Health Worker Profiles

Dr Sompwe Mwansa, Registrar and Anaesthesia Liaison for ICU at the University Teaching Hospital in Lusaka, is involved in the delivery of the Health Worker Action Fund project implemented by the Global Anaesthesia Development Project in partnership with the Society of Anaesthetists of Zambia to ensure that anaesthesia providers in Zambia are sufficiently trained and protected during the global pandemic.

‘When news of Zambia’s first Covid-19 positive patients broke, we tried hard to carry on as normal, while also trying to prepare ourselves for a surge in cases as we moved along the curve. The work environment had an underlying current of anxiety at all levels as we didn’t know what to expect in terms of case load and presentation, whether or not we would have enough protective equipment for staff or if we had enough drugs and equipment to provide adequate patient care.

As it became evident that we had established community transmission the majority of elective cases were put on hold and in the department the focus shifted to optimising both staff and equipment to ensure we would be able to launch a response to a huge surge in cases. This included rotas of work and rest weeks for the doctors. As we have gained an understanding of the pattern of disease in our population – the majority of patients have had asymptomatic or mild disease, this has helped ease anxiety among members of staff, who have adapted to a work environment with increased attention of infection prevention. We are starting to reintroduce elective lists and have a plan in place for the management of Covid-19 suspected or confirmed patients, both on ICU and in theatre, though adequate availability of PPE does remain a point of anxiety.

Despite having to withdraw in-country trainees, GADP has provided continuous support throughout: sharing experience and information from managing Covid-19 patients in the UK and other LMICs; supporting staff wellbeing; regular teaching to support exam preparations; and the procurement of essential PPE.’

Read more about the GADP Health Worker Action Fund project here.

Deme Tesfaye is a Curative Sub-Process Support Officer at Kotebe Heath Centre in Ethiopia.

‘I am the Curative Sub-Process Support Officer and am also the acting Medical Director at Kotebe Health Centre. This is a primary health centre; we deliver services to a catchment area of 44,600 people. There are 161 health workers at different levels, from clinical nurses to surgeons. We also provide community support at the district level in collaboration with the health extension workers. We have around 21 urban health extension workers.

I was working as a health worker for 8 years before joining this health centre two years ago, in total I have been working in the health service for 10 years. I decided to work in health because of my family, they are involved in the teaching service. My father is very engaged in education on health. I became interested in the health sector and in engaging with the community and developed an interest in maternal mortality.

On a day to day basis, I firstly undertake my responsibilities as a health officer in different departments, including emergency and OPD. After that, I am delegated as a Curative Sub-Process Officer to the in-patient department where I help to improve client outcomes by identifying the problem and solving it using a curative sub-process. My role is not only curative but related to prevention such as antenatal services. I work in between the client and the services; when a client has a problem, I help to solve it. I am happy when I can help a client.

In this community, non-communicable diseases (NCDs) are a big concern, especially in those over 40 years old. In this district, hypertension is most common. We treat both newly diagnosed patients and patients who are improving. Together, health officers and health extension workers undertake outreach to identify people with NCDs and refer them to the health centre for treatment. We also reduce the causes of hypertension and other NCDs by engaging with the community twice a week and increasing their awareness of the causes of hypertension, the causes of diabetes and others. In the last six months, awareness in the community of the symptoms of NCDs and the need to visit the health centre has improved and the health centre has become more focused on NCD clients.

Through the train the trainer approach staff in all departments, including those that aren’t focused on NCDs such as the OPD, triage and antenatal ward have become more aware of NCDs. Through the training, health officers have become more engaged and clients are satisfied. Patients are now screened for NCDs when they enter separate departments such as the OPD rather than only those who enter the NCD department and clients are satisfied with the service.

I think the community has benefitted from this project because a year ago people were not being screened at the community level and the service was more focused on treatment rather than prevention. Now, the quality of NCD treatment has improved and the community has become more interested in using the service, they attend the health centre to be screened without any pressure. This is very important on the community, sub-city, regional and national level for reducing NCDs. The more collaborative the health centre is with the community, the better.’

You can read more about how patients are benefiting from our NCD project in this blog from Novartis.

Ghana, a country of over 29 million has just over 38,000 nurses, just one nurse to 739 people which despite exceeding the WHO threshold for developing countries leaves the country with a 50% deficit of nursing staff.

With poorly equipped hospitals, high patient numbers and attractive pull factors leading nurses to move overseas [3] the challenges are many, but Veronica is a phenomenal example of dedication and passion.

Through a partnership between the Royal Hospital for Sick Children in Edinburgh, World Child Cancer and Korle Bu Teaching Hospital, Veronica is receiving training in laparoscopy to help improve the provision of care for the estimated 1300 new cases of child cancer in Ghana each year. Treatment is very expensive and footed by the families which currently leads to a high level of care abandonment. The hope is that by using laparoscopic techniques to perform biopsies and surgeries, the procedure will be less invasive and the quality of care for children will improve.

“I’m originally from the eastern region, but did all my training in Accra and was lucky to be posted to Korle Bu Hospital. Though I have moved between departments, I am my happiest here as a peri-operative nurse. People keep telling me I need to specialise but I like being this kind of nurse as we know how to help with anything the surgeons need.

The hospital is run independently and that means that whilst I can move between departments, I can never be transferred out of Korle Bu. In other hospitals, you can be sent wherever they want you and it’s a problem for people with families, especially mothers, who say live in Accra and get posted to a district hospital far away in another region. It’s the reason why a lot of people leave the government services and the Ghana Health Service and choose to join private hospitals in Accra or in the main cities.

I look upon all my nurses like my children. It is no good getting angry when something goes wrong, we sit down and talk through the problem or mistake and we look at how not to make the same mistake again. After all it is people’s lives we are dealing with here and that’s the most important thing.

We have to improvise with what we have available. We often go to surgeons and tell them we don’t have a piece of equipment that we need, and we then look to find other ways of doing the procedure. We are always innovating and changing our practices as necessary. It is hard but we make it work.

Working in theatre can be challenging and one of the hardest areas is oncology. Patient numbers are very high but in terms of how many people are suffering they are low particularly among children. I think that fear and a lack of knowledge often prevents young girls from coming to the oncology department. They see other girls losing their hair because of chemotherapy and are scared as they don’t want to look like boys. Families aren’t aware that there are wigs that the girls can use and that their hair will grow back eventually. There is a lot to be done in terms of education for families but the team and I really enjoy working with them to help them understand the situation and that there are things that we can do to make the process less scary. Recently we were treating one little girl who was so sad when her hair started to fall out and her family could not afford to buy a wig for her, so we put our money together and bought her one and the smile on her face I will never forget. It is not our job but it is our pleasure to do this for our patients.

Despite the challenges, I love my job and I’m very excited by the prospect of laparoscopic (keyhole surgery) training. At the moment we use open surgery even for simple procedures and as a result there are high rates of infection and all the complications that go with it. Beyond the physical impact, surgery also affects the patients and families psychologically because it’s hard for parents to see their children with large dressings and imagine what we have done to them! With laparoscopy we use tiny plasters and the patients and parents see that it’s minimally invasive and the rates of infection are low. I’m hoping that it will improve the quality of care for all of our patients.”

My sister trained as a Community Health Worker last year and after hearing about her studies and how much she enjoyed the course I wanted to do the same so I began my course in October 2018.  After four months of training I am very keen to get started. For me, health is crucial and I am determined to make a difference in my community.

So far we have been doing different modules from basic life skills to maternal and newborn health and we have just done our first semester exams. In Semester two we do seven weeks of field work, we are placed in a community and we use our training to help. Our tutors visit and assess and guide us through it. My hope for the future is to be employed, I know that only a few CHWs are employed currently, my sister is sadly not one of them, but I want to make a difference so I will do what I can until I am employed formally.

Balucka Jackie is part of the health partnership between the University Salford and the Ugandan Blood Transfusion Service. Over the past year, after completing her own training as a Biomedical Engineer she has been working with the partnership to train and mentor engineers and staff at the Blood Transfusion Service in Kampala and the blood banks across Uganda.

Originally I wanted to do medicine, then later on, I was in the hospital and seeing blood and I realised that wasn’t for me, so then I thought I think I want to do engineering but I want something that is medical, I couldn’t be with the blood  and patients. Of course I see blood all the time now working in the blood bank but it is not attached to anyone. When I heard of biomedical engineering, I thought this is me, so I went ahead and researched it all and then applied.

In a class of twenty there were only five girls, biomedical engineers are mainly men. I like being a woman in this field and showing that we can also do it. Here in Uganda, the boys would make fun of us: “What happens when you get pregnant and you have to work on a machine? This is men’s work”. so I have always wanted to show them that this is not only men’s work, we too are able to do it and actually I always encourage female students I meet, telling them they are on the right track and you can challenge these boys, you do not have to be intimidated by them. Now we have graduated the guys often come to me even and ask for my advice or help.

Initially I was working on general hospital equipment but now working in the lab the machines I work on are quite different. At first when I started working here I feared infections but now I find it cool and the team is great. We have also introduced lots of different safety precautions thanks to the training: we can’t handle anything without gloves, we keep the equipment separate, wash our hands constantly.

We have these water distillers and the type we have are not very common, they are made of glass and so are extremely delicate and you find that lime scale builds up quite a lot, something we did not know how to solve before the training. I used to go out to the regions and visit the other smaller labs who also have these fragile distillers and I saw how dirty they were, the water coming out of them was filthy. I would show them how to descale and clean, but would go back weeks or months later and they would look the same. Following the training, they came to the lab here and we spent time demonstrating and practicing the process with them. After, they were saying: “we will be able to fix these now, we will not need your help so much for this”. When I now go to the regions, once every quarter, they come out to me and say: “you come and see our water distillers, they are clean and working!” They are so excited to show me. So my life has really been made easier, and my workload when I go to the regions is easier to manage. The training has helped to re-spark their interest in their jobs and their willingness to learn and work hard.

The weighing scales were another piece of equipment we were able to provide training on, often they do not reset properly and so we wrote some instructions on how to use them properly and fix them. So we were able to demonstrate practically how to rebalance them for the chemicals that needed to be mixed.

There have been so many improvements since the training. Not only did I really enjoy giving some of the training myself but it was a great refresher for me and my work life is so much better now.

Wisdom Musonda Chelu is a Chief Anaesthetic Officer at the Ministry of Health in     Lusaka, Zambia. He is part of the Brighton-Lusaka Anaesthesia project in partnership with the Ministry of Health (Zambia), Lifebox Foundation, Brighton-Lusaka Health Link and Primary Trauma Care Foundation. The partnership aims to improve delivery of safe anaesthesia through capacity building of health workers and to implement (Brighton-Lusaka Anaesthesia Project) the training programme of Bachelor of Science Degree in Clinical Anaesthesia in partnership with Levy Mwanawasa Medical University.

As a young boy, I read medical related books and lived around medical doctors. I would watch as they were called out to homes to see someone who was sick, and the work seemed very thrilling and important. I did a three year training programme as a Clinical Officer General with a Diploma in Clinical Medical Sciences at the College of Health Sciences in Lusaka. I had a keen interest in surgery, and whenever I was in theatre, I assisted the Clinical Officer Anaesthetist. I learnt about anaesthesia through that process and then decided that I would specialize in clinical anaesthesia.

Obstetric anaesthesia is associated with higher risk than routine care, and requires specialized training for healthcare professionals to enable them to work safely and efficiently with the patients. THET supported the Ministry of Health to train anaesthetic providers in Safe Obstetric Anaesthesia with WHO Surgical Check List. I have been organising and coordinating SAFE- Anaesthesia Courses through Education supported by THET, Zambia and Lifebox Foundation and so far about 150 anaesthetic providers have been trained and 125 pulse oximeters donated to needy hospitals.

I recall a particular case with a patient who had a bad obstetric history, her newborns used to die upon delivery due to severe fetal asphyxia.  Due to the training I had received, when I saw this patient, I knew that I was to give her spinal anaesthesia and put her in left lateral position to avoid aortal caval compression to lessen the distress. I administered her oxygen by mask for her to breathe to improve oxygen saturation in blood (intrauterine fetal resuscitation). After three minutes from the start of surgery, the male baby was extracted and immediately after giving oxytocin, the newborn was resuscitated. Later, as I monitored the mother, she was in tears and told me that is the first time she has heard her own baby cry. I was humbled.

The courses add value to our work as anaesthetists, we are able to learn and develop knowledge and skills through sharing with others from different hospitals. I have seen and experienced that partnerships are key in developing and improving the provision of safe anaesthesia in Low-Middle Income Countries. We need partnerships to help in anaesthesia human resource development.

Sierra Leone has a population of over 6 million people, yet there is only an estimated 235 Sierra Leonean doctors serving the population. As a country, Sierra Leone has experienced a devastating war which lasted over a decade and in 2014-2015, the country was hit with the outbreak of Ebola which caused the deaths of almost 4,000 people in Sierra Leone and led to an even greater decrease in qualified and trained health professionals as it is estimated that over 200 doctors and nurses died during the outbreak.

Andrew Sesaye is a Community Health Officer at the Bimkolo Health Centre in the Bombali district and he is part of the REACH: RCGP Education for Advancing Community Health project, which builds on the pilot Non-Communicable Diseases (NCD) work that the partnership delivered in 2017.

When I was a young boy, my uncle became very ill with severe stomach pain. There was a community health officer who came to examine his illness, treated him and my uncle got well. Since then I have admired the work that community health workers do. How they are able to help patients who are sick become healthy and I wanted to do the same. This particular health worker helped me to get the education and training that I needed to become a health officer myself. I am now the lead community health officer at the Bimkolo Health Centre, in the Bombali district of Sierra Leone.

Last year, community health officers at the health centre received training on hypertension by Dr Padwan and now we do more hypertension screenings for the patients who attend our facility, many of whom are young and often are not aware that they have high blood pressure until we have screened them. Recently, I saw a woman who was only in her 40s and had a stroke. She had travelled 3 miles to reach our health centre. Due to the care she received, she is showing great improvement and can now walk without support.

With the support and training provided by the REACH: RCGP Education for Advancing Community Health project, we are able to offer a variety of health services to the local community. The most common conditions we treat are hypertension, malaria and urinary tract infections.

As a community health officer, every day is exciting and dynamic. Being in this field has taught me a lot, and I am able to share learnings with colleagues. The best thing about being a community health officer, is the fact that I am able to help my family members. If my child gets sick, I will be able to treat them and that is a huge plus for me.

In Ghana, stroke remains one of the top three causes of mortality and is a major cause of adult hospital admission[1]. The Wessex-Ghana Stroke Partnership, which began in 2009, has created four multi-disciplinary ‘stroke-leads’ at the Korle Bu Teaching Hospital supporting the development of stroke-specialist clinical skills through delivering a training programme for hospital staff. The partnership also created a dedicated Stroke Unit in 2014 which has to date treated over 700 patients.

“Since my employment, I’ve worked in various departments in the hospital but I love working in the neurology department the most. Whilst working in the department, I met Dr Akpalu, the head of the stroke unit. Dr Akpalu, is a very lively person, he loves teaching and engaging, so I quickly fell in love with the ward because he makes you feel very comfortable and he always wants your views on how his patients are faring, which is rare for doctors in Ghana. You can discuss anything about the patient with him and he always goes the extra mile because he loves his patients.

The training we received at the stroke unit has given me the confidence to discuss and ask for different opinions on specific therapies for patients. I wouldn’t stand up in a group and talk, but now I am able to stand in front of 50 to 100 people and deliver training to new physios, interns and students. Dr. Akpalu has inspired others and every nurse and doctor who passes through here goes back to their department with a changed outlook and approach to work.

As a physiotherapist, I have learnt that the simple basic things such as how we handle patients make a lot of difference. The functional independence of a patient is so important, so we start training them from the ward, that way they don’t have to wear diapers. We support the patients to use the bathroom or a commode, which we place by their bedside and we teach them other non-verbal means of communication if they can’t speak, so they can raise the alarm when they want to use the bathroom. Even just small things like working with the patient on their swallowing technique can make such a difference and bring independence back to their lives. What has also been a great outcome of the training is the way we now work with families to teach them how to move and support their relatives.

I have been working most recently with a patient from Liberia who was flown in because they had heard of our stroke unit. In three weeks he has gone from being paralysed and losing the ability to speak to now sitting up and saying hello. His wife is so happy and it has been lovely to work with her to teach her muscle techniques for when they return to Liberia in a week or two. I think he really will make a full recovery – what could be better than this!

A huge challenge in Ghana is that the system requires patients to pay for physiotherapy treatments, which can be difficult for our patients because insurance doesn’t cover physiotherapy in the acute ward. Some patients’ relatives even refuse to let them have physio because they can’t afford it, which is sad, but we are doing our best to explain the importance of physio to the relatives and little by little we are seeing more patients paying for the therapy.

I hope for sustainability in the future. I believe that here at the stroke ward, we will continue to do our bit and train, and hopefully we can inspire attitudinal change in other departments so we can all be on an equal level as health workers”.

[1] https://skemman.is/bitstream/1946/20589/3/EricSampaneDonkorFinalThesis_Skermann.pdf

Through the partnership between NDORMS, University of Oxford and Cure Ethiopia, Tewodros undertook training to become a Trainer of Trainers. This has allowed him to provide ongoing teaching to surgery residents from across Ethiopia as part of efforts to improve paediatric orthopaedic surgery.

Orthopaedics has long been a neglected subject in Ethiopia. There are currently less than 500 orthopaedic surgeons in Ethiopia, for a population of 100 million, so we can only imagine how many trauma patients with orthopaedic problems go untreated.

After working as a GP I moved to Kenya for five years of surgical training.  Within two weeks of the training beginning I knew that surgery was what I wanted to do and in particular to specialise in orthopaedics.

It is amazing, someone comes with an injury and we operate on them, the next day he is on crutches and maybe later that day he is back home. You get immediate results.

Many of the patients we see here at CURE are suffering from congenital deformities, simple things that can be corrected, as well as from road accidents with resulting trauma.

I sometimes see very sad stories, I remember a 13-year-old boy, he had lost his father in a road accident and just six months later on the same road his family were involved in another accident.  He was the only one who survived that crash, his whole family gone. He had complicated fractures, but we are able to treat him and he is recovering really well, making friends with other children his age on the ward.

We see children as young as 5 who have never walked before.  We treat them for a couple of months, sometimes just weeks. Years later they return grown up, walking, and you don’t even recognize them.  You get a hug sometimes a kiss.

Sadly there are still a lot of case where children with congenital disabilities are associated with curses and so other children don’t play with them. Sometimes, in the worse cases, the children are locked in a room whilst their parents are at work, to protect them from stigma.

For me and my development as a Surgeon and Residency Director being able to meet with other experts in the field and to ask them about the challenges they face was invaluable.

For the trainees, the residents in Black Lion, it was a blessing, because I know how it was before.  It has made a great difference.  Before they were not very sure what to do with trauma and deformity patients and often they ended up sending the patient home, just see them come back after six months.  This is costly for the patients.  But after this training, they were sure of what to do.

The partnership between King’s College Hospital, London and Shifa Hospital, Gaza began in 2015 and has supported the development of trauma care services in Gaza, with a particular focus on the newly established limb reconstruction service. Since the partnership began 59 clinicians have been trained in the team management of trauma including 25 health workers who are now able to deliver a limb reconstruction service. Moreover, the target to improve patient measures of pain, physical and psychological functioning was met and exceeded, so too was the reduction in number of patients referred outside of Gaza on clinical grounds.

With a strict blockade, continuous conflict and aid cuts, Gaza’s infrastructure, particularly their health system, has been gravely affected. Lifesaving treatments are hard to find and the supply of medical amenities is incessantly delayed, so too is the medics’ movement and training. We met Qasim Mohammed[1]  during her trip to London in June 2017 to further her fully funded THET training with Kings. She is one of 59 health workers we trained throughout the whole project.

“I joined the limb reconstruction team in 2015. My experience before the project was in orthopaedics.

In Gaza we are always at war and we receive many complex injuries, there is a great need for limb reconstruction and that is why I have specialised in this. While elsewhere people can afford the luxury to get treatment from abroad, in Gaza patients are grounded and it is upon us to treat them. I do my best and I am always happy when we achieve a good outcome.

The partnership has really changed things for our team in Gaza. We were visited by a physiotherapist from King’s College Hospital who discussed patients’ cases with us and explored the options on how best to treat them. This gave me new knowledge and experience and I became better able to support limb reconstruction patients who need qualified physiotherapists with specialist skills, as limb reconstruction is a long and complex process with many stages.

In Gaza we work in a similar manner to King’s but there really is a huge difference in working conditions. For example, we have a shortage of rooms. As a physiotherapist I need a gym in the inpatient clinic for patient exercises but we don’t have one.  Additionally, the hospital’s environmental hygiene is wanting so we are at a higher risk of acquiring hospital infections, health workers and patients alike.

Also here [in the UK] you can find everything; crutches and all assistive devices are available. But in Gaza sometimes there are shortages in assistive devices, like splints for patients with lower limb injuries. Sometimes without these, our job is difficult. I will try, when I go back, to get another room and redesign it as a gym for inpatients. This would be very helpful for the patient, helping them to build up their muscles, range of movement and get back to their normal life. When I return to Gaza I will definitely share the skills I have learnt with my colleagues.

Now more than ever, I am grateful for my newly acquired skills and knowledge in limb reconstruction from this training.”

[1] not real name for security purposes

I am head of the Stroke Unit and have worked in Jimma University Hospital for three years.

Through a collaboration with THET and the University of Southampton we opened the dedicated stroke unit here. Since then we have received training including: swallowing care assistance, positioning, how to help patients take medication and evaluating patients, and this has meant that we are now able to offer daily stroke patient care.

There are 3 doctors with 3 nurses per shift and we have 8 beds for stroke patients. The beds are always occupied, often we don’t have enough beds to transfer patients from the Emergency Department, and so there are many patients who have suffered a Stroke waiting there, if the beds are free we can transfer them here but if not they stay there.

Patients come from very far away to be treated here, some patients have travelled 3000km to be here. We mainly see elderly male patients suffering from hypertension and diabetes and because this has remained untreated they then suffer a stroke. Of course the stress of a stroke further harms their health and their hypertension often worsens.

Families often stay here with the patients and we then teach them how to position and how to care for their family members both in the hospital and also when they return home.

We have many shortages in the Hospital and these have led to many patients being unable to receive the care needed. A patient that I really remember is one who sadly died because of an absence of oxygen. They needed oxygen and yet at that time not only did we not have any in the whole hospital but we also had no way of measuring the oxygen levels in the patient.

Now things have improved but I hope that in the future and we can continue to receive training to expand the services we can provide and help patients even before they have a stroke.

Plymouth University Peninsula Schools of Medicine and Dentistry- Masanga Hospital, Sierra Leone

The partnership, which began in 2015, has improved the capacity and sustainability within the Sierra Leonean Health Service to improve resilience to future outbreaks of viral haemorrhagic fever. In particular, the iCare project sought to use mobile device apps to increase community awareness of infection prevention measures.

“Medicine was something I dreamt of since I was in high school and it was a career I admired greatly. I wanted to work hard for my community and country to help save lives.

Through my work at Masanga I was asked to work with the THET iCare project which sought to train healthcare workers and community members on infection prevention control (IPC) in the wake of the Ebola outbreak.

The training was done across Tonkolili district, Northern Province, where the ratio between the number of health workers and the population is among the lowest in the country (3.98/10,000). Together with other UK based medical volunteers I trained more than 1,000 community members and over 300 healthcare workers.

Through the THET partnership I increased my experience, knowledge and skills and learnt that I could provide help to those villages that were neglected and were not easily reached when it comes to health service and education. I believe the project will serve as a turning point for me in my career.”