It has been a little over a month since I got in Kenya. My time here has been a roller coaster, from very high disappointments to great surprises. I look back at the person I was a couple months ago and realize how much this project has stretched me. This has been quite a transformational process in personal development and growth. I remember telling myself that Kenya would not be a problem for me since I would be going “home”. My journey here has taught me that I was very ignorant assuming that being Rwandese would make my cultural journey here easier. When I left Nashville, I had the data collection tools ready and my initial plan was to start collecting data a week after arrival. The perfectly planned day-to- day activities was looked at and laughed at quietly when I got on the ground. I spent the first few days in Kijabe full of uncertainties since every day I was given different responses about our project. It got to a point where I almost gave up and started assuming that all I will have to do while in Kenya is to make sure that the data collection tools are comprehensive enough since the project would be implemented by someone else. Despite the uncertainties, I continued to ask daily for updates and ultimately we were given the approval three weeks after my arrival in Kenya. My time here has been a learning experience for me; I learned that to continue to be resilient but also to keep investing in the building blocks even if things seem not to be moving. We run through so many unpredicted obstacles and getting the approval at the end of this waiting journey was a real “miracle”.  

I started working on this project with the ImPACT Africa team since last Fall. I was working with them to design a pilot study for the evaluation of the impact of Kenya Registered Nurse Anesthetists (KRNAs) training program on obstetric care. I spent most of my time developing the right tools for the evaluation and getting feedbacks from people who were experts in evaluation of training programs and consulting with the Anesthesiologists at Vanderbilt.  I wanted to make sure that the questionnaires were appropriate for the evaluation, the training but also appropriate to capture data on anesthesia care. We ended up having 6 different tools by the end of the summer. A facility assessment on obstetric care, individual interviews for the KRNAs, the Medical superintend of each hospital and about 100 women at each intervention site who lived within the catchment area of the hospital. In addition, a focus group guide for women in each community (about 5/ site) and an in-depth interview guide for the KRNAs who worked in the same site were put together so that comprehensive data can be gathered in the intervention sites. The tools were rightly loaded in REDcap and I worked closely with the team in Kenya to make sure that the questions were cultural- specific. My biggest concern during the preparation was to get on the ground and realize that the questionnaires were not culturally appropriate for each region considering that we would be visiting nine different hospitals. During my time in Kijabe while waiting to hear back from the Maseno University Ethical Review Board; I spent time with the instructors of the KRNAs training program in Kijabe as well as the KRNAs who were in training at Kijabe. My fist mission was to understand how things function during the training time in Kijabe but also to get feedbacks from the KRNAs on the questionnaires. In addition to that I wanted to know if the questionnaires for the community were appropriate since was going to be questioning women from rural areas of Western Kenya and asking them questions that could be culturally delicate. 
In order to insure that the questions would lead to targeted information during data collection; I tested the tools with the KRNAs in Kijabe and administered the interview to about 20 women who volunteered to answer my questions in the Maternal and child health clinic at AIC Kijabe Hospital. After testing the tools in Kijabe, I made the appropriate edits based on the advice gathered and loaded all the questionnaires on two tablets. I headed then to Kisumu during the first week of October to meet our collaborators from Maseno University. I spent the first week in Kisumu meeting with the student from Maseno University who would be helping with data collection by interviewing the women at the study sites. My days consisted on training her on how to use REDCap so that she would be familiarized with the tool when the data collection starts. In addition to that I was following up with the status of the IRB study application with the Maseno University Ethical review board on a daily basis. When the approval was issued towards the end of the first week; the ImPACT Africa coordinator in Kisumu helped me to plan trips to visit health officers of all the counties involved in the study. Here is a list of the study sites with their respective counties offices visited:
  • Siaya County Referral Hospital: Siaya County
  • Bondo Sub-County Referral Hospital: Siaya County
  • Yala Sub-County Hospital: Siaya County
  • Port Victoria Sub-County Hospital: Busia County
  • Migori County Referral Hospital: Migori County
  • Homebay Hospital: Homebay County
  • Oyugis Hospital: Homebay County
  • Malava Hospital: Kakamega County
  • Vihiga Hospital: Vihiga County
The study sites were divided into intervention sites (Yala, Bondo and Siaya) that have KRNAs and they were matched with 2 control sites each. Each hospital requested an IRB approval letter and a letter from the county confirming that the county health office had allowed us to collect data at these institutions. In order to get the county approval letters, I spent my second week in Kisumu visiting the health county offices in order to obtain the letter from the specific health ministers of the counties. Some visits were very smooth and some others were quite challenging but along the way I learned that the notion of urgency and schedule does not mean the same thing everywhere. The most challenging part was to maintain a good balance with the Maseno university team so that the collaboration between the two Institutions will not be affected. I learned how to be patient and not to let the long delays or lack of reponses affect my temper. 
After the visits at the county offices, we were ready to start collecting data. I packed my bags and started the long journey to visit the 9 different sites. All six tools had to be administered in the control sites while only the facility assessment had to be performed in the control sites. A week and a half after leaving Kisumu, all 3 intervention sites were visited, 3 facility assessment were completed, 3 hospital directors were interviewed, more than 300 women had been interviewed in Bondo, Yala and Siaya as well as all seven KRNAs who work in these hospitals. The next step was to head toward the control sites were to perform the facility assessments in the six remaining control sites so that these data could be compared with the ones gathered from hospitals that have KRNAs. Looking back, from conception to implementation; this project has been a transformational experience for me. Every time I thought that I was patient, I had a humbling opportunity to learn that I still had a little more room for patience and that I needed to be a lot more resilient. With six sites left to visit, I cannot be more thankful for what I have learned at each sites so far and all the wonderful people that I had met. I look forward my experience during the other sites and I look on challenges now with a different perspective than I did few weeks ago. As they usually say: “what doesn’t kill you makes stronger”; this experience is surely making me a stronger and competent global health worker!