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‘I was just amazed at what they were able to do with so little’

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Matthew Grundy-Bowers tells Josie Le Vay how delivering training on sexually transmitted infections and HIV in Zambia broadened his perspective on nursing and resulted in him reflecting on his job in the UK 

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There’s only one nurse on shift. Her colleague couldn’t make it in today – if she did, they’d still be 50% understaffed. The centre is busy, too busy. People from all over the city are flooding through the doors. Staff are pushed for time and struggling to cope.

This could easily be painting a picture of the NHS’s winter crisis, but it is actually what Matthew Grundy-Bowers witnessed when he visited a referral clinic in Zambia. “They are literally so much more stretched than in the UK,” he says.

In 2009, it was recommended that, nationwide, Zambia should have 16,732 registered nurses, but they only had 7,123 – a shortfall of nearly 10,000. “It’s a huge, huge shortage,” Mr Grundy Bowers says.

The sexual health nurse went to Zambia in June as part of a team of British doctors and nurses delivering training on HIV and sexually transmitted infections to clinicians in the country’s capital of Lusaka. He already knew the figures, but it wasn’t until he spent time in the city’s STI and skin clinic that he truly understood exactly what that meant.  

“I was just amazed at what they were able to do with so little, in terms of the structure, the diagnostics, the staffing. They have to know about STI and dermatology. I was blown away really,” he explains.

”They loved it; they said that their practice was going to change because of it. We did what we set out to do”

The training courses that were delivered by the team were a success and tests showed that the knowledge of the participants significantly improved afterwards.

Mr Grundy-Bowers says: “We had glowing feedback. They loved it; they said that their practice was going to change because of it. We did what we set out to do.”

Due to homosexuality being illegal in Zambia, a session on men who have sex with men was removed from the course, but the issue was not ignored. As Mr Grundy-Bowers explains: “We still had to get that message in so we wove it into all the other sessions.

“One thing that came up from quite a few people was around working with gay men, and that they hadn’t thought to be a bit more open and a bit wider in terms of their questioning.

“They’d say things like: ‘Oh gosh there was that patient that I saw and he probably was gay and I hadn’t put two and two together. I would have treated him differently if I had known then what I know now’.”

Unfortunately, no nurses took part in the programme, but Mr Grundy-Bowers is hoping that the team can go back this year and provide bespoke training for them. And despite no nurses undertaking the courses, it didn’t take him long to notice that the role of nurses in Zambia is quite different to that in the UK.

“The doctors would do all the history taking and all the swabs and bloods; the nurses are there to support and facilitate. It reminded me of when I was a student and traditional nursing roles when they supported doctors,” he reflects.

”I think it’s becoming more about nurse-delivered care for sure”

“It’s difficult because if we give some of the nurses the work that the doctors are doing, who’s going to do the nurses’ work? And are they then going to be laden doing their own work and some of the doctors’ work?”

His job in the UK has evolved considerably since he first qualified, and the same changes could also happen in Zambia.

“Normally I would be doing surgery on a Tuesday morning, removing genital warts – 25 years ago there’s no way that I would have been able to do that,” he says.

“In terms of care delivery, I think it’s becoming more about nurse-delivered care for sure. There’s an important role for medics but it isn’t necessarily seeing somebody with thrush or gonorrhoea,” he adds.

Although the differences between nursing in the UK and Zambia are numerous, Mr Grundy-Bowers found one thing that remains consistent: “There were similarities in terms of the compassion and the care that I saw nurses providing,” he says. “That is the same whether you’re a nurse here in the UK or anywhere else and that was really heart-warming.”

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