University of Nairobi Fellowship

Pediatric Anesthesia Fellowship in East Africa:

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

In East Africa, having a simple operation can be a very dangerous predicament. Pediatric anesthesia mortality 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 Quality pediatric care including the ability for safe pediatric surgery and anesthesia is critical as 50% of the population in East Africa is under the age of 14 (75 million people).4 As in other parts of the world, these children require both basic and complicated surgical procedures yet they often do not often have the benefit of being attended to by a physician anesthesiologist, let alone a pediatric anesthesiologist. Not surprisingly, anesthesia fellowship training in East and Central Africa does 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 was started in September 2013. It is the first University fellowship-level training program in any specialty in East and Central Africa and is expected to serve as a model for other disciplines. In fact, since our program started a pediatric emergency medicine fellowship has started in Kenya, motivated by our success while following our development template. It is our hope that this fellowship will help to fill the training gap in pediatric anesthesia and improve anesthetic care of the pediatric surgical patient in East and Central Africa.

Dr. Mark Newton working with Dr. Emma Mutio at Kijabe Hospital, Kenya

This fellowship is 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 so that the ripple effect will quickly impact an entire region of Africa. The visionary leadership in Kenya by those interested in the improvement of the anesthesia care of East Africa’s children prompted a transitional template for this program. Although educators in Kenya will provide the vast majority of the clinical and didactic training, external lecturers have been requested during this time of transition towards the goal of a self-sustaining program. The visiting lecturers will not only provide lectures, but also assist in the clinical mentoring within the operating theatres of Kenyatta National Hospital, the large teaching referral hospital where the fellows spend a majority of their time. The fellows also rotate through additional hospitals that include: Kijabe Hospital, Gertrudes Children’s Hospital and Mater Hospital. The program is thankful to Dr. Charles Cote for his donation of “A Practice of Anesthesia for Infants and Children” to each fellow and educator in Kenya.

From left to right: Dr. Emma Mutio (fellow), Dr. Faye Evans (visiting lecturer), Dr. Carolyn Stickney (visiting lecturer), Dr. Richard Kabuye (fellow), and Dr. Susane Nabulindo (fellow)

The inaugural class (2013-14) consisted of three fellows: Dr. Emma Mutio (Kenya), Dr. Richard Kabuye (Uganda), and Dr. Susane Nabulindo (Kenya). Dr. Nabulindo was selected as the first Society of Pediatric East Africa Anesthesiology Fellow. After completion of the fellowship she has chosen to remain on faculty at the University of Nairobi and is playing a key role in helping to build the fellowship.

Dr. Susane Nabulindo accepting her award from the current president of the SPA Dr. Shobha Malviya as the inaugural SPA Pediatric Anesthesia Fellow

This year (2014-2015) there are three fellows: Dr. Alan Kochi and Dr. Nancy Okonu from Kenya and Dr. Christopher Chanda who is from Zambia. Dr. Chanda has been selected this year’s Society of Pediatric Anesthesia East Africa Anesthesiology Fellow. At the completion of his fellowship he plans to return to Zambia where he will play a leadership role in anesthesia training in Zambia.

Dr. Allan Kochi, Dr. Nancy Okonu, and Dr. Christopher Chanda

The population base in Africa has the steepest growth curve of any region of the world. As this population grows, the absolute number of children who need surgery in Africa every day will exponentially grow and based upon current estimates, thousands of African children will die due to unsafe anesthesia in the vast majority of African countries. This program will directly address this reality by training East African anesthesiologists in the specialty of pediatric anesthesia within a program rooted in a country’s national system. The program will also train residents alongside the fellows so that all levels of physician anesthesia education will benefit. The goal of training trainers as leaders in pediatric anesthesia will allow surrounding countries to benefit from this training. In five years, our goal is to have pediatric anesthesia educators in many of the East and Central African countries and start additional fellowship programs in West and North Africa.

We are proud of the SPA’s involvement in this program. In addition to providing full support for one of the three fellows in Nairobi, the SPACIES committee has helped to coordinate the external lecturers for the program; provide a scholarship for the “SPA Fellow” to visit a US Children’s hospital, and attend the SPA’s annual meeting. Last year, Dr. Nabulindo had the opportunity to spend several weeks at both Boston Children’s Hospital and Vanderbilt Children’s hospital after which she was warmly received at the SPA annual meeting in New Orleans. This year we are looking forward to welcoming Christopher Chanda for a similar experience.

This international collaboration provides a unique opportunity for members of the SPA to work with their African anesthesia colleagues to help raise the quality of anesthesia care throughout East Africa. In addition, this collaboration will expand our global impact through increasing our membership base into East and Central Africa. These Pediatric Anesthesia Fellows will always remember the supportive role that the SPA has had in their education and the leadership skills gained from this program will stimulate further safe pediatric anesthesia measures within their countries in Africa.

  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. Group WB. World Development Indicators 2013. 2013.