Loading

How nursing can change the world through global partnership and education

A new University of Edinburgh partnership is supporting nurses and midwives in low- and middle-income countries to step up and take on global health challenges. We talked to some of the people involved.

Rita Derick, 28, is pregnant for the seventh time. As an expectant mother in rural Liberia her prospects for having a safe and healthy labour are grim. She knows this too well. She’s already lost four unborn babies during pregnancy.

The west-African nation of Liberia has much in common with Scotland: a population of around five million spread across many remote and rural regions that can be difficult to reach. However, as one of the world’s poorest countries, afflicted by conflict and an Ebola outbreak, Liberia has a fragile healthcare system. This situation means drugs, equipment and other vital resources are scarce to non-existent.

Five thousand miles from Scotland, a pregnant woman or, in many cases, an adolescent girl based in rural Liberia will not only struggle to get to a hospital to deliver her baby but is unlikely to access specialist obstetrics care even if she gets there. There are very few doctors in Liberia due to a “brain drain” to wealthier countries. Those doctors who do stay tend to practise in private hospitals in the capital, leaving the government-run public hospitals, where the poorest people go, inadequately staffed.

When doctors are scarce, nurses are even more vital. Empowering nurses to do more is one of the aims of the University‘s Edinburgh Global Nursing Initiative (EGNI). Building on the University’s leadership in nursing research and teaching, this initiative seeks to support local and charity partners in the countries where the need is the greatest.

“The programme is about championing the role of nurses at the heart of communities. If nurses are educated, enabled, and empowered they can make a huge difference and save lives.”

Among these partners is Scottish-based charity Maternal and Childhealth Advocacy International (MCAI)*, which is directly addressing the skills shortage in Liberia by providing clinical obstetrics training to nurses and midwives working in the community. This approach is called task-sharing, which simply put means redistributing duties usually reserved for higher-qualified medical professionals to those who are more likely to be performing the day-to-day care. Nurses and midwives who can provide holistic care and can expand their scope of practice through advances education and training. The benefits can be far-reaching.

Left to right: Naomi performing a C-section; Emmanuel doing obstetrics outreach; Hannah undergoing training

“Task-sharing enables staff to have the skills to save the lives of mothers and babies when things go wrong,” says Dr Rhona MacDonald, MCAI’s Honorary Executive Director and Chair of the Trustees. “Our three-year advanced obstetrics programme trains midwives in advanced obstetrics care, including abdominal surgery for C-Sections and we also run a two-year programme for nurses in advanced neonatal care, which means when that girl goes into hospital to have her baby, she knows she is going to get the healthcare she needs if she has any complications.”

A cohort of nine midwives has just been funded by the Burdett Trust and the University of Edinburgh, as part of EGNI’s IGNITE programme. Once they complete their training, they will return to their own rural county to work at the county hospital. The training is appropriately licensed and regulated, a step that is especially needed to counter scepticism from a community of doctors that may already be uneasy about relinquishing control to nurses.

“The programme is about championing the role of nurses at the heart of communities. If nurses are educated, enabled, and empowered they can make a huge difference and save lives,” says Dr MacDonald.

However, for women like Rita Derick, expanding the scope of nurses’ and midwives’ practice isn’t the only solution to preventing more tragedy. While there are more midwives than doctors in Liberia, there still aren’t enough of them. The West-African nation has approximately one midwife per 10,000 people.

“We get lost in the numbers but each of these women and babies are individuals. These women often don’t have any access to ante-natal care. Many have experienced the loss of a baby. They’re frightened. And we’re trying to save lives one-by-one.”

Dr MacDonald and the MCAI team have taken task-sharing further by empowering pregnant women to monitor the heartrate of their unborn babies using simple Sonicaid devices.

“So many baby deaths could have been prevented if the unborn babies had been monitored during labour but because of the low number of midwives it’s usually impossible for midwives to attend each woman in labour. Again, it’s about educating, empowering and enabling,” says Dr MacDonald.

“We were told it couldn’t be done as there is a 60% illiteracy rate among women in Liberia. But we trained women to listen to their own unborn baby’s heart rate using a simple Sonicaid, like the sort you can buy from Amazon, and shared with them what a normal heart rate sounds like, and what would be considered fast or slow.

“Can mothers do it? Yes. And most found it rewarding and empowering. In 26 cases heart-rate changes were detected and in all 26 of these cases all the babies survived because the right interventions could happen at the right time. But the whole emergency system is important. If mothers can detect changes they need to know that the staff will be available to support them and that there will be the supplies and facilities to appropriately manage them.”

MCAI's fetal heart monitoring programme helped the midwifery team respond promptly to save Baby Derick.

These skills helped Rita Derick save her baby’s life. When she went into labour, she was able to detect that her baby’s heart rate had slowed down and raised the alarm promptly. The nursing and midwifery team, which had benefited from MCAI’s advanced obstetrics and neonatal training responded, delivered Rita’s baby girl via C-Section and resuscitated the new-born who arrived into the world struggling for breath. Things are currently looking good for Rita’s daughter: she has been admitted to the neo-natal unit and is receiving the round-the-clock care needed to help her thrive. The outcome could have been very different if Rita hadn’t known how to monitor her daughter’s heart rate.

“We get lost in the numbers but each of these women and babies are individuals. These women often don’t have any access to ante-natal care. Many have experienced the loss of a baby. They’re frightened. And we’re trying to save lives one-by-one,” says Dr MacDonald.

MCAI’s task-sharing work in Liberia is one of three projects supported by the IGNITE programme and the Burdett Trust.

“The IGNITE programme provides an opportunity to strengthen approaches to support pioneering nursing and midwifery clinical practice, directly impacting on patient and population outcomes, and accelerating progress towards the World Health Organization’s Sustainable Development Goals,” says Shirley Baines, Chief Executive of the Burdett Trust.

“As a nurse I know personally the privilege and joy it brings, however not everyone across the globe has access to healthcare, often meaning the difference between life and death, joy or pain. It’s not acceptable for us as human beings to sit back and do nothing."

As well as working with MCAI on maternal and neo-natal health, the IGNITE programme is also supporting the provision of specialist training for nurses who are treating and caring for women who have experienced complex sexual trauma in war in the Democratic Republic of Congo. Among the hospitals featured in the project is the Panzi Hospital, founded by Nobel Prize winner Dr Denis Mukwege to treat survivors of war-related violence.

In Uganda, IGNITE will support work between the University of Edinburgh, The Ugandan Ministry of Health and the Uganda Chief Nurse to train nurses in the clinical skills to deliver quality palliative care to reduce suffering experienced by those at the end of their life.

IGNITE is just one example of how the Edinburgh Global Nursing Initiative is creating partnerships to drive change and address global health challenges drawing from academic expertise from the University’s Nursing Studies and Global Health Academy teams.

“As a nurse I know personally the privilege and joy it brings, however not everyone across the globe has access to healthcare, often meaning the difference between life and death, joy or pain. It’s not acceptable for us as human beings to sit back and do nothing. The Edinburgh Global Nursing Initiative through partnerships with people and organisations who share the same values and vision, are doing something to make a difference” said Professor Aisha Holloway, Head of Nursing Studies at the University of Edinburgh.

The root of the Edinburgh Global Nursing Initiative, Aisha says, is to develop projects that invest in nurses and midwives and build meaningful partnerships to grow in-country capacity that is sustainable, scalable and able to address the needs of patients and people who use care services. To create a lifeline, to show we care.

“It will help propel nurses and midwives as drivers of change and to help them actively contribute and lead in making a better world for all. We are proud to be part of the global push to promote the role and sphere of frontline healthcare worker. However we cannot do this on our own, we can only do this through partnerships, support and collaboration.”

*As well as the University of Edinburgh, MCAI works with the Liberian Ministry of Health, WHO, UNICEF, the United Nations Population Fund and the Liberian Board for Nursing and Midwifery to deliver its maternal health and neonatal programme.

Banner image: Dominic Chavez/World Bank