Emotive responses to ethical challenges in caring:A Malawi perspective

AbstractThis article reports findings of a hermeneutic phenomenological study that explored the clinical learning experience for Malawian undergraduate student nurses. The study revealed issues that touch on both nursing education and practice, but the article mainly reports the practice issues. The findings reveal the emotions that healthcare workers in Malawi encounter as a consequence of practising in resource-poor settings. Furthermore, there is severe nursing shortage in most clinical settings in Malawi, and this adversely affects the performance of nurses because of the excess workload it imposes on them. The results of the study also illustrate loss of professional pride among some of the nurses, and the article argues that such a demeanour is a consequence of burnout. However, despite these problems, the study also reveals that there are some nurses who have maintained their passion to care

A Deeper Look: Looking Into the Lives of People and Projects That Are Making a Difference in Malawi

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Point of View: The importance of Leadership towards universal health coverage in Low Income Countries

Universal health coverage—defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection—was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries

SHORT COMMUNICATION: Lost investment returns from the migration of medical doctors from Malawi

Migration of medical doctors from African countries to developed nations compromises the delivery of health care on the continent. The full cost of producing a medical doctor was estimated in Malawi by adding the costs of education from primary school through undergraduate medical education. The cost in fees for one medical doctor produced was US$56,946.79. The amount of lost investment returns for a doctor who migrated out and served for 30 years in the receiving country ranged from about US$ 433,493 to US$46 million at interest rates 7% and 25%, respectively. Quantitative assessments of the estimated loss in investment allows for informed policy discussions and decisions.. Keywords: brain drain, Malawi, medical training, medical education, migration Tanzania Health Research Bulletin Vol. 9 (1) 2007: pp. 61-6

How are health professionals earning their living in Malawi?

BACKGROUND: The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. METHODS: The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. RESULTS: Health professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration. When asked what kept them still working in Malawi when the pressures to emigrate were there, the following were some of the ways the health professionals mentioned as useful for earning extra income to support their families: working in rural areas where life was perceived to be cheaper, working closer to home village so as to run farms, stealing drugs from health facilities, having more than one job, running small to medium scale businesses. Health professionals would also minimize expenditure by missing meals and walking to work. CONCLUSION: Many health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving "gifts" from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health workers in Malawi are recognized. There is however need to evaluate of these human resources-retaining measures are having the desired effects

Early career retention of Malawian medical graduates: a retrospective cohort study.

OBJECTIVE: There have been longstanding concerns over Malawian doctors migrating to high-income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. METHODS: We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi-squared tests were employed to investigate relationships by graduation year and gender. RESULTS: We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54-2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61-0.86, P < 0.0001). CONCLUSIONS: While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work

Association of the dominant hand and needle stick injuries for Healthcare Workers in Taiwan

BackgroundHealthcare workers face the risk of acquiring blood-borne infections from patients through needle stick injuries. Understanding the factors that are associated with increased risk, for example, the role of the dominant hand, is important so that preventive measures can be focused.MethodsThe EPINet (Exposure Prevention, Information Network- a trade mark of Virginia University) questionnaire was used to collect the data. The EPInet system started 2003 in Taiwan under C-MESH. When healthcare workers sustain sharp injury, they complete the injury report form, and report to infection control personnel, who then transmitted the data to EPINet website monthly.Results93.5% of the healthcare workers reported being right handed and only 6.5% reported being left handed. About two-thirds (65%) of the reported injuries were by self, 30% injuries were by others and 5% were reported as injured by unknown.There was an association between the dominant hand injury and the needle stick original HCW user, p&lt;0.0001. There is a significant difference between the dominant hand and the needlestick original HCW user.HCW whose dominant hand was the right hand were most likely at risk to be injured by &#8220;others&#8221; than &#8220;self&#8221; or &#8220;unknown HCW&#8221;; OR&#8804; 18.39; CI (0.42 &#177; 2.33 ).ConclusionNeedlestick injuries among health care workers in Taiwan continue to pose a serious occupational problem. Historically, prevention has focused on the use of protective wear than assessment of which hand may be at greater risk than the other. There is a greater need to prevent hand injuries as the dominant hand remains the most used and injured in process of patient care

Should female health providers be involved in medical male circumcision? Narratives of newly circumcised men in Malawi

Background: The Malawi government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The “policy” recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Limited finances, acceptability concerns, and the health system’s limited capacity to meet demand are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. This study explored the acceptability, by male clients, of female clinicians taking part in the circumcision procedure.Methods: Six focus group discussions (FGDs) were conducted, with a total of 47 newly circumcised men from non-circumcising ethnic groups in Malawiparticipating in this study. The men had been circumcised at three health facilities in Lilongwe District in 2010. Data were audio recorded and transcribed verbatim. Data were analysed using narrative analysis.Results: Participants in the FGDs indicated that they were not comfortable with women clinicians being part of the circumcising team. While few mentioned that they were not entirely opposed to female health providers’ participation, arguing that their involvement was similar to male clinicians’ involvement in child delivery, most of them opposed to female involvement, arguing that MC was not an illness that necessitates the involvement of clinicians regardless of their gender. Most of the participants said that it was not negotiable for females to be involved, as they could wait until an all-male clinician team could be available. Thematically, the arguments against female clinicians’ involvement include sexual undertones and the influences of traditional male circumcision practices, among others.Conclusion: Men preferred that VMMC should be conducted by male health providers only. Traditionally, male circumcision has been a male-only affair shrouded in secrecy and rituals. Although being medical, this study strongly suggested that it may be difficult for VMMC to immediately move to a public space where female health providers can participate, even for men coming from traditionally non-circumcising background

21 tapaa tehostaa korkeakouluopintoja

Tämä julkaisu avaa 21 tapaa tehostaa korkeakouluopintoja. Kymmenen ammattikorkeakoulun pedagogia ja kehittäjää tuovat näkyviin konkreettisia toimintatapoja ja pedagogisia ratkaisuja, joilla tutkinto-opiskelua voidaan ketteröittää. Kantavina teemoina ovat työn ja opintojen kietoutuminen toisiinsa sekä rikastuttava keskinäinen vuorovaikutus. Toimivia ratkaisuja tunnistetaan oppimisympäristöistä, osaamisperustaisesta ohjauksesta ja arvioinnista sekä autenttisen työn ja opintojen reaaliaikaisesta yhdistämisestä. Kirjassa pohditaan myös, millä tavalla osaamisen kehittäminen voi edistää tuottavuutta korkeakoulussa. Kirja on tarkoitettu korkeakoulussa toimiville pedagogeille ja tutkijakehittäjille sekä korkeakoulun johdolle. Toivomme kirjan löytävän myös kaikki ne muut tahot ja henkilöt, jotka kehittävät maamme korkeakoulutoiminnan ja työn välistä integraatiota. Olemme osaamisen ajassa ja korkeakoulujen on löydettävä siinä luonteva paikkansa kehittävänä toimijana

Developing a tool to measure health worker motivation in district hospitals in Kenya

BACKGROUND: We wanted to try to account for worker motivation as a key factor that might affect the success of an intervention to improve implementation of health worker practices in eight district hospitals in Kenya. In the absence of available tools, we therefore aimed to develop a tool that could enable a rapid measurement of motivation at baseline and at subsequent points during the 18-month intervention study. METHODS: After a literature review, a self-administered questionnaire was developed to assess the outcomes and determinants of motivation of Kenyan government hospital staff. The initial questionnaire included 23 questions (from seven underlying constructs) related to motivational outcomes that were then used to construct a simpler tool to measure motivation. Parallel qualitative work was undertaken to assess the relevance of the questions chosen and the face validity of the tool. RESULTS: Six hundred eighty-four health workers completed the questionnaires at baseline. Reliability analysis and factor analysis were used to produce the simplified motivational index, which consisted of 10 equally-weighted items from three underlying factors. Scores on the 10-item index were closely correlated with scores for the 23-item index, indicating that in future rapid assessments might be based on the 10 questions alone. The 10-item motivation index was also able to identify statistically significant differences in mean health worker motivation scores between the study hospitals (p<0.001). The parallel qualitative work in general supported these conclusions and contributed to our understanding of the three identified components of motivation. CONCLUSION: The 10-item score developed may be useful to monitor changes in motivation over time within our study or be used for more extensive rapid assessments of health worker motivation in Kenya