#Resilience in Action

Our latest photo essay captures some of our favourite moments from the recent #ResilienceInAction campaign, which highlights the progress our partners have achieved since the end of the Ebola outbreak.

New Year, New Partners, New Opportunities

By Dr Daniel Youkee, Acting Country Director

As the new year begins, I first want to look back and thank Francis for his sterling work as Country Director. He managed the growth of the organisation, cemented our internal policies, and maintained close relationships with our Ministry of Health partners.  He will be fondly remembered and we look forward to working closely with him in his new role as Country Director for Restless Development Sierra Leone.

January also marks the last month of the Infection Prevention & Control (IPC) grant. The team has been working tirelessly to protect patients and health workers across Connaught, King Harman Rd, and Lumley hospitals. While the achievements of the IPC programme are immediately recognisable – visitors line up to wash hands, gloves sit neatly on the ward round trolley, and water flows from taps – what impresses most is the way in which progress has been achieved. There are now fiercely independent IPC focal points and we are seeing our staff draw back and Saloneans step up in the gravitational dance of partnership.  A huge thank you to Natalie, Hannah and all of you who worked on this grant previously (Sachiko, Dominic, Annabel, Ambrose, Gilbert, Becca).

As the IPC project winds down, we are gearing up to focus on a new 20 month (~$800k) mental health and neurology project. Funded through John Snow International, this will develop mental health services nationally, provide a pathway to accreditation for mental health nurses, and develop the neurology training and services available at Connaught Hospital. Hannah and Hege are working hard to ensure that the KSLP ethos is embedded throughout all elements of the programme design and to ensure maximum impact of the grant.

Over the past three months we have witnessed tangible gains across the hospital – from the implementation of the country’s first viral load monitoring in the Connaught HIV clinic, the regular Quality Improvement Committee meetings starting to deliver system change, the arrival of surgical trainee residents, the development of antimicrobial guidelines through consensus, and supporting our partners in the roll out and quality assurance of national malaria treatment guidelines.

The team based approach to Sierra Leone Early Warning Scores (SLEWS) implementation continues to integrate our work from undergraduate through to postgraduate education. SLEWS drives the recognition of and response to acute illness, improves communication between nurses and doctors, and supports the development of an ICU outreach service. SLEWS is the vehicle for driving improved patient care and health worker accountability and is a key component of KSLP’s framework for achieving behaviour and system change. On the ward trainings are bridging the gap from theory to practice and will culminate in the hospital-wide SLEWS launch on Thursday 27th January.

Internally, we continue to increase our engagement and alignment with KCL, with Martha, Max, Steve and Molly strengthening and developing our financial and recruitment processes.  Academic engagement with KCL appears to have reached a critical mass, with ongoing joint research proposals ranging from surgery to HIV, and from stroke care through to epidemiology.

Finally, we are entering a new era of partner relations as the Teaching Hospital Complex Act draws the College of Medicine and Allied Health Sciences (COMAHS) together with the four tertiary hospitals in Freetown under a new Nigerian-led administration. Autonomous from the Ministry of Health and Sanitation, it is a radical redesign of existing governance structures. We welcome Dr Deen as the new Medical Superintendent of Connaught Hospital and salute Dr TB Kamara for his long and distinguished service as he moves to take the role of Postgraduate Training Coordinator. As an academic health science centre partnership, we are uniquely poised to support our partners to seize this opportunity and drive sustainable system wide change.

Partnership for change: first impressions in Freetown

I’d always wanted to volunteer in a developing country, motivated like many by an interest in applying my skills to help a place in great need. I was attracted to the strong partnership ethos of King’s Sierra Leone Partnership (KSLP) and delighted to have the chance to come and work with Connaught Hospital colleagues.

I joined the NHS as a graduate general management trainee in 2009, after which I worked in various operational and strategic roles including most recently as Programme Director for Diabetes & Stroke Prevention at Health Innovation Network (HIN), the South London Academic Health Science Network. I am grateful to my managers at HIN for kindly allowing me a six month career break to come to KSLP in Freetown.

During my first month at Connaught I was struck by how hospital life is on the one hand of course so totally different, and yet on the other hand many of the issues are similar to the ones that NHS managers devote their careers to solving.

laura-at-connaughtProbably the most striking difference is the spectrum of common diseases. Infectious diseases (such as TB, malaria, HIV, measles, meningitis, pneumonia and others) are very prevalent. Spending time observing in an outpatient clinic during my second week here I was also taken aback by the severity of advanced disease that Connaught staff are treating. In my years in UK hospitals I have never seen so many patients so poorly as I have seen here in just a few weeks.

But while there is what sometimes feels like an overwhelming amount of suffering, there is also a good deal of hope. Patients, relatives and staff are incredibly warm and friendly, greeting strangers they pass in the corridor and one person who I hadn’t met before thanked me profusely for my work! I have met some incredibly strong and resilient people here who have survived some terrible times and are committed to working towards a better healthcare system. The work they do every day is truly impressive and humbling, particularly when you remember that they have far fewer resources of all types than we do in the NHS.

The issues that Connaught has in common with the NHS that I’ve discovered so far are as follows (I’m sure there are more!):

  1. Issues around flow of patients through the hospital – together with Connaught doctors and nurses we’ve started some process mapping to better understand the problems before co-designing solutions
  2. Rotas and handover processes
  3. Ways to embed effective multi-disciplinary working
  4. Estates and maintenance issues
  5. Effective management of outpatient services and ensuring patients do not become lost to follow up
  6. Health records management
  7. Robust systems for audit and quality improvement

And it’s the last two issues where I am focussing my energies for now.

There’s a great deal of enthusiasm in the hospital for improving the health records system, both to improve patient safety and care quality as well as enabling staff to undertake meaningful clinical audits and quality improvement projects. The records office staff in particular are fantastic and we have been working together on the first stages of our improvement plan.

It’s also a fascinating process working with colleagues to start up a rolling programme of quality improvement projects. We’ve established a committee where projects can be proposed, registered and reported on when completed. Our first two projects are about implementing the new international guidelines for the treatment of malaria and improving antibiotic prescribing. We’re going to be running some multi-disciplinary training sessions soon on quality improvement tools and methods. I am learning a lot from colleagues here showing me what is likely to be effective and what is not, and why.

My third project is an evaluation of a major educational programme working with the medical, nursing and pharmacy schools at the College of Medical and Allied Health Sciences (COMAHS). I’m developing some new skills in designing qualitative evaluations and it will be interesting to hear the views of staff and students in the focus groups and interviews early next year.

I’ve always thought that the role of an effective healthcare manager is to provide the best possible environment and conditions for clinicians and patients, so that the best possible patient outcomes are achieved. This means making sure that systems work and that staff have the right skills, equipment and support to meet patients’ needs. As one of my first managers in the NHS memorably put it, “you have to be the glue” that brings the various parts of the system together. These principles are exactly the same here. I’m enjoying learning about how the Connaught management team is approaching this task and trying to make the best contribution I can.

Volunteering overseas is a “less trodden path” for healthcare managers than it is for clinicians, but I would encourage anyone who has an interest to pursue it and get in touch via volunteer@kslp.org.uk if you would like to know more. Whilst there are some tough times, it’s an incredible and very worthwhile experience.

Laura Spratling, Hospital management volunteer

Designing a Development Programme for the Faculty of Nursing Lecturers

The King’s Sierra Leone Partnership is moving into an exciting phase with our partners at the Faculty of Nursing at the College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone.

On 3rd November 2016, Sister Alicia Wilson-Taylor, Senior Nurse Lecturer at COMAHS, and Dr Matthew Vandy, Dean of the Faculty, co-led an interactive workshop with the support of Linda Jenkins, KSLP’s Nurse Educator. The workshop built on teaching sessions started with COMAHS in 2013/14, before the Ebola outbreak halted this work, and outlined current plans to design a development programme for the faculty of nursing lecturers.

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Topics of discussion included developing skills in carrying out teaching observations, peer evaluation of teaching, student assessment, ward teaching, research, and the use of IT. The session was attended by 8 of the faculty lecturers.

Sister Wilson-Taylor shared with the group an inspiring example of using interactive learning in a teaching session the previous day where students had been asked to work in pairs to define the characteristics of a nurse and feedback to the group. Sister Wilson-Taylor said the session had been very successful and that the students came up with great ideas and the team is looking forward to future sessions.

kslp-and-faculty-of-nursing-at-comahs-photo-1 Dr Vandy, Sister Wilson-Taylor, and colleagues will be working over the next 10 months, supported by Linda, to develop the nursing curriculum, teaching, and assessment methods and use the learning from similar work that has already taken place in the Faculty of Medicine, also supported by KSLP’s Education Manager Suzanne Thomas.

IPC Campaign Week

As part of our ongoing work with the Infection Prevention & Control (IPC) Programme, KSLP IPC nurse mentors have been supporting partners at Connaught, Lumley and King Harman Road Hospitals to implement regular IPC campaign weeks. These weeks have proven effective in building and maintaining enthusiasm among hospital staff about the importance of following IPC protocols.

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Hand washing during one of Connaught’s IPC weeks in May

Each IPC week is different, but typically each day of the week has a particular theme for which the IPC Focal Person collaborates with the link nurses to focus the day’s training and monitoring on one particular component of IPC.

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Bobson Fofanah explaining the correct disposal of sharps

For instance, this September featured Sharps Safety Day at King Harman Road Hospital. Assistant IPC Focal Person Bobson Fofanah visited each ward to ensure that sharps bins were assembled correctly and located in safe places in each ward. He also checked to see if there are instructional posters in place and to make sure every staff member is aware of the importance of proper sharps disposal.

IPC campaign weeks build a strong sense of teamwork and enthusiasm about IPC across the hospitals. The week ends with a celebration, with awards given to the wards showing improvement in IPC practices.

IPC weeks also give the team opportunities to show off their creativity!

King Harman Road Nurses sing the IPC Song from King’s Sierra Leone Partnership on Vimeo.

#anotherdayatKSLP

As the KSLP team has grown over the years, our work has expanded to include activities across a wide range of programme areas. These activities are unified by the overarching vision of the partnership: to work alongside local partners to build a strong and resilient health system in Sierra Leone. We showcased the breadth of our partnership’s work in a month-long social media campaign #anotherdayatKSLP, the highlights of which you can see in this photo essay.

New Developments, by Richard Lowsby

It has been a turbulent few weeks; the country’s leader has resigned and been replaced, senior politicians have been stabbing each other in the back and the opposition are in turmoil.  The population are divided after a bitter referendum, promises have already been broken and the rest of the continent look on in concern.  The health system is in financial crisis with concerns over sustainability, resources are stretched to the limit and morale is at an all-time low.   Patients are suffering and the staff that care for them are engaged in a battle with the health secretary with no signs of a resolution or solution.  I refer of course, to the UK and not Sierra Leone.

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Dr Rich Lowsby with final year medical students, photo by Ibrahim Kabia

I have been home for a few weeks, a trip slightly longer than planned, but have left the political turmoil behind and now arrived back in Freetown to experience the full assault of the rainy season. Gone is the dust and in its place, a damp humidity but at least it is slightly cooler now.  The large majority of my time before leaving last month was spent supporting the development of the hospital’s new acute surgical and trauma assessment unit.  This was the second phase of the new A&E development following the opening of the new department in March.  The unit opened while I was away and I am keen to see how it is going.

I was told that the ward had opened in a bit of a hurry when several seriously injured patients arrived simultaneously following a major traffic accident.  The staff had coped admirably and had continued to do so.  The sister and staff nurse in charge have the ward running smoothly, there is a list of responsibilities for each nurse on duty for each shift of the day.  Each bed has a chart on the wall above it with a plan for the patient.

The high dependency bed currently has a patient being monitored and provided with oxygen after admission for a gunshot wound and collapsed lung.  The lung is now re-inflated after placement of a drain and he is improving.  A patient with a significant head injury has just arrived in the trauma resuscitation room after an assault and the staff are assessing him, supported by the medical officer.  The surgical team are reviewing patients admitted overnight after their morning meeting, a man with a suspected perforated ulcer and a child with an infected wound after a snake bite may need to go to theatre.

Some of my colleagues have been conducting training to support the opening of the ward and have worked tirelessly alongside the staff to ensure it functions effectively.  I am thrilled to see how things are progressing and I have realised how important good relationships and team effort are in moving things forward.  Work initially began over 6 months ago and is now complete, the hospital has a new Emergency Department.  This has been in the planning for a while, well before my time and I feel fortunate to have played a part in it.

It is not only hospital management, doctors and nurses that have contributed, but we have been working alongside builders, biomedical sciences, cleaners, engineers, infection control, hospital stores, maintenance, Ministry of Health and Sanitation as well as the UK Department for International Development.  As a result of everyone’s efforts, the hospital now has a department that is geared to assessing and managing acutely unwell and injured patients, that staff can be proud of and patients can trust.  It is everyone’s responsibility to sustain this good work.

Published, with permission, from Dr Rich’s Lowsby’s blog, Sierra Leone Emergency

Enhancing Resilience: supporting the next generation of health workers in Sierra Leone

Freetown’s College of Medicine and Allied Health Sciences (COMAHS) was forced to shut its doors for nine months during the Ebola outbreak. Finally reopening in June 2015, COMAHS is critical for rebuilding Sierra Leone’s health workforce, despite its limited training capacity, poor learning facilities, and a major shortage of teaching staff in most areas. This essay tells the story of the partnership between COMAHS and KSLP, formed with the goal of building capacity and resilience in post-graduate education in Sierra Leone.

All photos © Katherine Wise/Momenta Workshops 2015

A Day in Connaught Hospital’s Intensive Care Unit

Today we are in the Intensive Care Unit (ICU) at Connaught Hospital where the nurses are conducting their afternoon handover. Alongside Sister Elizabeth Kamara, the ICU sister-in-charge, KSLP’s Dr Ruth is leading today’s handover.

DSC_0071 It’s is a quiet day in ICU so Dr Ruth is taking time to test everyone’s knowledge on the importance of fluids and how to provide oxygen. Her energy is contagious as she asks about each patient:

“Ok, so why might this patient’s condition have changed?”

“Fever?”

“Chest Infection?”

“Reaction to the blood?”

“Exactly, it could be any of those things, so if there is a change in the patient condition, we need to think about what might be the cause and what you need to tell the doctor in charge.”

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ICU sister-in-charge, Sister Elizabeth Kamara,

Such on the job learning is highly valued in this unit. The daily handover is appreciated as much for ensuring the consistency of patient care, as it is for the opportunity to receive further training.

“Mentoring other nurses is the best part of this job,” said Sister Elizabeth. “It’s great to be able to share my knowledge and understanding with others.”

A close relationship builds between the nurses and their patients. In ICU, they provide ‘complete nursing,’ which includes everything the patient like feeding, fluids, and pain management. Any and every change in the patient’s condition must be recorded. This is a major responsibility, but all of the nurses shoulder it professionally.

DSC_0015 Each provides a detailed history of every patient at the end of the shift. Histories include details of why the patient was admitted, when he or she was last seen, and the critical points in his/her care and management. Despite seeing some tragic cases, optimism abounds in the unit. After all, “ICU is where we treat critically ill patients,” said Sister Elizabeth. They are the ones we know we can revive again and bring back to life.”