Mary and Hannah have been helping on the paeds ward, which has given me more time to try and concentrate on things that will be more useful when we leave. I’ve been making and updating protocols, posters for the walls, and doing a small audit into the management of malnutrition, which has highlighted quite a few deviations from the national guidelines… so plenty to work on. It’s hard though as what they actually need is more trained staff! I’m hoping the malnutrition ward will be re-opened soon, which I think will make a big difference. The paeds and malnutrition wards were combined some time ago, to make space for a cholera ward during the cholera epidemic in Kambia last year. There are still occasional cholera cases, so I’m not sure where they’ll go (there’s talk of a tent…), but there are so many malnourished children that desperately need more specialized care, so I’m really pleased there is a going to be a designated ward for them. It won’t solve a lot of the problems, but might be a good opportunity to try and make a few changes and do a bit of training with newer staff.The teaching programme for the volunteers is going well – we are now running a ‘foundation module’, of very basic nursing skills, alongside the paediatric module, and hope to finish them both off before myself, Mary and Lorraine leave in July. It’s nice having 5 of us here now to share out the teaching. Alongside the teaching we all have slightly different projects going on which is really interesting. Lorraine has set up competitions between the wards – one is how many vitals (routine observations) are taken (we are pleased if they are done three times a day), and another competition on safe drug prescribing. The numbers of vitals taken and drugs correctly prescribed has massively improved, the nurses in charge of the wards have responded so well to the competition, especially when they do well! The female ward has done particularly well, and as a prize they were issued with some standing scales (to weigh the patients). They were so happy and danced around in joy when they were given them. The scales are now kept under strict surveillance in one of the nurse’s house, and bought to the ward each day, so they don’t go missing. (It’s not uncommon for things to go missing from the wards, there’s no clocks on the walls, but apparently when they are put up they go missing, lots of BP cuffs have been donated in the past, but it’s difficult to find one when you need one, the mattresses on the beds have to be signed in and out at the start and end of every shift, so that someone is responsible for them and they don’t get taken. Mad.)
Lorraine and Hannah have been creating ‘competencies’ for the VNAs, so they are observed and signed off when they can correctly take the pulse, respiratory rate, blood pressure or put up fluids or a blood transfusion. They do all these things with no formal training; some are very good but others a bit lost. Although it’s good that they are taking vitals, it’s not so good if they are just copying the respiratory rate from the previous entry, because they don’t really know what do do…but there’s definite improvements from when we arrived.
We’re hoping to go to Freetown this weekend. The matron from the National Childrens Hospital came to Kambia a few weeks ago to get some practical experience of the ward here. She was keen for Patricia (SRN from paeds ward) and myself to come to their hospital to see how things work there, and possibly pick up some protocols etc. So we’ve arranged to go there on Monday. It’ll be my first time into Freetown, which has a reputation for being a nightmare to travel through/across. Will be fun to experience it though, and we might even find some nice food and supermarkets there!
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