Global initiative aimed at teaching and training nurses in Malawi hospital Intensive care unit

One of the missions of the MGH Institute is to prepare the next generation of leaders who are ready to transform health care locally and globally. On July 16, three nursing students will take a significant step towards that goal when they fly to Africa and help educate nurses who are on the front lines of critical care.

The students – Leah Rothchild, Nicole Miller, and Sierra Gage -- will join Clinical Learning Lab Coordinator Jennifer Duran on a three-week trip as part of a Physicians for Peace trip that will have the IHP students help educate nurses in the adult ICU at Queen Elizabeth Hospital in Blantyre, Malawi.

“It's a real unique experience for our students to be able to have this opportunity during their education as future health care providers,” said Duran, who will be taking her fourth medical trip to Africa but first to Malawi. “It'll really improve their empathy and understanding and how they look at problems and propose solutions in the future. I think that it's going to strengthen them whether they work locally or internationally.”

Jen Duran
Jennifer Duran, IHP Clinical Learning Lab Coordinator, is taking three nursing students to Malawi to help educate hospital nurses; it’s part of a Physicians for Peace initiative.

The IHP team will assess what’s needed and proceed from there.

“The first thing that we're going to do is obtain baseline data - find out what type of care they're providing, what problems they're having, and any solutions that they foresee to help the problems,” said Duran. “Then we'll get to work with a plan. We have a lot of great educational offerings planned, but we don't know if they’re right until we get over there, meet the staff, and work alongside them.”

This type of experience has already changed the career trajectory for Rothchild, who accompanied Duran to Uganda last summer with the intention of pursuing pediatric mental health. But after enduring the death of a patient first-hand, Rothchild, a mother herself, decided she wanted a career in the neonatal intensive care unit.

This year, Rothchild will travel to Malawi as more of a mentor than student; she was invited by Physicians for Peace to participate as a Registered Nurse instead of as a student.

“I think that transition is really important because I'm able to help somebody else have that growing experience that I had,” said Rothchild, who is entering her final year of the direct-entry Master of Science in Nursing program. “I am really proud of my accomplishment of being licensed as an RN and being offered this experience by such an amazing organization.”

Leah Rothchild, a third-year direct-entry Master of Science in Nursing student, is part of an IHP contingent that will join Physicians for Peace to help educate Malawian nurses.

Duran, Rothchild, Gage, and Miller will be educating Malawian nurses about diabetes and ventilator management.

“I want to find out their baseline understanding of the functionality of the machines, their own understanding of the respiratory system, and meet them where they are,” said Duran, a nurse at MGH for the past 26 years. “I have a presentation ready to go but I don't know if it's appropriate until I start working alongside these nurses to find out if I’m meeting them at their education levels, so we will need to make adjustments when we're over there.”

Also, on the educational agenda is preeclampsia, one of the most common pregnancy-related diagnoses for African women. “One of the students has prepared a whole lecture around preeclampsia,” said Duran. “What kind of bacterial and viral infections are they encountering and what is the antibiotic availability?”

Hand hygiene will be another topic. “What do they have available as far as running water and soap? What is their understanding of risk factors for infection?” Duran. “We have a couple of fun activities. One of the students is going to lead a demonstration. We're going to bring over the germ gel with a black light and we're going to highlight how many germs actually stay on their hands even after hand washing just to demonstrate how important it is to properly wash hands to reduce risks to patients.”

Working in an adult ICU in a referral hospital where people will be sent from other healthcare locations, Duran and her student team expect to see a wide variety of ailments and complex issues, from diabetes to foot care to sepsis to patients on ventilators. And the team will help treat patients without the technological tools used in the United States.

“One of the things we hear a lot in our classes is, ‘Look at the patient, not the monitor.’ These machines aren't always right, and they don’t always give you the whole picture,” said Rothchild. “When you don't have these fancy monitors and fancy machines, it forces you to go back to the basics and really assess the patient and I think that that can really lead to better care when it's done correctly.”

Rothchild and her colleagues have already spoken to some of the lead nurses at Queen Elizabeth Hospital and have a solid idea of what they’ll be teaching and learning.

“I think there's a misconception with global health where people think it's going to be this unilateral knowledge transfer, where it's the people teaching are passing this knowledge into a new community,” said Rothchild, noting trips like this help attack disparities in global health by breaking down the barriers between cultures. “Where you’re born dictates so much about your life expectancy, your health, and your access to education and health care. So, when we're able to cross these borders, we're able to allow information and knowledge to flow across these borders as well. For so long, even with the existence of airplanes and global travel, we haven’t bridged the gap yet between education and health care.

“People have access to all these different foods and cuisines and language, and for some reason health care hasn't caught up,” she added. “I think that the more we do these trips, it's not about necessarily delivering care in that moment, but it's about slowly bridging these gaps and saying, ‘My version of health care doesn't have to exist within the boundary of Malawi,’ but that we can trade just like all other goods or services traded. We can trade our tips, trade our skills, and grow what we're able to offer everyone.”

While skills training will be offered, medical supplies will not.

”If I bring boxes and boxes of equipment that frequently gets stolen, lost, sold, or misused, those are tangible things that can be taken from them,” Duran said “But nobody is going to be able to take the skills that we're going to work with them on. We're hoping to elevate their nursing practice.”

Elevating by educating – a process both the Malawian and American nurses are sure to experience.

“I feel like nursing education is so powerful,” said Duran. “I love being able to see it in global health. I really enjoy teaching at the IHP, watching students go from very little knowledge to then becoming experts in a certain content area. So, I am really looking forward to experiencing that. As far as my Malawian colleagues, they're going to teach us things just as much as we’re going to teach them. It's not unilateral. We definitely will be learning from them as well. So, we’re really looking forward to that.”

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