I came to Gondar in Ethiopia to provide support for the hospitals failing healthcare system. Gondar is a teaching hospital, it is one of the largest in Ethiopia and I had hoped that it was fairly progressive and well run but under resourced. I was extremely surprised when I first arrived at how completely dire the wards were.
Now this isn’t my first visit to African hospitals, I have been to Sierra Leone and seen how much they struggle with complete lack of resources and trained healthcare professionals. However I knew Gondar received a lot of funding from schemes and NGO’s, including the Leicester- Gondar link I was part of to provide support and training to nurses on a Masters degree programme. Lack of staff is not an issue, I have seen more qualified staff and students in training than there were patients. The reason I was so surprised is it should be better and I can’t understand why it isn’t.
The wards are a sad place. Although the students I am supporting are motivated and conscientious and want to bring about change they are fighting a big battle with extremely unmotivated nursing and midwifery staff. I have never seen so many nurses sat around doing nothing on a forty plus bedded ward (not including the patients sleeping on the floor). From what I have observed I really think the biggest issue lies with professional registration and accountability and unfortunately neither of these things exist in Ethiopia.
To be a registered nurse in the UK, Europe, The US, Canada, Australia, New Zealand and most other countries you need to register your qualifications with a regulatory body, this is a council that decides your fitness to practice in that profession, in the UK it is the Nursing and Midwifery Council (NMC). You do not have to register with a council in Ethiopia and to be classed as a ‘registered nurse’ you have be complete a BSc programme, but you are not on a register! Without registration there is no professional accountability, I have asked my students what happens if you make a serious mistake and they say you may get a written warning. It absolutely terrifies me there is no real punishment for incompetence or negligence. I think this is one of the reasons why many nurses and midwives don’t really interact with patients. It really does make me so proud to be a nurse in the UK, part of a much safer and caring healthcare system. I know the NHS is not perfect and it really upsets me when I hear negative experiences from patients who didn’t receive the best care in the UK, but it really is a million times better than this. It certainly makes me more grateful as a service user.
My students tell me all the right answers; we should have proper drugs charts, we should record blood pressures, we should wash our hands, we should assist our patients in their care needs, but everyday I struggle to see these things happen. I really wanted to balance the positives and negatives I have witnessed in clinical practice but I do struggle. I think where lack of resources are concerned they cope very well, they run a very lean system and have great innovation for lack of some vital pieces of equipment. On the paediatric wards they do luckily have oxygen, but they don’t have oxygen masks, so they using intravenous giving sets and cut them to the patients needs and pop it up there nose, it think its very clever. On a number of the wards there are patients needing chest drains and they have the tubing but not the drain bottles so they use rigid bottles of intravenous fluids instead, again genius as its better than a collapsed lung, which could kill you if untreated.
The most amusing part of the hospital is the constant hike through a building site. When they started building I don’t think there was any system to it other than to build as much as possible in every corner you can find. On a daily basis I never know if I’m going to be able to get through the entrance to the hospital. Today there was new scaffolding blocking off the only 10 meters of path and a giant ditch has been formed between the end of the steps and the road, I had to help a poor blind man so he didn’t fall to his death.
I digress returning to my original point I think the whole hospital is terribly mis-managed; it lacks proper structure and systems. There is never any clean linen; not because there is no linen, washing facilities or people to do it, but there is no proper management of it. No one wants to take responsibility for anything. I really do hope my students continue to be as committed and implement their proposed changes. Its not a poor hospital it gets a lot of funding and it caters to a massive catchment area, it needs to learn the art of customer service to the poor and vulnerable people it treats.