Newborn care in Kenya is transforming rapidly, and for the better. A team of dedicated Kenyan neonatal nurses, pediatricians and neonatologists have come together to form a strong clinical training team that travels across country to train other healthcare workers. Focused on evidenced-based comprehensive newborn care practices that integrate the use of rugged robust technologies, the training also provides an opportunity for participants to work together and practice scenarios in simulations. The participants are then mentored through the implementation of these practices as real-life babies are admitted into the newborn units. This process has led to the creation of a network of newborn care champions in hospitals across the country.
"We are very proud of what we have been able to achieve even in the face of a pandemic. The virtual interactions we have with healthcare workers in the newborn units has created an atmosphere of positive change in newborn care in Kenya. We, however, must move this from head knowledge to hands on practical skills through mentorship. Real transformation occurs during mentorship, and this cannot be done virtually—it has to be face to face”
— Edith Gicheha, NEST360° Clinical Training Director
Then, in March of 2020, Kenya had its first cases of COVID-19. The team was suddenly faced with redesigning and adapting their training and mentorship approach due to the restrictions to avoid the spread of the COVID-19 virus. The clinical training team decided to host regular webinars using Zoom that were open to all healthcare workers in Kenya.
The first few webinars were attended mostly by senior healthcare workers who had access to internet and the Zoom app. However, frontline healthcare workers were not able to join because most did not have Zoom on their phones or know how to use Zoom - even though internet connectivity in Kenya is pretty good and affordable.
The clinical training team did not give up and went on a campaign to train everyone (especially nurses) how to download and use Zoom. Three nurses played a key role, using existing WhatsApp groups, they took the time to list out the steps to download Zoom and explain how to use the software. This extra effort paid off quickly.
With the number of people who wanted to join in the webinars, The clinical team had to increase their Zoom account maximum capacity from 100, to 300, then 500. Registrations for the webinars would even reach up to 2,000. The audience evolved to not only Kenyan, but also health workers from Uganda, Nigeria, Cameroon, Ethiopia, Rwanda and Mauritius. The webinars were held from April to July 2020 every Friday evening and during this time, the clinical training team became masters of using Zoom.
Building on this experience, the training team was able to transform the face-to-face newborn care trainings into a three-day virtual training for specific facilities, and sometimes they were able to combine up to three facilities at the same time. To make this possible, widescreen smart TVs and webcams were installed in the training sites, which were provided by NEST360°. Now facilities can continue regular virtual sessions that have facilitated low-dose, high-frequency trainings, which are improving mentorship in the newborn units—which is the most important component.
To illustrate this, Edith Gicheha recalls an incident when she and two mentors were in one of the facilities. Two nurses came running into the unit, shaken because the baby they were bringing in for referral care had stopped breathing and was lifeless. The staff who were supposed to receive the baby were hesitant, so the mentors immediately took the baby and began resuscitation. The mentors followed the protocol recommended for newborn resuscitation as well as care of a baby who needed abdominal decompression and immediate intensive phototherapy.
“For the staff in this unit, as well as the shaken nurses who brought in the baby, this particular experience really opened their eyes.” Edith recalls, “Observing the resuscitation, the nurses couldn’t believe what their mentors were capable of. You could hear them say, ‘Wow all of those things they have been teaching us—they really work!’”
Now at the end of 2020, there are over forty clinical staff who have stepped up as leaders and mentors in their hospitals. Most are making time to perfect their skills so they can mentor others. Trainings are happening in Kenya using materials prepared by the NEST clinical team and approved by the Ministry of Health.
“NEST has come to revolutionize how we deliver newborn care,” Edith says, “Now everyone is talking about newborn care, because we have created an environment where there is continuous conversation about improvement, change, and collaboration.”