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An innovative training program could save tens of thousands of children’s lives

Amélie von Saint André-von Arnim, MD
Dr. Amélie von Saint André-von Arnim

When I traveled to Kenya as a doctor in 2011, I came face-to-face with a harsh reality: Every day, 17,000 children in resource-limited countries die of preventable conditions.

I saw children dying of severe pneumonia, diarrhea, dehydration, and malaria. I met families who were left with a gaping hole in their lives. And I came to a troubling realization: The hospitals had some of the tools and the resources to prevent many of these deaths. They had medications for malaria and intravenous fluids that could help children recover from dehydration. But there were few, if any, doctors trained to help children who need emergency or critical care. Kenya is home to 17 million children but it has only one pediatric critical care specialist.

So I worked with my colleagues in Kenya—and at the University of Washington and Seattle Children’s Hospital—to create an innovative fellowship program to teach physicians to diagnose children with critical health problems, and to deliver treatment that could save their lives.

Most international training programs bring doctors from low-resource countries to hospitals in the United States or other developed nations. The trainees learn from expert physicians and are exposed to state-of-the-art technology. But the trainees don’t see children with conditions like malaria that are common in their home countries. And they don’t learn how to help children using the tools available in low-resource, low-tech settings.

Our program, which launches in 2017, will upend this model. Pediatric Emergency and Critical Care–Kenya will be the first fellowship program that trains pediatric emergency and critical care physicians in sub-Saharan Africa. Pediatric specialists from Kenya, Seattle Children’s, and the University of Washington will teach the fellows how to diagnose and treat common pediatric critical illnesses. The training will take place in both urban and rural hospitals.

The first class of fellows will graduate with the skills to supervise care for at least 12,000 children a year. As the program grows, we will bring in trainees from many more low-resource countries in sub-Sarahan Africa, and our impact will grow exponentially. Our target budget of $100,000 a year for the first three years shows how there are relatively low-cost ways to transform care. After three years, the program will be self sustainable.

We also hope to break down a key technological barrier to improving critical care. Physicians at most African hospitals still use paper charts to record a patient’s condition, the treatment they receive, and whether that treatment makes a difference. Some hospitals have graduated to Microsoft Excel spreadsheets to build simple clinical databases, but the doctors are so busy that it can take them days or weeks to update the records.

We aim to help implement a system that uses simple technology—such as Microsoft Surface tablets—so that doctors can record patient data in real time. This would make patient records more accurate and give physicians more time to care for patients.

Our team could mine that data to pinpoint ways to improve diagnosis and treatment. We could then build those lessons into our training program, ensuring that fellows are equipped to handle real-world challenges.

As a physician in the United States, I have the resources to give children the best chance to survive. Still, I never stop thinking of my Kenyan colleagues and doctors like them throughout the developing world. They work as hard as they can, but they lose one child after another. Our training program can close that gap and help tens of thousands of children lead happier, healthier lives.

Learn more about her training program at Pediatric Emergency and Critical Care – Kenya.

Dr. Amélie von Saint André-von Arnim is an attending physician at Seattle Children’s Hospital and an assistant professor of pediatrics and pediatric critical care medicine at the University of Washington School of Medicine.