In June 2019, four Master of Nursing in Child Nursing students from UCT travelled to Namibia on an outreach programme to the paediatric and neonatal service at Rundu State Hospital. The group, Akua Dwomoh Boateng (from Ghana), Ireen Muleya (from Zambia), Winnie Njuguna (from Kenya) and Jabulani Kgasapane (from South Africa), brought the knowledge and skills acquired in this clinical master’s programme as well as their combined experience from four African countries. In Namibia the nursing team was led by Beatrix Callard a programme graduate who now heads the neonatal nursing service at Windhoek Central, Namibia’s largest referral hospital.

Aim/Purpose: The Child Nurse Practice Development Initiative at the University of Cape Town (UCT) commitment is to build Children’s Nursing in Africa for Africa. The aim of this visit was an opportunity to serve and contribute to the support of neonatal and children’s nurses in a relatively new clinical service for neonates and children in the north of Namibia. They contributed to assisting with how to help strengthen services by ensuring good clinical practice, good clinical leadership and clinical governance.

Context: Rundu State Hospital is the government run hospital in Rundu. It serves the Okavango region (west and east), which is in the Northern part of Namibia. Rundu is next to the Angola border and sometimes serves the Angola patients who cross the border in need of medical assistance. The team visited the hospital’s paediatric and neonatal unit (also known as prem unit) which serves children from birth to 12years of age. The hospital has a bed capacity of 330 beds; however, this number is often exceeded due to large patient numbers.

Neonatal unit: This unit is referred to as the “premie unit” at Rundu hospital, however, they admit both preterm and term babies. The Cape Town team initially worked in the neonatal unit where they were oriented on how the unit operates.  This 25 bedded unit, with incubators as well as open cots, provides basic newborn services as well as CPAP machines for advanced respiratory support.

In June 2019, the unit received its very first mechanical ventilator from Prof Berger, who represents an organization called Neo For Namibia. Whilst we were there, he was training the doctors and nurses how to use the equipment and select patients for ventilation. They successfully had their first ventilated patient on the 14th July with a good outcome.

We found the nurses at Rundu to be very hard working.  They work effectively as a group and there is a harmonious atmosphere. The nurses displayed eagerness to learn and were able to share insight on how they work.

The team got to interact with other nurses and doctors in the unit, in addition to mothers with babies. They also familiarized themselves with some of the paperwork & documents used in the unit. To assist the unit staff, they collected data on neonatal unit statistics from January to May 2019.

People involved: The team met with the Pediatrician, Dr Kamara who gave them a brief overview of the current situation of Rundu state hospital. Dr Kamara was very happy to work with them over the two week period. The team was warmly welcome by the hospital matron, Sr Priscilla Shiwegdha, who took them round the hospital and introduced them to all the units. Also, they spent time with Prof Berger who ran training on invasive ventilation.

Referral data: Low referral rates to other hospitals could be an indicator of good care and is certainly a good governance outcome. The hospital refers patients to Windhoek Central State hospital and Katutura Hospital in Windhoek Region. This is approximately 715 kms away, and transportation is mainly by road and this takes an average of 7 hours to get there. The conditions commonly referred to these hospitals include those that require surgical interventions, patients with cardiac anomalies and other congenital abnormalities that Rundu Hospital are not equipped to handle. Referral statistics from Jan to May 2019 indicated that few babies were up-referred.

Conclusion: The team felt very welcome and were grateful to experience how things are run in Rundu Intermediate hospital NICU and pediatric departments. Thank you to everyone from the CNPDI office who facilitated the project, and the management of Rundu intermediate hospital for allowing us into their space, To the staff (medical and nursing) in NICU and pediatric departments as well as emergency unit who allowed us to be part of their team and work with them. Beatrix Callard for you input and guidance much appreciated. Professor Berger for allowing us to give input on the project he was busy with. THANK YOU.