By Sr Jackline Mayaka (FSJ), MSN, RN, PhD Candidate, Villanova University
The World Health Organization (WHO) has declared 2020 as the “International Year of the Nurse and the Midwife” in honor of the 200th anniversary of Florence Nightingale’s birth. The ‘lady with the lamp,’ as she was well known during her service to the wounded soldiers at the Crimean war, is celebrated as the founder of modern nursing. She organized and cared for the wounded soldiers using scientific knowledge, a rare commodity during that period. Nightingale is therefore regarded as a reformer and advocate for public health by using statistical evidence to support patient care.
Nurses, like Nightingale, continue to act as reformers and advocates for access to healthcare for all people. They develop everyday therapeutic relationships with their patients that enhances communication and healing. These relationships are based on mutual trust, promoting harmony, and nurturing faith and hope. Nurses use their sense of touch to console and be at the patient bedside even when no relatives are available.
In some parts of the world, including the United States of America (USA), nurses have been rated high by the polls as the most trusted group compared to all other professionals. In Kenya, despite there being no polls ranking professionals, there are stories describing how nurses are resilient and working in many parts of our country where we do not have medical doctors. In most cases, despite the sacrifices they make, sometimes living away from their families to dedicate their lives to doing what they love most as they provide essential health services to individuals and families, these nurses are unrecognized. These nurses wear different hats; for doctors, public health officials, laboratory technicians, cleaners, among others, distinct from their professional nursing training. Nurses are not trained for some of these skill sets, but they are courageous, adaptive, critical thinkers, innovators, researchers, and are resilient. They love what they do.
In marginalized rural populations where primary healthcare is much needed, nurses are at the frontline providing care for individuals and families. After the initial training, the majority of the nurses end up in rural communities where they work alone with little supervision and mentorship but never give up. Many nurses moved with compassion and love for their clients stay put, irrespective of the poor working conditions. Sometimes these nurses have to learn through trial and error, rationing available resources so as to provide healthcare to their patients.
The WHO declaring 2020 as the year of the nurse and midwife is a factual reminder to us that without nurses, no healthcare system can stand on its own. Nurses are the eyes and ears, and the connecting fabric of healthcare systems. Healthcare systems will not survive unless we have these heroic sacrifices from men and women called nurses in the frontline. I urge that we pay tribute to them and congratulate them for their service to humanity, especially for carrying on when many of their colleagues have not persevered.
I would like to share a story from a nurse who has had experience working in rural communities in Western Kenya. After completing her nursing diploma training, Jane took up a job at a health center as a charge nurse. As a novice graduate nurse, she was the only qualified nurse; the rest were nurse aides who had been at that facility for as long as they could remember. These nurse aides were well known around the community. They diagnosed, treated, and referred critical cases of the sick members of the community to the nearby level 4 healthcare facility. The nurse aides attended an average of 100 cases per month.
Fortunately, these nurse aides had admirable midwifery skills – thank God for their earlier training as traditional birth attendants (TBAs) by the government of Kenya before the ministry of health stopped training TBAs. This training gave them knowledge on how to care for mothers through pregnancy and under-fives, including immunization and other preventative care. The nurse aides reported that the facility had nurses posted there, but they lasted only a few months. Most left for the cities where the economy was better than in rural areas. The facility was therefore left in the hands of untrained personnel.
Thus, Jane was considered the most senior in terms of education but lacked the most critical experience in primary healthcare. The novice nurse, Jane, lacked the confidence even to examine a mother at the beginning of her work at the facility. In humility, Jane sat next to the nurse aides while examining patients to learn a few skills to jump-start her work. Whenever they had a mother in labor, she sometimes requested the nurse aides to be with her as she conducted the delivery. The nurse aides guided Jane through the delivery and baby care using the scarce resources available. Whenever there was a need to refer a mother to the nearest facility, the nurse aides accompanied the mothers with a delivery pack in case she needed to use it on the way.
Within a few months, Jane had gained confidence and was able to implement care according to her level of knowledge. She got more engaged in training the nurse aides on infection control, particularly in the maternity unit, and the use of standard protocols in the treatment of infectious diseases. Jane ensured that the laboratory was functional and equipped and advocated for pharmaceutical and other medical supplies from the district medical supplies store. Jane also attended district health management team meetings, where she aggressively advocated for her facility and community. Within a year and a half, the health center that was initially seeing around 100 patients per month, was reporting 500 outpatient cases and conducting an average of thirty deliveries each month. The facility had more clinical staff, including five nurses and one clinical officer. There were three monthly mobile clinics for mothers and children. Jane organized community mobilization to teach the community about infectious disease control, particularly malaria, Human Immunodeficiency Virus (HIV), and Tuberculosis (TB). The community members were made aware of the available services at the health facility and the need to seek healthcare when sick.
Majority of the nurses working in rural and marginalized communities in Kenya can identify with Jane’s story. Jane’s story depicts the situation under which many nurses work especially in most resource-poor settings where nurses have been forced to improvise in the most desperate situations to save their patients’ lives. In this time and age, this should never be happening, but nurses are out there trying to save lives amid limited resources, recycling what is not supposed to be, trying to promote access by providing urgent care to patients when needed. In the digital world, booming technology and globalization, healthcare entities need to be kind to nurses and take care of them. We need them 24/7, day and night. When a patient knocks at the door of a hospital, it is nurses who are often on duty waiting to help, never turning a patient away unless they are referring to the next facility.
We give special recognition to all nurses working in these situations and all other healthcare professionals for their fearless and resilient attitude that embodies their caring and unique calling to be community healthcare advocates. Many a time, nurses go unrecognized, especially those working in the remote parts of our country. Therefore, the timing for ‘the international year of the nurse and midwife’ cannot go unrecognized amid COVID-19, when the majority of frontline responders are nurses. Most of these nurses lack the personal protective equipment (PPE) needed for their patients’ care, putting their lives in danger. Many nurses, filled with compassion and a duty to serve, are out there saving lives. It is the responsibility of leaders of various healthcare entities to ensure that all healthcare providers are protected and cared for. Thus, we shall rest assured that our communities are safe as long as nurses are available, working, and happy. Congratulations nurses, God loves and cares for you all!