Thursday, 22 June 2017

Re-learning that ‘worn out tools’ are still the most reliable

From an NHS in ‘meltdown’ to domestic politics in turmoil and recent tragic news events, ‘crisis’ seems to be the word on everyone’s lips and certainly the media’s! Last month as I sat at Heathrow watching the BA screens turn black, just a week after being in the midst of a cyber-attack on the NHS, Rudyard Kipling’s famous lines came to mind; ‘If you can keep your head when all about you are losing theirs and blaming it on you’, I realised that I had already learnt that there is always another way of doing things.

The newly elected WHO Director General, Dr Tedros Adhanom Ghebreyesus, reminded us that the status of global health is in a far direr place; ‘still, half of our population doesn’t have access to healthcare.’

But why is this still the case and what can we do when our own NHS is struggling? Having proudly worked for the NHS for over 30 years and seen daily the dedication staff continue to apply, I feel a duty to stand up and say that things can change and I know at least one way to go about it. For a start we need to start listening and learning from each other and not just through echo-chambers between NHS departments, but exploring the way healthcare is done around the world.

In the last month, I have acquired first-hand experience of working in an NHS hospital during a cyber-attack, and of trying to board a BA flight on the day of a global IT problem.  These unrelated but equally disruptive events made me wonder what the NHS and the aviation industry could learn from our dependence on the idea that we know best. I came to the conclusion that the NHS, at least, could and should learn from hospital colleagues in lower income countries.

My hospital was not directly affected by the cyber-attack, and compared to some, the disruption was minimal. Others had big problems.  Hospital pharmacies and most other NHS departments are increasingly reliant on computers for pretty much everything.  In many hospitals in Africa, however, medicine bottles and boxes are labelled by hand and ward stock is accounted for by writing in ledgers using a pen. Many health facilities do of course have computers but power outages, surges, and internet issues mean they can’t always be relied on.

My recent experience volunteering in Mozambique with the DFID funded Health Partnership Scheme (HPS) has given me an alternative perspective, and as such I approached the challenges posed by the cyber-attack from a different angle to many of my colleagues. The Scheme’s emphasis on mutual learning, on teaching new  skills to our overseas counterparts whilst improving and furthering our own knowledge left me feeling that I gained more than I gave and as the attack continued, I began to realise just how crucial the experience had been. For a start, the lack of computers and inability to send and receive emails left me unfazed. We still had working telephones, after all. WhatsApp groups were also being used for general advice.

Although no IT expert (ask my colleagues!) I do see the need and great benefits of technology in the health sector, however given the increasing frequency of IT system failures, we must ensure our backup procedures are resilient.  Patients were both treated in hospitals and passengers flew on commercial airlines long before computers – it must be possible.

The HPS has given me the opportunity to think and learn differently, and develop and problem solve in ways I never thought possible. It has also given me new perspectives not only on my NHS role, but also on life in general.  In the grand scheme of things, complaining about a cancelled holiday (and missing by all accounts an excellent party), seemed a rather trivial first world problem.

In the last two weeks, the UK has been left not knowing which way to turn, and the NHS cyber-attack revealed our need to not forget the ‘worn out tools’. The NHS is considered the greatest learning institution in the world and a global leader on patient safety. We can learn a great deal from colleagues overseas and write in a few simple lines to our procedures reflecting how to best maintain a service, without the luxury of highly complex integrated IT systems.

“In the midst of chaos, partnership has been exemplified and is something I hope will continue to be championed. Certainly as I attended an event in Woodbridge on Sunday as part of ‘The Great Get Together Weekend’ in celebration of Jo Cox’s memory[1], it was clear in my mind, that these events, articles in the media and other joint contributions will continue to demonstrate the need for working and learning together and from each other wherever we come from and whatever our beliefs or established systems.

Sarah Cavanagh

Acting Director of the East Anglia Medicines Information Service, Ipswich Hospital 

Friday, 9 June 2017

From a New Director-General to Women Leaders in Global Health: A Week at the World Health Assembly

Andrew Jones, Head of Partnerships at THET was at the Assembly this year, with Graeme Chisholm, Volunteer Engagement Manager, and participated in events focusing on essential surgery, Universal Health Coverage (UHC), global health security and workforce strengthening and development. Here follows his round-up:

For the last two and a half years THET has been an NGO in official relations with the WHO, which allows us to work collaboratively on areas of common interest, defining a programme of work to suit those goals. One of the privileges it brings is the opportunity to attend the WHA in an official capacity.

Despite an extremely packed schedule and a plethora of events to choose from, I really enjoy attending the Assembly. After all it is a real melting pot of decision and policy makers – anyone who is anyone in global health is there – and it offers such a unique opportunity to network and raise the profile of THET in the global health community.

The WHA is at the forefront of global health initiatives as it is the formal decision making gathering of all of the member states of the WHO. The week has a very formal agenda which often leads to the passing of key resolutions which are then then given to the Director General and the Secretariat to implement. It is where a lot of global health policy decisions are made.

Last year for instance the ‘big piece’ was on Workforce Development 2030. The year before we had the resolution on Essential Surgery and Surgical Care. The difficulty for all if is that it is great to realise the global potential of resolutions and to have them passed but often the funds are not there to implement them and that’s the classic case with surgery at the moment.

Of course the week was dominated by the election of the new Director General Dr Tedros Adhanom Ghebreyesus  who THET are really proud to have worked with in the past within Ethiopia on the development of Non-Communicable Diseases programmes and partnerships. With his particular emphasis on UHC, something THET continues to advocate for, we are excited to see what the next five-years of the WHO will look like.

After the great excitement of the election, many of the themes that arose spoke to THET’s particular focus on workforce development from global health security and resilience to essential surgery. The official side events, provided a great opportunity for us and other NGOs to make official statements within the sessions which helped to identify potential collaborations and networking opportunities.

One of the highlights for me was the official side-event on “Scaling-up access to emergency and essential surgical, obstetric and anaesthesia care for better health systems and sustainable development”. During this session the Zambian government launched their National Surgical, Obstetric, and Anaesthesia Strategic Plan which THET and particularly our country office team in Zambia have helped to develop.

With our current KPI focus on understanding and furthering gender equality within health partnerships it was great to see so many sessions on women in global health. A particularly interesting session was on women leaders in health system strengthening, which featured a cross-sectoral panel who discussed the fight many women have faced in overcoming the many obstacles that stand in the way of progress in women’s leadership.

After a week of events, meetings and networking came to a close and as we look to renew our official relations status in 2018, the Assembly proved just as thought-provoking and vital in furthering the progress of global health actions, particularly for us in terms of collaboration with the WHO on global security, work force improvement, and surgery. 

Andrew Jones
Head of Partnerships

Maternal and Child Health: Breaking barriers in rural Uganda

Vincent Iusa is the manager of the St. Bernards Mannya Health Centre, situated in Masaka Province. Our colleague Edvige met him and his team in March 2017. Here’s the account of how the training he received through the Royal College of Paediatrics and Child Health (RCPCH) and the Kitovu Health Care Complex partnership - funded by THET - has changed the way he works and the experience of so many mothers in rural Uganda.

The sun was just beginning to rise over the eastern shore of Lake Victoria when our trip began. Destination: Mannya, a small village situated about 160km from Kampala. It takes us more than four hours to finally get there, through endless plantations of corn, coffee, tobacco, and forests shining emerald, mint and lime green, such as I had never seen before in Africa. It is clear to see how generously the Katonga River irrigates these lands.

On the way to Mannya we pass through a number of small villages: simple huts made of straw and wood, a well here and there, and many young women and children at the edge of the road, staring at us with curiosity, sometimes waving at our car. The last 9km are the worst: it rained only a couple of days ago and the road - more like a mudslide - is almost impassable. It gives us a taste of the kind of difficulties that people from the nearby villages have to face when seeking care at the Health Centre we are on our way to visit.

The buildings of St. Bernards do not look as I was expecting: the health centre is composed of about ten ordered small houses with sandy beige and scarlet walls, so similar to the colour of the land here. Elegant gardens and hedges surround the buildings. At the entrance, waiting for us is a very tall man, at first glance I estimate 6.5 feet probably. He has steady hands that he opens in a hug-like gesture to welcome us, and a calm smile. His name is Vincent, director of the centre and our guide for today.

Vincent, a clinician from Kampala, has been working in this rural area for four years now. His first words are filled with the sense of pride he has in showing us around and it becomes obvious how dedicated he is to his work. We start our visit. Vincent introduces us to his colleagues, mainly nurses and midwives, whilst explaining the activities of the centre and why offering maternal and child care services is so crucial in such an isolated area of the country.

“When I first arrived here, one of the main challenges was to convince pregnant women to even visit the centre! There are so many barriers involved. Fertility rate is high in the region.[1] When a mother delivers her first, second and even third child at home with no complications, she thinks that she doesn’t need any kind of support. Sometimes they would like to come here, but don’t have any means of transport and travelling would be either too long or too expensive for them. Sometimes they are just ashamed of their poor clothes. We have been working closely with the community to help these mothers to understand why it is important to seek care during pregnancy and after giving birth.”

The situation that Vincent describes seems to be very common in other areas of the country as well. As Theo, Clinical Officer at the Kitovu Health Care Complex, who accompanies us during our visit, explains:

“The fact is that today in Uganda only 42% of mothers are attended by skilled health workers. The cause is what we call here ‘the three delays’: one for socio-economic reasons; a second one for geographical barriers, and finally because once the mothers have finally decided to seek treatment they might not find a skilled health worker or a health worker at all!”

The training that Vincent received through the RCPCH-Kitovu partnership addressed this problem, by underlining the importance of building a relationship based on reciprocal trust with the patients.

“Mostly people were scared of coming to the centre. The training taught me how to speak to patients in the right way. And at the same time I could teach colleagues here how important it is to treat patients respectfully. Things are slowly changing. Women are more and more comfortable and have started appreciating the benefits of consulting a clinician when pregnant or after they deliver. They talk among them and for us this means that the number of patients we see regularly has been increasing, with incredible benefits for the whole community.'

To read the full case story please click here

Edvige Bordone
Communications Manager, THET

[1] Total fertility rate in Uganda was 5.8 in 2014 (Accessed online on 07/06/2017).