Surgical safety
Ministry of Health. No wonder this country has a severe shortage and many others who are desperate to leave! Is there a solution? Mozambique has an
interesting role profile in its health workers. Much of the surgery, especially in the rural areas, is carried out by non-physician technicians; around 40%. It is reported in recent literature that the operations that are carried out by non-medical surgeons are fractures, trauma, exploratory laparotomy and Caesarean sections.7
From this author’s experience, these can become serious and complex very quickly after they start – so these non-physician technicians must be very skilled. There are other countries in the African
region who employ medical officers. It is believed that they are the backbone of surgery and healthcare in those countries, but it is
very difficult to find out if they are medically qualified or have undertaken a different training schedule; it is believed it is the latter. Different countries have different regimes, and it is tricky to unscramble from recruitment advertisements what level of training they each receive.
Patient safety Patient safety is a key element of all healthcare delivery in high income countries. However, when there are barely sufficient staff to manage a ward or an operating theatre, it is no surprise that patient safety in Africa is at a lower level and not of sufficient quality to be effective. It is a persistent challenge for all healthcare workers. There are many obstacles to securing safe care to patients and many of them are completely out of the control of the individual staff member. These relate to the age and condition of the building and equipment (or lack of it), poor supplies especially in the rural areas; staff and staffing as above, with very little time for induction or ongoing professional education, and particular issues with hierarchy and cultural dynamics, leading to staff leaving or migrating. When we have, as a charity, initiated group work on a patient safety scenario, we have learnt that the nurses know the theory but generally are unable to ensure quality practice, due to issues with some of the above problems. They accept that the problems are out of their control but are aware that they are unable to fulfil their whole responsibility to their patients. This is very unsatisfactory from a professional perspective.
Infection prevention The same attitude is taken to aspects of infection prevention which, in the operating
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room, requires specific education and a team who is able to collaborate from a position of knowledge too. A recent guest lecturer at Friends of African Nursing education gave the results of a local Surgical Site Infection research study to the students. It was a fascinating talk as the presenter had led the research in a District hospital and compared the local conditions with papers in the literature. Deborah Mukamuhirwa reported that the SSI rate was 8.2% which compares favourably with many other countries. However, she also suggested that there are
many aspects of preventative action which could be taken to reduce the rate further.8 These are tackling inadequate sterilisation of surgical instruments, poor hand hygiene practices among healthcare workers, and limited access to antibiotics and antiseptics. She reported that the hospitals were overcrowded, with insufficient surgical facilities, as well as highlighting the impact of underlying health conditions and nutritional status of the patients. Those living with HIV were more likely to get a post-surgical infection. These aspects give FOAN a clear element for future education to this group of staff. It was excellent to have local input at such a high level and a great experience for the students to hear about proper research on such an important topic. It was mentioned by almost all the students in their evaluations as a highlight. It was hoped that we might be teaching
a group of nurses and nurse anaesthetists from the district hospitals on this visit, but just one week before we left for the country, we were told that the Ministry had no authority to ask hospitals to release nurses for training
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