FEATURES

Worldview 2008: A global nursing perspective

Team Morocco: Nurses helping nurses

by Kim Ann Guth

How did I find myself serving with a humanitarian team in Morocco? I wasn’t even sure where Morocco was, except that it was somewhere in northern Africa. But my friend and fellow nurse, Wafa Bennani, RN, BSN, convinced me that this was where we should go for the first humanitarian nursing trip sponsored by the Upsilon Beta Chapter of the Honor Society of Nursing, Sigma Theta Tau International.

Bennani is an experienced neonatal nurse, and I am a nurse-midwife and lactation consultant. We first became friends when we were BSN students at California State University, Fullerton, and we worked together to establish an honor society chapter on our campus.

After our chapter was chartered, we wanted to do something to promote the vision of Sigma Theta Tau International. It wasn’t enough just to be a member of an international honor society; we felt it was important to work toward advancing the honor society’s mission and goals. We wanted to be part of a global community of nurse leaders using our knowledge and resources to serve others. This was a big vision. Where should we start?

Our first step was to form a committee to pursue our dream of worldwide outreach. We named it the International Nursing Scholarship Committee. We then persevered through two years of growing the committee and developing plans for future nursing missions.

From the beginning, our vision was to reach out to nurses in need throughout the world. This differs from most humanitarian mission efforts in that we wanted to provide support directly to nurses in developing countries. We wanted to help nurses help themselves by providing education, training and support. Our main goal was to improve patient care through building leadership skills and sharing scholarly materials with nurses who want to improve their practice. We chose Morocco as the country for our first project.

In 2005 and 2006, Bennani visited the Children’s Hospital of Rabat, Morocco, to identify potential needs and to meet with neonatal nurses. She found them eager for support as they shared their ideas about improving patient care. The hospital itself had many desperate needs and lacked resources of every kind.

Utilizing Bennani’s assessments, the committee developed a plan for our first trip. Our newly formed Morocco Mission Team expanded to include Upsilon Beta members Lisa Bretches, RN, BSN, IBCLC, a lactation consultant, and Deborah Byrum, RN, BSN, CCM, an oncology nurse case manager.

We were not alone in our efforts. St. Jude Children’s Research Hospital Foundation helped us by sponsoring the travel costs of several team members and providing infection-control training materials. We raised funds to support our mission and collected more than 500 pounds of donated medical supplies and nursing textbooks. Seven months later, on Oct. 29, 2007, our team of four nurses left for Morocco with nine large duffel bags and six carry-on bags filled to capacity. For the next two weeks, we would deliver medical supplies and provide training to nurses and medical staff of the two major public hospitals in the cities of Rabat and Casablanca.

When we arrived in Casablanca, we were greeted by Wafa Bennani’s family, our hosts while in Morocco. They welcomed us with exotic Moroccan food and showered us with kindness at every turn. Arabic is the native language in Morocco, and French is the academic language, so we needed a lot of help to communicate. Our main tour guide and translator was Wafa’s Aunt Fouzia. She was indispensable, explaining the culture and translating as we toured the hospitals and taught nurses.

Our first day in Casablanca, we visited two orphanages, one for disabled children and adults ranging in age from 4 to 35, the other for abandoned orphans from infancy through age 3. The ratio of infants in cribs to caregiver was 40-to-1. Even though the caregivers took good care of the children, we were moved by their hunger for attention and affection. Language and cultural barriers meant nothing to them; a smiling face and open arms were all they wanted as they climbed into our laps. The orphanage directors explained that they needed sponsors for the children while they await adoption.

The remainder of the trip was spent at the hospitals in Rabat and Casablanca. Our team offered programs in neonatal resuscitation (NRP), oncology, infection control and lactation. We also assessed the level of nursing care in these areas to determine needs for future missions. We were well-received by the nurses and doctors, and we established many good relationships with staff members, clinical educators and members of the nursing faculty.

We were privileged to meet the Rabat Ministry of Health nursing director. He was very interested in our mission and promised to facilitate future outreach efforts. He explained that, while physicians are provided some ongoing training, resources for nurses are lacking.

We spent a lot of time just listening as the nurses described working conditions in their hospitals. Nurses in Morocco struggle with many of the same issues we face in the United States, but on a much larger scale. The nursing shortage in Morocco is extreme. While the Children’s Hospital of Rabat needs 296 new nurses, the Ministry of Health has budgeted for only 15. The patient-to-nurse ratio in the oncology unit sometimes reaches 30-to-1.

The hospital environment poses risks to the staff, as well. During our tour of the oncology unit, we discovered that many nurses have become ill because chemotherapy medications are mixed beneath a nonfunctioning vent hood. There were more problems than we could fix in one visit, but we were determined to make a difference. Fixing the vent hood to protect the health of the nursing staff was high on our list. Since returning to the United States, we have been working with St. Jude Research Hospital to correct this problem.

One of our main goals was to provide basic infection-control information. We knew that nosocomial infection rates at both hospitals were very high. To reinforce the hospital’s new infection-control program, we gave a hand-hygiene presentation to 140 doctors and nurses, stressing the link between high nosocomial rates and basic hand hygiene. It was really something to see a roomful of nurses and doctors singing “Happy Birthday” in Arabic as they practiced the hand-washing techniques we had just taught them!

Hand-hygiene training was not enough, however, as most units didn’t have soap, water and paper towels available. Lack of basic resources is a huge barrier to effective, safe, quality health care in developing countries. For the infection-control program to be fully effective, we needed to provide the necessary resources.

We donated wall dispensers for hand sanitizer to the oncology unit, along with a three-month supply of alcohol-based hand gel. The hygiene information we provided will be disseminated by the nursing staff using flip charts we brought with us. Nurses were selected to gather data on hand-washing compliance by the oncology staff, and an infection-control committee was established at each hospital. We plan to follow up when we visit next year by utilizing length-of-stay data as a key determinant of nosocomial infection rates.

With the aid of translators, each team member helped teach classes to the nursing staff. Bennani taught neonatal resuscitation and neonate pain management to NICU nurses. Another exciting thing that happened is that we met the director of Operation Smile Morocco. That organization provided us with CPR mannequins and, in return, two of their nurses joined Bennani’s NRP class. We agreed to work together on future projects.

One of our most satisfying experiences occurred on the final day of the NRP class in Casablanca. During the return resuscitation demonstration, a baby suffering from severe respiratory distress was brought in. The nurses were able to use their new skills in a real-life situation to stabilize the infant. After returning to the United States, we learned that the baby survived and was later discharged. This opportunity to put their skills in action gave the nurses a real sense of accomplishment and showed them the possibilities that lie ahead.

As an experienced oncology nurse, Debbie Byrum presented classes on line care, oncologic emergencies and side effects of chemotherapy. Even though we all struggled with cultural and language barriers, the nurses were eager for information, and they invited Byrum to return next year to provide more in-depth oncology training.

Lisa Bretches and I toured the maternity units and the NICU, providing lactation information, demonstrating the use and importance of breast pumps for feeding premature neonates, and instructing nurses on proper wrapping and positioning of infants in incubators. We distributed medical supplies and scores of nursing textbooks that we brought with us. On our last day in Rabat, we presented hospital administrators with an automated external defibrillator (AED). The hospital did not have a defibrillator, and the staff was thrilled to receive it. Imagine the lives that will be saved!

All of our efforts were received with deep appreciation. The nurses we trained promised to disseminate what they learned to other nurses on their units. We gave educational posters of each program we taught to the staff for use as teaching tools. We are sure that all of the medical supplies we lugged halfway around the world will be used to save lives. The nursing textbooks we brought were given to class participants as gifts and to reinforce their learning. Everything we did for the nurses will improve the quality of their nursing practice and make a difference in the lives of the patients they care for.

The nurses in Morocco asked us to come back to provide additional nurse education and leadership training, and to support their ongoing efforts to improve their practice. We invite you to join us in our efforts to help nurses worldwide. For more information, contact the International Nursing Scholarship Committee, Upsilon Beta Chapter. E-mail me at kimguth@sbcglobal.net. RNL

Kim Ann Guth, RN, MSN, CNM, IBCLC, is a lactation consultant and prenatal educator at St. Joseph Hospital, Orange, California, USA, and lives in Fullerton.