Stories from the Field: Kenya

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​Building capacity for Helping Babies Breathe Second Edition in Kitui County, Kenya

​Introduction

Figure 1: Screen shot showing planning, by the HBS Kenya Master Trainer Corps, and their AAP mentor, for a Nairobi-based HBB 2nd Edition Course.

Since 2009, Kenya has been at the forefront of efforts to strengthen newborn care through dissemination of the simple, low cost, high impact neonatal resuscitation program, Helping Babies Breathe (HBB). HBB-Kenya started as one of the initial beta-evaluation sites with Pakistan (funded by the AAP), then expanded to be part of a 5- country field test (funded by USAID), and eventually, was one of 3 global sites in the largest research trial ever of HBB implementation in health facilities in Kenya and India (funded by the National Institutes of Health). Similar to efforts in India, Tanzania, and other parts of the world, HBB has had tangible impacts among neonates and healthcare workers in Kenya, where public-private national and international partners integrated the first edition HBB into national guidelines for pediatric emergency care.

One of the Helping Babies Survive Country Mentors for Kenya, on behalf of the American Academy of Pediatrics, is Dr. Sherri Bucher (Indiana University School of Medicine). Dr. Sherri has worked with local authorities and partners throughout East Africa to build local expertise and capacity for Helping Babies Breathe. As part of this effort, a reliable, and highly skilled team of Master Trainers, called the Helping Babies Survive Master Trainer Corps, have been established in Kenya. In conjunction with partners including the Kenya Pediatric Association, Ministry of Health, Moi University College of Health Sciences, Amref, Save the Children, and non-governmental organizations, the HBS-Kenya Master Trainer Corps have been instrumental in the successful dissemination and implementation of Helping Babies Survive (HBS) programs throughout Kenya and the East African region.

Among the many master trainers Dr. Sherri is mentoring for HBB/HBS in Kenya, there is a group of three comprising of Mr. Sammy Barasa (lecturer Kenya Medical Training College), Mr. Geoffrey Mwai (MNCH Program coordinator, KOICA) and Mr. Bonnie Munyalo (Nurse/Midwife Lecturer, Amref International University). Having been in the program for the last seven years, and conducted numerous HBB trainings in the country and internationally, the team is glad to share information about our most recent training. We believe that this example serves as a good case study for the importance of bi-directional collaboration among local and international partners to support successful HBS training efforts.

August 2018 Training

Figure 2: Mr. Sammy Barasa describes the simulation equipment and educational materials (table), learning methodologies (blue poster), and workshop objectives (yellow poster), utilized in Helping Babies Breathe trainings.

In August 2018, three resident doctors and one nurse midwife from Michigan state in USA began a rotation at Mutomo Mission Hospital, located in Kitui County, some 250km South East of Nairobi, Kenya. The visiting health workers were eager to leave behind an impact, and they sought to be equipped with HBB skills as they headed down to the facility located in an arid, inaccessible, resource-constrained region within Kenya, where only 43% of deliveries are attended to by skilled birth attendants, and neonatal mortality is among the 3rd worst in east Africa, at 22 deaths per 1000 live births.

Preparation for the Training Workshop

The Michigan-based health care providers contacted the AAP to inquire about North American-based HBB Facilitator courses. However, no workshops were scheduled prior to their departure for Kenya. Thus, the AAP suggested that they contact Dr. Sherri, the Kenya HBS Country Mentor. In turn, Dr. Sherri, linked the visiting health workers with three master trainers in Nairobi via an ever-active WhatsApp group, created to keep abreast of trends in HBS, share collaborative opportunities, and discuss trends in maternal-newborn health. Three highly experienced Nairobi-area Facilitators from the HBS-Kenya Master Trainers Corps indicated that they were available to conduct the training. Planning happened rapidly, and purely virtually, through emails and WhatsApp messaging. The Kenya-based Master Trainers availed the needed training materials, arranged for a convenient venue, identified and looped in the Michigan-based trainees. The trainees were guided through downloading and printing useful HBB 2.0 materials from the AAP website, and were provided with guidance as to obtaining training equipment.

HBB Second Edition Workshop

Figure 3: Mr. Geoffrey Mwai describes key changes in HBB 2nd Edition related to revised recommendations for suctioning of newborns.

2-day Master Trainer workshop was conducted in Nairobi, August 4-5, 2018. On Day 1, the four Learners were led, by three co-Facilitators, through the initial routine registration and introductions. Each Learner was asked to share at least one expectation of the training. This helped to align expectations among Learners and Facilitators, and illuminated gaps that guided the training. Pretests (Knowledge Check and Bag-and-Mask Ventilation skills checklist) were administered to help understand the trainees’ baseline knowledge and competencies, and to inform the co-Facilitators as to the amount of time to allot, within the course, for mastery of the skills. The team also agreed on norms that guided the training during the two days (Figure 2). The course utilized paired learning, with each pair working with a master trainer. This ensured that each Trainee received thorough, intensive, skilled mentoring, and also helped speed up the learning process. Day One content was dedicated toward highlighting the changes between HBB 1.0 and HBB 2.0, and ensuring that Learners obtained mastery of the action plan, through ample role play practice and positive de-briefing (Figure 4).

Figure 4: Allowing ample opportunities for paired learning, and for Trainees to receive mentored role play practice, followed by positive de-briefing and self-reflection among supportive peers and mentors, are key educational methodologies for HBB 2nd Edition.


Figure 5: A Trainee practices facilitating the Red Zone of HBB 2nd Edition.

On Day Two, the trainees were taken through principles of adult learning and allowed ample time for actual facilitation practice (Figure 5). Each Learner was given a section in HBB 2.0 to facilitate to the rest of the group members. Self-reflection and positive debriefing, with prompt and relevant feedback to reinforce mastery of the skills, were employed. Post-test assessments, including knowledge check (MCQs), Bag and Mask ventilation (BMV), simulated practical assessment on routine care (OSCE A) and ventilation for golden minute and with slow heart rates (OSCE B; Figure 6). Learners were asked to give evaluation for the training their feedback included that the training had been well-organized and executed.

Follow-Up

To cement team-building, upon successful completion of the course, the Master Trainers and newly minted Facilitators went on an excursion to Nairobi National Orphanage, Safari Walk. A WhatsApp group has been formed, so that the HBS Kenya Master Trainer Corps can provide on-going, in-country support and advice to the North American HBB Facilitators as they liaise with stakeholders at Mutomo Mission Hospital, and build sustainable capacity for neonatal resuscitation in Kitui County.

Figure 6: Mr. Bonnie Munyalo conducts a post-course skills and competency assessment
Key Lessons
  1. Social media and mobile based applications and solutions can effectively be used to organize and deliver a successful Helping Babies Breathe training, even across international time zones and borders. The key is that cooperative, collaborative relationships, among trusted partners, must already be well-established. In this case, a social messaging platform that has been utilized for several years to maintain a collaborative network of like-minded mentors and mentees, and to provide on-going support to trained HBS health workers for quality improvement efforts, was leveraged to quickly organize a successful Kenya-based training for North American participants.

  2. “Local adaptation” of the HBB program can go beyond aligning content to local Ministry of Health guidelines. Adaptation can also be utilized, to great success, in creating flexible accommodations for in-country workshops. HBB training must not always happen in a hotel; even the living room of an Airbnb can be a successful training venue for HBB!

  3. Ultimately, successful dissemination and implementation of Helping Babies Survive programs is predicated on building equitable partnerships, and collaborative friendships, among partners.







Authors:

Mr. Sammy Barasa1, Mr. Bonnie Munyalo2, Mr. Geoffrey Mwai3, Dr. Sherri Bucher4
1Lecturer, Kenya Medical Training College (sammybarasa28@gmail.com); 2Nurse-Midwifery Lecturer, Amref International University (bonniemunyalo@gmail.com); 3Mr. Geoffrey Mwai, MNCH Program Coordinator, Korea International Cooperation Agency (mwaigeoffrey@gmail.com); 4Sherri Bucher, Assistant Research Professor of Pediatrics, Indiana University School of Medicine, Indianapolis, IN (shbucher@iu.edu)