Multidisciplinary Team Partnerships to Improve Maternal and Neonatal Outcomes: The Kybele Experience

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IntroductionAn estimated 500,000 women die each year from pregnancy-related causes.1,2 Pregnancy-related deaths often occur because of delays in recognizing complications that require hospital-based healthcare, difficulties in transportation to medical facilities, and inefficiencies within hospital settings.3,4 Unfortunately, in resource-constrained settings these deadly delays are compounded by a paucity of trained health professionals.5,6 In addition, substantial quality gaps exist such as inadequate prenatal screening, knowledge and utilization of evidence-based treatment protocols, medication and blood product availability, prompt access to cesarean delivery, and multidisciplinary interventions, which place young mother's lives at risk.1,5,7 As a result, 7 million stillbirths and early neonatal deaths occur each year8 primarily caused by infections, birth asphyxia, and prematurity.9 More than 99% of these maternal and perinatal deaths occur in low and middle-income countries. Maternal and infant mortality are considered basic health indicators that reflect the overall adequacy of a healthcare system.10In September 2000, a Millennium Declaration was adopted by 189 nations and signed by 147 heads of state and governments during the United Nations Millennium Summit. There are 8 Millennium Development Goals targeted to be achieved by 2015 (Fig. 1) and goals 4 and 5 specifically target reductions in child and maternal mortality by two-thirds and three-quarters, respectively.11,12 In response to the Millennium Development Goals, the World Health Organization, academic institutions and non-governmental organizations are engineering partnerships with healthcare facilities around the world. This report will highlight the activities of one such organization, Kybele, Inc ( based in North Carolina, USA.Kybele, For Safe Childbirth WorldwideKybele, Inc is a 501 (c)(3) non-profit humanitarian organization dedicated to improve childbirth conditions worldwide through medical education partnerships. Multidisciplinary healthcare teams travel at the invitation of host countries to work alongside physicians, nurses, and midwives in their home environments. Local medical licenses and/or practice privileges are obtained as required. Initial site assessments are made and then evidence-based guidelines are used to develop country-specific, medical training programs with consideration of local infrastructure and culture. Programs have included the following: the safe administration of epidural, spinal, and general anesthesia; sterile technique; resuscitation of the bleeding mother; the management of pre-eclampsia; ultrasound diagnosis; laparoscopic surgery techniques; and resuscitation and postpartum care of the newborn.13–16Kybele seeks to improve maternal and child healthcare in countries which have a sufficient medical infrastructure to support and sustain progress after training. The overarching goal is to increase medical and nursing standards of healthcare countrywide, not just within isolated hospitals. Kybele faculty model compassionate healthcare and multidisciplinary teamwork, while working side by side with local colleagues within the existing infrastructure in the labor wards, operating rooms, intensive care units, and wards. This demonstrates to host practitioners that patient care can improve even when resources are limited. In addition, Kybele has spearheaded educational programs to quickly implement sustainable interventions at minimal cost. Integral to this effort, Kybele builds long-term relationships, cultural awareness, and trust with local healthcare teams. The organization also sponsors physicians and nurses from host countries to visit North American and European hospitals for 1 month observation periods of childbirth-related medical care. After the programs, Kybele faculty remain a constant resource for host countries, and improvements in healthcare are monitored.14Kybele has a dedicated and growing volunteer trainer base currently with 235 participants in just 5 years. Assessments of the ideal Kybele team member characteristics include the following: open-mindedness, good listening skills, ability to understand different work and national cultures, team oriented, flexible, and adventurous. Members also are able to engage local partners and colleagues.

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