Hello WFSA blog readers,

I am an ST-7ish anaesthetist from London, working as the SAFE Obstetrics fellow in Kenya for 6 months, and I will be sharing some of my experiences through a WFSA blog series.

My job here involves following up candidates from the SAFE Obstetrics training courses funded by THET, and trying to measure and record change in practice as well as mentoring and trying to reinforce learning. This has, I now realise, inherent rewards and challenges that are at the same time, physical, emotional, cultural and spiritual. My Christian faith plays a fundamental part in my experience out here, and was my motivation for applying for the role.

After settling into life in Nairobi, I decided to take the bull by the horns and start venturing out. With lots of support from Phoebe and Shelmith in the KSA Nairobi office I set up my first week of visits, and then a 4-day field trip from which I have just returned.

A field trip consists of leaving around 7am and getting an early morning matatu from the centre of rush hour Nairobi. A matatu, for those of you who have not experienced what I think is the ultimate form of transport, is 12-14 people packed into a small Toyota/Mitsubishi van (plus their luggage…and their chickens).

I now have a much better understanding of the barriers to accessing healthcare; the real journeys people have to take to get to hospital. In a country where there is no 999 or ambulance service, people rely on good Samaritans to get them to a hospital if help is required, which may very well be by matatu. Witnessing the sheer ludicrousness of some of the over-taking and driving styles, I also realise where a lot of the need for medical care comes from.

Once I arrive at a hospital and locate the maternity theatres, as well as the candidate I have arranged to meet, we do a day in theatre. I observe what is going on, conduct a questionnaire, and do some teaching and mentoring where I can.

I then source a matatu back to Nairobi, and chug back to the big smoke. I scramble the last 1/2km back to my hostel, and am usually the last one to make it to dinner. There is then an evening of writing up reports and data analysis required to assess whether the SAFE course has changed practice. I will be honest, my head has hit the desk a few times in exhaustion as they are long days!

Having spent this week visiting 4 hospitals in an area 3 hours from Nairobi, I have realised that I may need to factor in more admin time to my week, and 5 days of field trips in a row is quite an undertaking. However we have set the target of assessing 100 anaesthetists in my 6 months, so better keep going!

Let it be said, I am learning as much as I am teaching. Making do with very little resources in some of these centres is incredible - who knew you could make an ECG dot out of a saline soaked swab? So far I have visited 7 hospitals outside of Nairobi in the last week and a half, with some incredible experiences. I met with a relatively newly qualified anaesthetic officer, someone who is not a doctor, but has had 3 years general training and 18 months anaesthetic training. He works in a team of three – himself, a nurse and a healthcare assistant, who are all on call 24 hours a day, 7 days a week, and need to ask permission to be away from the hospital.

He was so incredibly happy to have someone visit and teach him – we did 5 hours straight anaesthetic teaching: I was peppered with questions from how to treat pre-eclampsia, and the finer points of neonatal resuscitation, to flow-volume loops and what all the numbers and traces on his anaesthetic machine actually meant. I had to access bits of my brain that have been in a coma since I finished my exams, but he was so grateful and enthusiastic – it made me realise just how spoiled we are as trainees in the UK with so much access to continued professional development and teaching.

For every incredibly busy day, there are encouragements to be had. There seems to be a habit of suctioning newborn babies for ages to try to get them to breathe. Watching a little one going quite blue, I assisted on Monday and was able to teach the inflation breaths to a midwife who had not previously been trained in neonatal resus. To see this little baby pink up and start crying, and to see the penny drop for this midwife, was a wonderful moment – definitely worth the hours in a matatu that day!

Outside of my SAFE Obstetrics Fellowship duties, I had a great weekend seeing a bit of wildlife in the national park, attending a fascinating anti-corruption event at a theatre in Nairobi, and joining an incredible church service at All Saints cathedral with my new friend Anne.

So, that is a little of what I have been up to, and although I am quite grubby and need to get a bit more sleep, this has really been an incredible experience so far.

Next time I will write about my journey by night bus to Kissii in the southwest of Kenya, to begin a couple of months’ field trips in that area, moving between various large hub hospitals and satellite centres.

Until then,
Naomi