August 26, 2015

Rochelle DeLacey, an intensive care nurse from Auckland, New Zealand, has gone on two field assignments with Doctors Without Borders/Médecins Sans Frontières (MSF) in Gaza to provide training to local nurses.

“The nurses were really enthusiastic," said DeLacey. "They were very grateful to have the opportunity to develop their intensive care skills. Their only other option really was to Google ‘intensive care’ because they don’t have any other access to training.”

"Their only other option really was
to Google ‘intensive care’ because
they don’t have any other access to training."

Intensive care is a highly technical field of medicine which is extremely important in this small territory where the population is often subject to violence and trauma. Local people not only suffer due to the bombing and fighting, but Israel’s blockade on Gaza also tightly restricts movement of people and supplies. This means health care workers are unable to travel easily to access training, and there are also inadequate educational opportunities within Gaza itself. All this limits their capacity to improve their knowledge and provide the best quality care to their patients.

To help remedy this, MSF has organized a series of specialized medical training sessions in Gaza in recent years.

Bedside training; short courses

In 2013, DeLacey spent six months in Gaza providing bedside teaching in intensive care to local nurses. "Because they can’t leave and a lot of educationalists can’t come in," she said, "they have never received specialized intensive care nursing training in Gaza.”

While DeLacey was delivering the long-term training program to nurses, MSF also sent a team of doctors, including an intensive care specialist, to teach a short course in intensive care to physicians as well.

MSF asked DeLacey to return to Gaza this year to teach an additional short course in intensive care for nurses. She and another intensive care nurse traveled to Singapore to learn how to deliver the course, called the "Basic Collaboration". The course, which was developed by the Chinese University of Hong Kong, aims to disseminate high quality teaching materials that can be taught by other people.

The two nurses worked to adapt the course to the low-resource Gazan context, such as removing modules that rely on high-tech monitoring equipment that’s unavailable in Gaza.

During her five-week placement in Gaza, DeLacey taught the two-day course nine times, reaching a total of 116 nurses, which is the vast majority of nurses in Gaza. A pre-course and post-course exam showed that the nurses in Gaza made significant gains in skills and knowledge, with 90 percent passing the course. 

One of the key challenges is to ensure that the nurses continue to apply their new skills after the training team departs. A local MSF doctor and a nurse have been tasked with providing follow-up and delivering additional training opportunities.

Building up new skills

The lack of training is just one of many challenges for the Gazan nurses, all of whom have lived through years of insecurity and violence.

“I heard lots of stories from nurses whose family members had been injured, or who had lost their homes in the war, or who knew people who had been killed," DeLacey said. "But they are so resilient, they’ve lived through it so many times. It’s a part of their life, unfortunately."

While the training aims to improve the practice of intensive care in Gaza, ultimately it is the people of Gaza who will benefit when they need high-level critical care whether to manage serious illness, or war injuries.

“The ultimate aim is to increase the quality of care that patients receive, to improve patient outcomes, reduce mortality rates and reduce the length of hospital stay,” DeLacey said.

 

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