Fieldset
Assignment number three, no better place to be!

Brigitte is in the Central African Republic where she and the local staff are working together to make the small changes that can save lives on the ward...

Some of the Central African team pose for a photo

After running the MSF training course sharing with Central African staff on how MSF started and how it continues, I stayed an extra day in Bangui before heading off on my third assignment.

Even though I still feel as if I am new to this “MSF stuff”, having two assignments under my belt puts me in the veteran category.

However, this third assignment is still filled with many firsts and new challenges. Mainly, I will not have the same responsibilities that I have become comfortable with as as an outreach nurse (a nurse who works with our outreach teams that drive to isolated areas to treat patients who are not able to come into town to access care). Rather, I’ll be spending the bulk of my time in the hospital, somewhere I have not spent much time since I left the hustle and bustle of Montreal in mid-2010.

On top of this, the security in Bambari, in the south of the Central African Republic, is more complex than my two previous assignments. It is exciting because there are many new developments within the project.

We recently took over the support of the hospital and a health centre from another international NGO. Taking on new projects means ensuring they meet the supervision and quality of care standards that MSF expects from its facilities. That’s where I step in. I am here on a short two-month assignment to concentrate on a training strategy for the project and develop and deliver trainings during my time here. Considering my previous missions were nine and seven months, two months is very little time given the big task ahead.

I had been warned during my briefings that a lot of work would need to be done in a short amount of time, but I went in with an open mind. Based on previous experiences and my own imagination, I had expected conditions to be much worse.

In the week before my arrival the team had done a huge clean-up of the therapeutic feeding center and the pediatric ward cleaning was underway. I spent my first week observing, going on ward rounds, spending time with the nurses and watching them do their daily tasks. I quickly learnt that we needed to start trainings emphasizing the basics.

Due to a previous lack of basic supplies, including a clock, the ability to check for a patient’s vital signs consisted only of checking their temperature. Hand hygiene was almost non-existent; the team didn’t have a regular supply of gloves or would re-use the same ones. However, now supplies of gloves and disinfectant had arrived, staff required frequent reminders during rounds.

By the end of the week it was slowly becoming a reflex for the intern and head nurse to disinfect their hands between patients; we even made a game out of it!

Documentation had previously been minimal as they often didn’t have blank papers for charting, but now that they had supplies, the documentation was happening.

A harsh reality was the difficulty in being able to give oxygen to a patient who needed it. If a child needed to be put on oxygen, we had to find the hospital administrator to ask for fuel for the generator. It was an old generator and could only run for 1-2 hours at a time due to fuel consumption. Thankfully, within my first two weeks, MSF had installed a smaller, more fuel-efficient generator allowing a child to be on oxygen for as long as they needed.

With the refurbishments underway, my training strategy and schedule for the hospital has now begun. The idea was very well received by the hospital administration and I had been given lists of names of people in each service by mid-week. We started with hand hygiene and the concept of transmission of microbes. I was very impressed by the enthusiasm of the staff and the fact that 83% of those who were eligible to come, meaning not on maternity leave or in Bangui, attended!

Now when I walk the halls of the hospital I am greeted with laughter and singing, as we have made up a song to make sure that we wash our hands for the recommended amount of time and with an effective technique! We have even increased the amount of hand washing stations in the paediatric and therapeutic feeding wards.

I am really enjoying visiting the different wards and being able to create a relationship with different teams. I thought that I would feel “trapped” after being used to leaving every second day as an outreach nurse, but I have had little time to even think about it.

In the first three weeks since my arrival the improvements have been staggering!

We still have a long way to go, but I try to concentrate on our achievements. I still hope to develop a strategy for our health centers and work closely with the outreach team (you can take the girl out of outreach but not the outreach out of the girl!).

It’s always so reassuring to work with such dedicated and motivated colleagues within MSF. Both national and international staff are so committed and are working together to be able to provide the highest quality of care to our patients in the shortest amount of time.