EDEN AID - Promoting Social Justice





During the month of June, 2009, I volunteered in the AYDER Hospital in the town of Mekele in Ethiopia. Contact with the hospital was made through Professor Shlomo Ma'ayan from Hadassah Hospital in Jerusalem; he has been associated with the hospital through a center for treating AIDS and has initiated training programs for doctors with funding from the PEPFAR program. The trip itself was made possible with the assistance of "Havatzelet", the humanitarian fund of the kibbutz movement, and of Kibbutz YOTVATA. I was invited to the AYDER Referral Hospital in Mekele, Ethiopia, by the director of the hospital, Dr. Muhammed Abdulkadir. The purpose of the visit was to inculcate standards and methods in nursing practice.

Ayder is a university hospital belonging to the University of Mekele. The School of Health Sciences includes a medical school, a nursing school, a school of pharmacy and a school for health officers.

The hospital opened a year ago. It has 470 beds, but only 216 of these are active. The hospital has an Emergency Room, and departments of Internal Medicine, Surgery, Gynecology & Obstetrics, Pediatrics and Dermatology. It has surgical theaters, delivery rooms, an intensive care unit for adults, a premature infant unit, outpatient clinics, a pharmacy, laboratories and an X-ray and imaging department.

The hospital has a staff of 140 nurses under the leadership of a head nurse; all of the nurses, with the exception of one with an academic background, are practical ("Diploma") nurses. There are 25 doctors who are specialists.

Ayder Hospital Mekele EthiopiaThe hospital serves as the tertiary hospital for Tigray region's residents, who number 7 million.

The vision of the hospital is to be a leader in the quality of medical practice and quality of service. One of its goals is to be the first hospital in East Africa to be able to provide kidney transplant operations.
A team sponsored by the Clinton Fund assisted in preparing and building an infrastructure for personnel in the hospital prior to its opening. With its guidance a booklet "Nursing Standards and Practice Protocols" was written, and this was to be the basis for nursing work in the hospital.
However, after the booklet was prepared, the staff was unable to implement the instructions. There was a considerable gap between the level of nursing practice in the hospital and acceptable standards.

The deficits were in basic levels of nursing and also in professional areas such as infections prevention, midwifery and emergency medicine.

During the period I was in the hospital I helped the nursing staff to build a work program that was possible to implement to promote significant professional advancement of the personnel. The contents included the following areas: discipline and appearance, patient's safety, infections prevention, record (using standard nursing tools), expanding knowledge and skills, and teamwork.

The program featured immediate steps that were absorbed and put into practice during my visit, and other short and long-term steps that depend upon outside support and funding.
Nurses training Ayder Hospital
"In-service training" was proposed to the nurses, in cooperation with the medical specialists, most of whom had undergone training outside of Ethiopia, notably some in Israel. Still, there are limits to how much can be accomplished in a short visit, and in order to implement real change there is need of an additional program to be certain the lessons have been assimilated and applied over a long period.

I propose sending a team of three nurses in the relevant fields mentioned for a period of 3-4 weeks each, throughout a period of at least one year. The nurses chosen should have considerable broad knowledge and be able to promote additional nursing subjects as needed. It is important to send a team (not just a single nurse each time). This would provide a "support group" and ensure better adaptability and perseverance. Conditions are not easy in Mekele and being part of a group will make the challenge of being there less demanding.

Similarly, from the point of view of the professional challenge, a team can more conveniently provide guidance and workshops and achieve results. The nurses could also contribute to the nursing school adjacent to the hospital. The nurses would work in the Ayder hospital on a volunteer basis, on their own vacation time, but they would need to be supplied with airline tickets, and have lodging and meals provided (in negotiation with AYDER hospital).

It is important that the project have a coordinator who will serve as a liaison. In a similar model, a group of doctors from Italy has been providing Dermatological care in the hospital and has been training the medical staff in this field.

This program is unique because it strengthening and advancing of the primary staff at the hospital. Without a quality nursing staff it will be very difficult for this hospital to achieve its goals and fulfill its vision.