Emergency medical care has never been an integral component of Kenya’s healthcare system. During emergencies, the system is often dysfunctional and fails Kenyans. This is despite Kenya having the medical resources and facilities to provide emergency medical care to its citizens.
Historically, the focus has always been to develop other components of the healthcare system and it may have been thought that providing emergency medical care was not a priority or costly. The reality in Kenya currently is that an increasing number of patients with acute illness and injury present to facilities across the country every day and we can provide better emergency medical care to Kenyans without incurring significant additional costs through better coordination and focus.
Timely, accessible and quality lifesaving emergency medical care will benefit Kenya in many ways. For the public, it will provide them with confidence that they will be looked after in an emergency and that they are valued as members of society. It also ensures better long-term outcomes for them and their families. Quality emergency medical care makes sense economically because the recipients of the care contribute to the growth of the country through businesses, paying taxes, providing services and caring for other people. Quality emergency medical care also prevents long term complications that can save costs for the healthcare system in the long term.
The Emergency Medicine Kenya Foundation (EMKF) is a not-for-profit organization founded in 2015 by local healthcare professionals to help guide and inform the development of a sustainable emergency medical care system in Kenya appropriate for the local healthcare system.
Most people working in Kenya’s healthcare system would readily acknowledge that emergency medical care is lacking and must be improved. Unfortunately, the problem is so big and complicated that it cannot easily be fixed, and this deters many from trying. Also, for many in the system, their single focus is providing care to patients in their direct care, and they cannot see what is happening across the healthcare system.
A Kenyan doctor, Dr Benjamin Wachira went to South Africa and witnessed first-hand how a functioning emergency medical care system worked. Together with his colleague Dr Jeremiah Gitau, they realised that in order to improve Kenya’s emergency medical care system, they had to increase the focus on emergency medical care within the existing healthcare system and gradually over time integrate it so that emergency medical care is delivered seamlessly inside and outside the hospital system. After his emergency medicine training in South Africa, Ben returned to Kenya in 2012. He became the first Kenyan Emergency Physician based in Kenya and together with Jeremy, established the Emergency Medicine Kenya Foundation (EMKF) in 2015. The Foundation had one pressing objective and that was to improve the emergency medical care system in Kenya. To do this, they had to encourage everybody involved in Kenya’s healthcare system to change the way they saw emergency medical care.
First, everybody needed to be convinced that to be of maximum benefit, emergency medical care had to be provided as quickly as possible. When an emergency occurs, some patients need immediate lifesaving treatment. This means an adequately equipped ambulance with qualified EMTs/Paramedics should be sent to the emergency as quickly as possible so that the EMTs/Paramedics can diagnose and provide this initial treatment. Once the patient is stabilised, the ambulance then takes the patient to the most appropriate emergency department where they can receive further emergency care, and be admitted for more specialised treatment. One of EMKF’s challenges is to increase the number and availability of adequately equipped ambulances with trained EMTs and Paramedics throughout Kenya because ambulances play a critical role in saving lives and providing early notification to emergency departments so that they are prepared when the patient arrives.
Delivering a patient to a hospital quickly is critical but it is just the first stage of treatment. Until recently, once a patient arrived at a hospital in an emergency, the hospital’s response was chaotic as the facilities were not appropriately designed or equipped to handle these medical emergencies and the healthcare providers had no specific training or guidelines on emergency medical care. While most of the hospitals in Kenya are accustomed to handling regular illnesses and injuries in a planned way based on experience, emergency medical care requires innovative approaches, sudden changes of plans, access to surgery at short notice, sequencing different treatments and working with colleagues across different specialities while managing multiple patients simultaneously.
It was clear to EMKF that to be successful it had to promote a new approach (evidenced by a new national policy) and this approach needed to be adopted not only by the national government but also by county governments and various stakeholders and partners. Ben and Jeremy’s specialised knowledge, expertise, experience and vision for a better emergency medical care system gave them credibility and their willingness to volunteer their time to provide training to colleagues and hospitals earned them respect. As a result of this work, EMKF was instrumental in positively influencing the development of Kenya’s first Emergency Medical Care Policy by the Ministry of Health (the Policy) in 2020. The Ministry of Health clearly values their advice and input and Ben has been appointed to the National Emergency Medical Care Steering Committee to support the government to operationalise the Policy and provide oversight of emergency medical care in Kenya as guided by the policy for the next three years.
The stewardship of the Board of Directors has over the years seen EMKF experience significant growth and establish itself as the trusted partner in the development of emergency medical care services in Kenya. EMKF has benefitted enormously by having a talented, almost all-female team totally committed to improving emergency medical care in Kenya because they understand the massive, positive impact an improved emergency medical care system that values and respects human life can have on society. They have strongly contributed to a unique synergy of purpose shared throughout the organisation which encourages ownership and pride in everything EMKF does. Together, they are building an emergency medical care system in Kenya that will save lives, make Kenya a better place and provide a model for other countries wanting to improve emergency medical care.
Now that we have the Kenya Emergency Medical Care Policy 2020-2030, the next step is to disseminate this across the country in all 47 Counties and directly support its implementation. However, the barrier to this is funding. If we want to change the status quo, funding has to come from external sources to get the work moving which in turn will motivate the National and County governments to prioritise the development of an emergency medical care system within Kenya’s healthcare system to ensure timely, accessible and quality lifesaving emergency care across the county.
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The Foundation is governed by a Board and it provides guidance and leadership on policy, strategy and approval of the projects. The day to day affairs of the Foundation are managed and coordinated by an operational team lead by an Executive Director.