Emergency Medicine, Anaesthesia and Critical Care colleagues from both Bristol and Nanyuki are engaged on mutual project work to progress the provision of critical care in both regions, and better understand this provision of care for severely injured and unwell emergency patients. These projects allow both teams to reflect and learn from each other’s systems, to allow integrated care between emergency departments, critical care units and theatres. Dr Rebecca Oram is leading on the introduction of Global Critical Care and Anaesthesia fellowships within Dharura.

Dr Claire Kilbride leads a program to deliver sustainable development of skills to Nanyuki clinicians, in order to deliver structured education, mainly around the use of simulation as an educational tool. Once educators are highlighted, they are offered an intensive structure week long course in delivering simulation, and are then mentored in the delivery of this as they work to become simulation trainers themselves. Claire has worked previously for MSF developing the delivery of simulation as a development tool for both health systems, individuals and teams.

As a combined project between Dharura, Nanyuki teaching and referral hospital and the Lewa Wildlife Conservancy, we deliver a structured education program in emergency care to clinicians from rural health facilities in Kenya.

Nanyuki clinicians who have been trained to deliver educational sessions are mentored and work alongside UK clinicians to provide whole day regional education sessions of case discussion, teaching and clinical simulation/skills hosted in rural health clinic facilities. This also provides a forum for clinicians from a huge geographical area to meet and share practice, helping to develop services and clinical processes. Clinic staff members attending are then offered the opportunity to return with the Nanyuki team for a period of observation at NTRH to develop their skills and broaden their clinical exposure.

Dharura have developed a system since 2022 of remote Global Grand Rounds, where UK clinicians meet monthly with a variety of international partners to present clinical cases along with thought provoking presentations, to share different practices and learning. These are hosted by various UK organisations in Bristol, Plymouth and Truro, and by international partners. This project has been led by two previous Global EM clinical fellows, Dr Sam Zhang and Dr Nick Smith.

Team Talk is a project that uses rugby camps as a vehicle to enhance gender equality and health behaviours. Team Talk enables social and behavioural change in communities to give a better life for women and girls in Kenya.

We use the game and values of rugby to build relationships and respect between girls and boys. Team Talk recognises the vital role that women play in the long-term prosperity of local communities. Empowering teachers and village elders and using a combination of classroom sessions and rugby-based exercises and competitions, they build understanding and foster social interaction between the children, as well as using education to promote female empowerment. As the young boys develop greater respect for the girls, the lives of the girls themselves are improved through greater education and self-confidence.

Successes of team talk include:

• More girls reaching the final year of primary school

• Adaptation of cultural practices

• Shifting perceptions of the roles of girls and women in communities

Dharura have harnessed the relationships we have with front line health facilities to work with THET and the Commonwealth Pharmacists Association on a large scale project to develop antimicrobial stewardship (AMR) practices. This work includes surveys of infections and their treatment in hospital and clinic settings, while providing healthcare professional and public education around antimicrobial use and prescription. Kenyan pharmacists and clinicians are offered the opportunity for reciprocal UK visits to aid practice development. This work also encompasses “One Health” principles acknowledging the intrinsic interaction between the health of humans, livestock and the environment they collectively inhabit.