University of Nairobi Fellowship

Pediatric Anesthesia Fellowship in East Africa:

An International Partnership with SPA, APAGBI, AAGBI, WFSA, and the University of Nairobi (Kenya)

Pediatric anesthesia mortality in East and Central Africa is poorly documented but reports indicate anesthesia mortality is as high as 1 death per 144 cases. 1,2 This is in stark contrast to the anesthesia mortality in the US which is 1 death per 100,000.3   In low and middle-income countries (LMICS) over 40% of the population is reported to be under the age of 14.4   It is estimated that 85% of these children will require surgery before the age of 15.5   As in other parts of the world, these children require both basic and complicated surgical procedures yet they often do not have the benefit of being attended to by a physician anesthesiologist, let alone a pediatric anesthesiologist.  In fact, prior to 2013, anesthesia fellowship training in East and Central Africa did not exist.

Through the collaborative efforts between the University of Nairobi School of Medicine, Department of Anesthesiology, the World Federation Societies of Anesthesiologists (WFSA), the Society of Pediatric Anesthesia (SPA), the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI), and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) the University of Nairobi Pediatric Anesthesiology Fellowship began in September 2013.  The process was several years in the making and was the first University fellowship-level training program at the University of Nairobi. It now serves as a model for other disciplines.

This fellowship is also unique among WFSA supported fellowships as it is the only fellowship with University accreditation. The academic foundation of this program allows graduates to become fully recognized as experts in Pediatric Anesthesia within their home countries thus improving anesthetic care of the pediatric surgical patient in East and Central Africa.

The leadership provided by Dr. Mark Gacii and Dr. Susane Nabulindo has contributed to the early success of the fellowship. Educators in Kenya provide the vast majority of the clinical and didactic training while external lecturers provide additional requested mentorship and support.  Since 2013, the fellowship has graduated 9 pediatric anesthesiologists representing 5 countries in East and Central Africa.  Each graduate has returned to his or her home country and is helping to lead the development of pediatric anesthesia care both through education and direct clinical care.

The Society for Pediatric Anesthesia (SPA) in the United States is committed to supporting the development of the specialty of pediatric anesthesia in East and Central Africa. Since its inauguration in 2013, the SPA has provided mentorship, guidance, as well as financial support. Each year the SPA financially supports one fellow who has been designated the SPA East Africa Pediatric Anesthesiology Fellow. The SPA is excited to continue this collaboration and is committed to this level of funding for the next 5 years.

It is our hope that this international collaboration will continue to grow and allow SPA members to be directly involved in a medical education solution which will impact the lives of children in Africa for decades.

2016-17 SPA East Africa Pediatric Anesthesia Fellow

Dr. Tsitsi Chimhundu-Sithole
Dr. Tsitsi Chimhundu-Sithole

Prior to starting the fellowship, Dr.Tsitsi Chimhundu-Sithole worked as an anesthesiologist in the 2 major referral hospitals in Zimbabwe. Harare Children’s Hospital is a 350-bed hospital that performs approximately 1,300 surgical cases annually. There are 3 OR theatres dedicated to pediatric patients, a 6 bed PICU, as well as a burn unit. In contrast, Parirenyatwa Hospital is a 1,800 bed hospital that cares for both adults and pediatric patients.  There is no operating room dedicated to children. Despite there being 3 paediatric surgeons and 6 paediatric surgery residents, Zimbabwe has no trained paediatric anaesthetist at present.

Dr. Chimhundu-Sithole shares her interest in pursuing a fellowship in pediatric anesthesiology…

“During residency I noticed this deficit and developed a keen interest in Paediatric anesthesia. Joining the University of Nairobi paediatric anesthesia fellowship has been an amazing opportunity for me. The exposure has been absolutely phenomenal. I have already joined the University of Zimbabwe as junior faculty and am very much looking to teaching in Paediatric Anaesthesia upon my return. I have a particular interest in cardiac and simulation training. My short-term plan is to commence SAFE paeds in Zimbabwe and set up capable retrieval teams for children in the peripheries. I also want to do an assessment of the unmet burden of paediatric surgical disease in the country and how Anaesthesia plays a role. I hope to work on this immediately upon my return. I have already made some contacts in the Ministry of Health. At Parirenyatwa I’ve initiated a move towards opening a dedicated Paediatric OR. Plans are ongoing and we are currently looking for financial support for the equipment, drugs, and dedicated staff. Long term plans include an interest in establishing a Paediatric Anaesthesia fellowship in Zimbabwe in conjunction with previous fellows in Africa as well as further developing my research interests.

I am very fortunate to have a family that is very supportive of my professional career. My husband and 2 children are still in Zimbabwe and have been gracious enough to allow me to do this. My kids are my inspiration.” 

Past SPA East Africa Pediatric Anesthesia Fellows

Dr. Susane Nabulindo Kenya
Dr. Susane Nabulindo Kenya
Dr. Christopher Chanda Zambia
Dr. Christopher Chanda Zambia
Dr. Singatiya Stella Chikumbanje Malawai
Dr. Singatiya Stella Chikumbanje Malawai

References

  1. Walker IA, Obua AD, Mouton F, Ttendo S, Wilson IH. Paediatric surgery and anaesthesia in south-western Uganda: a cross-sectional survey. Bull World Health Organ. 2010;88(12):897–906. doi:10.2471/BLT.10.076703.
  2. McQueen KAK. Anesthesia and the global burden of surgical disease. Int Anesthesiol Clin. 2010;48(2):91–107. doi:10.1097/AIA.0b013e3181d36d09.
  3. Li G, Warner M, Lang BH, Huang L, Sun LS. Epidemiology of anesthesia-related mortality in the United States, 1999-2005. Anesthesiology. 2009;110(4):759–765.
  4. World Bank. Population ages 0-14 (% of total). Retrieved from http://data.worldbank.org/indicator/SP.POP.0014.TO.ZS
  5. Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. World Health Organization; 2002;80(10):829–35.