Stories From the Field:

KENYA

Growing Anesthesia Services in a Government Hospital in Kisumu, Kenya

Puneet Sayal and Tao Shen's trip to Kenya was supported by an MGH Global Health Travel Award. Dr. Sayal and Dr. Shen are Anesthesiology Residents at Mass General.

Our time in Kisumu, Kenya was spent largely focused on medical education initiatives at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) with an organization called ImPACT Africa (Improving Perioperative Anesthesia Care and Training in Africa). We had the opportunity to work with providers at multiple levels, which gave us a comprehensive picture of many issues surrounding care delivery, mainly regarding the availability of physical resources, qualified personnel, and differential utilization of healthcare amongst the Kenyan population.

We started out in the intensive care unit (ICU), a 5-bed unit with the capacity to provide mechanical ventilation to each patient. The majority of patients admitted to this unit were young, healthy patients with multi-trauma injuries, usually motor-vehicle collisions. The two initiatives we worked on were implementation of an ICU rounding tool with the nursing staff and bedside teaching with medical students from the Maseno University School of Medicine.

The ICU rounding tool allowed a systematic and holistic approach organized by organ system, with the goal in mind of empowering the nursing staff to participate in rounds more directly and to advocate for their patients with objective data.  The nursing staff were very receptive and began the process of adopting this into their daily practice. Change in these settings comes slowly and often with obstacles, but we met with almost all the nursing staff over the course of multiple days to obtain buy-in.

The Maseno medical students were eager to participate in dedicated teaching rounds where they presented the patients, and we offered specific teaching points. This was a unique experience for the students as they rarely receive bedside teaching that was problem-based and interactive. The ICU consultants often rounded at different times of the day, and were pressured for time, making bedside teaching difficulty. Specific issues that presented themselves during these rounds that we found informative and thought provoking were end-of-life issues/withdrawal of care, the ethics of the distribution of resources and the structure of medical education. The Maseno medical students took a chance and participated well in Socratic rounds, a teaching style they are generally unfamiliar with.

A major component of our visit was teaching in the nurse and clinical officer anesthesia training program, a program that started in Kijabe, Kenya and is now growing to other sites across Kenya, including JOOTRH. Due to the scarcity of MD anesthesiologists in western Kenya, nurses and clinical officers are being trained to deliver safe anesthesia to serve in community and rural hospitals. This process is often challenging as the providers-in-training have varying degrees of education and clinical background to build upon. The four components of our teaching program were an ICU teaching block, intra-operative teaching, an OSCE exam and simulation training surrounding airway management.

The aspect that we found most interesting was the simulation training. This was the first time the students had any interaction with simulation. We incorporated learning topics we felt were pertinent to their level of training and performance in the operating room. The feedback from the students was very positive and they embraced this teaching modality with ease. We anticipate that they will further simulation education once their simulation center is complete.