Safe mistakes for better learning, improved childbirth outcomes

Cutting-edge learning to ensure safer childbirth

We lose 300 babies and mothers each day in Kenya because of pregnancy or delivery-related complications. One way to change this picture vastly and quickly is a rapid deployment of skilled health workers to curb the number of deaths during delivery.

One anesthetist can make a difference to the lives of mothers and newborns. The Simulation Center in Kisumu is helping nurses and clinical officers become the game-changers in this fight for maternal and neonatal survival. It provides cutting-edge learning opportunities for anesthesia and other medical trainees.

Learning through mistakes is one of the best ways to learn, but not if the consequences are a matter of life or death. The Simulation Center makes experiential learning a reality for nurse anesthesia students. It gives the students the extra edge they need to deal with emergency cases, including Cesarean sections, one of the most common cases of emergency surgery.

Nurse anesthetists help to bridge the huge gap between the need for C-sections in Kenya and the number of available anesthetists. Only 4% of deliveries in Kenya are by Cesarean section when the WHO recommends it be 10-15%. A lack of C-Section often means maternal and/or neonatal death after a complex and delayed referral process. One of the main reasons for the abysmally low C-section rate is the acute shortage of anesthetists in the country.

In much of Kenya and Eastern Africa, it is physician anesthetists (anesthesiologists) and non-physician anesthetists, primarily clinical officer anesthetists who provide anesthesia services. Kenya has about 500 practicing anesthetists for a population of about 44 million. So that would be 1 anesthetist for every 90,000 Kenyans. It is also true that in many of these countries, one of the most common cases of emergency surgery is C-section.

The Simulation Center in Kisumu has been set up as part of the Nurse Anesthesia training program that the Center of Public Health and Development (CPHD) runs in partnership with Vanderbilt University and Kijabe School of Nursing with a grant from GE Foundation, technical assistance from Assist International and support from the Clinton Global Initiative. The Kenya Medical Training College (KMTC) has been a key partner as well in making this program happen.

The Simulation Center is fully equipped with advanced manikins and supporting technology, methodology and faculty to create a state-of-the-art learning environment. It offers the budding anesthetists with the much-needed scope to practice their skills in a realistic setting before handling actual patients. So the nurse anesthesia students can now afford to learn through their mistakes without the fear of harming a patient.

The center now has a fully working control room, operating room and a debriefing-cum-classroom. Cameras installed in the OR, debrief room, reception and control room ensure a seamless learning experience for the students.

The first batch of students for the Kisumu chapter of the program had started classes in September 2015. “Simulation training is great when paired with anesthesia training because it Improves student confidence, offers immediate and applicable feedback during the debrief sessions. It also improves knowledge retention and repetition of scenarios serves to help students master the art of practice,” says Dr Mudola Manyano, who is the Program Director of ImPACT Africa (Kisumu).

The second cohort of anesthesia students in Kisumu has also its started classes. The center at Kisumu augments the Nurse Anesthesia program running in Kijabe. The teaching team from Vanderbilt has helped draw up the curriculum and is part of the training unit as well. These nurse anesthetists, once they graduate, will be the key pieces in the bigger picture of safe surgery. By the end of the program, the number of anesthetists in Kenya is expected to increase by 15%. Six students from the first cohort of the Nurse Anesthesia training program have already been making a remarkable difference. They were trained in Kijabe and were deployed in their original county, Siaya, at the end of the 18-month course. In Yala sub-county, the 2 nurse anesthetists were deployed in April-end 2015. In 4 months, the number of general surgeries in the hospital has increased 5 fold while the number of C-sections has more than doubled.

Western Kenya has one of the higher maternal and neonatal mortality rates in the country. The availability of anesthetists improves access to safer deliveries, reduces the distance to emergency C-section and thereby reducing the delay to critical maternal care. In an area of Western Kenya, a survey by the CPHD team in 2012 showed that there were 36 operating theaters with only 12 staff trained to provide anesthesia; and there were 13 persons capable of doing surgery (surgeons, obstetricians and general medical doctors) for every person trained to provide anesthesia.

The birth of a new generation of anesthesia providers through this program is expected to fast track the C-section rate in Kenya to the WHO-recommended rate.


 

Communications team
CPHD