MATERNAL ULTRASOUND BY MID-LEVEL PROVIDERS
Ultrasound equipment and training are rapidly improving and new ultrasound machines are far more affordable than ever before. Consequently, point of care ultrasound in the hands of front-line doctors, nurses and midwives is revolutionizing diagnostic capabilities in developed countries. However this has not been the practice in Developing countries. For this reason;
KMET in partnership with Massachusetts General Hospital, Harvard medical School USA and Sonosite is rolling out ultrasound knowledge and skills to mid-level providers in Kenya.
Currently the program is operating in Western, Rift valley and Nyanza provinces through the use of hand carried (portable) ultrasound machine.
The goal of this program is to empower mid-level health care providers with knowledge and skills on proper and effective use of ultrasound as a diagnostic tool to make early diagnosis of obstetric complications to ensure safe delivery and prompt action on complicated cases. This would in turn reduce maternal and child mortality rates as a result of late diagnosis leading to late decision making.
• So far 238 (Nurses midwives, Clinical officers and Doctors) health providers have been trained and are currently doing quality obstetric ultrasound in their respective hospitals.
• These scans have changed decision making leading to better care of clients.
• Strong partnership with the Government of Kenya on roll out of the program.
• The training of these providers has revived the use of ultrasound machines which were lying unused due to lack of radiographers.
UTERINE BALLOON TAMPONADE INTERVENTION (UBT)
Uterine balloon TOT team from Western & Nyanza Provinces.
In Kenya, the maternal mortality ratio is at 488 per 100 000 live births [KDHS, 2008/9] with the risk of dying being 1:20 . Close to 60% of all deliveries are conducted at home by an unskilled attendant and the Post natal care attendance within 48 hours of delivery is at 42%. PPH contributes to 34% of maternal deaths and it is the most common cause of maternal mortality in Kenya. It is therefore critical that health care workers expand their options of managing PPH. One such option is to help healthcare workers to master use of a uterine balloon for tamponade. Uterine balloon tamponade (UBT) is a medical technique used to control postpartum hemorrhage uncontrolled by primary interventions. UBT uses a balloon to apply pressure to the inside of the mothers’ uterus to stop bleeding after delivery. UBT can be performed with devices ranging from expensive, high-grade manufactured balloons to simple balloons made of condoms or rubber gloves.
In an effort to compliment the Ministry of health ‘s strategies to achieve the millennium Development goal(MDG)5; improve Maternal Health, MET in partnership with Massachusetts General Hospital(MGH),Harvard Medical School,USA is piloting the use of UBT with 12 private midwives to document evidence that UBT can alleviate hemorrhage and saves live. The facilities are based in Siaya, Kisumu and Nairobi.
• There has been successful usage of 17 UBT kits in managing PPH
• 14 TOTs from nyanza and western province (Reproductive health coordinators) from MOH/G.O.K have been trained on UBT. This will facilitate rollout of UBT in public facilities especially at the peripheries
Massachusetts General Hospital (Mass General or MGH) is a teaching hospital of Harvard Medical School and a biomedical research facility in Boston, Massachusetts.