Can virtual mentorship for junior doctors help reduce maternal deaths?

The theater room at Mother and Child Hospital in Makueni, Kenya, was a buzz of activity when Devex visited the facility in December. Scrubbed up in green and blue, the hospital’s surgical team — made up of junior doctors — went about setting up for a cesarean section that would be undertaken later that afternoon. In 2013, the government of Kenya scrapped delivery fees in all public hospitals and health facilities to encourage pregnant women to deliver in these facilities. Ten years down the line, Mother and Child Hospital now carries out an average of 300 deliveries every month with a third of these being done through cesarean section, according to Jhpiego, a nonprofit health organization affiliated with Johns Hopkins University. “Deliveries can become complicated and once a delivery complicates, it will end up as a cesarean emergency,” Louise Nzilani, the nurse manager at the hospital said. But many hospitals across the country still lack the necessary facilities and qualified personnel to provide safe deliveries through cesarean sections. Makueni county has three consultant obstetrician-gynecologists to oversee around 900 cesarean surgeries per month. Maternal mortality in the county stands at 452 deaths per 100,000 live births — higher than the national rate of 355 deaths per 100,000 live births. In a bid to equip junior doctors and surgical teams to deal with obstetric emergencies, Jhpiego partnered with surgical platform Proximie to establish a remote mentorship program for surgical teams working in the county. Through the program, surgical teams based in five hospitals can receive virtual support from experienced doctors during surgeries. The project — which was launched in December 2021 — will run for 22 months and aims to support the county in reducing maternal and newborn deaths, and obstetric-related injuries by improving the quality of cesarean sections. Dr. Doris Mbithi, a consultant obstetrician-gynecologist at Makueni County Referral Hospital uses the program to train junior doctors and nurses to perform cesarean sections, handle complications, and take care of babies after the procedure. “Six months of internship is not adequate for a medical officer to be confident enough to perform these emergency surgical operations,” Mbithi said, adding that it takes time and mentorship for a doctor to develop the necessary skills. The program uses four cameras mounted in the theater and connected to a laptop with Proximie software which allows multiple people in different locations to interact virtually. One camera focuses on the patient and the surgical field, the second on the whole team in the theater, the third on the anesthesia mat, and the last on the baby. Mbithi said this system allows her to help surgical teams at any of the five participating facilities through an emergency. It also allows her to access recorded surgical sessions for review. “I can even audit a case from my office with a team in Kibwezi. They log in and I log in and we review a case that they did. We pick gaps and discuss,” she said. According to Jhpiego, the project has helped in standardizing the care that is given by surgical teams across the county. “At the beginning of the project, the compliance to the safe surgery checklist was zero, by March 2022, the compliance was 100%,” the Jhpiego Kenya Obstetric Safe Surgery team said in a statement.