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UK educators deliver pioneering critical care programme in Zambia

Delivering health care in a country like Zambia is a challenge, but a pioneering scheme involving UK nurse educators is helping improve the care available to critically ill people in the country
zambia

Delivering health care in a country like Zambia is a challenge. Nurses often work with limited resources and in conditions very different to those in the UK. But a pioneering scheme involving UK nurse educators is helping to improve the care available to critically ill people in the country.

Nurses from hospitals across the country are undergoing additional training in critical care nursing in the countrys capital Lusaka. Over 12 months, they acquire the skills and knowledge to deliver enhanced care to some of their most seriously ill patients. In many cases, they are pioneers who will return to set up a new service in a hospital that has no critical care facilities. Others will be among a small group of nurses trained to deliver this level of care in an existing unit.

Lecturers

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Delivering health care in a country like Zambia is a challenge. Nurses often work with limited resources and in conditions very different to those in the UK. But a pioneering scheme involving UK nurse educators is helping to improve the care available to critically ill people in the country. 


Major Chris Carter uses a dummy patient during a demonstration. 

Nurses from hospitals across the country are undergoing additional training in critical care nursing in the country’s capital Lusaka. Over 12 months, they acquire the skills and knowledge to deliver enhanced care to some of their most seriously ill patients. In many cases, they are pioneers who will return to set up a new service in a hospital that has no critical care facilities. Others will be among a small group of nurses trained to deliver this level of care in an existing unit. 

Lecturers at the University Teaching Hospital in Lusaka have been helped by staff from Birmingham City University’s Defence School of Healthcare Education (DSHE). Major Chris Carter, DSHE nurse educator Major Sue Viveash and the university’s head of adult nursing Kevin Crimmons have delivered teaching sessions as the students approach their final exams. 

Major Carter says: ‘These students are going to be using their skills in a very different environment when they go back to their home hospitals. There is a professional spirit and I have total admiration for them. They genuinely care and want to make a difference.’


A student addresses the class during a lesson delivered by Major Sue Viveash.

So what awaits the nurses when they go back? The case mix in such units will be varied, from road traffic accident trauma to diabetes, acidosis or severe hypertension. Nurses may also be involved in the long-distance transfer of seriously ill patients. 

Changing practice 

Nancy Mwansa will be returning to the private Malcolm Moffat Hospital in the Copperbelt province, which already has critical care beds. She will be one of five nurses there with critical care training and is keen to use her new knowledge and skills to change practice. 

‘If I know the patient’s temperature is high, I can do something. If the oxygen saturation is low, I can check the air entry and suction the patient,’ she says. 

She is aware that even five trained nurses is a small number to deliver critical care, but says the hospital is supportive and will take care of them. 


Major Chris Carter and Major Sue Viveash with students.

Precious Mwanza works in St Francis Hospital, the second largest in the eastern province of Zambia. ‘Right now preparations are being made to set up a critical care unit,’ she says. Like Ms Mwansa, she will be one of a small number of nurses trained to work on the unit. 

At the moment staff do the best they can, but sometimes this involves having to refer on to other hospitals. She sees one of the challenges as identifying which patients would benefit most from being admitted to the unit. ‘We want to use the resources in a good way,’ she adds. ‘We have acquired a lot of knowledge in the field of critical care. In the past we might not be able to do things like airway management to such a high level.’ 

Although the number of trained nurses is low, Ms Mwanza says there is support from managers and other staff. ‘It is good to have a multidisciplinary team around for consultation,’ she says.

Operating in this environment will demand resilience. There are few nurses with critical care nursing skills working in hospitals and the pressure on them may be significant. They may also be working in an environment inwhich they have to cope with infrastructure challenges, such as power cuts (most hospitals have generators which cut out if the mains supply fails) and water supply problems. 

Future challenges will include passing on some of the information and skills the nurses have acquired to other staff, thus boosting the number of nurses able to work in the units. The nurses also hope that having a proper critical unit may help their hospitals to attract other staff such as specialist doctors. 


(From left to right) Student Nancy Wansa, principal tutor Lillian Jere Sitwala and Precious Mwanza.

Lillian Jere Sitwala, principal tutor at the critical care nursing school at the University Teaching Hospital in Lusaka, says: ‘The hospitals that already have intensive care may not have proper guidelines, around admission criteria, for example, and patients are just taken to the ICU.’ 

Virtual network

The students will help to implement guidelines, she says. There are also too few beds, leading to difficult decisions about who to treat, and separate paediatric intensive care is poorly developed.

For nurses working in small units or with small numbers of trained staff, continuing to share information and experiences will be important. Part of the way they hope to do this is through a Facebook virtual network, but they are also keen to support peers in their own hospitals. 

Ms Mwanza and Ms Mwansa were grateful for the input of Major Carter and his colleagues, saying that as well as passing on knowledge, they introduced them to equipment they had only seen in books before. ‘We need more people like them,’ says Ms Sitwala.

While the facilities and resources may differ from other countries, Ms Mwanza says: ‘The principles of care will remain the same – we are just working in a different environment.’


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