Teaching lifesaving clinical skills to Kenyan healthcare workers. OHSU students and faculty lend a hand in Kenya~ Trish Kohan, Marilyn Gran-Moravec, Nabha Goldfedder
The Golden Minute: Helping Babies Breathe
Kenyan neonatal mortality rates are 23 per 1,000 births, and infant mortality rates are 36 per 1,000 births (UNICEF 2012). These devastating statistics are difficult to accept, knowing there are organizations whose goal is to provide the needed education and support to prevent these high mortality rates in limited-resource areas. The proportion of births attended by skilled health personnel is only 66 percent. There is a need to educate local healthcare workers to provide critical birth assistance.
The Perinatal Rescue Network (PRN) is a non-profit organization in southern Oregon that offers communities a sustainable solution by empowering the workforce to be better equipped to care for a newborn. Two OHSU School of Nursing faculty (Trish Kohan and Marilyn Gran-Moravec) and one OHSU School of Nursing student (Nabha Goldfeder) collaborated with Medtreks and Village HopeCore International to travel to Kenya for the summer 2018 to offer classes to 25 Kenyan nurses and healthcare workers. The training is based on the “train the trainer” model. Two people are identified out of this group who showed great skill to teach the course to other health workers, teachers and neighborhood community health volunteers.
Village HopeCore International is a community health and poverty eradication program that has been operating in eastern Kenya since 2001. The program now has 90 employees, including nurses and community health workers. Their services reach more than 100,000 individuals in over 500 villages. The region, Chordia Kenya, is rural and has limited healthcare resources.
The program model is based on mobile healthcare and the health education of community members. They provide mobile child-maternal health clinics in over 200 schools and have regular, weekly market day mobile clinics where basic health services are provided free of charge. The nurses and community health workers conduct up to 15 mobile clinics a week as well as perform house visits and follow up office visits with mothers, babies and children.
The World Health Organization (WHO) identified that Africa has 24 percent of the world’s burden of disease but only 3 percent of the healthcare workforce to address it. One of the programs at Village HopeCore is supported by MedTreks, which was initiated to provide ongoing skills training for the staff in Kenya. EMTs, Nurses, Nurse-Practitioners and Doctors travel from all over the world to provide training to the staff.
The Helping Babies Breathe (HBB) training offered by PRN is an evidence-based neonatal resuscitation course that has been shown to reduce neonatal mortality by up to 47 percent (Msemo et al., 2013) in resource-limited countries. The American Academy of Pediatrics along with the WHO developed the HBB program to train birth attendants, especially in outlying communities that lack basic equipment and nearby referral resources. Prior to teaching birth attendants in other countries, HBB trainers engage in a training course and mentorship program.
Using low-fidelity simulators, a manual suction device and reusable bag-masks for ventilation, birth attendants engage in a hands-on training to initiate resuscitation within the “Golden Minute” after birth. PRN provides the tools and the teaching materials that remain within these communities, enabling the trained birth attendants to train others. The bags are reusable, and birth attendants are trained to properly disinfect the equipment. Sustainability of this program relies on maintaining communication with the new trainers along with revisiting these communities for evaluation and planning.
“As a nursing student interested in public health/global health, underserved populations, and direct patient care, Village HopeCore was a perfect volunteer experience for me,” wrote Nabha Goldfeder. “The foundational education included understanding microfinance businesses, observing community health education, viewing clean water/hand washing initiatives, visiting the teen center and lectures on healthcare in the Kenyan village in Africa and global health impacts. I gained a comprehensive grasp on where HopeCore had grown from, how they are working to best serve the community and their importance as a sustainability model for healthcare in developing nations.”
The clinical experience gave a practical perspective of rural healthcare. Each Medtreks volunteer was paired with a Village HopeCore nurse. Teams saw 15 to 70 patients a day with a large variety of complaints such as fevers, suspected malaria, respiratory infections, parasitic infections, malnutrition, pseudoseizures, diabetes, HTN and common colds and made referrals for serious issues.
Some of the OHSU members’ most gratifying volunteer days were spent attending the community clinics and training PRN’s HBB curriculum. Teaching Kenyans to train HBB imbued a sense of contributing to something much bigger than themselves, appreciating the witnessing of the HopeCore healthcare staff excel as they taught each other the curriculum.