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Field Report: Nancy Douglas on becoming a new PRONTO Trainer in Kenya

Nancy Douglas, one of PRONTO’s newest volunteer Trainers, recently returned from Kenya and shares her insights and experiences leading PRONTO trainings for the first time with us on the blog:


This was my first trip with PRONTO and I can already say I definitely hope it is not my last. The more I learn about PRONTO, the more I have respect and admiration for it, as well as being honored that I am involved. PRONTO teaches OB and neonatal emergency procedures in low-resource settings in hopes of improving maternal and infant outcomes. Dr. Dilys Walker and her team have already been doing this for some time in Mexico and Central America with success, and now they are bringing this program to the continent of Africa.

My background is a long time (coming up on 30 years) as a Labor and Delivery/Maternal Child RN almost all in high-risk settings. I have always loved what I do and this was an incredible opportunity to go experience and teach Maternal Child nursing and medicine in a developing country setting.

I would like to share my thoughts and perspective on this trip… and to also share a typical day on the road. We went to Kenyatta Hospital which is Kenya’s biggest public hospital in the country. For those of you who know Seattle, it is what Harborview is to the state of Washington. I know the team was a bit nervous about how I would react to such a different hospital setting, but they did a good job of preparing me with their videos from Central America. Kenyatta is definitely not a western hospital. I did witness laboring women sharing beds, three babies in one incubator, and a labor and delivery ward with 45-50 women laboring with only one bathroom available to them. That said, the people there were wonderful and are working very hard to get things right and maximizing everything they do have. They are a group of fantastic and very knowledgeable nurses and doctors that I grew to have immense respect for; Doreen, Saluma, Mickie, Wycliffe: all of you ROCK!


My first day started out with making blood…a very important skill to develop as we use a lot of fake blood for the scenarios. We arrived at Kenyatta Hospital to discover that the chairs for the event had not arrived and there was some sort of hitch with getting them…so we had to scramble and we did find some…but we had to carry about 25 chair desks through the wards of Kenyatta! Very interesting and I hope we did not disturb the patients too much.

Throughout the day there are combinations of activities, scenarios and then debriefing the scenarios. There is not a lot of traditional lecturing in this program and frankly I think most people would say at the end it was fun and A LOT of learning occurred. One of the hallmarks I see with PRONTO is learning in a very life like scenario. This is an excellent teaching tool.  Also, there is a big emphasis on team and group dynamics and how everyone communicates and works together in an emergent situation.  A philosophy that I think really works.


The scenarios take place using one of the students who wears the PartoPants for the simulation. We tried, and I think succeeded, at creating a labor/delivery room just like the one at Kenyatta, with the same medications and equipment they use there. One of my main jobs was to set-up and tear down the scenarios and I became knowledgeable about how the PartoPants work.

The days are long, starting at breakfast where the team usually has a little check in (7ish) the program goes from 8:15 (sharp) to 5:30 PM and then the team does a debrief and then goes to dinner. Dinner was often at 8 or 9 in the evening. I would say 12-hour plus days for me and Julia and Dilys were frequent, often doing 14-16 hours with added meetings and etc. By the way they are both GREAT to travel with, both very lovely and gracious as well as very interesting.

IMG_9021If I had to advise anybody out there thinking about becoming a PRONTO trainer, the one quality that is very essential is flexibility. Things change and the unexpected happens all the time and if you have a personality that can, “go with the flow” you are perfect. If constant surprises in unusual circumstances is something that bothers you, then you will probably not be a good fit. Also, cultural sensitivity is another important quality and I mean this very seriously. Most of us consider ourselves culturally sensitive, but there is a whole new layer when going into a low-resource setting. One has to respect their condition and be sensitive to sharing a lot about how “great” the USA’s system is, or even all the great equipment we have or whatever. We do have luxuries beyond what they can imagine, but the real truth is that as people we are just the same and I found their knowledge as medical professionals exemplary and their ability to apply it in challenging circumstances worthy of my greatest respect.

Another interesting side story is that the elections are occurring in Kenya. The day I arrived, the primary had just finished and the final election is coming up in March. After the last election there was a lot of unrest (5ish years ago) and over one thousand people died. Because of this, most foreigners become very cautious around the elections. However, it turns out that the hotel we were booked at was the sometime election headquarters for the TNA party. One evening, Julia and I returned from an outing to find a huge political rally in front of the hotel! It was big enough that we could not even get to the front door. Nothing happened and there was no violence, but it was a little anxiety producing just because of the past history.  This is a good example of how one need to be flexible and calm in unusual circumstances.

After the program I got to spend another week in Kenya and go Safari. Absolutely one of the greatest times of my life! The wildlife and scenery are just exactly like the Discovery channel…only better!

I love working with PRONTO!

-Nancy Douglas

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