International Nursing Education

Diane Strout (center), Chair of Physicians for Peace's Global Nurse Education Committee, making friends with nurses from Algeria, Philippines, Egypt and Libya during a recent mission to Libya International Medical University in Benghazi.

 

In honor of our 20th anniversary,we have been recognizing those whose work has contributed to the success of Physicians for Peace. It would be impossible to talk about the heroes of medical volunteer work without giving credit to the nurses who devote their time, hard work, and expertise to Physicians for Peace programs.

Nurses are a vital part of every surgery mission, but that is only the beginning of the important contributions they provide. As an organization focused on medical education, we could not do the work we do without the help of volunteer nurses. The Physicians for Peace Global Nurse Education Committee has developed curriculae for teaching a variety of medical skills in resource-poor settings. Creating these replicable programs in medical education has enabled thousands of medical professionals in the developing world to gain life-saving information which they have used to improve the quality of care in their communities. These training programs, which cover everything from midwifery skills to treatment of pediatric burns, have also allowed more volunteers to effectively teach around the world, reaching more people in need.

The Global Nurse Education Committee (GNEC), part of the Physicians for Peace Medical Operations Committee (MOC), is comprised of nurses practicing in a variety of fields, representing hospitals, universities, and medical schools throughout Virginia. But its members are not only concerned with training and academia. They are the ones on the ground in the developing world, working side by side with their in-country counterparts caring for patients, delivering medical supplies and medicines, and helping to establish self-sustaining clinics and treatment centers around the world. These ambassadors of international health education also exchange cultural awareness and develop valuable friendships. 

Their on-going work is invaluable to the mission of Physicians for Peace, and we honor them as our heroes! 

Here is the lastest news from Robin Jones, a Registered Nurse and Women's Health Care Nurse Practioner, who is currently leading a team of Physicians for Peace volunteers on a mission to Zaria, Nigeria, to assist with work being done there as part of the United Nations Millennium Village Project. The core mission of the project is to help underserved regions of sub-Saharan Africa reach the Millennium Development Goals for ending poverty and improving maternal and child health by 2015. Physicians for Peace volunteers are working with local clinics to assist in midwifery education. This is an exciting look at the work being done daily to improve health care for women and children in this region...

Thursday, Oct 15, 2009

Greetings from Pampaida!

Wow! What a week! Monday, a woman came to the office in Zairia. She was introduced to me as a Midwife/Lecturer at the local Training Hospital. Dr. Woje asked that we meet and have open discussions and perhaps I could lecture with the students one day. We traveled over to the teaching hospital, where I was introduced to the Director of Midwifery and the Principal (Dean of Nursing Education). A meeting with the Faculty has been arranged for Friday (tomorrow) morning. I have also requested to spend a day following a midwife. I have drafted a list of questions for discussion. Also, I will ask their help in developing a Safe Childbirth Checklist.

Monday afternoon, in the middle of a rain storm, we headed out to Pampaida Village. There were 17 of us crammed in a small van, plus supplies. I did wear my seatbelt (ALWAYS!) The driving is a bit crazy. They use the horn all the time.

I settled in my room. I have a bed net here. No mosquito buzz attacks in the middle of the night. Banke, one of the nurses, has the other room on the women’s side of the quarters. She also does the cooking. She is an excellent cook. I have had French fries, fried yams, fried plantain, beef stew, spaghetti, rice, beans, greens, and melon and custard. My stomach hasn’t adjusted to the greens just yet. A sauce is made from sun-dried tomatoes and red peppers. It is put on rice, meat, vegetables and spaghetti. I am really enjoying the food. This morning for breakfast I have spaghetti with sardines and hash brown plantain. I was finally able to convince Banke to let me wash dishes. I told her the cook should rest after the meal and allow the ones she served, to serve her.

In clinic at MV1, Maru-a village Health Worker, has learned to do tummy checks. She measures the uterine height and also assesses how the baby is positioned so we know where to listen for the heart beat. She learned very quickly. Next week, I will work with Banke.  The Doppler is a hit with Dr. Oje. He works with the Doppler and I follow with the fetoscope to perfect my newly learned skill.  We have discussed the need to maintain the fetoscope skill as it is not dependant on batteries, nor does it have components that can break. The problems with technology...

In the late afternoons, Banke and I have been strolling through the village. The small children- toddlers are still frightened of the white skinned woman! The rest of the children flock around as they love having pictures snapped. I have to be careful - sometimes there is shoving to get attention and the littler one are pushed to the ground. I took pictures of the settlement-cooking, bedrooms, shops,etc. I have finally learned what millet is. It is a grain that grows on a stalk that looks similar to bamboo.  The grain grows on the top, similar to the tops of the corn stalk. When it is harvested, they beat the stalk to remove and collect the grain.

Today, we had our first training session. We discussed the reproductive system, fertilization and fetal development and prenatal care before the computer died. I have 4 students, one of which is a male. Lots of great questions were asked. We will continue on Monday.

I have enjoyed sleeping with a mosquito net. When I arrived back in Zairia, I was told they are going to put one up here also.  Not sure if it was the open spaces of the village or the net,but I certainly slept well there.

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Monday

Oct. 19, 2009

As another week begins, we will be heading out to Pampaida in the next hour. I will do another lecture today.  We will wrap up prenantal care-maybe even a quiz. Then we will go over the components of labor. Tomorrow, I will be working with Banke in the clinical setting-doing ‘tummy checks’.

This weekend was much better than last weekend. I spoke with Jeff on Friday via Skype, so the feelings of homesickness weren’t so bad.  Saturday, I did some laundry. Boy, did I take my washer and dryer for granted!  I used a bucket and a large bowl to wash the clothes.  I ran out of bottled water so I boiled the municipal water (when it was on). Even after 20 minutes of boiling there was still a dirty looking sediment. I only used it for cooking. I couldn’t bring myself to drink it.

I read 2 books this weekend and did some knitting.  My exercise routine is up to 20 laps around the compound, 30 toe touches, 50 sit-ups and 50 leg lifts a day.

Yesterday, Dr Woje and his family came by to take me to church.  The message was on willingly doing God’s work. Another timely message. The Sunday school lesson was on daily Bible reading and study.  Mrs. Woje (Hannah) was very disturbed that I only brought my little New Testament. She has lent me a Parallel Bible and also given me a Study Booklet.  She has invited me to go to a Revival Convocation in Kaduna the last weekend of the month. She is going to be the boost I need to become more disciplined in reading/studying the Bible!  After church, I was invited to have lunch with the family at their home.  I helped cut up cabbage for cole slaw.  The meal was wonderful-rice with the spicy red sauce, curry, fried plantain, cole slaw (not quite like ours) and paw-paw. It was my first time trying paw-paw.  It is almost like a cross between the mango fruit, papya and cantaloupe. Very good!  Dr Woje extended an invitation that I stay in their guest wing on the weekends. I thanked him, but declined.

His wife has a water filtering business next door to the house.  They take the municipal water and filter it through sand and ultraviolet filtration, then bag it in small bags. People bite a hole in the corner of the bag and can enjoy clean water. Quite impressive!  He dropped off about 50 bags last evening.  I will take about half out to the village with me.

I transferred another 180 pictures from my camera. Maybe Friday, the IT guys can show me how to attach/send them. Or I can figure out Flickr. 

Signing off until Thursday afternoon when I return to the city.

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Friday, Oct 23,2009

Greetings from Nigeria!

 

This was a very busy week. I taught Monday and Thursday. We covered labor and delivery and complications. They have grasped previous concepts well. I continually quiz them on things we have already covered. Prenatal clinic days  are Tuesday and Wednesday. The male student, Tajudeen, did  "tummy checks" with me on Tuesday. He did a very good job.  He also taught the  pregnant women about condom use. I know...too late to prevent pregnancy, but they are encouraging condom use to cut down on the HIV incidence. He always asks the most questions during class.

 

We had a little girl that the doctor thinks might have sickle cell disease. She was dehydrated, febrile and didn't make a sound when they put the IV in. By late afternoon, she had perked up and was eating without vomiting. They will send blood for Hgb electrophoresis.

  

On Wed, at the other clinic, we saw 52 pregnant women! The nurse was gone to a conference so the doctor and I were busy. We took Maru, another nurse, with us. One woman said she was 4 months pregnant, but we couldn't feel anything on palpation. Did a pregnancy test which was a very faint positive. So we will see her back in 4 weeks. Either she is newly pregnant or had a blighted ovum. Another thought she was 6 to 7 months but had no uterine enlargement above the umbilicus. There was a lot below-either twins- I heard heart tones in the right and left quadrants or the baby was transverse. We referred her for an ultrasound.

  

After clinic, I showed Maru and Tajudeen how to clean up - wash the exam table, doppler, tape measure and scale with alcohol. They are using hand sanitizer between each patient. I have enough to last a couple of months. We had an assistant clean cobwebs, wasp nests and mouse and lizard droppings from the exam room in Saulawa. I wanted to do it, but the doctor vetoed the idea. The clinic is scheduled for a renovation, but we need to have it as clean as we can for the sake of the patients.

   

I have been doing a lot of walking - through the village or just down the road. It feels good to move. I have watched the men play football a few times. (soccer) They sure are good at heading the ball and also lots of fancy footwork - even barefoot or in flip-flops. There is certainly that sense of competitiveness. I guess that is a universal trait among males!!!

  

Banke, my housemate in the village, is coming by to take me to the market today. I want to get some material and have an outfit or two made. It will be my first trip out. I need that. The weekends are the worst as far as homesickness goes. Today is the halfway mark. Part of me wants to leave today and the other part knows there is still much to do. 

    

We have 9 women at term at Saulawa clinic so I am hoping we are around for a couple so the nurses who haven't done deliveries get some experience before I leave. The goal is to have the women come to the clinics to deliver. I warned the doctor that change takes time. If the nurses can train the TBAs (Traditional birth attendants) in warning signs and when transfer to the clinic or hospital is appropriate, they may be more successful with their goals.

  

I showed my Breech delivery/Shoulder dystocia video yesterday. Dr Woje informed the staff that I would leave the video so they can review it whenever they want. Guess I will get another when I get home! I have been able to utilize my teaching powerpoints from school. Most of the time my computer battery lets me get through the lecture.

  

Banke has asked me to let her take notes from the powerpoints in the evening when we have generator power.  I will probably download my powerpoints on Dr Woje's computer or a flash drive if he has one. Also, he has asked me to download the soft copy of "A Book for Midwives." I told them we believe in See one, Do one, Teach one - so I expect everyone to pass on the knowledge they are obtaining.

  

I will talk with Bala today to see if he can arrange a visit with Biya Dogon before I leave. Dr Woje doesn't know the name.

 

That's about it for now. Have a great weekend!

 

Robin

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We thank Robin for her excellent reports from the field, internet access permitting! If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site atwww.physiciansforpeace.org.

 

This blog comes from Diane Strout, one of our amazing volunteer nurses who is also a member of the Physicians for Peace Medical Operations Committee and Chair of our Global Nurse Education Committee. She arrived in Libya on October 3rd as part of a medical mission team whose goal is to continue the work begun by Dr. Fred Ward on his trip in July, providing training for local doctors and nurses where needed, as well as making plans for future medical education missions and programs:

Got to Benghazi last night at 9pm.  Met with director of one of the hospitals and the director of the medical school until 11pm...

 

This morning we met with directors from 2 hospitals at the medical school - Libyan International Medical School - LIMU, toured the medical school and got an overview of the health system here - although I must admit there are still large gaps in my knowledge.  In the afternoon,  one group went to the pediatric hospital, one group to the Jamhouriya (Republic) hospital.  We are warmly welcomed.  The nursing leadership speak some English so we are able to work together without translators.  Plans are made for rounds, case presentations and lectures for the following day.

 

Will be making daily rounds at the pediatric hospital - challenging cases - presentations from 10:30pm - 2pm at the peds hosp as well. The nursing situation is  very poor - I will be going  back to the peds hospital tomorrow to make rounds and gather additional information

 

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Greetings!  All is going well! Our group met with the director of the public medical school today, and I have meetings set with the faculty and leadership of the public university nursing schol tomorrow.  The team has continued  to offer education at LIMU - the private medical school -- and the pediatric hospital.  

 

I will be meeting with nursing leadership at the peds hospital tomorrow to plan our next steps to support the implementation and exection of some basic programs - infection control, process improvement activities and orientation/ nursing internships.  There is an Egyptian nurse charged with this work (she is master's prepared, very rare level of education in Libya) who has asked for support -  she has only been in the country for a month or two.  I hope to be able to connect her with resources at the university as well.  We'll see how it goes.  Everyone acknolwedges the nursing crisis - in one unit there were 2 nurses for 52 patients.  In addition, the nurses that are working function at a very basic level.    

 

We will be leaving Benghazi on Wed afternoon for Tobruk. There are 2 hospitals where we will consult on Thursday. 

 

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Good morning!

 

We had another productive day yesterday - physicians working at 3 different hospitals. I worked with the nursng leadership at the peds hospital and the two nursing schools.  In the afternoon, Dr Ward led our wind-up meeting with LIMU (the private medical school) and then Dr. Dow  conducted a telemedicine conference. Approx 30 physicians were in attendance and 3 cases were reviewed with specialists at VCU/MCV.  It went very well.  In addition, a surgeon from El Jala University hospital, Abdel Karlm Kbaili, will be coming to the States for the American College of Surgeons meeting.  HD put him in contact with a VCU surgeon who will be attending the meeting as well - great networking and support.   Half the team drove to Tobruk last night and the other half is in al Bayda - last day to visit hospitals.

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During the week, Fred Ward was teaching at the medical university, Chris and Joann did case studies and rounds at the Peds hospital, Renee and HD went to the trauma hospital and provided consultations. I was at the Jamahiriya Hospital. They deliver 23,000 babies each year - the hospital is incredibly overcrowded. I see two patients in one bed, babies sharing bassinets. New moms stay in the hospital on average 6 hours after delivery.

 

Lots of work to be done here. This has been a fantastic trip!
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We look forward to hearing more about the progress our volunteers are making to improve medical education in Libya and address the shortage of nurses there. To find out more about our volunteer medical missions and support our efforts in international nursing education, visit our web site at www.physiciansforpeace.org