Getting to grips with THET's Resource Library.

THET’s Evaluation & Learning Officer, Emily Burn, guides us through the Resource Library on thet.org/hps and explains why it’s useful for those working in health partnerships.

The Resource Library of the Health Partnership Scheme website provides a unique range of materials to help health partnerships deliver diverse projects. Everything in the Resource Library is aimed at partnerships both new and old and we add to the content on a regular basis in order to make sure we are providing current and relevant information. 

The library includes publications, case studies and good practice guidance. For example, you’ll find the Monitoring and Evaluation planning template helps with rigorous, resource specific M&E plans; interviews with health workers from the Kambia District, gathered by The Kambia Appeal as part of their evaluation of their IHLFS grant; and case studies of IHLFS projects in Zambia and Uganda. 

Many of the resources we have published take inspiration from or are using your stories and experiences to educate and support others who are engaged in health partnership work.  For instance, we heard directly from both the UK and developing country partners about their experience of Health Links under the IHLFS and we have produced good practice guidelines and advice that cites the challenges and effective solutions they found.

We now need to hear from you: what do you want to see on the Resource Library pages?  We are always looking at templates and guidelines that help to make sense of key project planning activities, specifically in the context of health partnerships, but what else would you like to see here that will help you and your partners to work effectively together? Comment below or contact us directly at hps@thet.org

A Student's Perspective on Global Health

Christina Chandra is working as a communications intern for THET this summer. She is a senior at Yale University majoring in the History of Science, Medicine, and Public Health. In this blog, she reflects on her experiences with global health.

My interest in global health began in high school. For summer reading one year, I chose to read Mountains Beyond Mountains by Tracy Kidder. It was an inspirational story about Paul Farmer, a doctor and anthropologist who co-founded Partners in Health with some of his friends, including Jim Kim who is currently the president of the World Bank. For the next few years, Paul Farmer was my idol. I had always wanted to become a doctor, yet I could never decide on what kind of doctor I wanted to be. But now, I wanted to become a doctor who volunteered overseas part-time and specialised in infectious diseases, just like Paul Farmer.

Since I have been in college, I have realized how naïve I was. Although reading Mountains Beyond Mountains inspired me to develop my own convictions that health is a human right, I was naïve in thinking that the message of the book was that the world needed more doctors who volunteered overseas. I actually thought that was how impact would be made: by healing one patient at a time. Naturally, I became frustrated with not having the skills, expertise, or funds to do anything to help those suffering in a country miles and miles away from me. But then my perspective changed once I started taking classes on global health and joined the Yale Student Global Health and AIDS Coalition.

Through my coursework and experiences as a student AIDS activist, I learned that doctors alone could not rid the world of health inequalities and eliminate all barriers to healthcare. I also learned that institutional power played a major role in the health of nations, that global also means local, that inequalities in a society would be reflected in health inequalities, and that I had a role to play as a student. Since then, I’ve gone to actions and have met with my congressmen and community leaders to talk about both domestic and international health policy. What I love about global health is its strong roots in social justice. Global health is interconnected with advocacy for everything from LGBT rights, women’s rights, and minority and immigrant rights. Therefore, I have been able to engage in grassroots activities that have also encompassed many of the issues I care about.

These experiences brought me to where I am today, working as a communications intern for THET. I have only been at THET for a week, but I already have a strong sense of purpose within this organization. Every day I learn something new about how policies are implemented, how to successfully carry out programmes, and how a small NGO with global impact operates. It has been exciting to see what I have learned in my courses be put to practice at THET. Although I do not know what the future holds for me, I know that I will continue to be involved in global health work and my experience here at THET will be a valuable one.

I am very grateful to the THET team for making me feel welcome and for giving me this opportunity to learn and work with them.  I am looking forward to the rest of the summer together!

Nurses at the centre of stroke care in Ghana

The Wessex-Stroke Partnership was established in 2009, supported with funding from THET’s Health Partnership Scheme. The partnership works collaboratively to support the development of stroke care in Ghana at the Korle Bu Teaching Hospital (KBTH), Accra.  Stroke is the second biggest cause of death in greater Accra, only preceded by Malaria (de-Graft Aikins, 2007).

In this blog, senior nurse, Colleen Lloyd, describes her experience volunteering with the partnership.

I felt very privileged to get involved with the partnership, and it was the start of an amazing journey with the Ghanaian nursing team. My first day on the wards at KBTH was a very humbling experience. I was used to working in UK hospitals with a great deal of resources, so I admired greatly the dedication of the Ghanaian nurses who worked with little resources, relying on their personal skills and whatever patient’s families could afford to care for patients.  Consequently, all aspects of my UK practice had to be re-thought and adapted to be meaningful in Ghana. And to match the compassion, dignity and a genuine passion for the role that the nurses had, which was very evident at all levels.

The UK nursing team, working alongside a multidisciplinary team, established nursing stroke skills on the medical wards at KBTH. The four clinical areas identified for development were swallowing, positioning, communication and continence.

The Ghanaian lead nurse was very welcoming and receptive to learning and improving her patient’s outcomes.  It was apparent from the outset that the goals would be small and very specific.

Dysphagia (swallowing problems) training was initially undertaken on a one-to-one basis using the train the trainer model.  The Ghanaian team had no experience of swallow assessments or the risk of aspiration despite pneumonia being very common in stroke patients in Ghana.  Having observed the patients being fed on my first day, I asked to meet the dietitian  Once I had explained the rationale behind our teaching, the response was amazing.  We looked at local foods which were cheaply available to families and adapted the various foods and fluids to suit the consistency required. The following day the lead stroke nurse proudly showed me her nursing team feeding patients the appropriate diets in the correct position.

All stroke patients admitted to the medical wards now have access to a stroke diet provided by the hospital kitchen. A major step in a very short time.

The importance of supporting families to understand the impact of stroke was also a key development aim. We produced a secondary prevention leaflet, which the lead nurse distributed during family meetings.

Funding has now been secured locally for the publication of this leaflet, which will be used to educate families of stroke patients and, hopefully, further influence families in the community. 

The lead nurse has a comprehensive learning log evidencing her learning as do all Ghanaian nurses who complete the training in the four stated clinical skills.  She also leads dedicated training sessions to all medical wards within KBTH and has visited other hospitals in Accra.

The stoke profile has been raised considerably at the hospital and a dedicated stroke unit at KBTH is due to open very soon.

I would strongly recommend working with an overseas health partnership. It is one of the most rewarding challenges a nurse can accept.

Colleen Lloyd (right) with Ghanaian consultant and team physio.

Visit the THET website to find out more about the Wessex-Stroke Partnership.

Preventing Malaria in Sierra Leone

In this blog post, Dr. Suzanne Howell, volunteer at the Kambia District Hospital, Sierra Leone, for The Kambia Appeal, shares her experience of treating children with Malaria.

The Kambia Appeal, which received a grant under THET's Health Partnership Scheme, aims to send 30 long-term, UK health worker volunteers to Kambia to improve health outcomes and quality of healthcare delivery within the Kambia District.

Preventing Malaria in Sierra Leone

I was working in the northern province of Sierra Leone for the last 6 months as a volunteer for The Kambia Appeal, and dutifully took my antimalarial tablets everyday as instructed.  For the majority of the people in this part of the world malaria isn't just the annoyance of taking a daily pill, it's the reason you have extra children.  I arrived in the middle of the rainy season in Kambia District when malaria was at a peak. Young children were being admitted to the ward in great numbers and dying on a near daily basis just in this small area.  It was very distressing to see these little ones arrive so sick, but such a joy to see the effects that a few medical supplies and the simple care of incredibly hard working nurses can make.  Unfortunately, children can deteriorate very rapidly and mothers went to unimaginable lengths to try to save their children, but everything is against them getting to hospital in time.

Through the shared sadness with these families, the local hospital staff and I were encouraged to promote simple malaria prevention education, so that families would know how to prevent the deaths of more beautiful children and present a united message that malaria does not need to be a way of life. The parents who care so much for their kids have a huge role to play in stopping this disease.  

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www.kambia.org.uk

Strengthening Palliative Care in 4 African Countries

Dr. Liz Grant from the University of Edinburgh discusses the burden of cancer, partnership and improving palliative care in sub-Saharan Africa.


We are all born equal but into very unequal circumstances.  And we all die. And, like birth, the circumstances and the experiences of dying across the globe are markedly different.  Despite good analgesia and good care systems to enable people to live towards death in as pain free and comfortable a way as possible, an estimated three quarters of the world’s population do not die well. Many in low income countries fail to receive any diagnosis of illness. They die in pain, unsure of what is happening, unclear of what is curable, what is treatable, and what is inevitable. Dying is also costly. Many spend their money ‘forever searching for cures and never finding them.' The process of dying can drain families’ incomes, destroy life chances of children getting educated (as school fees are not paid), while farm land and farm animals have to be sold to in the hope that the money raised will be enough to make a loved one better.  

The burden of cancer looms large. With an estimated 600,000 men, women and children dying from cancer last year in Africa alone, less than 1% of them are able to access any specific cancer treatments. The most common cancers recorded in Africa are cervical cancer, breast cancer, and cancer of the liver and prostate, alongside Kaposi's sarcoma and non-Hodgkin's lymphoma.  The global consumption of morphine, one of the cheapest, most powerful and effective analgesics is centred in high income countries with North America, Europe, Australia, New Zealand and Japan consuming 92% of morphine in 2008.  Less than 0.3% of morphine was available in Africa.  

Though globally there are a number of shared risk factors leading to cancer such as tobacco, sexual activity, alcohol and obesity, the causes of a significant proportion of the burden of cancer in low income countries appears to be linked to poverty and injustice, where those most vulnerable are exposed to most risks: sexually transmitted HPV-infection, urban air pollution and exposure to indoor smoke from charcoal and other fuels burned in cooking. 

Set alongside these risks are chronic health and social care system failures which result in the failure of many cancers to be detected early enough for effective interventions. As well as the failure of on-going treatment plans to alleviate suffering and stave the progress of the disease. Ultimately there is the unacceptable failure to provide care as patients move towards the end of their lives. Many die screaming from searing, constant pain. The words of one woman dying of breast cancer in Kenya speak of a terrible injustice. Speaking of her pain she explained, ‘I want to go to sleep and wake up dead.'

In April 2012 THET funded an extraordinary programme focussed on building and integrating palliative care into the health systems of four countries in Sub Saharan Africa. The University of Edinburgh, the African Palliative Care Association (APCA) and Makerere University Palliative Care Unit are working in partnership to strengthen current palliative care programmes in Kenya, Rwanda Uganda and Zambia. Guided by the Ministry of Health in each country, and working through the excellent National Associations of Palliative care, the programme is setting up additional training in palliative care approaches. In practices they are training link nurses and hospital and community staff in key areas such as symptom relief and holistic pain assessment.

Twelve hospitals, three in each country, are being tasked to model a new form of palliative care, comprehensive palliative care that does not stop at one disease. This care recognises that the patient rather than the illness determines the care needs, and builds on the importance of engagement from a multi-disciplinary team, and response from nurses, clinical officers, clinic and hospital based renal physicians, obstetricians and gynaecologists, paediatricians, cardiologists, diabetologists, internal physicians, surgeons, pharmacy and  social workers and laboratory technicians. They all play a role in proving, enabling and supporting care systems. Systems that enable timely identification of illnesses that are life limiting, identification of the right pain control and symptom management, and  holistic care that supports patients emotional, social and spiritual needs as well as their physical needs.    

As one Chief Executive of a hospital engaged in the programme explained, ‘up until now we sent home patients who were dying, with the words “discharged to hospice at home” knowing that there was nothing more we could do in hospital, but also knowing that there was no hospice at home.  It was our way of coping.' He explained that now things were different. Through the programme a system of comprehensive care is being built. A system that establishes a pathway of care for all those with palliative care needs that includes an assessment of physical, social and spiritual needs, and ensures that patients are not just neglected or lost from care.  


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A Health Systems Strengthening project between the Mildmay Mission Hospital and the Kilimanjaro Christian Medical College delivers pioneering HIV services.

Andrew Main describes the life changing work that the health partnership between Mildmay Mission Hospital and the Kilimanjaro Christian Medical College are doing for those affected by HIV and AIDS.

When I think of Tanzania I think of Africa’s highest mountain - the snow-capped Mount Kilimanjaro that attracts so many visitors to the region and forms an imposing backdrop to the town of Moshi. I think of a people, warm and friendly, and proud of a rich cultural heritage. I also think of those challenged by the effects of HIV/AIDS in a land where the prevalence rate is 5.6% and 1.4 million infected people (2009 est.)  

Mildmay International delivers pioneering HIV services, and in Tanzania the focus is on training and health systems strengthening, in particular for orphans, vulnerable children and prisoners. The partnership with the Kilimanjaro Christian Medical College (KCMC) in Moshi supports a diploma course focusing on health systems strengthening. The programme is based on Mildmay’s own course, validated by the University of Manchester, and on our experience of facilitating a similar programme in the Kenya Medical Training Colleges.  

As a health and social care educator, with many years’ experience in nursing education and education management, I share my knowledge and experience as joint project leader with my colleague, the Dean of the School of Nursing at KCMC. I have learned much through the partnership and get satisfaction and motivation from seeing the achievements of the students and the contribution they make to their communities as a result of the course.

With the support of funding through THET, Mildmay has supported the development of the infrastructure at KCMC with up to date text books and a computer suite giving students access to the internet.

Teaching and learning workshops focusing on adult approaches to learning for KCMC staff have been shared with teachers from other faculties. Staff have also improved their knowledge of HIV in order to teach the programme. The Dean says that the whole process has been an ‘eye opener’.

The approach is appreciated by students who in turn use the knowledge and approaches in their own work. They also share their learning with professional colleagues, as one student illustrated when he told me that he ‘shares his knowledge with his fellow priests’.

Another, working in Karanga Prison, Moshi, set up a support group for HIV positive prisoners. Using Action Learning learned through the course he facilitates prisoners to address their own issues. He also set up an outreach service for community prison workers and prisoners families to provide food for the families.

Whilst KCMC benefits from Mildmay’s practical experience of supporting communities to manage the challenges of the disease, Mildmay has been able to sponsor a number of course participants from its own key project areas, and benefits from the academic training these health workers receive.

This is a very important project with great potential to support health systems development not only for those living with or affected by HIV but also to meet wider health care needs of the community. Whilst the course clearly strengthens Mildmay’s work it also has a wider reach in terms of capacity building in the country and KCMC is in strong position to cascade the course throughout Tanzania.  

Reflections On Mental Health In Somaliland

In this blog, Dr. Peter Hughes, Consultant Psychiatrist, looks back at his involvement in the Kings, THET, Somaliland Project and the impact it’s had on mental health care in Somaliland.

I’m writing this piece on World Mental Health Day, which seems an ideal time to reflect on the progress of the Kings, THET, Somaliland Project (KTPS) and its impact on mental health care in Somaliland.

I came across KTSP by chance. An acquaintance, I can’t remember who but I’m grateful for their prompting, knew of my work in Malawi and Ghana and suggested that I get in touch with KTSP. This sparked an association with the project that started in 2008 and continues today.

I was lucky to be on the first mental health training trips to Somaliland and, since then, I’ve been on seven more. In this time, I’ve been able to see the changes and the great deal that’s been achieved in mental health care, achievements that KTSP and our Somaliland colleagues can be proud of.

I barely knew anything about this self-proclaimed independent state when I set off on my first volunteering experience. The combination of a war that ravaged the country and extreme poverty meant there was barely any health infrastructure, and mental health was not on the map at all before 2008.

When I arrived in the capital of Somaliland, Hargeisa, it was hot and dusty, the streets crowded and markets bustling. Somalilanders walked tall and erect; all women wore traditional Somali hijab; goats were seen everywhere and Qat, the local amphetamine based drug, sold on stalls on every street corner. The place is exotic and exciting.

On my first trip, I took on the role of teaching the graduate doctors. I’ve had quite a bit of experience with international teaching so was able to put my skills into practice. I taught six interns who had no previous training and got them up to speed on mental health. I’ve seen them many times on my trips to Somaliland and have followed up their progress with interest.  I’m proud of their continuing aptitude for the mental health aspects of clinical care. One of the interns is now working on the mental health ward in Hargeisa. 

Since that initial trip, it has been a process of fine-tuning the teaching programmes. We have added areas such as ethics, developed a culturally appropriate bank of Somali cases, and more recently introduced the WHO mental health curriculum.

The training in nursing and other specialities has similarly developed over the years with KTSP. I did training for nurse tutors during one trip and it is immensely satisfying to hear from my former students now working and teaching themselves. I hear from them regularly on Skype and they tell me about cases they see now and how they are now teaching.

During my time in Somaliland I have seen cases of autism that were never diagnosed previously, depression, mania, and somatic problems. What is most difficult are when the problems are born out of poverty or gender inequality. If you leave the main towns of Hargeisa, Boroma, Berbera or Burao there are absolutely no provisions for the mentally ill.

There was a lot to learn along the way about Somaliland culture. Everything is prismed through religion. Religion is a hugely important psychosocial aspect of all mental health and we learned ways over the years as to how our students would address this. Gender is a huge issue too and women have a very different and challenging life in Somaliland. Qat, or Khat, use in Somaliland also badly affects Somaliland society in terms of economic, mental health and family life. 

When I first arrived at the Hargeisa Group Hospital there was one mental health ward. The conditions were horrible and all staff there recognised this. The care was not good and clear violations of human rights; most of the male patients in the male ward were chained up.  Now five years later there is hardly any chaining and there is professional nursing and medical input on the ward. We’ve been able to use this experience as a base for our teaching of medical students.

In my most recent teaching programme, in May 2012, I went with a core trainee, Lauren Gavaghan. It is so important for trainees to get this experience and bring a new energy and freshness to the project. We had two Somaliland graduates who were our co-lecturers. These co-lecturers directly delivered 40% of the teaching to the undergraduate group and indirectly facilitated role-plays, clinical sessions and all other aspects of the teaching.

One can’t talk about the KTSP experience without talking about Edna Aden and her hospital. Edna has created this maternity hospital out of nothing and it really is a place of excellence. The hospital also provides support including mental health support to their nurse trainees and midwives. Edna is a hugely inspirational character in Somaliland in advocating for the health of women and is very accepting of the need for good mental health.

Mental health is now very much on the map in Somaliland thanks to KTSP and the doctors and nurses who have gone through our teachings.  We have invested in young, professional Somalilanders to support them with their future careers; we have Dr. Jibriil in Boroma and Dr. Abdirizak in Hargeisa who are now local leaders and providers of mental health care; mental health is now delivered in hospital, community, maternity settings and prison; supervision is embedded from UK to undergraduate and postgraduate doctors and nurses. There is a lot to be positive about. We have come a long way from August 2008 and long may it continue and prosper further.