emergency medicine has always been adaptable. We’ve faced war, pandemics, and disaster. Now we face longevity—a success story of modern medicine, but one that challenges us to evolve.

Dr. Melady leaves us with this call:

“Let’s reframe aging not as a burden, but as a victory. And let’s make our emergency departments places that honor that victory with dignity, excellence, and humanity.”