Empowering Healthcare Champions: Remarkable Gains Achieved Through EMONC Mentorship

Background of the Facility

Emurua Dikirr Level 4 Hospital is situated in Emurua Dikirr Center, a serene town in Transmara East. USAID NPI Expand project through the Anglican Development Service South Rift (ADS SR) supported EMONC mentorship of staff at this hospital. As the ADS SR staff walk into the facility, we are welcomed by the Transmara East Sub County Reproductive Heath Coordinator and Mercy Langat a Nursing Officer in the facility. Mercy gives us a brief background as she takes us around the facility which is operating as a health Centre. The facility has a fully-fledged maternity, operational Maternal Child Health and Antennal Clinics. The facility is able to handle a capacity of at most 150 deliveries in a month. Currently 120 to 170 deliveries per are conducted in a month.

The facility handles most emergency cases however there are those that they refer depending on the circumstances. In a month the facility receives up to about 50 obstetric emergencies of which they manage and refer those that they do not have capacity to manage to Transmara West Sub County Hospital,

The facility has a Medical Officer who is also doubling up as the Sub County Medical Officer of Health (SCMOH). He is actively involved at the maternity ward and assists in handling the obstetric emergencies.

In addition, the RH Coordinator added that the facility has mentor mothers, has an SMS program to communicate to mothers. She talked about implementation of the 4th and 8th ANC visits whereby the clients are encouraged to attend at least 8 ANC visits throughout pregnancies, ale involvement and outreaches which are among other activities conducted by the facility.

Introduction of Mercy a Nursing officer at the facility and her role

Meet Mercy, a very welcoming, enthusiastic, self-motivated and eloquent Nursing Officer at the facility. She paints for us a picture who she is, her background and her work at the facility

The Anglican Development Services South Rift (ADS SR) team is privileged to watch a resuscitation demonstration conducted by Floridah Sena (the Sub County RH Coordinator) assisted by Mercy who successfully resuscitated and delivered a new born. Mercy joined the facility in November 2022 and is a passionate Maternity nurse, EMONC Mentor at the facility, CME & Drill Coordinator, Student Clinical Mentor, She narrates her achievements…”I have been able to conduct several CMEs, a number of Drills, that is, at least 1 drill and 2 CMEs per month”. She continues to affirmatively confirm that the mentorships have equipped the facility staff with skills, better knowledge and attitude when handling obstetric cases. Mercy continues to say “I personally have a very specific interest in EMONC mentorship and I actually enjoy it!”. She adds that she enjoys teaching and learns more while she does so.

“I am very grateful to partners who have made this possible for me especially USAID NPI Project through ADS SR., I was one of the participants during the EMONC mentorship training

As we concluded, Floridah highlighted some of the impacts that she has observed “Previously there was an increased number of referrals since the staff had minimal knowledge, skills, attitude and right equipment to tackle obstetric emergencies Currently the referral cases have reduced by half since the staff have been equipped with the right skills, knowledge and attitude to handle obstetric emergencies, the community has since developed trust in the facility staff and the facility in general, evidenced by 100% facility deliveries indicating reduced home deliveries, there is early detection of complications and proper management and lastly knowledge and skills gained by the mentees. All these are gains achieved through the USAID NPI project implemented by the Anglican Development Services South Rift”.

Asked if there was any recommendation she would give as the RH Coordinator, Floridah said the following “I wish to request if more mentorship trainings can be supported. The facility would appreciate if the project procured for them equipment mainly the KIWI, Support to be holding maternity days at the facility and lastly receive support to conduct monthly review meetings”.

SUCCESS STORY 1

Breath of Life: Excelling in Neonatal Resuscitation for a Brighter Tomorrow

A story of hope where there seemed to be none

“Knowledge and skills gaps amongst the facility staff in handling obstetric emergencies had been a great challenge for an extended period of time before the NPI Expand project came in to bridge the gaps”. Mercy, a 28-year-old female, a Nursing Officer at Emurua Dikirr level 4 Hospital in Transmara East Sub County recounts her experience working as a midwife at the maternity unit.

Prior to this mentorship, “I couldn’t manage most of the obstetric emergencies including cord prolapse, cord presentation, breech delivery, Postpartum Haemorrhage (PPH), eclampsia, Neonatal Resuscitation amongst others. However I was able to successfully deliver a non-vigorous baby utilizing the skills and knowledge that I had gained during the mentorship!”. Additionally, Mercy excitedly reports “I was able to resuscitate the newborn from an apgar score of 2 to a score of 7 within 10 minutes!”. Mercy then recounts the new born baby case study to us so as to have a better understanding of the case

Mother and Child in the success story

CASE STUDY of BABY ANGEL

Mother arrives at the facility with complains of lower abdominal pains which began 3hrs prior to admission.

• 18-year-old para 0+0 G1, Obstetric history; Non remarkable , Medical history; Non remarkable, Exam; baby longitudinal, vertex presentation, Descent-4/5 , Cervix dilatation; 4cm, Vitals; Temp 37 degree Celsius BP134/68mmHg RR- 20

After 6 hours of monitoring labor, she was found to be fully dilated, She has low effort during delivery, She then delivers an asphyxiated Male Infant with an apgar score of 2 in the first minute, Birth weight-2565gms.

Neonatal resuscitation commenced, baby scores 5 at the fifth minute who later scores 7 after 12 minutes resuscitation. Half an hour later, the neonate had scored 10 and was generally stable.

“Since the mentorship, I have gained remarkable confidence while handling obstetric emergencies in facility . I can say confidently that there is positive impact demonstrated by through my refined skills, knowledge and attitude when tackling Neonatal Resuscitation!”. By extension, she has intentionally mentored her colleagues to ensure the community has benefited through quality service delivery.

In conclusion, patient referrals have dipped by nearly 50% between the months of September 2023 to January 2024. Moreover, neonatal complications and death have plummeted to 14% down from 37% recorded each month. Mercy says that this tremendous and notable impact has been a result of prompt identification and management of obstetric emergencies. In her own words, Mercy stated, ‘The mentorship has positively impacted my nursing profession because I can now manage mothers who come to my facility with a lot of confidence’. Consequently, there has been a remarkable positive uptake and trust by the community members pointing the importance of continuous mentorship in the facility!”.

SUCCESS STORY 2

Empowering Healthcare Heroes: The Transformative Impact of EMONC Mentorship on Hospital Staff’s Emergency Response Skills.

This is the story of Paul Sang, a 40-year-old male, Registered Nurse at Emurua Dikirr level 4 Hospital in Transmara East Sub County

Facility and staff unpreparedness for obstetric emergencies had been a great problem for quite a long period of time. From the inadequate supply of non-pharmaceuticals and medical equipment to significantly deficient knowledge amongst the staff on the requisites for anticipating obstetric emergencies amongst others were the causes of the unpreparedness.

Paul Sang, a registered nurse who worked in EMURUA DIKIRR level 4 hospital, recounts that before the mentorship, “I didn’t really have the skills or the confidence to handle most of the obstetric emergencies, you know, like Neonatal Resuscitation (NNR).” He highlighted that he performed neonatal resuscitation in unstandardized procedures and therefore resulted in either poor neonatal outcomes or unnecessary patient transfers.

Through the NPI Expand project, ADS partnered with obstetric mentors, and the relevant county officials to train Paul sang amongst other mentees through presentations and drills. Paul narrates that “the practical approach allowed me to experience an almost real-life scenario while handling neonatal resuscitation”. He continues to recount how during one of the drills on neonatal resuscitation which took place in Emurua Dikirr level 4 facility at the skills lab on 14th September 2023, he was able to identify the mistakes he had been making and he successfully demonstrated the standard neonatal resuscitation procedure on a simulator (baby Natalie).

In summary, Paul recounts his experience by citing, ‘there has been drastic reductions of both neonatal deaths and unnecessary referrals in my practice since the mentorship’, ‘knowledge gaps have been bridged, he now undertakes his services and deliveries with more confidence’. In ripple effect, the hospital reputation is at a higher stake in the community unlike before.