A big step towards paediatric anaesthesia delivery in Kenya

Dr Gichingi was operating on a one-year-old baby. As is the norm with every operation, the anaesthesia team was present, monitoring the baby’s oxygen levels. Suddenly, the baby’s blood was quickly turning dark brown and, within a few minutes, the heartbeat was gone.

Was the anaesthesia machine faulty and could therefore not signal a fluctuation in the oxygen supply? A crisis ensued and no more operations could proceed until the problem was solved. This is just one example of how delicate it is to operate on children and the importance of adequate anaesthesia provision.

Kenya has a total of 20 paediatric surgeons with 14 based in Nairobi. This has been attributed to social and financial dynamics, where wealth is concentrated in the city. However, the challenges are multifaceted and require a comprehensive approach to address them effectively.

First off is specialised expertise. Providing anaesthesia to children demands distinct skills due to their unique physiological and psychological needs. Unlike adults, paediatric patients are twice delicate when it comes to surgery and require individualised care that takes into account their age and size. Ideally, paediatric anaesthesiologists should administer anaesthesia to children, but that is not the case in many African countries. Until 2013 when the University of Nairobi partnered with the World Federation of Societies of Anaesthesiologists, individuals had to seek paediatric anaesthesia training outside Kenya.

Another factor is inadequate resources. Access to modern medical equipment and facilities is crucial to ensure the safe administration of anaesthesia to children. Regrettably, many healthcare institutions across the country lack the necessary resources, anaesthesia machines, appropriate monitoring devices and paediatric-sized equipment. These shortages compromise the safety and effectiveness of paediatric surgeries.

Mortality and disabilities

That said, paediatric anaesthesia is set to make significant progress. Last week (June 30), I attended the launch of the Society of Paediatric Anaesthesiologists of Kenya- SPAK. The association aims to grow the capacity of this super-speciality to meet the high burden of surgical needs as shortage of paediatric anaesthetists translates to more mortality and disabilities. The society aims to enhance training and capacity among county governments and hospitals. It will also roll out short courses to improve knowledge and skills.

Research and data collection is another key area the society aims to reinforce. Medical institutions, universities and government agencies are all avenues that can generate data and research. This data will help identify trends, challenges and areas requiring intervention, ultimately leading to better guidelines and protocols. Of course, research tailored to our context will also help with policymaking at the county and national levels.

There is also collaboration and partnerships. Strengthening collaboration between healthcare institutions, professional societies and global agencies is crucial for sharing knowledge, expertise and resources.

At Kids Operating Room, as a global health charity, we support hospitals with paediatric equipment worth US$300,000 per operating room that we install. Among the equipment is a modern anaesthesia machine. Additionally, we are supporting countries in Sub-Saharan Africa in collaboration with College of Anaesthesiologists of East, Central and Southern Africa to develop an e-learning platform on paediatric anaesthesia. Specialists are also able to comfortably perform complex surgeries such as co-joined twins among others.

Rosemary Mugwe is the Africa Director, Kids Operating Room.

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