Improvise and Overcome: Bringing EMS to Kenya, Part 2

Just over 10 years ago, a small group of paramedics set out to teach prehospital emergency medical care skills to a group of nurses, clinical officers, physicians and police officers in the small lakeshore village of Homa Bay in western Kenya. The idea of a prehospital care system, which began as a small program in a rural village, has since turned into an initiative for an entire country. More than three-quarters (78%) of Kenya’s 32 million people live in rural communities; delivering prehospital emergency medical care to those with otherwise-poor access to healthcare has and will continue to save countless lives.

As a continuation of the first part of Bringing EMS to Kenya, which appeared in the October issue, this article will highlight the most recent journey of SHARE EMS paramedics and the sweeping changes that have taken place within the country, and also describe current and future collaborative projects between Kenya’s Ministry of Health, SHARE and Kenyan and U.S. teams of healthcare providers.

The Society for Hospital and Resources Exchange (SHARE) is a non-governmental organization (NGO) with a primary goal of improving the health and well-being of disadvantaged children and communities throughout the world. SHARE personnel have been traveling to Kenya for the past 15 years, working on short- and long-term projects like safe drinking water initiatives, immunizations, HIV and AIDS education, and tropical disease prevention and treatment, to name a few. SHARE EMS has been going to Kenya for the past 11 years, assisting in the development of a comprehensive and quality prehospital emergency medical system.

The most recent trip occurred in May 2004. The U.S.-based team consisted of four volunteer providers/educators from New York: David Violante, Heidi Maguire, Chris Summers and George Contreras. Violante, a 15-year EMS provider and educator, is the SHARE EMS coordinator. He currently serves as assistant director of EMS for the Arlington Fire District and co-coordinator of the Dutchess Community College Emergency Services programs. Maguire is a former paramedic and currently a firefighter/EMT for the City of Kingston. Summers is a nine-year veteran of the U.S. Coast Guard and an eight-year NYC paramedic. Contreras has 12 years’ experience serving as a NYC paramedic, former director of EMS, and an instructor in various areas of EMS and emergency management. All of the participants on this trip had been on previous missions, exemplifying SHARE’s desire to help Kenya’s medical community—and ultimately the people of Kenya—take care of their own.

The Setting

In Kenya, daily concerns differ quite a bit from those we are used to in the U.S. Factors contributing to poor health include unclean water supplies, poor sanitation, lack of immunizations, high transmission rates of infectious diseases, and natural disasters such as floods and droughts. Accidents such as vehicle crashes, falls, fires and drownings also contribute to the poor statistics, as does violence. Poor infrastructure exacerbates healthcare concerns, but that has been steadily improving. With a little work and assistance, many of these problems are preventable.

Table 1 highlights statistics from the World Health Organization’s 2004 World Health Report. The data are from 2002.

In addition to the aforementioned issues, other problems exist, but are improving. Most of these have been related to communications, road conditions, safety and security within major cities at night and along roadways after dark, and safety of public transport. The U.S. State Department’s 2003 Consular Information Sheet describes some of these conditions so that travelers can make informed decisions about travel to and within the country. Last year alone, many changes occurred that drastically improved conditions in Kenya: Cell phones are readily available, inexpensive and reliable; Internet connections, the availability of information and the ability to communicate have exponentially increased; road surfaces are improved within cities and along major thoroughfares; transportation is safer and more reliable; facilities are improving; and the police force has been expanded and its salaries increased.