How two weeks changed my professional life

One of the fundamental objectives of the project is to achieve improved quality of health care, in particular MNCAH, through capacity building of health care providers (HCPs). One of the trainees selected was Ms. Abida Jiskani, a Lady Health Visitor (kind of community nurse following two years training), who received two weeks of training at an AKU secondary hospital in Kharadar, Karachi.

Meet Abida – the Lady Health Visitor from Dadu

Abida lives in the catchment population of Taluka Head Quarter (THQ) hospital. She aspired to become a doctor when she was a young child, but could not pursue her dream, and instead decided to continue her career as a Lady Health Visitor (LHV) to devote herself to the service of marginalized communities around her. After completing a two-year long course from a public health school in Hyderabad, Sindh, she began working at THQ Johi hospital, and practiced there for more than twenty years. Since then, she has been providing health care services to the community of Taluka Johi.

Overtime, her responsibilities increased day by day and she started conducting deliveries by herself along with providing other maternal and newborn services. Though she was able to do her job independently, there were no formal professional development, training, learning opportunities, or on-the-job supervision in the hospital system, limiting her access to modern knowledge, skills, and techniques. Despite these barriers, she continued to provide much-needed services to the best of her abilities.

A relatively short training session with great effect on the quality of health care

The capacity building training helped her realize the importance of obtaining informed consent in every patient encounter. In her daily practice, sometimes she would obtain blanket consent from the patients or their attendants instead of informed consent. Additionally, high patient load and time constraints would occasionally hinder her from informing patients about possible complications of delivery and other procedures in detail. Following the training, she now believes that regardless of the circumstances, her patients have the right to be provided due information and as their health care provider, it is her duty to educate them and follow the standard protocols she learned through this training.

She suggested this training to be arranged for other nurses and LHVs to update their knowledge so that they can contribute to reducing preventable maternal, neonatal, and child deaths.

She found this training instrumental in reviving foundational knowledge and skills and teaching her more advanced care, enabling her to deliver quality maternal, neonatal and child health services. She mentioned that the capacity building training was an opportunity to reinforce following:

• Importance of screening during pregnancy
• Maintaining a patient-centered approach to consultation. For example, when patients in her community visit a health facility, they tend to be anxious, so it is extremely important for the health care providers to receive them respectfully and listen to their problems carefully and empathically.
• Importance of implementation of infection prevention protocols. For example, being more mindful of using separate instruments for every patient and ensuring high-level disinfection in the same way she observed in AKU hospital as part of her training.
• Maintaining the partograph which was not her usual practice to monitor the process of labor which enabled her to be alert and take an action.
• To be able to manage eclampsia, postpartum hemorrhage (PPH), and puerperal sepsis independently and confidently
• Performing episiotomies if indicated
• Essential newborn care especially the golden minute technique to help baby breath

She added that after this training, she has started to protect herself more vigilantly. As of now, she makes sure that she has soaps and hand sanitizers available whenever she is in the hospital. Abida said that this training has also enhanced her understanding of how to ensure continuity of care when handing over her patient’s care to the incoming health care provider colleague at the end of her shift. She ensures that she provides a comprehensive medical history, as well as the treatment provided so far, and the care needed in the future. She said her practices and behavior have improved now and with the support of the other two colleagues, who received the same training by this project, the newly learned knowledge and skills, and protocols are being shared and implemented in the hospital.

She was very happy to share that this knowledge refresher and the simple techniques she learnt have given her the confidence and motivation to deliver quality services professionally. She suggested this training to be arranged for other nurses and LHVs to update their knowledge so that they can contribute to reducing preventable maternal, neonatal, and child deaths. (Interviewed by Dr. ShahmuhammadJhokio; Aga Khan University, Pakistan)