Year established: 2011

Fields of work Other
UK Partner Torbay & South Devon NHS Foundation Trust
Developing Country Partner Nanyuki Teaching & Referral Hospital and Nyahururu County & Referral Hospital, Laikipia
Contact --

Nanyuki Teaching & Referral Hospital and Nyahururu County Hospital are the 2 main government hospital facilities in Laikipia County in central Kenya. The population of the County is just under half a million people. In 2014, changes in Government structure led to devolution of certain functions, including healthcare to Counties which now each have their own Ministry of Health. The Ministry of Health for Laikipia County is based in Nanyuki. The hospitals’ constituency is the two towns and the large surrounding rural area. They are similar in size and composition with outpatient departments covering general medical & surgical specialties including Orthopaedics/Trauma, Paediatrics, ENT, Obstetrics/Gynaecology, Ophthalmology and Dental Specialties. They have Imaging Departments with X-Ray and ultrasound capability. Inpatient facilities support the specialties above, and operating theatres – one in Nanyuki (plus a smaller emergency theatre), and 2 in Nyahururu.  They also have pharmacies, laboratories and medical engineering departments. At the start of the partnership there were no Emergency Departments and no ambulance service. Both now have Emergency Departments. There are less than 10 Consultants in both hospitals.  Other medical care is delivered by Medical Officers of variable experience, interns and Clinical Officers (a non-medical grade which delivers a high proportion of care in Kenya). Nurses are in short supply, as are all grades of staff.

Torbay & South Devon NHS Foundation Trust is part of England’s National Health Service (NHS) and is an Integrated Secondary, Community and Social Care Trust which includes a medium-sized District General Hospital (Torbay Hospital), situated on the SW coast of England. It serves a population of approximately 350,000, increasing by up to 100,000 in the summer months because it is a tourist area. It covers similar specialties but with a greater degree of sub-specialization. It is acknowledged nationally as a progressive and innovative organisation with good patient outcomes. It is much better staffed and equipped than its Kenyan partners.

The history of the Kenya partnership goes back to 2008, when Dr. Ndanya, surgeon at Nanyuki Hospital met Dr. Lucy Obolensky, who had been engaged in long term rural community projects in the Laikipia District since 1997. Dr. Ndanya asked if she could find an orthopaedic/trauma team to visit Nanyuki Hospital as the workload was rising exponentially, there was a lack of equipment and internal fixation operations were unaffordable for poor patients.  She responded by forming the multidisciplinary Kenya Orthopaedic Project (KOP) team, most of whom worked at Torbay Hospital and the first KOP project went to Nanyuki District Hospital in Feb 2009.

This team brought orthopaedic, anaesthetic and imaging equipment, drugs and expertise in trauma surgery, anaesthesia and peri-operative care, nursing, physiotherapy, radiography and medical engineering.   The team operated on Nanyuki patients and started teaching to meet local requests.  The British-based charity MEAK* generously provided substantial financial support for this first ‘Kenya Orthopaedic project(KOP).  Team members from other hospitals, particular Derriford (Plymouth) joined the project.

The team was then asked to go to Coast General Hospital in Mombasa to deliver a similar project and the team established a yearly visit to each hospital.  The charity EGHO (Exploring Global Health Opportunities)* was formed to support the work.  Staff from other sites, particularly Derriford Hospital in Plymouth became increasingly involved.

It was clear from the outset that the best outcomes from the Trauma surgery would only result from improvements along the whole trauma pathway from pre-hospital care through to rehabilitation.   Ward teaching started and the GRASPIT (Global Recognition & Assessment of the Sick Patient and Initial Treatment) course emerged. Nanyuki Hospital wanted to develop its Emergency Department and the partnership started this work, supported by a THET/UKAid grant.  Further work on community First Aid, equipment (medical engineering), patient safety, leadership & quality improvement started through the ‘Springboard’ course.  GRASPIT developed not only its adult case scenarios for the course but paediatric, maternity and Emergency Medicine scenarios, making it applicable to all disciplines. The GRASPIT course is currently a one day multidisciplinary course that promotes a systematic and structured approach to the assessment and initial treatment of acutely unwell patients; it is delivered as a combination of lectures and scenario based training. Springboard is a series of 2 courses (Foundation & Advanced) which help staff to establish patient safety and other improvement projects using skills acquired through the courses in improvement methodology and leadership.  For these courses, frontline clinical staff learn & work alongside County Government staff.

Alongside the partnership, community work has continued to develop with ‘Team Talk’ taking sport and education to rural communities to improve health through encouraging the confidence of girls (primarily) and encouraging them to remain in education. Team Talk Mentoring takes this a step further.

The Laikipia County Government asked for the partnership to be extended to Nanyuki’s sister hospital in Nyahururu and that occurred in 2014 with the first KOP and GRASPIT projects there.  Other hospitals requested KOP, GRASPIT and latterly Springboard. The first THET/UKAid grant ran until July 2015 but further THET/UKAid grants running until April 2017 for GRASPIT and Springboard are carrying on this work.  KOP projects continue and are funded by the EGHO and MEAK charities.

This Nanyuki-Nyahururu-Torbay partnership has grown naturally and excellent relationships have developed between Nanyuki and UK staff. Each project concludes with a joint team activity. For example, staff from both hospitals have successfully summited Mount Kenya together, played football matches against each other, run half marathons together.  The exposure that the visits provide for both UK and Kenyan staff has proved to be highly developmental for these individuals.

Dr Obolenksy continues to make frequent return visits to continue her work in the rural community health clinics which she first established many years ago. All Trauma patients operated on are followed up by a member of the team at approximately 6 months. Discussions are emerging regarding the possibility of establishing ongoing research and community links outside of healthcare linked to Torbay and South Devon. Several individuals who have volunteered on the projects have also become involved in teaching on the Global Health & Remote Medicine Certificate/Diploma/Masters’ course at Plymouth University (Programme lead Dr Lucy Obolensky).  They are also in the process of establishing a Centre for Global Health for the South West, based in Plymouth.

*MEAK (Medical & Educational Aid to Kenya) is a registered charity established by a British couple Mike & Dee Belliere – established to deliver  to ophthalmic and  paediatric cardiac surgical projects – now also and dental projects.  MEAK has also provided substantial financial support to Orthopaedic/Trauma projects delivered in Kenya.through EGHO (see below)

Drs Lucy Obolensky and Kerri Jones established the charity EGHO (Exploring Global Health Opportunities) in order to support and fund-raise for the Kenya projects.  It is currently funding Orthopaedic/Trauma, rural and other projects.

 

Time line of key events in the development of Nanyuki-Nyahururu-Torbay Partnership 

Oct 2009: The Peninsula Medical School (universities of Plymouth & Exeter) granted permission for medical students to accompany each project visit

Nov 2009: The team was invited to work in Coast General Hospital, Mombasa (a large Government teaching hospital).

Dec 2009: Dr Jones & Dr Obolensky organised and ran a conference (Exploring Global Health Opportunities)¹  in Torbay at which Dr. Ndanya was invited to speak. They then formed their own charity of the same name (EGHO) to facilitate fund raising.

Feb 2010: During the 2nd KOP visit, team members started to teach on wards and the GRASPIT course was born­ a course for all hospital staff to help with the identification of sick patients and to improve communication skills. The team then started an annual visit to both hospitals, again supported financially by MEAK.  Reciprocal visits by Kenyan staff to the UK started; 4 people per year for an 8 day visit to Torbay.

Oct 2010: The British Orthopaedic Association awards a fellowship to support a trainee orthopaedic surgeon to accompany each visit for 3 years which is then continued because of its popularity.

Oct 2011: Dr Mathenge became the principle resident surgeon. Across the hospital, the team introduced and worked on the wider concept of whole hospital improvement including pain management and Patient Safety. Pulse oximetry was introduced (WHO ‘Lifebox¹ Global oximetry project) and the WHO checklist in the Operating theatres. 

Oct 2011: The team ran the first ever Primary Trauma Course (PTC) in Kenya with PTC staff from S Africa. Nanyuki identified their inadequate Accident & Emergency service and infrastructure and requested help to set up a new department.  This was outside the capability of the finances available and it was decided to seek a THET grant to support this new major development.  A Memorandum of Understanding between Nanyuki District Hospital and Torbay Hospital was signed, describing the potential for working together in a much broader way to support Nanyuki¹s general development and to continue to allow exposure of UK staff to this work. 

July 2012: The partnership was awarded a large THET PIP grant funded by the Dept for International Development (UKAid) and a 12 month volunteer bursary to develop the whole trauma pathway from pre-admission, through the Emergency department, operating theatre, ward, rehabilitation and encompassing the elements of whole system improvement including patient safety, management and leadership.  Medical engineers and a pharmacist became part of the project. Activities continued to spread well beyond the original partnership.  GRASPIT is recognised by the Resuscitation Council of Kenya.

Jan 2013: A volunteer project manager starts a 6 month placement in Nanyuki, supporting the project.

Feb 2013: The team is invited to undertake similar work in Kitale Hospital in Trans-Nzoia County and KOP, GRASPIT and patient safety work starts there. Volunteer midwives start to support and train nurses and midwives in Nanyuki.  Increasing numbers of medical students request elective placements and doctors volunteer their time to the project.

June 2013: The new Emergency department in Nanyuki opens!  Paramedics join the team to deliver First Aid training.  The Patient Safety Programme is established.

Aug 2013: THET personnel visit Nanyuki independently as part of their governance procedure and approve our work.

Feb 2014: The first long-term volunteer placement (THET Bursary) starts for 6 months (shared for the second 3 months by 2 others)

June 2014: Dr Njoroge, previously medical Superintendent of Nanyuki Hospital, becomes Minister of Health for Laikipia County under the newly devolved structure of Government in Kenya.  He visits the UK with a team from the Ministry to explore solid waste management, ambulance services, Public Health links (with a focus on drug and alcohol abuse) and how to stimulate employment for young people. He asks that the partnership is extended to the other hospital in his county, Nyahururu District Hospital to undertake similar work.

Aug 2014: The second long term volunteer starts in Nanyuki (Dr Ellie Gregory)

Sept 2014: Facilitated by the partnership, an MOU between the Ministry of Health, Laikipia County and SWAST (South West Ambulance Trust) is agreed and signed.

Nov 2014: Four UK and 12 Kenyan health professionals attend the African Federation of Emergency Medicine International Conference in Addis Ababa, Ethiopia. Links are made with Dr Benjamin Wachira, ED physician who is leading the development of EM in Kenya.

Nov 2014: Nanyuki has a UK ED team for a week to undertake in-hospital and community training (First Aid). In addition, the following activities take place:

  • Scoping for a management & leadership event (Dr Simon Knowles (Lead2Improve)
  • An Ophthalmologist spends a week with the Nanyuki Ophthalmologist
  • A medical engineer spends a week working with the Nanyuki team

 

Nov 2014: The first visit to Nyahururu County Hospital takes place with an orthopaedic camp and a scoping exercise looking at ED.

Nov 2014: GRASPIT is delivered for the first time in Nyahururu

Nov 2014: A new SW Deanery GP ST4 Global Health & Leadership post is established, part based in Nanyuki and part in Cornwall and the post-holder scopes drug & alcohol education needs.

April 2015: The first 5-day Springboard Foundation course in the Science of Improvement and the Art of Leadership is delivered in Nanyuki.  This course is primarily aimed at developing capacity in Kenya to empower staff to undertake their own improvements in a structured and effective way for greater sustainability of partnership activities.

July 2015: Orthopaedic project in Nanyuki.

July 2015: 4 Kenyan staff come for an 8-day study visit to the UK visiting Torbay & Derriford Hospitals

July 2015: 2 further grants are awarded for
 GRASPIT - £96,000 to test the spread of the course to 4 further hospitals in Kenya
 SPRINGBOARD - £86,000 to further test & develop the concept in Nanyuki & Nyahururu

Nov 2015:
1st GRASPIT Conference held in Nairobi.  SPRINGBOARD Refresher course run in Nanyuki.

Jan 2016: SPRINGBOARD ADVANCED course is delivered in Nanyuki and also a bespoke course for ED staff from both Nanyuki & Nyahururu hospitals.  5 Kenyans offered free places on the IHI ‘Open School’ via the SW AHSN. Dr Holly Eadsforth takes up the GRASPIT long-term volunteer post, resident in Nairobi.

April 2016:  GRASPIT courses and local faculty now established at Nyeri, Kisumu, Kajiado and Karatina Hospitals.

May 2016: Orthopaedic project run in Nyahururu.

May 2016: 2 Kenyan staff attend the IHI Patient Safety Officer Training in Exeter, with free places donated by the AHSN and also make a 3-day study visit to Torbay

May 2016:  SPRINGBOARD FOUNDATION delivered in Nyahururu.

June 2016:  SPRINGBOARD FastTrack delivered at Kwale Eye Centre in Kwale County.

Sept 2016: Dr Craig Miller takes up the GRASPIT long-term volunteer post, resident in Nairobi

Oct  2016: SPRINGBOARD FOUNDATION & ADVANCED delivered in Nyahururu. Dr Maryirene Ibeto takes up long-term volunteer post for combined GRASPIT and SPINGBOARD programme support.

Nov 2016: SPRINGBOARD FastTrack delivered at Kwale Eye Centre in Kwale County. GRASPIT courses and local faculty developed established at in 2 hospitals in Mombasa: Bomu Hospital and Mombasa General Hospital. Orthopaedic project run in Nyahururu.

Nov 2016: 2nd GRASPIT Conference held in Nairobi in partnership with SPRINGBOARD showcasing both projects and facilitating learning across all the sites.

Dec 2016: 2 QI PROJECTS authored by Kenyans are accepted as poster presentations for the International Forum for Quality & Safety in Healthcare, London April 2017

Mar 2017: SPRINGBOARD FOUNDATION & ADVANCED delivered in Nyahururu

Apr 2017: 3 Kenyans are funded to attend the International Forum and make a study visit to their partner hospital in Torbay.

Participants to the Springboard courses have consisted of multidisciplinary, multinational from Nanyuki Teaching & Referral Hospital, Nyahururu County & Referral Hospital, Laikipia County Government, Kenyatta National Hospital and Kwale Eye Centre. Participants from the US and UK have also benefitted from the training.

GRASPIT website: http://www.graspitkenya.com
SPRINGBOARD website: http://www.q4a.global

 

Link Requests

Orthopaedic projects are very expensive to run as they are kit-intensive. We are principally operating on complex fractures.
Any operating instruments, drills, plates, nails or other implants, imaging equipment, theatre accessories etc would be very welcome.
We are also helping Nanyuki to establish an Accident & Emergency department and any equipment to support that would be welcome also.

Contact Details

Dr Kerri Jones
Hon Consultant Torbay & South Devon NHS Foundation Trust
Hon Research Fellow University of Exeter Business School
Lead for Springboard in the Nanyuki-Nyhaururu-Torbay partnership

The Horizon Centre
Torbay Hospital
Torquay
TQ2 7AA
UK

Tel: +44 (0)7725 071441
email: kerri.jones@nhs.net

 

 

 

 

 

 

 

 

  

Dr Matt Halkes
Consultant in Anaesthesia 
Director of Education at Torbay & South Devon NHS Foundation Trust
Lead for GRASPIT in the Nanyuki-Nyhaururu-Torbay partnership

Education and Development Directorate
Horizon Centre Torbay Hospital
Lawes Bridge
Torquay
TQ2 7AA

Tel: +44 (0)7835264427
email: matthew.halkes@nhs.net

 

Additional Contacts

Dr Kilonzo                   
Medical Superintendent at Nanyuki County Hospital
email: sammymutisya@yahoo.com

Dr Kamande                
Medical Superintendent at Nyahururu County Hospital
email: kamandeln@yahoo.com

Dr Lucy Obolensky
Programme lead for Global Health & Remote Medicine Certificate/Diploma/Masters’ course at Plymouth University

Tel: +44 7545 971972 (personal)
email: lucyobo@me.com