The Kendeya Community Health Partnership: Connecting a metropolis and the Sahel

1. The Kendeya Community Health
Partnership
Connecting the Metropolis and the Sahel:
Communities, the Public Health Sector, and Students

2. The Kendeya Community
Health Partnership
Overview:
• Student-driven non-profit organization
• Formed in 2006: facilitates collaboration between
the Senegalese Ministry of Health, communities in
Saraya district, and US students
• Works with the district health team to identify key
health needs and develop interventions:
• Examples:
– Implementation of an effective adverse-effect
monitoring system for anti-malaria therapy
– Development of maternal mortality reduction projects

3. Introduction:
Global Health Partnerships
One side. . .
• A surge in interest among health professional students in
global health
• Academic engagement with global health: from curriculum
content to research support
• Value of direct experience and immersion for students.
The other side . . .
• Specific community public health needs
• Technical assistance and research-based advocacy
• Up for debate: In a setting of limited health resources,
what is available for education of “outsiders”?

4. Where We Work: NYC
Mount Sinai Medical Center
• Serves Upper East Side and East Harlem.
• Works closely with underserved through
Department of Community and Preventive Medicine
(est. 1967).
• School values stress ethical and socially
responsible practice
• Student engagement in community and volunteer
work
• Mount Sinai Global Health Center :
– Global health opportunities for medical students, residents,
faculty
– Long-term partnerships for sustainability and higher impact
• High level of interest in global health among

5. Where We Work: Southeastern Senegal
• Under-five mortality: 254 deaths per 1,000 live births
• Maternal mortality: 826 per 100,000 (~1 in 19 women)
• Life expectancy: 48 years (female), 45 (male)
• Malaria is largest cause of mortality and morbidity
Saraya
Source: Google maps
Sources: Pison 2005; Guyavarch 2007.

6. District of Saraya:
Barriers to Access
District health post nurse packing a
month’s supply of medication on the
back of his dirt bike
Villages are located up to 90 km from nearest
health facility; laterite roads are in disrepair
• Population of 35,000
•1 government doctor, 3 nurses, 1 midwife
•1 health center Villages up to 90 Km on laterite roads from
closest health facility

7. The Kendeya Health Partnership:
Reinforcing the work of communities and the
government health service
• Activities:
- Primary health care
- Nutrition
- Evacuation for emergency
obstetric care
- Health communication and
promoting women’s
education
- Malaria
(RTDs/ACTs/ITNs)
- Outreach: screening
through a mobile clinic
Community birth attendants during a training session
- Family planning: increasing access to contraceptives
- HIV: increasing voluntary testing
- Maternal mortality reduction: training of community birth attendants

8. Current Interventions: Adverse effects
monitoring of anti-malarials
• New drugs introduced in 2006 in
response to chloroquine
resistance:
1. Artemisinin-based combination
therapy (ACT)
2. Intermittent preventive treatment of
malaria (IPT): Sulfadoxine-
Pyrimethamine (SP).
• Priorities:
- Monitor safety of ACTs and SP
• Health staff and CHWs were
trained to recognize and report
adverse effects from the drugs.
• 24 total cases of adverse effects
were identified and treated in
2008.
A falciparum rapid diagnostic test being administered at the
Saraya District Health Center

9. Working toward reduction
of maternal mortality
• Maternal mortality in Saraya:
- Maternal mortality: 826/100,000
- Births attended by trained health
practitioner: <13%
- Total Fertility Rate: 6.2
•Our Work
• Mobile clinic: Perinatal care.
• IPT of pregnant women with SP
• Training birth attendants in safer
birth practices and triage.
• Promoting secondary education
of girls through scholarships.
Community birth attendants at a training
in Saraya

10. Student Practicum Program
• Students of medicine, public health, and sustainable development
have the opportunity to do a practicum program
• Participate in long-term relationships and research to inform future
interventions and priorities for the health district
NMSA Scholars at KCHP in Summer 2007

11. How can we do better?
• Suggestions?
• We are looking for partners, particularly in
improving emergency obstetric services:
– Ultrasound equipment; obstetric equipment;
training; visiting OB/GYNs…
• Contact information:
– Demetri Blanas: dab2108@gmail.com
– Dr Youssoupha Ndiaye: youndiaye@hotmail.com

12. Thank You
Saraya Community Birth Attendants During a District Training
•Local Communities
•The Saraya District
Health Team
•The Senegalese Ministry
of Health
•UNICEF
•ASBEF
•Enda Santé
•The Hesperian
Foundation

13. Works Cited
• AbouZahr C, Wardlaw, T., Hill, K., Choi, Y., Mathers, C., Shibuya, K., Lwin, N.. Maternal Mortality in 2000:
estimates eveloped by WHO, UNICEF, and UNFPA. 2004.
• Collumbien M, Gerressu M, Cleland J, Non-use and use of effective methods of contraception. In: Ezzati
M, Lopez AD, Rodgers A, Murray CJL. Comparative quantification of health risks: global and regional
burden of disease attributable to selected major risk factors, vol 2. Geneva, World Health Organization,
2004.
• Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, and Gardner P. Global Health in Medical
Education: A Call for More Training and Opportunities. Academic Medicine. 2007. 82(3):226-230.
• Family Health International. Maternal Mortality and Morbidity <
http://www.fhi.org/en/Topics/maternalmort.htm>. Accessed 2008 March 12, 2008. FHI, 2008.
• Hunt P. Special Report on the Right to the Highest Attainable Standard of Health. United Nations. October
19, 2006.
• Kanter, SL. Global Health is More Important in a Smaller World. Academic Medicine. 2008. 83(2):115-116.
• Kodio B, Bernis, L., et al. Levels and Causes of Maternal Mortality in Senegal. Tropical Medicine
International Health. 2002;7(6):499-505.
• Luthra R. Safe Motherhood: A Matter of Human Rights and Social Justice. UN Chronicle Online Edition.
2007.
• Maine D, Yamin, A. Maternal Mortality as a Human Rights Issue: Measuring Compliance With International
Treaty Obligation. Human Rights Quarterly. 1999;21:563-607.
• Marston C, Cleland JC. Do unintended pregnancies carried to term lead to adverse outcomes for mother
and child? An assessment in five developing countries. Population Studies. 2003, 57:77–93.
• Pison G, Guyavarch, Emmanuelle, Sokhna, Cheikh. Bandafassi DSS. Senegal. Population and Health in
Developing Countries. International Development Research Center. 2005.
• Starrs AM. Safe Motherhood Initiative: 20 Years and Counting. The Lancet. 2006. 368:1130-2.
• Serrano AMT and Jensen J. The New Route to Safer Childbirth in Rural Senegal. UNFPA New Feature.
2004.
• Women's Human Rights Programme. Susan B. Bora Laskin Law Library. 2008.
• World Health Organization. The World Health Report 2005 - A safer future: global public health security in
the 21st century. Geneva: WHO, 2005.