Imagine you are a midwife in sub Saharan Africa who runs a community health center with a large population. In this health center, resources are severely restricted and there is a recurrent acute shortage of qualified staff in your team. Imagine that as the midwife you have poor problem-solving skills, have very little knowledge on expected standards of patient care and safety and knowledge deficit on how to be a leader and yet you are expected to act as one and lead a team effectively. Imagine that you are constantly under pressure to improve patient outcomes especially maternal and newborn outcomes despite all the issues mentioned above. Almost seems like you are being asked to perform miracles in the dark right? It is almost obvious the kind of outcomes one will have both for the patient and the staff who get frustrated and suffer from burnout.
This scenario is not unique to one nurse/midwife or primary healthcare unit but is easily copied and pasted across Africa. However, the attitude of the healthcare workers working under these circumstances is not something that can be replicated. Each individual chooses how to carry themselves and how to manage their patients. This is why human factors are now considered as part of standards in health systems accreditation. There is a lot of public outcry over the poor attitude of the nurses and very little about nurses who have a positive attitude despite all the issues mentioned above.
One such midwife who chooses to have a positive attitude and is composed, compassionate, self-driven and confident is Christiana Jillo Will, Midwife in-charge, Lunsah Community health Centre in Sierra Leone known for having one of the highest rates of maternal mortality in the world with huge lack of Maternal Health Care.
Within 6 months of training, mentorship and coaching on basic improvement methods, she rose to become one of six healthcare workers who were recognized for their efforts in achieving and sustaining gains in their health centers. I must acknowledge as a facilitator and mentor that the attitude of the team mentored was a defining factor.
During our chat recently this is what she had to say about what drives her and vision for nursing:
” Learning how to use data to identify gaps in my maternity unit and using the model for improvement has empowered my team and I to develop solutions for gaps within our control. This automatically changed our attitude as we felt in control of our situation most of the time.
For example, ever since I learnt to use the partograph correctly during mentorship, I feel empowered to monitor my patients and make the necessary decisions in a timely manner. This has greatly improved my maternal and neonatal outcomes, patient satisfaction feedback and my team and I have developed confidence to work in the labor ward.”
She concluded to say; ”I look forward to having platforms where I can share my knowledge with other nurses to empower them as well to help change their attitude towards patient care.’’
If you are a medic you might be thinking the use of a partograph is something basic, but when you have been on the ground and seen the reality you will know that availability of patient care standards in the midst of complex health systems is not equivalent to the use and compliance to them.
As much as there are a lot of challenges in the already complex health system, the reality is that the leadership cannot be on the ground every day to solve all the emerging issues. Majority of the staff in the health system are nurses and midwives, empowering them with problem solving skills automatically improves patient outcomes, their attitude and eventually transforms the health system.
Ultimately, the attitude of the healthcare worker across the healthcare system remains a defining factor.
Christiana Jillo Will, we at Nurses In Africa  celebrate you in a big way.


Pediatric Nurse Winnie Kubai, Kenyatta National Hospital seizing an opportunity to mentor her colleagues at work.

It takes a special person to be a nurse but it takes an extra special person to be a pediatric nurse who is passionate about her calling.  One such nurse is Winnie Kubai, pediatric Nurse who works at The Kenyatta National Hospital, Kenya’s largest public referral hospital situated in Nairobi. You would be amazed to hear the reviews I got about her from the larger nursing community who share a learning platform on social media! I contacted her and we had a conversation and this is the story behind what drives her.

This is what she had to say:  I am a registered Nurse with a specialty in pediatrics and my heart belongs to children.  I grew up loving children and on my first posting, I was fortunate to be deployed to the Maternity wards. My passion for children grew even stronger after I took one year of specialization course in pediatrics and began to associate their every action with what’s in their mind, according to their developmental stage. This enables me to handle each child differently including adolescents who are not ‘’small adults’’.

I seize every opportunity to promote health to the community and preventive measures on common illnesses that affect children. Opportunities such as: social gatherings, meetings, church, at work and one time in the bus on my way to work. My deepest desire is for children to seldom get sick and those who do to get well with minimum or no sequel at all. Its always a heart wrenching experience to see them suffer when sick and the pain it brings their families.

I want every caregiver to understand the simple, cost effective measures that will be used to protect the children from complications of current illness. Some practices like thorough history and clinical examination, even in the well child clinic, environmental hygiene, personal hygiene and infection prevention and control go a long way to ensure better outcomes for the little ones. Since it would be impossible to achieve this goal on my own, I decided to pass on my skills to others through intentional mentorship that way we would have a well-equipped team. I focus on nursing students on clinical rotations, healthcare providers during short courses pediatrics courses including ETAT+, Pediatric BLS, PALS, Newborn Resuscitation and Neonatal Standards of Care.

I look forward to the day healthcare providers will finally get the attention they seek from the ministry of health in Kenya to address recurrent issues that pose a challenge to offering the optimum care.

Pediatric Nurse Winnie Kubai, Kenyatta National Hospital [left] with her colleague at work all smiles!!
To my colleagues, I have this special request: Listen to the caregivers of the sick children. In the public hospital where I work, the mothers from low socioeconomic backgrounds have a lot to tell us that can affect the patient’s outcome and ultimately reduce hospitalization days. But due to huge workload, many a times we’re forced to postpone the session, as we have to attend to all the demands of the other patients and their caregivers. Some days we are assigned to over 30 children per nurse in a shift and it makes the delivery of service a huge challenge.

So, what keeps you going? Seeing a once unconscious child now play in the hallway, brightens my day especially when one is overwhelmed. Children don’t not how to pretend so when they feel better, they will be up and about. It makes my day!

At Nurses in Africa, we believe every nurse has a story and Winnie’s story is one to be celebrated. Through her, standards of care are communicated daily creating consistency which is a cornerstone of quality improvement. The nurturing environment she has created in her work environment to provide meaningful mentorship is an added advantage too after all quality improvement is not a microwave solution but a crock-pot solution.

In this already complex health system, sometimes all the staff need as motivation is recognition of their efforts by their leaders. A pat on the back from you makes a huge difference.

What keeps you going when the going gets tough?