Jocelyn Makori and Roy Wambua are two of the nearly 60 health facility staff being trained in emergency obstetric care through MI´s Linda Afya Mama Na Mtoto project in Kakamega County, Kenya.
They are taking part in simulation and team-based training in rural Kenya where resources are minimal. The MI-supported session is being run by PRONTO International who have successfully conducted similar training sessions in Mexico, Guatemala, and Ethiopia.
One of the things that makes this training different is the ability to have hands-on practice without the risk. Using PRONTO-developed PartoPants that are worn by someone acting as a patient, health facility staff are led through simulations of labour and delivery complications that could arise in real life. Since emergency births are not common, staff at rural health facilities don´t encounter these situations very often. It can therefore be difficult to retain the skills from their clinical training. And simple practices – like delaying the time between birth and umbilical cord clamping – can have a profound impact on the nutrition status of the newborn.
This is the second of two training modules for Jocelyn and Roy, both registered clinical officers – a type of clinical assistant to nurses and doctors in Kenya. The first module was held three months ago, and they have returned to the training able to show off the skills they´ve learned and put them into practice.
Jocelyn says the skills she learned in the first module in uterus massage and umbilical cord control were new to her and she put those into practice immediately. She´s delivered more than 10 babies since the first training and some of those have had complications she´s been able to manage. One in particular stands out for her: a pregnant mother arrived at the Emusanda Dispensary in full labour and the baby´s head had already started to crown. Once delivered, the baby was non-responsive and not breathing. Jocelyn describes it as a scary moment for her, but she immediately kicked into gear with the training she´d received and was able to resuscitate the newborn. Both the mother and newborn left the facility healthy and Jocelyn is particularly proud of that moment.
Roy describes a similar proud moment when a pregnant woman arrived at the Bushiri Health Center, after being in labour at home for more than 12 hours. She was admitted and delivered her baby shortly after that, but almost immediately started to hemorrhage.
“I called an ambulance to take her to the hospital, but it was very slow to arrive. In the training, they taught us how to insert a uterine tampon to stop the bleeding, so I did that. She stabilized and by the time the ambulance arrived, she was OK,” said Roy. “If you resolve the case, you feel satisfied. Or, if you refer the case quickly, and you find out they turned out OK, it makes you feel good.”
The mother and baby came back a couple days later for their postnatal check-up and immunizations, and Roy was happy to see the mother had fully recovered.
Another skill Roy and Jocelyn are learning is how to deal with shoulder dystocia – a complication that affects 1-2% of deliveries and, if untreated, can result in death for either the mother or newborn and, sometimes, both.
“This training is timely,” says Jocelyn. “Just yesterday, I assisted a delivery with this complication.” Luckily, with the help of the community health worker who referred the pregnant woman to the facility, she was able to resolve it.
The majority of women in Kenya do not receive antenatal care in their first trimester of pregnancy. They are also faced with differing health services throughout the pregnancy period, leaving them and their newborns at risk of serious illness, lifelong debilitation or death. Compounding their risk is the fact that most women enter their pregnancy with a low nutritional status, which can get worse throughout the pregnancy.
MI is working in partnership with the Kenyan Ministry of Health, AMREF, PRONTO and the University of Nairobi to improve maternal and newborn health and nutrition programs. Working with pregnant women, community health workers, traditional birth attendants, community organizations as well as facility-based health care providers, we are reaching women earlier and more often throughout pregnancy.
It is the dedicated facility health workers like Jocelyn and Roy who help make the difference between women surviving or dying during labour. And it is through the investment, commitment and colaboration of partners, governments and MI to provide valuable alternatives such as this project which can be implemented throughout Kenya, into neighbouring countries and around the world.