Kenya, Australia partner to boost nursing care for fistula, chronic wounds

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Kenya and Australia have sealed a deal that would enable local nurses undergo specialised training in management of fistula, stoma – a surgically created opening in the abdomen that allows waste to leave the body – and other chronic wounds.

The nurses are being trained at the Aga Khan University School of Nursing and Midwifery (SONAM) in Nairobi under the Kenya Stoma Wound and Continence Nursing Education Programme.

The programme, which is the first of its kind in East Africa targets about 20 nurses annually, to be trained by medical tutors from the Australian Association of Stomal Therapy Nurses (AASTN).

A total of 53 nurses have so far been trained on a pilot basis under the programme and the number is expected to increase with the signing of the agreement that will bring a huge relief to fistula and stoma patients in the country.

The number of patients with stoma, fistula and chronic wounds is on the rise in tandem with increase in Non- Communicable Diseases (NCD). Most of the patients with gastric cancers end up with bowel stomas- a surgically created opening in the abdomen that allows waste to leave the body.

The SONAM Dean, Professor Sharon Brownie, said nursing care for patients with fistula and stoma remains a major challenge due to few health personnel with specialty in management of the conditions and high cost of quality disposal bags and dressing materials.

“In the absence of adequate knowledge and care, patients with stoma may have odour and skin problems, management issues and stigmatisation and most likely, undergo unnecessary suffering. Patients with acute and chronic wounds may undergo unnecessary complications leading to amputations or even death due to infections,” said Professor Brownie.

She said nurses who undergo the programme successfully will help ease the pain of many people trying to cope with the social, psychological and basic management issues associated with conditions.

“A nurse with knowledge about this condition can provide the skills and knowledge to allow these people to live with dignity, and continue confidently with activities of daily living,” she said.

In Kenya where majority of people live on less than a dollar per day, the cost of stoma bags, which are mostly imported and sold in select pharmacies at cost as much as Sh1,400 and Sh100 per bag for reusable and disposable ones respectively is unaffordable to many poor patients.

The reusable bags are disposed after using them twice or thrice. In addition, users have to buy a base that ranges from Sh700 which is attached to the pouch and used up to four times or less if it soils.

The programme is structured to include 50 percent clinical and 50 percent theoretical learning, and the nurses mainly undertake their clinicals at the Aga Khan University Hospital (AKUH), Kenyatta National Hospital (KNH), Kijabe Mission Hospital, the Spinal Injuries Hospital and St Mary’s Mission Hospital. A total of 17 volunteer Australian nurses participated in training the local nurses.

Professor Brownie said dedicated nursing positions for stoma wound and continence care have been establishment at AKUH Nairobi and KNH. There are also stoma and continence nurses in  Machakos, Kijabe, Homa Bay, Malindi, Nyeri, Meru, Kisumu, Eldoret, Samburu, Bomet, Kilifi, Kakamega, Siaya, Kwale, Kisii and Wajir.

“The Stoma Wound and Continence Nursing Association of Kenya has been established to support the sustainability of stoma management. An international delegate to the World Council of Enterostomal Therapists (WCET) has also been appointed to ensure Kenya is well represented on the world stage,” said Professor Brownie.