Over the next three years, GE Foundation and its partners will expand their work in the Nyanza Province of Western Kenya to address maternal and infant mortality related to surgical intervention during childbirth through the existing 'Improving Perioperative & Anesthetic Care Training' (ImPACT) program. Through this commitment, GE Foundation and partners will train 25 nurse anesthetists and expand its services to four additional hospitals. Further, the commitment will develop a comprehensive perioperative care training Center of Excellence at Kisumu Regional Hospital to address each stage of surgical care in a comprehensive manner and provide ongoing training to obstetric and anesthesia care teams.
This ImPACT program employs a 'Train the Trainers' approach by selecting top graduates of the program to become 'trainers.' Kisumu Hospital will serve as the central campus for the training. However, the expansion to four new hospitals (Homa Bay County Hospital, Busia County Hospital, and Sagam Community Hospital) will provide sites for clinical rotation as part of the training. The program will develop dedicated trainers in each hospital to provide for ongoing training in the most rural hospitals in Western Kenya.
The training program will be supported by a perioperative care Center of Excellence (COE) at Kisumu Hospital. The goal is to sustain the COE to continue to serve as the training facility for ImPACT trainees. It will also provide training opportunities for health workers in the region in different clinical functions like Emergency Obstetrical Care and Trauma Care. The premier training at the COE will be a simulation training that will address the needs of the entire obstetrical team (nurse, midwife, pediatricians, and obstetricians) and anesthetic team-a critical tool used to lead students through a wide range of scenarios they are likely to encounter in hospitals. The COE will leverage the simulation training and education materials developed with Kenyan Medical Training College-Kisumu (KMTC) and Maseno University, with the hope to serve as a model for other countries in East Africa and globally.
Trainers: Identify 10 trainers from graduates of the Kenya Registered Nurse Anesthetist Program (KRNA) at Kijabe Hospital. Participation in the ImPACT program, will upgrade the trainers' accreditation from Registered Nurse to Bachelors of Science in Nursing, to will allow for increased responsibility and professional upward mobility. Provide eLearning methods to allow local trainees to access lectures and educational materials from COE. Trainers will be trained in education delivery and assessment, as well as the simulation protocols and management of simulation to sustain the program at KMTC, Maseno University, and hospitals within the ImPACT network.
Phase 1: 1/2015 to 3/2015 - 3 trainers
Phase 2: 7/2015 to 12/2015 - 4 trainers
Phase 3: 1/2017 to 6/2017 - 3 trainers
Trainees: Increase the number of anesthesia and critical care trainees in Western Kenya by 50% (25 additional graduates), and expand to four additional hospitals.
Phase 1: 1/2015 to 2/2016 - 11 graduates
Phase 2: 2/2016 to 10/2017 - 14 graduates
Center of Excellence and simulation training:
Phase 1: 1/2015 - 12/2015 - Establish education materials for anesthesia and critical care workers. GE will work with KMTC and Maseno University to develop an international curriculum for the simulation training, with oversight from Vanderbilt University.
Phase 2: 1/2016 - 12/2016 - Simulation trainings begin at Kisumu Regional Hospital. Perioperative and obstetrical emergency team trainings of common scenarios will be taught by a Vanderbilt trainer with impact measurements for critical actions. These simulation training sessions will be two three-day sessions. GE Foundation will use simulation infrastructure to train all team members within the operating room and labor ward environments. Each simulation training program will include training for an obstetrical team (of 21 people) and a perioperative team (of 21people) to respond to both obstetrical and perioperative (trauma) emergencies.
In Sub-Saharan Africa, improperly administered anesthesia is one of the top four causes of death in rural hospitals among maternal patients undergoing surgery. An insufficient number of anesthesia providers have exacerbated the issue of maternal and infant mortality during obstructed labor. The provision of anesthesia and access to proper perioperative care can support life-saving surgeries such as caesarian sections, and mitigate maternal hemorrhage, which is the number one cause of morality in obstetrical patients.
In addition to a lack of anesthesiologist and nurse anesthetists in Sub-Saharan Africa, the World Journal of Surgery reported that only 13 out of the approximately 120 anesthesiologists in Kenya work in public hospitals (African Medical Research and Education Foundation, 2009).
This commitment focuses in the Nyanza Province in Kenya. The Nyanza Province has a population of 5.8 million people and the highest maternal and neonatal mortality in the country (Multiple Indicator Cluster Survey, 2011). A 2012 joint-survey conducted by the Center for Public Health and Development and the Ministry of Health in Kenya found that there were only 12 trained anesthesia providers supporting approximately 36 operating rooms (OR) in the region. Typically, it is recommended that each OR have four to five anesthesia support staff for effective coverage. Due to lack of anesthesia providers, there has been a grave impact on maternal and infant health in Nyanza - one in 27 pregnancies result in infant mortality just before or just after birth, and in every 25 live births, infant mortality occurs for reasons typically related to complications at birth. It is estimated that approximately one woman dies for every 200 live births in Nyanza. This high rate of maternal mortality can be directly attributed to the inability of most pregnant women to access emergency obstetrics care services, including emergency caesarean sections. A severe shortage in anesthesia personnel in the area is one the leading causes of this scenario.