Stories from the Field

Strengthening Community Health Services In A Nurse-Driven Health System

Leribe district, Lesotho

During the first mentoring visit to one of our clinics, our nurse participant saw a man recently started on TB meds who had returned for another counseling session for ARV’s. He was gaunt, dehydrated, and could barely walk. Our nurse started an IV after three unsuccessful tries, put him to bed, and eventually our nurse educator drove him to the hospital for admission.

Our nurse participant then had to deal with a young woman who had a retained placenta for three and a half hours and was bleeding because no other nurse in the clinic was checking in on her. The only blood pressure cuff in the room was new and still in the box, which meant that no one had checked her blood pressure. The driver had gone out with the ambulance, and although he was in a nearby town, he took more than an hour to arrive.

During this time there were at least 80 patients in the waiting room to be seen by our nurse participant .

This is the daily reality for many nurses in health centers in Lesotho.  They are understaffed, under resourced, and incredibly busy.  LeBoHA’s program works with nurses on-site and helps them improve their situation, their system and the quality of care they provide.

At the end of the day described above, our nurse educator pulled the nurse participant aside and told her she was doing a remarkable job with little resources and that she understood how difficult it must be at times. The nurse responded that LeBoHA’s classes were ‘helping me a lot…I used to hate OPD [out-patient department], but now I am beginning to understand more of what I can do.’

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After six weeks of training and mentoring, great improvements have been seen at the clinics.  At another site visited during mentoring, all patients in the waiting room had vital signs.  A Nursing Assistant was in the Waiting room triaging patients and the 2 patients who were classified as critically ill were seen first.  This is a huge change at this clinic. Previously, no vitals were done unless the nurse did them in the consultation room, and most medical records simply said ‘cough’ and a list of medications.

At another small health center visited after 6 weeks of training and mentoring, about 35 patients were lined up by 8:30am. It was very organized: the few kids in line all had temperature recorded; all adults had blood pressure and pulse. After morning prayer (sung and in harmony), our nurse participant gave an interactive 40-minute talk on HIV, TB, Hypertension and diabetes.

These small acts, such as triaging, taking vital signs, organizing incoming patients, and giving health talks, may seem routine to most people.  But in situations like Lesotho, where a nurse must see one hundred patients with limited resources and limited support, these are often the tasks that fall through the cracks.  By empowering our nurse participants to address these issues, LeBoHA is working to make health centers a better place for nurses and patients alike.

Strengthening District Hospitals and Health Centres in Lesotho: The Family Medicine Specialty Training Program

During his work with the Maternity Quality Improvement Project at Motebang Hospital, Dr Machai [a second year registrar in the Family Medicine Specialty Training Program] became aware of the urgent need for improved care of high- risk prenatal patients in order to decrease pregnancy associated complications and the maternal mortality rate. He led the multidisciplinary QI committee in establishing criteria for high-risk women and gave a series of presentations to the hospital staff.  As a result of these efforts the Maternal and Child Health nurses were trained in the identification of high-risk pregnancies and a mechanism was set up to refer these mothers to the appropriate Motebang physicians.

Dr. Malope  [a third year registrar in the Family Medicine Specialty Training Program] gave a series of trainings in managing a complication of delivery – shoulder dystocia. He trained nurses on the maternity ward and at the Maputsoe filter clinic. The day after he trained the nurses at the filter clinic they delivered a woman with shoulder dystocia and managed her successfully. The nurses were excited about their skills and competency.