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Learning in action in Nauru > Sharon Humphries 22 Learning in action in Nauru In August 2011 AVI Learning and Development trainer, Sharon Humphries, delivered a four-day fi rst aid workshop to Republic of Nauru Hospital community workers and medical staff as part of the Pacifi c Technical Assistance Mechanism (PACTAM). Sharon writes about her experience of working alongside PACTAM Health Educator deployee Min Lene and Nauru Nurse Educator Vania Scotty and witnessing capacity development in action. Monday, 1 August I arrive in Nauru at 4am after fl ying all night. Everyone on the fl ight knew each other. This surprised me. I was asked immediately upon boarding “Who are you? What are you doing in Nauru?” After a great sleep that morning in the hotel, Min picks me up and we drive to her offi ce at the Republic of Nauru Hospital (RON). I ask as we are driving through the gate “who is RON” and she laughs at me. I soon realise my mistake. It [the hospital] looks run down and a tree has just collapsed that morning, falling on the fence and a car with a woman in it. Min informs me that the woman is OK but her car is written off and the engineering men are fi xing the fence and the tree. Min and I tie up any loose ends around the workshop. I leave thinking this will be like any other workshop I have delivered in Australia. Tuesday, 2 August I arrive to deliver the Level Two First Aid training to the community workers at 8.30am. It is a two-day program for 20 participants. There has been a huge response to the training and Min has had to turn people away. That is until it’s 9.30 and only 11 people are there. They spend the next 10 minutes madly ringing up colleagues and seeing if they want to participate. There’s nothing I can do but wait. We fi nally get underway at 10am. Six more participants drift in over the next half hour. A media group come in and take photos while I am trying to get everyone’s attention and want to interview participants. I keep taking deep breaths. My approach to training involves punctuality and focus. We do get through the day and wrap up at 4pm. I explain how important it is to have everyone here on time the following morning otherwise they will miss parts and possibly not pass their assessment. I am concerned that not all of the participants will be able to train fi rst aid and Vania and I have a discussion about allowing them to decide if they want to just receive certifi cation or whether they want to train and set up another assessment for those people. Wednesday, 3 August The shower doesn’t work properly this morning and there is no hot water. None of the electrical appliances work. No cup of tea this morning! I get to the training at 8.30am, dubious that anyone will be there but I arrive to fi nd all of the participants waiting for me. I start on time. Halfway through the morning the power cuts out so I have no projector, powerpoint or cooling. We swelter through the day as we complete the fi rst aid information. To compensate for the loss of access to electronic learning material I work hard doing lots of actions and writing on the board. They all complete their assessments with fl ying colours – a surprise to me again considering the power outages, disruptions, occasional language issues and that this was the fi rst time they were taught fi rst aid. Some of the quiet participants do incredibly well. The group present me with a gift of a Nauru t-shirt and phosphorous necklace. I am genuinely touched. They are very pleased to have passed and to receive their certifi cate. We take a group photo and as I stand there relieved the two days were successful I realise I have sweat dripping everywhere. I am exhausted, hot and tired but very happy and proud.
Thursday, 4 August Back into the training room at the hotel at 8.30am for the nurses and doctor’s CPR training. We start both sessions of the day late but they are responsive to the new CPR processes and all practise. Some are defi nitely better than others and they do all need to be encouraged to have a go. There are lots of questions and the education team and I are surprised at their responsiveness. Friday, 5 August I have a day off and I enjoy relaxing at Min’s house. Min drives me to the hospital and it’s the fi rst time I get to see around the hospital. I meet some of the doctors and nurses on the wards so it’s great to say hello and see them in action. I also start to get a greater understanding of the issues they face on a daily basis and conditions they are working in. While the hospital is clean, I see they face a range of challenges with the minimal facilities and resources available to them. There is a lot of equipment and medications, but they tell me there has been little training and few protocols put in place in regards to use. Saturday 6 August Min and I head off to the training in the education room at the hospital. Both sessions of the day start 15 minutes late but I have discovered that is very good for Nauru. All of the doctors and nurses turn up, which is excellent. I go through the presentation about advanced life support and explain the new guidelines in place from 2010. They have a practise of CPR again and move through the drug station and the airway station. We get the anaesthetists involved in running the airway station and that works well as the doctors and nurses practise assisting skills. There is a real positivity about the new guidelines and great teamwork during the pretend code. The head falls off the mannequin and everyone dissolves into laughter. We discuss the importance of the automatic external defi brillator to the patient and the code team (AED). Then the phone rings and there is a woman unconscious at emergency and she is not breathing. The doctors rush off and Vania also attends the emergency. I talk to the four nurses left behind encouraging them to participate during a code. I then pace the room until the staff return 20 minutes later. They ran the code just like they had practised minutes before. They worked like a team and it was successful. They are excited to tell me it is the fi rst successful code blue they have had for fi ve years. Vania delivered seven defi brillations (in AED mode) while coordinating CPR and performing CPR herself. She coordinated the administration of drugs after the doctors put in a drip and placed a tube down the lady’s throat to connect her to the AED. Having dinner with Min that night, we couldn’t help being amazed at how the training had all worked out and the success of the code blue. The protocols, equipment and methods of working in a team were completely new to the hospital’s medical staff and they demonstrated competence in all components; administering drugs, CPR, defi brillation and management. Sunday, 7 August Min heads into the hospital to see how our patient has gone overnight and she returns home to report the patient died in the early hours of the morning after another attempt at CPR. Despite this, the doctors on duty were able to provide a report on how effective the resuscitation team was and how during the process they were able to use the AED. Monday, 8 August I am up at 4am to catch a plane back home. On the fl ight I think about what I have learnt about me, Nauru and the RON staff. I felt proud to see the knowledge and skills that I had passed on to the doctors and nurses over the past week, being put into immediate action at the Nauru Hospital. I was impressed by the basic nursing and assessment skills the hospital staff demonstrated and their willingness to increase their competency and knowledge. One of the greatest rewards was to see how the opportunity to participate in training has increased confi dence in themselves and teamwork. I also think about how effective PACTAM has been in providing access to human resources like Min throughout the Pacifi c and providing professional development opportunities such as the fi rst aid training. It’s been a rewarding experience for me and small step towards building the capacity of Nauru’s health sector. < Opposite > AVI Learning and Development trainer Sharon Humphries with Republic of Nauru Hospital doctors, participants in the First Aid training. Left > Republic of Nauru Hospital community development workers participated in First Aid training delivered by AVI Learning and Development trainer, Sharon Humphries and funded by PACTAM. Top > AVI Learning and Development trainer and Republic of Nauru Hospital Health Educator Sharon Humphries Vania Scotty doing CPR as part of the PACTAM-funded First Aid training in Nauru. Photos > Courtesy Sharon Humphries 23
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