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Reflections of a Young Nurse, Midwifery Leader, and Agent for Change

By IHI Team | Thursday, June 10, 2021
Reflections of a Young Nurse

Celebrating International Nurses Day: NCNI GLDP virtual workshop sessions with guest speakers Lord Nigel Crisp, Professor Sheila Tlou (Botswana), Rosemary Jose (Barbados), Professor Charlotte McArdle (Northern Ireland), Mary Frances McManus (Northern Ireland), and Dr. Catherine Hannaway of the Nursing Now Global Campaign.

I am a nurse-midwife currently working as District Clinical Coordinator, Maternal and Child Health, mothers2mothers (NGO) in Lesotho. I am from Lesotho, an up-and-coming independent country landlocked by South Africa. Lesotho works at the country and global level with the World Health Organization (WHO) and other stakeholders to improve the health of the nation, striving to achieve Universal Health Coverage and attainment of the Sustainable Development Goals (SDG), and aiming to ensure that high-quality health care is available to many people, not just the few.

My aspiration to become a nurse-midwife was formed in my early childhood years as a young rural boy, witnessing mostly home deliveries. This was a normal practice in my village, with no health care support and the nearest health clinic available to support pregnant women located too far for them to travel to it. I later learned that home deliveries can be a very dangerous practice, but I couldn’t voice my feelings given the cultural practices in my village. Even now, the maternal mortality rate in Lesotho is still estimated to be 618 per 100,000 live births. Compare that to the average rate for South Africa, our neighboring country, at 119, or to “high-income” countries where the rate is 11. As a country, Lesotho needs to play our part in achieving SDG 3, Target 3.1: Reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

At the time I said to myself, “I will become the person who brings a similar health center to rural communities as is available in urban settings, and advocate for better access to health care services in my village one day.” Following a sound high school education, I began the journey toward my goal. In 2012, I undertook a nursing qualification locally and achieved recognition as the top student for the program, for which I am very proud. I then moved onto specializing in midwifery care, which was my main ambition.

From 2017 to 2019, I attended the University of South Africa, where I achieved a Bachelor of Science in Nursing Education, Health Science Community and Nursing Management. I was recognized as a top-performing student, receiving 27 distinctions from 30 modules. I went on to study Pediatric Nutrition with Boston University School of Medicine. In the health care field, seeing both communicable and non-communicable diseases skyrocketing, I was compelled to develop my expertise in public health, to change and improve health care for the population using evidence-based research practice. I then became involved in research and recognize how important it is to underpin changes in policy and nursing practice.

In 2019 I attended a learning program in Geneva for young nurses and midwives, organized and led by senior leaders from the WHO, International Council of Nurses, and the World Innovation for Health (WISH). My passion for contributing to health care transformation was further inspired by senior leaders such as Dr. Tedros Adhanom, Director General, WHO, Elizabeth Iro, Chief Nursing Officer, WHO, and senior nurses from the International Council of Nurses. They helped me better understand the importance of working together across the world to improve the health of the global population. Influencing policy makers was one new role I learned that nurses and midwives need to pay attention to, given the current health challenges and need for development in all health systems, locally and globally.

As a result of attending the Geneva program, I was nominated as a “Global Associate” for the Nightingale Challenge Northern Ireland Global Leadership Development Programme (NCNI GLDP). Dr. Catherine Hannaway, Director for the NCNI GLDP Programme, helped me realize that, by being politically astute, nurses can contribute to the global and local health agenda, particularly by “thinking globally, acting locally.” Dr. Hannaway also helped me see that it is essential for young nurse leaders to feel empowered to identify opportunities for transforming nursing care and leading change by being a voice at the decision-making table. The program provided an excellent learning experience, the opportunity to network with other young nursing and midwifery leaders from around the world, and equipped me with additional leadership and advocacy skills and confidence and competence to engage at all levels of health care.

As an emerging and capable young nurse/midwife leader, I am committed to using my knowledge and experience to influence policy and act as a positive role model and “agent for change.” My current focus as a Clinical Coordinator is to support adolescent health and youth development, and childbearing women, their children, and families to be able to access vital health services and support, ranging from pre/antenatal care and support during birth to the postnatal period, including Sexual Reproductive Maternal Neonatal Child and Adolescent Health (SRMNCAH), nutrition, Expanded Programme on Immunisation (EPI), and Integrated Management of Childhood Illnesses (IMCI) in the early years. Services in Lesotho are being impacted by challenges of the COVID-19 pandemic, however. While we have adapted our approaches, we continue to make progress in improving services in community health centers and nursing and midwifery practices across local communities.

I work alongside the Minister of Health, Director General of Health, Director of Nursing Services, QUAD, and nursing associations in my home country of Lesotho, assisting in the development of health care models and policy frameworks. Much of the learning that has transformed the way I do things came from the IHI Open School Quality Improvement online courses, which I successfully completed as part of the NCNI GLDP. These modules gave me a practical global toolbox and knowledge for improvement. I have implemented the improvement knowledge and skills gained from the IHI courses to improve midwifery services in a number of ways:

  • Created positive change through QI projects in nursing/midwifery practice
  • Planned, designed, implemented, and advocated for QI in health care service delivery
  • Implemented improvement approaches in daily work to achieve better outcomes
  • Provided training to colleagues and stakeholders and built powerful teams
  • Identified gaps in areas of practice and established QI committees and projects to close these gaps
  • Greatly improved program indicators as a result of applying QI methodologies

There are now more than 10 quality improvement projects in different facilities, ranging from scaling up an HIV program, Reproductive Maternal Neonatal Child and Adolescent Health programs, and a Sexual Reproductive Health program. Most teams are now capable and involved in QI programs.

My key reflection from the NCNI GLDP is how, by collaborating as a nursing and midwifery profession — globally, regionally, and locally — we can achieve so much more than if we seek to make changes or influence on our own.

Sehloho Ntlhane, RN, RM, BCUR, PGPN, APGDPHR, is District Clinical Coordinator at Southern District Mohale’s Hoek in Lesotho, Africa.

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