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Critical Care Nurse in Developing Health System

Ousman was finishing science studies at high school when he decided he wanted to become a registered nurse. It proved to be the ideal role for him and he is well suited to the profession. When Ousman graduated, he still had a 4-month Internship to complete, this was an intense period of clinical activity. Ousman smiled when he told me he first learnt to cannulate veins in paediatrics, including neonates! Its particularly interesting that the internship consisted of placements to medical, surgical, maternity and paediatrics. Many registered nurses (adult) in the UK, would love to have this range of placements.
Ousman’s desire to be a good nurse and his technical ability were recognised and his first job was in an Independent hospital in The Gambia. Ousman quickly settled into a multi-dimensional
role, rotating between ICU and the Major Trauma room within the hospital. Moreover, Ousman like other is part of the emergency ambulance team. The ambulance is modern and well equipped. Ousman, along with a driver has attended casualties that have been involved in road traffic collisions or have become ill in the street, as well as initiating emergency care in peoples homes. Patients with specialised needs or tourists that become critically ill are often resuscitated and stabilised within the Gambian ICU and may be transferred to an ICU in the Gambian public sector or repatriated to the patients home country. Ousman is very familiar with the airport and has handed over patients to Flight Medical Teams from Dakar (Senegal) and numerous European countries. He feels good about giving comprehensive handovers to specialist teams that appreciate the good communication.
Did I mention that Ousman has only been qualified for one year!
In the ICU, Ousman can have up to three patients to care for, they are usually a mix of Level 3 (critically ill) and high dependency (level 2) patients. All the equipment are old and well used and looked after. A Biomedical engineer is employed and visits at intervals, meanwhile the nurses find ways to adapt and improvise to replicate critical care in developed countries. Level I and 3 critical care is the norm, single-organ or non-invasive support is missing. For example, non-invasive ventilation isn’t available as the second-hand equipment is almost worn out when the equipment is purchased or donated and quickly fails. This is an unintentional situation that I have seen inflicted on other developing Health Systems. Fortunately, mechanical ventilation is available. Pressure Control or SIMV is possible and adequate sedation is given by intermittent fentanyl and diazepam. IV therapy is restricted to drugs that can be given through peripheral IV cannulas, some Infection Control Nurses would approve of this!
Ousman recalled occasions during ambulance work and in the ICU, where a gold standard airway was required but took too long to organise. Consequently, some registered nurses have learnt basic Intubation skills. Critical care nurses in Africa, learn and undertake expanded roles due to necessity rather than professional progression. As expected, Ousman was soon intubating a manikin and familiarising himself with the basic equipment. Some of the critical care nurses that I taught seemed remarkably familiar with advanced techniques such as intubation. This was due to an intense study of medical video clips on You Tube. I have an MA Open and Distance Learning and yet I was amazed to be ‘preaching to the converted’ and being corrected on occasions.

David Muir

RN BSc DipTN MA ODE MRes PhD candidate
Clinical Educator

BASICS Instructor
Critical Care Nursing in resource-limited environments

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