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It’s well documented in medical literature that women of African descent develop uterine fibroids five to six years earlier and are more than 5 times as likely to have severe symptoms than Caucasian women of a similar family history.1

With the increasing number of women requiring fibroid treatment, hospitals in Kenya have welcomed international doctors to treat their patients with uterine fibroid embolisation (UFE).

In July 2018 Merit Medical joined Darren Klass, MBChB, MD, MRCS, FRCR, FRCPC, on a trip to Kenya to educate Kenyan physicians, including gynaecologists (referring clinicians) and radiologists, on this uterine-sparing, minimally invasive option. The aim was to educate referring clinicians on UFE and provide one-on-one training to Kenyan radiologists, in order for them to provide this treatment to their patients independently and offer a full-time service.

In an intensive 10 days, Dr. Klass presented a number of UFE courses to several clinical teams in Karen and Kenyatta National Hospital in Nairobi and Aga Khan in Mombasa. Along with physician training, patients were also scheduled to undergo UFE in both cities. Dr. Klass observed and trained the teams while they treated their own patients.

The transradial approach proved to be an eye-opener to both the Kenyan interventional radiologists and their cross-disciplinary teams. They were able to observe how patients immediately ambulated post procedure and made themselves comfortable without the worry of laying still on their backs, which is required for a femoral access site.

A culmination of the skills transferred and education of the referring clinicians (gynaecologists) occurred on the eve of the final day in Mombasa. Following a long day of training, Dr. Klass was called by a gynaecologist to discuss an emergency case. A bedside consultation was done together with the referring gynaecologist at around 8pm. The patient was successfully embolised the following day and discharged 24 hours post-procedure. In this particular case, due to extenuating patient circumstances, UFE provided not only a uterine-sparing therapy for symptomatic fibroids but also a life-saving option. This cemented the education to referring clinicians that UFE is an effective fibroid treatment option and that our goal is not to remove patients from their care. The case was presented to a multi-disciplinary audience by the gynaecologist at a weekly Kenyan Medical Association meeting the eve following the procedure.

The skills learned by the Kenyan radiologists can have a far-reaching impact, well beyond UFE. Because of the training with Dr. Klass and Merit Medical, radiologists can now provide a post-partum haemorrhage service in both Mombasa and Nairobi. Statistics show that 6,300 woman die in Kenya each year during pregnancy and childbirth.2 A Kenyan policy document published in 2015 quoted the maternal mortality rate at over 2,000 per 100,000 live births in North Eastern Kenya, and 212 per 100,000 live births in Nairobi, with haemorrhage accounting for 44% of those deaths.2

“Post-partum haemorrhage is an avoidable complication of childbirth and providing the radiologists here with the ability to treat this devastating complication with an effective therapy will hopefully have a dramatic impact on this shocking statistic,” Dr. Klass explains.

The time spent in Kenya was brief, but the main objective was achieved. Kenyan physicians are now independent operators providing these essential services.

“I arrived here wanting to improve the lives and care of women in Kenya,” Dr. Klass tells Merit Medical. “I am pleased that by training interventional radiologists in Kenya to perform this life-changing procedure, I saw this happening. Every single person I met in Kenya was grateful for the purpose of this trip.”

To learn more about future ThinkRadial education opportunities, visit merit.com/thinkradial.

REFERENCES

  1. Huyck, K. L., Panhuysen, C. I., Cuenco, K. T., et al. (2008). The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyoma among affected sisters. Am J Obstet Gynecol, Feb;198(2):168.e1-9.
  1. National Council for Population and Development. (2015, Jun). Reducing Maternal Deaths in Kenya (Policy Brief No. 46). Retrieved from http://www.ncpd.go.ke/wp-content/uploads/2016/11/Policy-Brief-46-Maternal-Deaths-in-Kenya-1.pdf.

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Emergency UFE case being presented at a Kenyan Medical Association meeting.