We are Elrha, a force for change in the humanitarian community. The research and innovation we support equips the humanitarian community with the knowledge of what works, so people affected by crises get the right help when they need it most.
Our purpose is clear: to empower the humanitarian community to improve humanitarian response. We make this happen by supporting and championing the outcomes of robust research and proven innovations.
We empower the humanitarian community. Find out how we can support you...

Principal Investigator: Thomas F. Burke, MGH

Research snapshot

Get an overview of this research study and its findings in this research snapshot.



Five of the 7.2 billion people on earth have limited access to emergency surgery when needed and one of the primary barriers is a lack of anaesthesia services. The research set out to rigorously test the safety and effectiveness of Every Second Matters – Ketamine Humanitarian Crisis™ (ESM-Ketamine HC™) when administered by non-anaesthetists in the crisis-affected regions of Kenya that border South Sudan and Somalia. The project aimed to improve access to emergency and life-improving surgery after implementation of the ESM-Ketamine HC package in Garissa, Turkana, Mandera, and Wajir counties.

Key Findings

  • During the project period, a total of 1989 operative procedures were supported with ketamine. 425 (21.4%) cases were emergency cases, of which 236 were caesarean sections, 125 were laparotomies, and 9 were open fixations of fractures. Given that there were no deaths or disabilities attributable to ESM-Ketamine among the 1989 cases, the package safety profile is very encouraging—especially since many were true emergencies that were likely to have been lethal without surgery.
  • The patient interviews suggested that most patients had positive experiences with the ESM-Ketamine package when it was used in support of emergency and essential surgeries when no anaesthetist was available. More than 85% of surveyed patients considered their experience with ketamine positive and 95% would recommend it to a friend.


The project helped gain a clearer picture of the feasibility and safety of ESM-Ketamine in humanitarian settings. The research also demonstrated the value of ESM-Ketamine according to providers, surgeons, and facility administrators, most of whom enthusiastically support the expansion of the program throughout Kenya and to other resource-limited settings. The wide availability and low cost of ketamine helped with the financial burden of surgeries. ESM-Ketamine was found to significantly decrease waiting times, increase institution surgical capacity, and improve the reputation of facilities and perception of quality of care based on perceived outcome improvement and timely management of surgical emergencies when no anaesthetist was available.

MGH was awarded a follow-on Saving Lives at Birth (SLAB) Transition to Scale grant to expand ESM-Ketamine to 15 additional facilities across Kenya. SLAB funding will support further improving and advancing the science regarding the package quality, safety, and impact; securing the necessary political will (to include local, regional, and foreign stakeholders); and developing a sustainable, pre-service training model aimed at providers in resource-limited settings where anaesthetists are not consistently available. (https://savinglivesatbirth.net/summaries/332).

Related Resources

Peer Reviewed Health Systems & Services

Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures

Article, Peer Reviewed Maternal and Child Health, Sexual and Reproductive Health, Surgery

A ketamine package for use in emergency cesarean delivery when no anesthetist is available

Peer Reviewed Injury & Rehabilitation

Intraoperative awareness and experience with a ketamine-based anaesthesia package to support emergency and essential surgery when no anaesthetist is available


ESM-Ketamine Manual

Peer Reviewed Injury & Rehabilitation

Feasibility of a Ketamine Anesthesia Package in Support of Obstetric and Gynecologic Procedures in Kenya When No Anesthetist is Available.

Article Injury & Rehabilitation

The role of ketamine in addressing the anesthesia gap in low-resource settings

Peer Reviewed

‘Lassa Fever: The politics of an emerging disease and the scope for One Health’

Latest Updates

From the Front Lines: A Surgeon on Increasing Access to Emergency C-Sections When No Anesthetist is Available

Aug 2018

Turkana County in Kenya faces unique barriers in access to care, particularly flooding, poor roads, and the rural environment. “Often people are five to six hours from the hospital, sometimes…


Closing the ‘anesthesia gap’ in the face of unexpected challenges

May 2018

As our in-country partner, Sagam Community Hospital (SCH) is the central training hub for ESM-Ketamine providers, we sat down with Mr. Javan Imbamba, a Clinical Officer at SCH, and Mr….


Project blog

May 2018

The team reflect on their experiences to-date in this project blog. This includes a discussion with in-country partner, Sagam Community Hospital (SCH), the central training hub for ESM-Ketamine providers.

Dr. Taha Yusufali, (Chief of Surgery at Sagam Community Hospital) during an ESM-Ketamine training week. Credit: AIHT.
Future ESM-Ketamine providers complete a test during ESM-Ketamine training week.
Debora Rogo presenting the ESM-Ketamine certificate to a clinician from Turkana County, Kenya.
A trainee completes their first solo administration of ketamine during a training week.
Operating theatre during a “ketamine week”.
Mid-level providers being trained on ESM-ketamine at Sagam Community Hospital in Luanda, Kenya. Credit: AIHT.

Subscribe to our newsletters....

Elrha © 2018 - 2022 Elrha is a registered charity in England and Wales (1177110). KEEP IN TOUCH Want to stay up to date with our latest updates? Sign up to our newsletters
Elrha Please upgrade your browser

You are seeing this because you are using a browser that is not supported. The Elrha website is built using modern technology and standards. We recommend upgrading your browser with one of the following to properly view our website:

Windows Mac

Please note that this is not an exhaustive list of browsers. We also do not intend to recommend a particular manufacturer's browser over another's; only to suggest upgrading to a browser version that is compliant with current standards to give you the best and most secure browsing experience.