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.