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Project Lauded for Innovative Instruction

Since it’s inception, the Bangladesh Health Project has relied on the generosity of overseas volunteer faculty who have taught students, developed courses and mentored local faculty.  Many of the volunteers originally visited IUBAT as nursing students themselves, through the arrangements that their own school had with the Project.  Some students came solo, others in groups with an instructor.

One such academic partnership was with the University of Vermont (UVM) through Professor Rycki Maltby. The relationship between the two institutions was featured in the book, Innovative Teaching Strategies in Nursing and Related Health Professions by authors Martha Bradshaw and Arlene Lowenstein. The immersion course, offered to senior nursing students, was highlighted as a unique learning experience and noteworthy for instructors as a teaching example. IUBAT and the Bangladesh Health Project welcome future partnerships with academic institutions and any students that may have an interest in getting involved.

The Bangladesh Health Project has accommodated many volunteers in our guest house.  We are grateful for volunteer faculty, as we could not have succeeded without their assistance in building the scholastic foundation of the Project.  For pictures of the guest house, please check out our Flickr page and to read about volunteer opportunities, please visit our website.

Bangladesh Health Project Plans for 2017

As the Bangladesh Health Project (BHP) progresses, we focus on new priorities and needs. With IUBAT alumni now taking more senior roles as nurse educators and managers, our volunteers offer more mentoring and coaching and less student teaching. Looking ahead, these are our objectives:

  1. Provide mentoring support for faculty of IUBAT College of Nursing

BHP has completed mentorship and training of several cohorts of BSN students.  Our next goal is to strengthen nursing faculty capacity.  Through phone contact, e-mail and visiting faculty volunteers, we will assist with program development, classroom teaching, clinical supervision and student evaluation. As feasible, we will continue to supply textbooks and teaching materials. We will provide demonstration lectures for IUBAT nursing students and for staff at our teaching hospital sites.

  1. Support IUBAT graduates in their professional development

In recent years, we have supported IUBAT alumni working in hospitals, colleges and NGOs with mentorship for issues related to advanced education, nursing administration and access to technical information. We will continue supporting our graduates as they advance in their careers and undertake leadership roles.

  1. Develop resources to promote nurse education in Bangladesh

We will continue to offer textbooks to local nursing colleges, ideally establishing a central library for advanced materials, to be used by faculty and senior hospital staff. We will continue developing our Open Education Resource, an open-source collection of BSN curriculum materials for faculty to use in lesson preparation: www.OR4NED.com

  1. Build relationships with colleges and NGOs to improve health services in Bangladesh

We have good relationships with many health care organizations; some are practicum or internship sites for IUBAT, others offer good-quality education or health care services. Most are in Dhaka, while a few are in outlying areas. We will support these agencies as requested, with consultation and educational materials.

  1. Support research projects on quality of health education and health services

We will arrange student internships and projects to link local and global researchers. We have the potential to support some applied research projects on quality of health services, particularly for training and mentorship in research.

We continue to welcome volunteers, either working from home, or at our guest-house in Dhaka. Please contact us about current opportunities.

Part II – Challenges in the Real-Life Clinical Setting

In our last post, we shared the story and dilemma of one of our graduates, who was recently promoted to a higher office position of Nursing Superintendent.  The wards at her hospital faced many issues, such as coworker discord, lack of patient confidentiality and an absence of aseptic procedures, amongst others.  There were many areas requirimg her focus, and we are glad to report that progress has been made in the workplace since she was promoted.  She writes:

“We had a difficult task at hand, but we believed in ourselves and we worked even harder to improve matters.  After six months of careful observation and assessment by our Nursing Office administrators, it was evident that things needed to change. We proposed many changes to the hospital authorities; some were accepted and some were postponed for the future.  One of the accepted changes was ongoing training for the nurses.  We have recently finished skills and knowledge development sessions.  All of the nurses (including the General wards and the Critical Care wards) were involved in the 3-month long program, however, the content differed slightly for the general ward nurses and the Critical Care nurses.

We were able to involve the doctors for teaching nurses and as we thought, the doctors started to see situations from the nurses’ perspective, which helped build teamwork and camraderie.  So far, it’s hard to gauge exactly how successful the training session has been, but I can see many changes in the wards.  I can see the nurses being interested in knowing the rationale behind procedures.  We also plan to take a small written exam as a part of the evaluation process.  Furthermore, we have also recently introduced the handover format to our nurses.  In it, I referenced the care plan from our classes at IUBAT and modified it for our hospital.  It was challenging for those nurses not comfortable with English, so there was an extra class for those needing more help with the material.  As a team, we go on rounds and note any issues with maintaining the handover sheet.  We hold weekly meetings for each ward to address their problems with workable solutions, and I am overjoyed to say that it is working!

I also noticed that the nurses were demotivated in their roles, so we set out to find out why.  We completed a survey on 100 general and Critical Care nurses, and although there seemed to be a variety of reasons behind this dissatisfaction, the main 3 issues that were raised were the low pay, the low overtime pay, and the attitudes and behaviours of fellow colleagues.  To address this, our Nursing office sought a higher salary and overtime pay rate from the hospital authorities.  After a very long discussion, the request for higher wages was approved, along with the overtime requests, after the hospital authorities realized that they needed to change their part of the problem as well.  Since this wage increase, I have seen a higher amount of respect from the nurses for the Nursing office.  They trust us as a representative for their collective voices and this unity has already been shown to have positive effects in the wards.

I must give credit where credit is due.  The hospital Chairperson, Vice-Chairperson and Director were all very cooperative with me, and consistently supported my work.   Furthermore, I had the chance to work with the hospital Chairperson of International Affairs.  As a part of this close collaboration, we are getting closer to an international joint venture with a hospital in Bangkok wherein annually, five of our nurses will travel to their site in order to learn, experience the nursing standards and apply their knowledge in practice at home.

Our Nursing office had to fight a lot with the hospital authorities for many things, but we never lost hope even if the result wasn’t what we were looking for.  I must say we are progressing and it takes much effort and work to achieve the goals.  I am happy with all we have accomplished so far, but there are still challenges left to solve.  For example, there is still conflict between the nurses.

In one unit, the nurses do not even want to talk to the other unit nurses; they do not have any collaboration and respect for each other.  This is creating a huge problem for the hospital and is even affecting the patients.  It makes me recall the conflict management workshop in the final year of the program at IUBAT.  I never realized that I would encounter such scenarios in my actual life when I was a part of that workshop.  Now, I am experiencing it and everyday I realize that IUBAT has prepared us in every possible way. Frankly speaking, it has been really tough for me to address this issue, but I know it takes time to bring about change in any attitude and behaviour.  I am optimistic that my training from IUBAT will continue to help me in this post and with improving this hospital for years to come.” 

We appreciate this graduate sharing this anecdote with our readers, and explaining how her education at IUBAT set a standard of care that she implemented in her workplace.  It was also revelatory to see how her training helped with the resolution of some of the problems that she encountered in the hospital, both technical and interpersonal.  These experiences that this graduate has shared are not specific to Bangladesh; rather, they appear globally, across a number of different industries, in one form or another.  Interestingly, these conflicts between nurses is not uncommon in Canada either (http://hospitalnews.com/a-hidden-truth-hostility-in-healthcare/).  It is prudent to note that expectations should be set about civil behaviours amongst colleagues; those who work together do not need to like one another, but they must act professionally in the best interest of patients, their families and the hospital.

Part I – Challenges in the Real-Life Clinical Setting

The clinical skills and science learned in the classroom are invaluable for the healthcare workplace, however, it is the soft skills, the art behind the science, that often needs to be applied in the clinical setting as well.  For a real example given to us by one of our graduates, please continue reading.  We will outline the issues that our graduate faced and describe how they continue to work and progress through these factors that impact patient care in a two-part blog series.

One of our nursing students who is now is working in a hospital in Dhaka, began working in April 2015 as a cardiac nurse and was later promoted to the position of Joint-Nursing Superintendent in January 2016.  She has expanded upon her skill set since graduation and has experienced a variety of both triumphs and tribulations.  She writes,

“I was excited to start my position as a cardiac nurse and was eager to work with both new and old colleagues within our ward and other wards.  Since ours was just a four-bed ward, we had a smaller workload in comparison to the other wards.  Nevertheless, it would be so hectic when 4 patients came at once for coronary angiograms!  We had plenty of time to apply the pragmatic knowledge we gained from IUBAT in practice – it made us stand out from the crowd.  We got a lot of compliments from the patients we cared for, from those who were undergoing the coronary angiograms, to the critically ill patients from the Critical Care Unit.  Our patients used to say that they would wait for us to start our shifts during their hospital stay.  The majority of the patients who were stable and getting moved to other wards used to demand for a spot in our ward; they remarked especially on how professional our ward was.  To this day, we have had more than 60 patients who have waited for hours just to say hello to us while they are in for a follow-up.  It really made me proud of myself!

While I was at bedside, I had many experiences that conflicted with my expectations that were formed during training.  I explored many ethical dilemmas and learned by being a curious observer and keen investigator of the physicians and nurses.  Some were very encouraging of our curiosity, but unfortunately, some preferred to neglect.  With Professor Karen Lund’s encouragement, however, I persisted.  We new nurses had many adjustment problems: physicians questioned our use of the stethoscopes, the need for our thorough assessments, and the senior nurses resented that the patients preferred our care.  Because of the intertwined nature of the nursing care, however, it was especially challenging to manage the attitudes and behaviours of the other nurses.  It was very difficult to work alongside some of the senior nurses, some of which had little respect and confidence for our methodology.  At the end of the day, we had argued, we had conflict, but we eventually accepted one another and finally, we mingled.  I learned skills, I developed confidence and I stood firm to my beliefs.  It became easier for me to initiate new ideas and standards once I felt “a part of the team”.

All the while, we were gaining the attention of higher management and the chairperson would often call me for help with translation and special tasks.  Soon after that, I was given an offer letter informing me that I had been selected for interviews for the post of nursing supervisor.  Initially I declined, but they insisted that I at least sit for it.  I did get promoted, however, to joint Nursing Superintendent, not supervisor!  I gladly accepted the job, but was so worried about my duties and responsibilities.  For the first few months, I was totally lost and felt horrible because nothing was clear to me.  I did not receive any guidance nor did I understand what my duties and responsibilities were because the previous Nursing Superintendent had resigned from the post a week before I was appointed.  I faced a worse problem than I had expected; looking after a ward and after an entire hospital was wholly different – I was bearing a huge responsibility.  To complicate matters, my reporting supervisor was not very cooperative; however, I got two newly appointed supervisors as helping hands shortly after.  Though I was well acquainted with this hospital since 2014, I saw things so differently the day after attaining the higher position.  That day I realized that a lot of things have to be changed.  I, along with my team, had to work so much to make things better.

There was chaos in every ward due to huge communication gaps between co-workers. Every day I used to go on rounds and see the things that I never saw before.  There was no proper handover system (which always creates a major challenge in quality care), no use of aseptic techniques for any procedure.  The patient ethics, rights, privacy and confidentiality seemed to be optional, and would take years of training to achieve.”

This graduate wrote to our faculty for recommendations and tips to help ameliorate the problems that she saw in the hospital in regards to nurses and their practices.  Tasked with improving operations, there were many aspects that she needed to work on, but it is always a difficult task to change fully entrenched patterns.  Nevertheless, with the goal of better patient care in mind, it is a worthy endeavour.  In our next post, we will revisit this case and reveal the progress and changes that have occurred at this alumna’s hospital.

 

 

Strides Made in Recognition of Alumni

The Bangladesh Health Project team has advocated strongly in the past for IUBAT’s Nursing Program and their graduates, working hard to allow alumni the opportunity to receive national accreditation, despite barriers along the way.  The recent hiring of 14 IUBAT Nursing graduates into civic service has been very significant because it represents acceptance of the program from the government and the medical community.  Furthermore, to get hired into government service, nurses must take the Public Service Commission Exam.  Previous to this exam, there was no merit-based appointment and nurses would enter government service due to seniority.  Currently, here is some pushback to this new change, but the serious senior nurses see the induction of this exam as a step toward the right direction.  Anecdotes from our alumni also indicate more respect shown to them by their colleagues in senior positions (even in different sectors, such as military officials), which is a much different reality than even several years ago.

We are thrilled to hear about the strides in acceptance of our graduates and recognition of their accomplishments and skills.  Through hard work and thorough training, the nursing alumni have shown their competence in the classroom, on exams, and at the workplace.

 

Greetings from Alumnus in the United States

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Isata Jalloh, a 2013 graduate of IUBAT’s program of nursing, writes to us about her latest achievement and her new position in the United States of America.

I was inspired by two people to pursue nursing: my mother, who is my greatest inspiration and always believes in me. Additionally, my sister, who passed away 14 years ago, helped me understand the true meaning of caring, the desire to help people and make a difference in their lives in their time of need. It brings joy in my heart to help in this way. I passed my NCLEX exam on April 1st, 2016 and I am currently practicing at the Meritus Medical Center in Hagerstown, Maryland as a trauma unit nurse since August 8th, 2016. I perform comprehensive physical exams and health histories, make daily compliance rounds on my assigned unit, supervise direct care staff and make decisions about patient care needs. I also administer medications, treatment, wound care and provide direct care to patients according to physician orders. With all of the diversity that I have been exposed to for the past 12 years of my life while travelling, I am really enjoying my job here in the US. I believe every new role comes with its challenges and I am learning every day with a goal of making a difference. Once again, a big thank you to Alex, Karen and IUBAT Bangladesh for giving me the opportunity to become a better nurse.

We love getting updates from our alumni, and are thrilled that the impact of the Project is reaching all of the corners of the world!  Isata, we are grateful that you can share your progress with us, and please continue to keep us updated throughout your career (and your travels)!

 

Part II: Graduate Reflects on Influence of Nursing

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In this post, we continue sharing the story of Bimala, who was featured in our most recent blog entry.

“I had worked at the Midwifery Society of Nepal (MIDSON) for 1 ½ years, spanning 2012-2014, so I had the opportunity to learn a lot about normal births and respectful maternity care. When I gave birth to my baby, I had a really bad experience in the first hospital I went to, but fortunately also a good experience in the second hospital where I eventually delivered my baby. I had a strong will to give birth normally, and despite doctors’ mistreatment, I was able to stay confident and assert my wishes throughout the childbirthing process. My nursing education from IUBAT and work in MIDSON had a great role in building up that will and confidence in me. As an advocate for the right to quality health care, I felt it necessary that I share my experience with MIDSON and add to their knowledge of yet another example of professional misconduct in hospitals around childbirth in Nepal. They soon replied, offering me to publish as well as present my story in the 2nd National Midwifery Conference held on May 4-5, 2016.

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I shared my story to an audience of 250 personnel from various professional backgrounds and organizations in the field of maternal and child health. A downside while presenting was that they reduced my timeslot of 30 minutes to 10 minutes (an error that the announcer made), and the time for participation from the audience was not allowed. However, all of the participants had a copy of my story with them to read and also, many of them shared their sad childbirth stories with me offstage.

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All of us agreed that there is need for awareness and empowerment of mothers to speak up against the obstetric abuse to bring about the change.”

Bimala, it is truly inspiring to see the empowerment that you have gained from nursing and your resolve to use your personal experience to share knowledge and relate to others as well.  Please continue what you are currently doing, this message that you are spreading is one of importance and worth hearing, for nurses, healthcare professionals and for all of us, as patients.

Part I: Graduate Reflects on Influence of Nursing

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Bimala, pictured above with her daughter Ninama, is one of the first graduates of IUBAT’s College of Nursing (you may read about that here). She has been featured extensively in our blog, but she writes us again to share her preconceived notions of nursing and the impact of her training on her life, even long after she completed the program.  She shares how her perspective of nursing has evolved over the course of her schooling and how it continues to shape her experiences. She writes:

“When I had to choose a Bachelor’s degree program for my career, I chose nursing for two reasons: 1) The ever increasing demand for nurses and 2) Good salary for qualified nurses in developed countries. That would take me away from my meddling family for sure!  Hence, I chose the College of Nursing at IUBAT, Bangladesh, which was far away from family. It did not go as I planned but I am glad it is that way. Why? I’ll tell you.

My ideas about nurses and nursing took a complete 180 degree turn while at IUBAT. I used to think nurses carried out doctors’ orders: gave medications and maybe dress a wound sometimes. These notions were built up from my observations while visiting family members at hospitals in Nepal. However, through my nursing education in IUBAT, I learned that a nurse is supposed to be responsible and accountable for providing compassionate care to his/her client through a holistic approach, which integrates not just physical but social, psychological, and spiritual aspects that are interconnected and affect an individual as a whole. I learned that a nurse is a linchpin between patients and the rest of his/her multidisciplinary team, that a nurse is the patients’ advocate. I learned that nurses were highly respected professionals, not because of the salary they were paid, but because of the important roles and responsibilities they carried out in patient care (although, hence the salary!).  The IUBAT instructors were true role models for nurse professionals. They were kind, caring, respectful, and always trying to help improve the patient care of the health care facilities. They were also encouraging us, the students, to be the catalyst for a better nursing care practice. As I learned more about nursing, I became aware of the greater role of nurses in patient care and the wider scope of their practice. I then truly started to respect the nursing profession and was proud to call myself a nurse.

Aware of the true potential of a nurse, I came to understand that there is a greater need of professional nurses in countries like mine. I immediately realized that there was a big difference between IUBAT teachings and actual nursing care practices in most of the healthcare facilities of Nepal and Bangladesh.  It also became clear that the nominal and substandard roles of nurses and their scope of practices in these countries were a direct result of poor nursing regulations and education. This realization was life changing to me. I became more interested in improving the nursing care and healthcare standard of countries like mine and Bangladesh instead of working in developed countries. It has become my goal to help Nepal, and if possible, other similar countries, attain a health care system that provides quality healthcare to its citizens regardless of their race, gender, and social or financial status.  

Apart from finding my goal, the skills, knowledge and attitude that I obtained from the IUBAT Nursing Program has saved me from possible obstetric abuse during an important phase of my life – my childbirth. Through the program I have become passionate about advocating for the patients’ right to quality healthcare. The program taught me to become assertive, a critical thinker, and a lifelong learner of good health care practice. Because of these traits, I was able to research current practices around childbirth cases like mine and was empowered to humbly question practices of the doctors/nurses caring for me. I had the confidence to stand up against their professional misconduct and deny their intervention. I was also able to seek the right professionals and place for my childbirth. Because I had become a strong nurse (thanks to IUBAT’s Nursing Program!) I was able to give birth to a wonderful baby girl and experience a wonderful childbirth.”

We are grateful that you shared this lovely narrative for our readers and glad that you were able to give some insight as to how the program was transformative in a variety of ways.  Please stay tuned for the next post, wherein Bimala uses her personal and professional experiences to craft a presentation for healthcare professionals and industry experts.

Alumnus Lands Position with Médecins Sans Frontières‎ (Doctors Without Borders)

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The journey for some students through the rigorous training program at IUBAT is decidedly challenging, and the English language instruction, as well as comprehensive curriculum, require dedication and hard work in order to master.  Samir Chandra Das is a graduate from our College of Nursing and is now finding success in his career as a registered nurse, but he describes the bumps he encountered along the way, and the support he received in return.  He writes:

“My name is Samir, and I graduated from the College of Nursing at International University of Business Agriculture and Technology (IUBAT) in 2014.  As a child, I wanted to be a health care leader.  I love to serve those that are marginalized, poor and vulnerable.  As I love working with people, I selected nursing as a profession, since there are many opportunities to serve and benefit that population.  Furthermore, my brother inspired me greatly to pursue nursing.  He explained to me what nursing was all about and about the prospects and job fulfilment.

Once I made the final decision to become a nurse, I was looking for the most reputable nursing institution.  That is when I encountered IUBAT.  After my admission to IUBAT, I met with Dr. Karen Lund, the Faculty Chair for Health Sciences at IUBAT.  She spoke to me about the variety of job prospects that I could have after graduation, including other benefits regarding nursing jobs in Bangladesh and abroad.  At the beginning of my studies, I was quite depressed because of my poor English skills.  After some time, however, I met with our respected Alex Berland, Senior Advisor in Health Sciences at IUBAT.  I shared my problems regarding my studies with him, and he gave me some valuable suggestions that helped me with completion of my studies and with my English skills and competency.  I am really grateful to IUBAT and our faculty whom taught me, including our international volunteers and national staff.  Because of all of them, I am where I am now.

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Samir, shown here, working with the Kamrangirchar Urban Slum Project with MSF

Just after my graduation from IUBAT, I got an opportunity to work at Gastro Liver Hospital and Research Institute in Dhaka as a staff nurse.  Currently, I am working in Medecins Sans Frontieres-Holland (MSF-H), Bangladesh as an Occupational Health nurse since November, 2015.  

As an Occupational Health nurse, my role is to provide basic health care to the factory workers and to find out the occupational health diseases.  I am also responsible for providing vaccinations to the children, women and male factory workers, medication administration, IV cannulation, nebulization, dressing, history taking, room temperature monitoring, measuring of vital signs, maintenance of infection control protocols, patient counselling, maintenance of medicine inventory and consumption, maintenance of the cold chain of vaccine, and performance of laboratory tests such as urinalysis, pregnancy tests, syphilis etc.

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My opinion is that the College of Nursing at IUBAT is the best nursing college in Bangladesh.  The knowledge that I learned from IUBAT is really essential for my practical services.  I am thankful to IUBAT and our all faculty (national and international) for their valuable suggestions and time, which make me competent enough to provide standard quality of care to patients.  Again, thank you so much for everyone who was with me in my entire nursing journey.”

Thank you for sharing your accomplishments and challenges, Samir, and we are certain that your story will bolster and encourage students currently in the program who may be facing some difficulties of their own.  We congratulate you on your new position with Médecins Sans Frontières, and we hope that you continue to thrive and grow in your role as a nurse.

Snapshots of Student Life

The following are photos taken at Aysha Memorial Hospital on the last day of clinical practice of the Spring 2016 semester for the students in NUR219. These are second year students and the NUR219 class is the first time that students attend clinical practice. Prior to this experience, the students are in the lab classes on campus.

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On the left is Shuvashish Das Bala, the instructor for NUR219. It was Shuvashish’s first time in this role as Assistant Lecturer at IUBAT University, taking students on clinical.  This is significant as to highlight the importance of the volunteer faculty (in this case, Roslyn) to help support these new and eager faculty members transition into this role. Next to Shuvashish (from left to right) are nursing students Philomena, Khadiza, Roslyn (volunteer faculty) and Sumona.

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In this photo is Mohammad Ali (Kiron), Assistant Lecturer at IUBAT University, with Philomena, Khadiza, Roslyn and Sumona. Whilst not responsible for this class, Kiron participated with clinical to gain experience in this role and to prepare himself for when he will be responsible for taking his students on clinical placement.  He is also featured on our blog here.

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Nursing students, Philomena, Sumona and Khadiza are illustrating standard dress while on clinical. Students are expected to be neat, professional and in uniform, and ready to participate in any and every experience while on practical. They are expected to take notes, ask questions and learn as much as possible. The teachers supervising are available to help and ensure that international standards being taught at IUBAT University are being upheld in the clinical environment.

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Finally, this photo showcases nursing student, Sumona, at Aysha Memorial Hospital on the female ward at the nursing station, reading a patient’s chart.

In this course, students attend the hospital one day/week for clinical practice and according to volunteer faculty, Roslyn, “it was really great to see how excited and eager the students were. They would come to the teachers with charts to show us patients on the wards that had conditions related to what they had been learning in lectures. They would describe skills they had participated in with the nurses on the wards, follow doctors on rounds, tend to patient care and translate to English for the foreign faculty what they were discussing/asking patients. The students improved greatly over the semester and it was a pleasure to see them grow in their skills and confidence as student nurses.”

A huge thank you to Roslyn Coltheart who helped with the descriptions of the photos and elaborating on this course during the nursing curriculum.  To read more about Roslyn, please click here.

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Please visit our Flickr page for more photos!