Learning from AMR focused health partnerships.

Ipswich Hospital has had a link with Beira, Mozambique for many years, initiated in 2000 by a partnership between our trust and Beira’s Medical School. Since then we have had a number of health partnerships focusing on infection control policies, an often neglected health theme. In 2016, as part of our project funded through the THET managed Health Partnership Scheme, we expanded our existing patient and staff safety program at the Central Beira Hospital and worked to develop new programs in medication safety, maintenance of key equipment and safe disposal of medication waste.

Working to build resilient health systems throughout the world is crucial if we are to protect our population. For example, our ability to prevent and resolve future pandemics is greatly improved if health systems in other parts of the world are better equipped to manage them.

Our visit in November 2016 concentrated on the safe use of medicines, with a focus on sepsis prevention and management, hand hygiene measures, and injection safety – all important components in the fight against antimicrobial resistance. This went hand in hand with the with the upcoming third WHO medication safety challenge, “Medication Without Harm”.

I was responsible for two pieces of training – a refresher on effective handwashing, and the safe use of injectable medicines. Working in health partnerships often presents challenges but what we have quickly learnt is everyone’s ability to adapt and learn new ways of working. In Mozambique, the primary language is Portugese, a language none of our pharmacy team spoke and so with the use of online translators I had attempted to translate my slides before leaving the UK, but despite my best efforts online translators it seems can only get a person so far! Fortunately, the nurse in the Ipswich Team was a native Portuguese speaker, and as well as clarifying the areas which didn’t translate very well, was able to add vital, practical information from her own experience, which could otherwise have been lacking in my own presentation. This helped to demonstrate the value of the multidisciplinary team, which was only just beginning to take root as a technique in Mozambique.

It rained heavily for most of the day of the hand hygiene refresher, which wasn’t ideal as the main water supply was in a portable storage tank (borrowed from one of the wards) outside – leading to the awkward situation of wash your hands effectively, and get soaked in the process. We used a UV-reactive gel to simulate the presence of bacteria and ensure everyone was able to follow the WHO “effective handwashing” procedure, which almost fell down at the first hurdle when we discovered that the UV light – an essential component of the training – was itself lacking an essential component; batteries!

Feedback on the training was obtained by our health psychology colleagues from the Change Exchange, University of Manchester, who later published an article in Globalization and Health about their findings (focusing on teaching of calculation skills). Nursing staff were all very positive, giving comments such as “the training was good, constructive and I would like it more often. I liked most the information for the care of the patients” and “It was good because I learned others techniques; from now on I will implement and pass on to my colleagues.”

This was an invaluable experience that really helped put a lot of things into perspective. Often we experience technological or financial challenges in the NHS, but delivering the same level of training in a low-resource setting emphasised that most barriers aren’t completely unsurmountable. I feel more confident in suggesting alternative solutions to problems, and finding ways around obstacles instead of deciding that I can’t get past them.

Globalization and Health article: DOI 10.1186/s12992-017-0265-1