Improving Care of the Injured in Kenya

By Dr. Kent Stevens, Johns Hopkins Bloomberg School of Public Health

Each year, more than 8,000 individuals die in Kenya as a result of road traffic crashes. When someone is injured in a crash, there is seldom an ambulance available to transport them to a hospital; and if an ambulance does arrive, oftentimes the ambulance driver and care provider have had minimal training. Adding to the situation, doctors and staff at hospitals and care facilities typically lack the appropriate training to address these common road traffic injuries.

In Kenya, the largest percentage of deaths from an injury comes from road traffic crashes; and a majority of people injured are frequently some of the most productive members of society: individuals between the ages of 19 and 45.

On a recent trip to Kenya, I witnessed a roadside crash involving a Matatu, a type of mini-bus. When we later arrived to the district hospital in Thika (45 kilometers northeast of Nairobi), we discovered that all 17 occupants of the Matatu had been transported to this center. The facility is small, and the injured occupants had received minimal treatment at the scene and en route to the hospital. The sole physician on call and his staff did their best to care for each patient. Those who were severely injured were transferred to another hospital, but again, received minimal treatment in transport.

Because of the high frequency of road traffic crashes in Kenya and other low and middle-income countries, stronger laws, improved on-site and hospital care, and protocols standardizing care can greatly improve road safety and injury outcomes.

Over the past three years, as part of the Bloomberg Philanthropies Global Road Safety program, the Johns Hopkins International Injury Research Unit (JH-IIRU) has been working in Kenya to address patient care from road crashes. Collaborating with the Ministry of Health, county governments, the World Health Organization, the Center for Disease Control-Kenya, and local organizations such as the Kenya Council of Emergency Medical Technicians, we have begun to improve post-crash care – on site, en route, and in hospitals. We have trained emergency medical technicians, ambulance drivers, hospital-based care providers including physicians, surgeons and nurses, standardized the training curriculum, collected data to better define the burden of injury and identify gaps in care, and worked on national policies to bring change to patient care in Kenya.

While prevention is our ultimate goal, we understand that even with the best interventions and political will, it will take time for road traffic crashes to decline. Meanwhile, we must work together to improve patient care and reduce deaths from traffic injuries. Improved trauma care not only saves lives, but also allows patients to return to their lives quickly – creating long-term benefits for families, communities, and society.

Dr. Kent A. Stevens is a trauma surgeon whose practice includes trauma, critical care and acute care surgery at the Johns Hopkins Hospital. Dr. Stevens is the associate director for clinical services and trauma care in the Johns Hopkins International Injury Research Unit at the Johns Hopkins Bloomberg School of Public Health.