“A leader is a dealer in hope.” This is a description of leadership I have heard attributed to the French leader and naval commander, Napolean Bonaparte. But for me it loudly resonates with the vision of those leading a very different kind of ship across oceans – the crew aboard the hospital ship ‘Africa Mercy’ seek to fulfil the vision of Mercy Ships to bring ‘Hope and Healing’.

Most obviously this vision is manifestly demonstrated in the lives of hundreds of patients who are receiving free and life-changing surgery on the ship. However, it is not only the patients who need hope, but also those who are working day by day to provide care for them, often in challenging circumstances. Our department of Medical Capacity Building has the privilege of coming alongside the health care workers in this beautiful country to work together towards better building healthcare.  

Hope for change

You may recognize the feeling; you and your team are already working hard, personnel and resources are stretched thin. Even just managing can feel like a big challenge, never mind expecting improvements in performance. This is one exciting thing about the WHO surgical safety checklist. Without the need for extra staff or lots of expensive new equipment, this simple communication tool can help surgical staff to improve their teamwork and safety awareness, and research consistently shows astonishing benefits to patient outcome after surgery. But introducing changes to day to say practice can be difficult at the best of times! You need leaders who are willing to step up and be ‘dealers of hope’.

Since the last post from our team introducing the WHO surgical Safety Checklist throughout Madagascar, we have visited another 4 hospitals in our tour of 20 regions! Below is a summary of what we have been up to, and some observations of what leadership looks like as demonstrated by these diverse teams from around the country.

‘The challenge of leadership is to be strong, but not rude; be kind but not weak; be bold, but not bully; be thoughtful, but not lazy; be humble, but not timid; be proud, but not arrogant, have humor, but without folly.” – Jim Rohn. 

Antsiranana AKA ‘Diego Suarez’ – professorial participation

Diego Suarez lies at the far northern tip of Madagascar, where we were warmly welcomed by the hospital team in this very hot (but mercifully breezy!) port city. We have been hugely encouraged to see the energy and example of those in clinical leadership roles in these hospitals, supporting their teams in implementing a new system. At Diego Suarez, 2 Professors from the surgical team attended every single training session, enthusiastically immersing themselves in discussions, demonstrations and scenarios and engaging their whole team in the process.  Everywhere we go, staff mention the benefit they see that using the WHO surgical safety checklist has on their team spirit, level of communication, and awareness of patient safety. The vision and example of senior leaders like these in Madagascar is crucial to the training becoming a lasting part of the working culture in their teams. “Culture does not change because we desire it to change. Culture changes when the organisation is transformed; the culture reflects the realities of people working together every day’ – Frances Hesselbein. 

 
Sambava and Antalaha – share, support and serve

After returning briefly to Antananarivo to pick up supplies, we caught another plane up to the north east, to the Regional Referral hospital in Sambava where were also joined by staff from the nearby district hospital in Antalaha. It was fantastic to see these two very busy teams collaborating, sharing ideas, and using the WHO checklist in real emergency cases in the theatre before we left Sambava. By the time we reached Antalaha on Saturday to run through the final day of teaching with the rest of their team, those who had been at the training in Sambava were  already teaching their own colleagues about what they had learned! These teams are often hard-pressed, and expressed the importance of giving time to their relationships with each other. One of the surgeons described how they often take time at the end of the working day to eat together and support one another, before seeing everyone home after work. “We have to rely on each other and support each other here.” 

 

 
  

Miarinarivo – leadership at every level

A few hours drive outside the capital city, we met the team from Miarinarivo in the Itasy district. Of course it is not only professors or those in management roles who can impact a team with strong leadership! The training includes all theatre staff including surgeons, anaesthetic staff, scrub nurses, technicians, the whole team. During a particularly challenging clinical scenario simulation in the operating theatre, one midwife was exemplary in leading the team clearly through the elements of the checklist. After the teaching sessions, the anaesthetic nurse gave a dynamic and detailed 10 minute summary of the teaching on Lifebox (the medical equipment that allows monitoring of oxygen levels and heart rate during surgery – an essential part of the WHO Checklist) to the rest of the theatre staff. As he remarked during the teaching…

‘There is always something more to learn, you never know 100% of everything! So we should always be learning.’

Of course, he is right. I am enjoying learning from these incredible people. Our hope is that each of those who have been part of this training (now at the 7th site this week) will share what they have learned, face the challenges of introducing new practice, little by little changing things for the better and leading the way in being dealers of hope. 

‘We must accept finite disappointment, but never lose infinite hope.’ – Martin Luther King Jnr.