Pain relief for new mothers in ill-equipped rural clinics

Expectant mothers can now undergo emergency surgeries and painless procedures in village clinics without anaesthesia following the launch of a new drug.

The drug, known as ESM–Ketamine, is an alternative to anaesthesia— a drug commonly used in hospitals to reduce pain during surgery– which is inaccessible in rural areas, leading to death of women.

Ketamine which is more accessible than the regular anaesthesia can also be administered easily by trained midwives unlike anaesthesia which requires trained experts to administer.

Kenya has few anaesthetists, with most concentrated in major hospitals. The cost of using their expertise is also beyond the reach of many.

Dr Thomas Burke said that emergency surgeries can now be done safely.

He was discussing the findings of a study on the use of the drug during the 40th Ruby Annual Scientific Conference of the Kenya Obstetrical and Gynaecological Society in Kisumu.

In the trial, non-anaesthetist clinicians in three sub district hospitals in western Kenya underwent a five-day course in ESM Ketamine complemented kit.

“The primary outcome measures centred on capturing the ability to safely support emergency and life improving surgeries when no anaesthetist was available,” he said.

The World Health Organisation (WHO) and the World Bank expect that by 2026, the burden of diseases requiring surgery will eclipse that of HIV/Aids, tuberculosis and malaria.

“Lack of anaesthesia services is a barrier to caesarean sections and other emergency surgeries in resource-limited settings,” said Dr Burke who is one of the authors of the study.

The trial was done to assess the impact and safety of ESM–Ketamine for use in emergency caesarean sections and life-improving surgeries by non-anaesthetist clinicians in resource-limited settings when no anaesthetist is available.

It was done by Sagam Hospital in Siaya County, Maseno University Medical School in conjunction with Harvard Medical School and Massachusetts General Hospital.

Dr Burke said 57 per cent of hospitals in western Kenya with operating theatres and surgical providers lack skilled personnel.

“It becomes very difficult to operate on emergency cases with no skilled doctors around but with the kit it is easier and safe to perform the operations,” he added. He said from the trials the ESM-Ketamine package has been used 414 times when a professional doctor was unavailable.

“We have done 84 emergency caesarean sections, 28 abdominal surgical and other additional cases like open fracture repairs,” he said, adding that using Ketamine in a protocol-driven fashion will save lives in rural areas.

The doctors recommended future research on safety and barriers to uptake and implementation.

Dr Khama Rogo, lead health specialist, World Bank, said: “We are also going to do research on economic environment involving ESM-Ketamine package and the potential it has to increase surgical demand.”

ESM Ketamine confirms functions of pulse oximeter, oxygen source, suction, blood pressure device and bag valve mask.

“We believe that these unique features allow for a great opportunity to develop and test a carefully controlled task shifting package,” he said.

The KOGS Conference with the theme Delivering reproductive health services in a devolved health system:  challenges and opportunities, was graced by over 500 participants including local, regional and international professionals who are engaged in provision of reproductive health services.