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Principal Investigator: Thomas F. Burke, MGH


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.


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.

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.

Key outputs

  • Four peer reviewed articles, one editorial and one commentary have been published
  • Two further peer reviewed articles are planned
  • Every Second Matters for Emergency and Essential Surgery – Ketamine. Course Manual has been published.
  • Dissemination of findings at a number of conferences including: Consortium of Universities for Global Health, Global Health & Innovation Conference, American Public Health Association, Women Deliver, Siaya County Annual Health & Research Conference, American College of Emergency Physicians Scientific Assembly, World Congress of Gynaecology and Obstetrics (FIGO), African Conference of Emergency Medicine, COSECSA AGM & Scientific Conference.
  • Stakeholder dissemination events in Garissa and Turkana Counties, Kenya

Next steps

MGH has been 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. (

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….


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

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

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