Loise's Story
Loise Nzilani Muthami finds she thrives when under pressure. As Head Nurse at Makueni County Referral Hospital she strikes a balance between hospital oversight, including quality control, administration, and nurse management, as well as practice - assisting maternity nurses and providers on her ward with deliveries, and averting maternal complications as they arise. Yet despite its demands, she finds the role fulfilling; allowing her to stay closely in touch with day-to-day issues in the ward, whilst also being empowered to find and deploy the resources to practically address them.
Over the last decade, Loise has witnessed a number of concerted efforts to strengthen the advanced and primary level care for mums and babies across the county, including the establishment of a dedicated mother and child county hospital in 2018. Nine years ago, Makueni County had only three facilities providing comprehensive emergency obstetric and newborn care (EmONC), forcing mothers in need to travel long distances - often at the risk of their own lives. Now, the county has X. But there is still more to do.
In early 2019, Loise was among the first nurses in the county to be trained through Jacaranda’s EmONC mentorship program when it was introduced in her hospital. A initial baseline survey of her facility found significant gaps in the delivery of care in the hospital; the majority of maternity nurses were found to have little to no training in emergency care, making them ill equipped to deal with mother’s complications - such as cesarean section, postpartum hemorrhage (excessive bleeding after delivery), or birth asphyxia (when a baby is not receiving enough oxygen). A lack of documentation and monitoring meant low competencies had not previously been identified, a persistent issue reflected in the falling patient numbers at the facility. ‘When the Mentorship Program was introduced, we realized our team couldn't handle most complications during delivery’. explains Loise. ‘Some of our patients had stopped using the facility altogether, realizing that we couldn’t offer skilled birthing support to them - especially during an emergency.’
Alongside robust skills-training to avert complications, the Mentorship program takes a more holistic approach to building back mums’ confidence in the facility, and that of the nurses who serve them. ‘The program taught us how to better communicate with our patients, as well as offer respectful, dignified care.’ says Loise. She explains that gaps in nurses knowing how and when to communicate effectively with mums had dented critical trust between patient and provider, and mums had gone in search of other facilities to support them through pregnancy and delivery. ‘Strong communication and a good attitude is everything.’ says Loise with a smile. ‘You could be the most competent midwife in the world, but if you lack communication skills, you’ll lose your clients. If we make concerted efforts to improve our attitudes to mums, they’ll always use our services.’
Maintaining continuity of care is critical to better health outcomes; mums returning to the same facilities for antenatal and postnatal care build better relationships with the nurses who treat them, and their medical records are already on the system, and familiar to providers. But to achieve care continuity, the quality and dignity of care mums receive must be of a high level from the onset.
Loise has started to see a ripple effect in the program’s impact in her facility. ‘As the number of trained mentors increases, the more providers are gaining skills’. She excitedly explains. She explains frequent mentorship, whether within groups or one-on-one, has really encouraged nurses not to be complacent about what they already know, as well as being instrumental in routinely identifying skills gaps and tailoring training accordingly.
She alone has mentored forty providers, focusing first on clinical skills-building and then training them to be better problem-solvers and communicators. ‘Once a nurse and midwife knows when to intervene, how to document, how to partograph, and how to treat clients with respect, they are able to attend to most complications that arise.’ She says.
Loise looks forward to refreshing her own knowledge, and that of her providers, with ongoing mentorship as a key to continuing the upwards trajectory of patient numbers she's seen over the last two years. ‘The program has massively impacted our approach to attending emergencies and preventing mortalities.’ She explains. ‘It’s changed the way we think about service care and delivery. Suddenly, there’s a great deal more teamwork, as well as emergency preparedness in dealing with complications. Just like that - we’ve become competent.’