Maslow’s hierarchy of needs

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We have been teaching the Generic Instructor Course today, one of the best train the trainer short courses in the world I think and it travels well.  We learnt about Maslow’s hierarchy of needs in one of the sessions.

Maslow (1943) divided this five-stage model into deficiency needs and growth needs. The first four levels are often referred to as deficiency needs (D-needs), and the top level is known as growth or being needs (B-needs).

Deficiency needs arise due to deprivation and are said to motivate people when they are unmet. Also, the motivation to fulfill such needs will become stronger the longer the duration they are denied. For example, the longer a person goes without food, the more hungry they will become.

We had a beautiful example of this here in Liberia where our learners have been a bit vexed by a misunderstanding over food provision during the courses.  They were hoping to get money to buy their food with (and no doubt save some of the money out of this allowance) and were not pleased to find out that “their” food money had been given to caterers to provide the food.  This was compounded when the caterers failed to turn up with the food!  Jo and I were trying to persuade them to prepare for the GIC course over the weekend but they could not do that because they were still animatedly discussing the issue around food allowances.  It was not until that issue had been sorted out this morning that they could start to move up Maslow’s pyramid.  In one day we’ve gone from level 1 to level 4 and will nudge our learners into level 5 by (complimentary) morning coffee tomorrow.

Rainy season

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In Liberia the climate is tropical, hot and humid all year round, with a rainy season from May to October due to the African monsoon, and pretty frequent rains in the other months, except in the short dry season that runs from December to February.  This makes for a green, lush environment in most of the country as we found out on our evening walk earlier.

The rains have gone on longer than usual this year and this picture from the Liberian Observer shows just how bad the road is from the capital to the county in which we are based currently.

The health professionals coming to our Newborn Care Courses this week have to travel this road.  On motorbikes apparently because the cars that were supposed to be bringing them can not get through.

This evening, I was admiring the sunset from the UNHCR compound where we are staying.  The next thunderstorm is obvious on the horizon in this picture and is just breaking now as we are going to bed.  The rain on the corrugated iron roof is deafening and there is a leak in the ceiling just above the sofa.  How do the children study in the evenings in conditions like this?   It makes me think of Maslow’s hierarchy of needs which is one of the topics on tomorrow’s GIC.  More about that in tomorrow’s post – if the internet is still working.  A lightening strike has damaged our Wifi so we’re reliant on Kola’s data at the moment.

Zwedru

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UK instructors, Jo and Julia, arrived in Zwedru on 2nd November along with local Liberian instructor trainees Kola, Advanced Neonatal Nurse Practitioner (ANNP) with Maternal and Child Health Advocacy International (MCAI), Agnes, Gertrude and Christina, all of whom have been trained as neonatal clinicians (nurses with extended roles) within the MCAI programme.  Kola has been training two neonatal clinicians here in Zwedru and they have set up a neonatal unit which they hope to expand.  UNICEF is collaborating with MCAI now to further develop the programme around safe delivery of babies and extend it into the rural areas around Zwedru.  Our role here this week is to help with the training of the nurses and midwives based in Grand Gedeh county.  Our 4 Liberian colleagues (well, Kola’s Nigerian actually but based here now) will do the Generic Instructor Course in the next 2 days and then – supervised by Jo and Julia – teach the Newborn Care Course to nurses and midwives here in Zwedru.

Getting here was quite fun!  The rainy season has gone on a little longer than usual in West Africa this year and the roads from the capital, Monrovia, are impassable.  So we came by twin engine plane….

Muddy, red laterite soil landing strip in Zwedru
Medical Aviation Fellowship (MAF) 10-seater twin-engine plane and a pretty impressive Australian pilot
Selfie of the instructor team on board the aircraft. 2 of them had never flown before.
Tropical rainforest from the plane window

 

Kalafong wraps

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Kim and Julia have been busy in London (and Alison in Amersham) making these baby slings for mothers of preterm babies in Liberia.  They will be used on the training courses in November and then left in country for use on the neonatal unit.  Skin to skin mother care develops the bond between mother and baby as well as helping to prevent infection and keeping the baby warm.  You can read more about the advantages of skin to skin care at http://www.nicheinternational.org.uk/2018/11/13/skin-to-skin-mother-and-father-care/.

We call them kalafongs on the Newborn Care Course but they are not actually called kalafong wraps – even in Kalafong hospital in South Africa which is where the pattern for these (very cheap and easy to make) skin to skin wraps is from, see https://www.up.ac.za/media/shared/Legacy/sitefiles/file/45/1335/877/thariinstructionsnewkmcwrappatternmay2011.pdf.

United Nations Convention on the Rights of the Child

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The rights of children across the world are enshrined in the United Nations Convention on the Rights of the Child, or UNCRC, signed by all UN members except the USA.  The Convention has 54 articles that cover all aspects of a child’s life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.

Every child has rights, whatever their ethnicity, gender, religion, language, abilities or any other status.

You can read more about it at https://www.unicef.org.uk/what-we-do/un-convention-child-rights/.

The UN rights of the child are often violated when families are in situations of conflict.  In particular articles 19 (protection from violence, abuse and neglect) and article 38 (war and armed conflicts) from the UN Convention, are relevant in this regard.

Over the last 2 years, while NICHE has been working in Cameroon, West Africa, we have seen how civil unrest there has affected patients, and indeed, hear firsthand from health professionals who continue to try to care for them.

A young doctor who attended one of our Newborn Care training courses earlier this year in Cameroon, has recently written about the direct effects on children’s health that she has witnessed.

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Over the past three years, the English-speaking North West and South West Regions of Cameroon have been affected by civil unrest.  Since the crisis started in October 2016 following a strike action by teacher and lawyer unions, it has escalated to an armed conflict. There has been heavy military deployment to the regions and violent attacks by the opposing forces in urban and rural areas, leading to disruption of activities in communities, displacement from homes, and loss of property and lives. Education, business and healthcare are some of the most directly hit activities in the different communities affected by the conflict. Its adverse effects are numerous, including difficulty in providing and accessing proper health care facilities, causing diseases, which had been under control, to regain grounds, become virulent and lead to increasing levels of disability and death.

Working in the Pediatric Unit of the Bamenda Regional Hospital over the past months, we have witnessed this centre, which is the only very accessible reference centre of the North West Region, struggle to manage the current challenges despite the continuing conflict. We have seen a rise in the severity of epidemic diseases like Malaria and Dysenteric illnesses, seen by the 198 cases of malaria treated from January to August 2019 as to the 168 treated in the same duration in 2018. In 2018 alone, 119 cases of meningitis were managed in our health facility.  Added to these, are diseases which are now poorly managed due to lack of health facilities and personnel in the surrounding villages, notably Tuberculosis, HIV/AIDS, Sickle cell Disease, Pneumonia, and  Severe Malnutrition.

Children are the most affected, with two out of every five inhabitants of our Region being under the age of 15 years old. As the conflict continues, access to hospitals and other health centres from surrounding villages remains very difficult for these populations notably the children. By the time they successfully arrive at facilities like ours, it is either too late and they expire, or they end up disabled.

The lack of adequate health infrastructure and personnel especially in the periphery of Bamenda and surrounding villages has also adversely affected vaccination coverage for children in these areas. We are therefore exposed to a high risk that vaccine-preventable diseases may resurface, with catastrophic effects on the children. We have unfortunately had cases of children as old as 1 year who haven’t received any vaccines since they were born in the bushes to displaced mothers.

On a final note, we have been witnessing an alarming rise in cases of sexual abuse on children. The numbers are on the rise, thereby increasing the risk of sexually transmitted disease infections as well as additional psychological trauma, which would both have disastrous consequences.

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The current crisis in Cameroon is complicated.  Good resources to look at if you want to know the timeline of the conflict are:

https://africanarguments.org/2019/08/13/cameroon-crisis-three-deepening-divides/ and

https://www.bbc.co.uk/news/av/world-africa-44459488/cameroon-crisis-explained which has links to up to date information like the recent release of the opposition leader from prison and the current peace plan.

More trustee exertions!

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Alison Grove and her friend, Helen, have just completed the Killin 10K in Scotland (in only just over an hour which is pretty impressive), raising just shy of £1000 towards NICHE’s next Liberia trip in November 2019.  You can still sponsor them at https://www.justgiving.com/fundraising/alison-helen.

 

Relief at the finish line
Exhaustion at the finish line

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fantastic work both of you!

Friends of NICHE

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We are fortunate that NICHE has friends who support us in various ways.

This is Gloria, approaching her 10th decade, and an inveterate knitter!

One of WHO’s main recommendations for newborn care is prevention of hypothermia.  Newborn babies quickly lose heat through their heads; drying and covering the head with a hat immediately after birth is a simple but vital step.  This is equally important in hot and cold countries.

When NICHE instructors train midwives and other birth attendants in a low resource country, we leave equipment for them to use.  This includes a supply of hats for babies, as mothers do not always have their own baby clothes.

Gloria has bought wool, and knitted hundreds of baby hats for us, including tiny ones for premature infants.  She says that this is her contribution to our work: it is a valuable one, for which we – and about 200 babies in west Africa so far – are very grateful.

How many health professionals do 10,000 people need?

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The WHO suggests that the critical threshold is 23 doctors, nurses and midwives per 10,000 head of population.  Of their 49 priority low-income countries, only 45 cross this threshold.  Instead of 23, Liberia has 3.

Purely looking at doctor numbers, Liberia has 0.3 per 10,000 head of population.  Which is why the work that MCAI (www.mcai.org.uk) is doing to train midwives and neonatal nurses in extended roles is so important.  We are looking forward to playing our part with this when we return to Liberia in November 2019 to teach the first Generic Instructor Course and 4 more Newborn Care Courses.