Global Links: Working Together to Improve Child Health Across Africa
So the five countries that we work with in East and West Africa all come pretty low down on the index of infant mortality and paediatric mortality and so on. And Sierra Leone is probably the country where we work that has the worst statistics. So the relationship I have with the management at Ola During School has developed over the past couple of years. I think what’s really important and what we did quite successfully at the beginning is to set our expectations of each other, where we put together a bit of a memorandum of understanding which we then have been able to refer back to if there’s been any, issues or blockages or whatever. So that work we did at the beginning I think was really really helpful and that has helped us to build a consistent relationship with them. The whole hospital is almost 200 bed hospital, and we have nine wards in this hospital, which means at least we need nine doctors But, you are not going to believe this we have only two doctors in this hospital. All the others are house officers, I mean apprentices, people who are still learning and they have not got their licence. So even having somebody, just one person from outside, from Global Link or anywhere, it boosts a lot.
So the sort of things that myself and the other volunteers are doing is I think primarily joining in with the local workforce, and I think that’s very supportive just in its own right, that people realise that they’re not on their own, they know that people around the world are interested and care. The thing that Global Links refers to one of the things they encouraged us to do was when we arrived was to gather the lay of the land, try and see where we thought we could see improvements and then, discuss with local staff whether they thought that was a good idea and get their thoughts. And then once you’ve done those two things to try and bring something together let’s say ‘do we agree this is how we move forward’ or ‘do we agree this is what you want to be taught on’. You’re prepared for varying and different levels of motivation compared to what you’re used to in the UK, and I think its only something like 10% of the nurses here who are paid it must be incredibly difficult to motivate yourself to get going for a night shift when you’re doing that. The doctors have all been great so I’ve been working with one doctor in particular in CPU (Child Protection Unit) and she’s been really helpful in teaching me bits of Creole here and there, the local language, as have the nursing staff actually they’ve been very encouraging to do that too, and with their help in translation they’ll explain things if I’m trying to kind of scratch my head and work out why that’s happening. So yeah, in general they’ve been very supportive, very welcoming, and you’ve never felt excluded as an outsider coming in. One of the problems in Sierra Leone is that no doctors can get specialist training here. So they have to go overseas, and certainly in Sierra Leone, a lot during and then with some of the other partners like WellBody Partnership they’ve been working for three or four years to get accreditation from the West African College of Physicians, to train paediatricians in Sierra Leone.
So, just recently there’s been inspections and the West African College has given accreditation to Ola During to train the next generation of paediatricians. And Global Links have contributed to that because they have been able to put consultants like me and residents into the system, that are actually requirements to get accreditation I think the skills that we probably bring are things to do with team functioning, team behaviour, looking at the way things are organised and looking at efficiency. I think a really good example would be in a sense in a really organic way over four or five months on the intensive care unit a new way of learning which eventually acquired the name ‘Speed Learning’ developed. So with the Staff Nurse and some of her team, there were always questions coming up on the ward round. So, we’d identify the question, have fifteen minutes of process and then at the end summarise to everybody what they had found useful and interesting and what they were going to change having had the fifteen minute session. To take the whole nursing team away for an hour is very disruptive to the management of the ward and the actual care of the children. But taking fifteen minutes a day and just sitting at Sister’s desk still in the view of the parents seemed a very elegant situation and actually, not only have we delivered individual bits of knowledge and skills but actually in the process Staff Nurses has become very empowered that she was a major driver of this and then her nurses around her have seen that actually they influenced this Then there’s demands form the rest of the hospital ‘why don’t we have Speed Learning’. So, I think that small example is a quite nice illustration of how just a small initiative allowing a local contribution, allowing the local environment to influence what happens actually pulls people in.
So, it wasn’t something that was done to them, it was something that people really took the major lead on. The nurses are really benefitting from them because from what I see when I am doing my rounds in the morning, you know, I see the doctors doing their rounds together with the nurses and whatever they do they explain to them, and then they allow them to ask questions. They are doing this in a developing country. So much of what has been learnt or what has been taught at the faculty of nursing is not what we are really seeing out here, because we do not have all the things. But with the help of the volunteers they are doing a remarkable something here in the hospital. Training isn’t just about giving people new knowledge and new skills but actually I feel one of the unrecognised things is that it actually shows people it’s a reward.
So one of the things that external people like Global Links funded by THET can do, is actually bring that in, and actually send the message to nurses or nursing aids that what you’re doing is valuable and it is important to invest in you and invest in your training. Before departing overseas, we gather all of the UK paediatricians at the college to do a two-week training programme, and we also invite the doctors from Africa to come during this time so that they do a two-week training programme together which is really helpful in terms of being able to draw on each other experiences and learn from each other and really helps with the whole expectation management of the UK guys; they’re able to talk to the African doctors about any concerns they have. And it also helps the African doctors as well to get an idea of what it’s going to be like working in the NHS.
‘..the way we use our resources so that we sustain them’ and we also have UK paediatricians who come on placement. Global Links have started a programme, like in my country we have the ETAT (Emergency Triage Assessment and Treatment) project, and we also have UK paediatricians who come on placement. So they are trying to assist us, or rather support us, in improving their outcomes of sick children admitted in our hospitals through personnel support, and also by improving maybe our equipment, they buy for us a few equipments and such things and also exposing us to what happens here in the UK, to see if we can take it back and implement it somehow.
For me my main role here this week was to come and sensitize the UK doctors on ETAT implementation and what it was about. So, I hope by the end of the training they can be able to go back to the facilities they are attached to and be able to implement ETAT and not feel out of place. For our doctors who are here I hope that when they go to their various hospitals with their own attachment, hey will learn something, and come back with that knowledge home. So, the exchange visits that the African doctors do in the UK, kind of fall into two categories. So, on some occasions the doctors will come to the UK and, do a two weeks of training at the college here, on things like clinical audit, UK child protection, that kind of thing. And then follow that with a four-week clinical attachment at a hospital in the UK,really focusing on their area of interest, their sub-specialty.
And then the other type of exchange is that we recruit doctors, from so far mainly West Africa to come to the UK on a twelve-month training programme. So they join the UK trainees, they spend six months doing general paediatrics and then they spend six months doing neonatal care. And then we ask them to report back on how well they’re developing and so on. I will be in Birmingham Children’s Hospital, where I’ll be working principally in the cardiology department. Then subsequently I’ll work in the newborn unit. I’ll be starting my rotation in about two weeks-time, and I intend to spend about six months each in them, get to know what the general paediatrics is like here, then know what the cardiology specialty and probably haemato-oncology, then know what your newborn unit is like and compare that to what we do back in Nigeria. I intend to acquire the skills that are available here, and get knowledge, then share my experience with colleagues back home and see how the practices can be influenced in Nigeria for better outcomes. It’s these doctors from East and West Africa that are helping to really develop a consortium of doctors in Africa interested in international child health.
And then we can really draw on them in the future to develop future programmes. One really good thing about the Global Links programme from my perspective is the quality of the volunteers that we’ve been able to recruit. The commitment that they’ve shown has been fantastic. This kind of work is never easy, so the way that they’ve faced the challenges, the way that they’ve picked themselves up, the way that they’ve overcome their frustrations, and the relationships that they’ve built with the staff that they’re working with in the local hospitals has been fantastic And without that kind of commitment, without their levels of expertise, their clinical skills, this programme would have not had the impact that it has had so far. Success for colleagues in Sierra Leone would be that there was an internal self-sustaining confidence that nurses and doctors and midwives and others actually felt that they were the leaders, that they could control things, that they could come up with ideas and priorities and implement them. And that the workforce would be self-sustaining.
I like the idea in that the royal help hasn’t come to us and told us what to do they actually asked us ‘what do you want us to do for you?’ And the decisions made at a country level were not made at a very high place what the people of the Kenya Paediatric Association did is that they came to the facilities and asked us 'what do you want?' So it was basically a bottom-up approach, and what facilities wanted to help them improve on their healthcare outcomes. So I think, it’s quite a – it’s a great thing according to me.
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