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page title: field Stories

LESOTHO-BOSTON HEALTH ALLIANCE: Strengthening Community Health Services In A Nurse-Driven Health System Leribe district, Lesotho

Being Mentored
LeBoHA - mentoring in OPD
During the first mentoring visit to one of our clinics, our nurse participant saw a man recently started on TB meds who had returned for another counseling session for ARV's. He was gaunt, dehydrated, and could barely walk. Our nurse started an IV after three unsuccessful tries, put him to bed, and eventually our nurse educator drove him to the hospital for admission. 

Our nurse participant then had to deal with a young woman who had a retained placenta for three and a half hours and was bleeding because no other nurse in the clinic was checking in on her. The only blood pressure cuff in the room was new and still in the box, which meant that no one had checked her blood pressure. The driver had gone out with the ambulance, and although he was in a nearby town, he took more than an hour to arrive.

During this time there were at least 80 patients in the waiting room to be seen by our nurse participant .

This is the daily reality for many nurses in health centers in Lesotho. They are understaffed, under resourced, and incredibly busy. LeBoHA's program works with nurses on-site and helps them improve their situation, their system and the quality of care they provide.

Training
LeBoHA - nurse participants being trained
At the end of the day described above, our nurse educator pulled the nurse participant aside and told her she was doing a remarkable job with the little resources she had, and that she understood how difficult her job must be. The nurse responded that LeBoHA's classes were 'helping me a lot...I used to hate OPD [out-patient department], but now I am beginning to understand more of what I can do.'

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making rounds
LeBoHA - ward rounds with doctor during training
After six weeks of training and mentoring, great improvements have been seen at the clinics. At another site visited during mentoring, all patients in the waiting room had vital signs. A nursing assistant was in the waiting room triaging patients, and the 2 patients she classified as critically ill were seen first. This is a huge change at this clinic. Previously, no vitals were done unless the nurse did them in the consultation room, and most medical records had simply the word 'cough' scribbled above a list of medications.

At another small health center visited after 6 weeks of training and mentoring, about 35 patients were lined up by 8:30am. It was very organized: the few kids in line had all had their temperatures taken; the blood pressure and pulse for each adult was recorded. After morning prayer (sung in harmony), our nurse participant gave an interactive 40-minute talk on HIV, TB, hypertension and diabetes.

These small acts, such as triaging, taking vital signs, organizing incoming patients, and giving health talks, may seem routine to most people. But in places like Lesotho, where a nurse must see one hundred patients with limited resources and limited support, these tasks often fall through the cracks. By empowering our nurse participants to address these issues, LeBoHA is working to make health centers better for the patients in need and the nurses who want to help them.