In this volunteer profile, Dr. Mark Lee reflects on his placement with RCPCH Global Links programme in Kenya.
Mark Lee is a paediatrician working in the NHS who spent six months volunteering with the Royal College of Paediatrics and Child Health Global Links Volunteer Programme in Kenya. Woking in the Paediatric Department at Narok District Hospital, Mark worked in collaboration with a local Paediatric Consultant and a team consisting of medical officers, medical officer interns, clinical officer interns, medical students, nurses and healthcare assistants.
Narok District Hospital has a 32 bed paediatric ward and a neonatal unit with space for up to 20-30 babies if sharing cots. The hospital struggles to get medical supplies, including antibiotics, and manage broken equipment such as incubators, and the ward is often over-crowded with limited staff.
The wards were always busy, often with up to 3 patients sharing a single bed and parents sleeping on the floor or under the bed at night. Out of hours, there was usually a single medical officer intern covering A&E, the paediatric ward, deliveries and the neonatal unit. There were also doctors who had not been paid for 3 months who inevitably ended up striking.
Mark saw a range of cases while on placement, many that he would not see back in the UK, including malaria, TB, HIV, rheumatic fever/heart disease, as well as pneumonia, gastro-enteritis, malnutrition, meningitis and sepsis. Sadly, the ward has a high mortality rate of 30% of neonatal admissions, with most deaths due to birth asphyxia, low birth weight, prematurity and neonatal sepsis.
The hospital covers one of the larger districts in rural Kenya with few tarmacked roads. This meant that some patients could take more than 12 hours to reach the hospital without motorised transport. The delay in presentation often resulted in poor outcomes.
Mark Lee with paediatrician Grace Odhiambo.
Mark’s main focus while in Kenya was on service improvement, and sharing knowledge and experiences with his Kenyan colleagues. This involved a mixture of clinical work such as leading ward rounds and running outpatient clinics, as well as formal teaching sessions, simulation training and quality improvement projects/audits.
Mark developed a curriculum of key paediatric topics that was covered on a twice weekly basis in formal seminars using a problem based learning format to maximise the involvement of the interns. There was also bedside teaching that focused on clinical skills in small groups, with the most popular sessions being real-time simulation training which was a new concept for most of the interns.
The first time I coordinated a simulation training, I asked one of the interns to assess the breathing in a scenario where a 3 year old has arrived in A&E with difficulty in breathing. The intern told me with a completely straight face, that the patient was not breathing because it was a mannequin. After the initial hilarity had passed and I had done a better job of explaining the concept of simulation training, that same intern then became the biggest advocate of the sessions and would regularly take a lead in training new interns.
During his placement Mark helped to make significant changes at the hospital, including the setting up of a triage system, meaning the sickest patients were fast-tracked to A&E rather than waiting for hours in the queue to be seen in clinic; however, the placement was not without significant challenges:
The patient volume and workload is hard to imagine but speaks volumes for the accumulated experience the local doctors acquire in a short period, all of this without being paid for months on end! The hardest aspect of my time in Kenya was dealing with the absence of the NHS and a free at the point of delivery healthcare system. It was difficult to see patients not getting the correct blood tests, antibiotics or radiology scans because they weren't able to pay for them. With the cost of a CT scan at about £65, this was unaffordable for the majority of the locals.
Like many overseas volunteers, Mark stated that he’s picked up new skills that he is now using back in the UK.
I'm more acutely aware of service improvement and potential quality improvement projects in my NHS hospital. With the lack of resources for investigations, I had to rely on my history taking and clinical examination skills which made me a better clinician. Anytime spent working in a low-resource setting will highlight how lucky we are to have the NHS. In addition, being exposed to high intensity environments where patients often present very late into their illness, and very sick, is invaluable experience that can only make you a better doctor.
RCPCH Global Links is working in partnership with institutions in Kenya, Uganda, Myanmar and Sierra Leone to deliver health worker training and improve child health care. You can watch a short video about the programmes work in Sierra Leone here.