Interview: Ruth Davidge, South Africa

In our Interview series, we are grateful to present Ruth Davidge, South Africa, a strong and passionate advocate for neonatal nursing! Among achievements, she was the founding president of the Neonatal Nurses Association of Southern Africa (NNASA). Today, Ruth Davidge is the responsible coordinator for improving quality of neonatal care in a province where 200.000 infants are born every year.

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How would you introduce yourself and where do you currently work?

My name is Ruth Davidge. I am a passionate neonatal nurse and Christian.  I am unmarried but am a devoted aunt to my nephew and niece of 5 and 3 and 'mother' to a darling dog who keeps me sane. I could not do what I do without the loving support of my family and the strength, love and wisdom given me.

I live and work in Kwa -Zulu Natal on the east coast of South Africa. It is a very diverse province with spectacular scenery, bush veld, mountains and 100s of kilometers of pristine coast line.

Our population is mainly rural but we also have some big metropolitan centers.

Kwa -Zulu Natal is the epicenter of the HIV pandemic with an incidence of 39/1000. This has a huge impact on the health of our population and demands for health care. However with much hard work and the availability of antiretrovirals we have dropped our mother to child transmission rate to less than 1%.

Approximately 200 000 babies are born in the province annually. Combined births in Kw-Zulu Natal and Gauteng (another province with Johannesburg as its capital) account for approximately 42% of all the births in South Africa. The province is working hard to reduce neonatal mortality which is currently less than the national average with a neonatal mortality rate of approximately 12/1000. However there is great inequality. Durban (our largest city) has the lowest under-5-mortality in the country but some districts in the province have mortality rates 4-5 times greater! We have some state of the art NICUs and yet some hospitals cannot provide blended oxygen or guarantee that the baby will be seen by a doctor every day.

How did your professional career lead you to this spot?

I started nursing neonates in 1994 and received 6 months training in 1996. I was the unit manager of a busy tertiary referral hospital for 10 years, the founding president of the Neonatal Nurses Association of Southern Africa (NNASA) and a board member of the Council of International Neonatal Nurses (COINN) before commencing my current role. I am now the provincial neonatal coordinator for Kwa -Zulu Natal - responsible for improving standards of neonatal care in all the public hospitals in the province.

I have been fortunate to work in a hospital renowned for the quality of its nurses and standards of care and have learnt from the visionary leadership of 2 special doctors.

My current supervisor and head of paediatrics in the province has always passionately believed that's hospitals and those that work in them have a responsibility not just to their patients but to the whole population they represent. He has doggedly persisted in striving to ensure all our population has equal access to quality care.

A friend and colleague is a neonatologist who has taught me the true meaning of dedicated servant leadership, excellence in neonatal care and passion (compassion) for the vulnerable babies and families we serve.

I believe the solid grounding I received during my early years and the exposure both nationally and internationally to other passionate skilled professionals has bought me to where I am today.

I think NNASAs core values of Care, Passion and Excellence really sum up what I believe are critical for every nurse.

What do you typically do during a working week?

I really enjoy the variety of my work. 2 days of the week I'm in the office trying to catch up with emails, writing reports, compiling and updating guidelines and developing standardised records and quality improvement / monitoring and evaluation assessment tools amongst other things. (We are about to launch a new set of neonatal records for use in all our neonatal units in the province and have just completed a detailed baseline assessment/ accreditation of  each hospital's neonatal service)

When not in the office I travel to each hospital in order to support and encourage their efforts at improving neonatal care. I teach the nurses and doctors and meet with management to ensure they are aware of the required norms, standards and systems for neonatal care. This allows me to keep my skills up clinically ( I think I would shrivel up and die if I didn't spend some time actually caring for babies!), to gain insight into the challenges experienced at the coal face and ensure staff feel motivated and supported in the work they are doing. I also conduct workshops on Helping Babies Breath, KMC etc and run short (2 week) basic neonatal training courses.

What are the challenges?

Working in a middle income country, lack of resources is always one of the biggest challenges. This includes personnel, equipment and consumables. There is such a feeling of frustration when you are aware of the money that is available nationally that just disappears before it gets to the front lines. Corruption, politics, favouritism and complicated dysfunctional systems make for a very challenging and frustrating work environment.

The lack of neonatal nurse training in South Africa and many other countries around the world poses huge challenges to the delivery of quality neonatal care. There are very few trained neonatal nurses in South Africa. (Our nursing Council stopped neonatal training a number of years ago believing that there was insufficient unique knowledge/ skills required in neonatal nursing that couldn't be taught during post basic midwifery or paediatric training) This has resulted in either general nurses or midwives caring for sick and small babies. They have no extra training for this and cannot learn from experienced colleagues/ leaders (as was my experience) as these are now few and far between. They therefore feel nervous, inadequate and ill equipped for the work they are doing resulting in large absenteeism and rapid turnover of staff.

It concerns me that in global planning neonatal nurses are seldom mentioned. Midwives are necessarily advocated for but there is little understanding of the need for specialised nurses to care for sick and small babies at all levels. There is an idea that  neonatal nurses are only relevant in first world intensive care or academic centers and yet from my experience when rolling out even basic neonatal programmes at low levels, an experienced neonatal nurse can have far more impact and influence than other nurses/ doctors.

I am also personally challenged in that I don't have a gift for languages (we have 11 official languages) and I don't speak the first language of most of my colleagues and patients. This can sometimes make communication slow and difficult. However people are usually patient with me and we laugh together at my poor pronunciation.

I feel sad when I see colleagues, who through lack of training, support and exemplary leadership, have become lazy, dispirited and hopeless - mainly driven by a desire to earn more or achieve greater status rather than a passion for their patients. This makes it very difficult to introduce new ideas, skills or programmes as they lack motivation to implement them and don't believe they are sustainable.

However I am encouraged by the joy, excitement and interest with which my visits are usually received. Frequently I am met with colleagues who are trying to give of their best despite challenging circumstances and who are craving knowledge, support, advice and encouragement.

What are the greatest potentials you see unmet in neonatal care?

• Specifically trained and allocated nurses ( allocated just to neonates) acting as skilled advocates for and deliverers of improved quality care
• More accessible research/ evidence based care - nurses have very limited access to academic journals and lack training and insight in how to interpret research findings. I have been recommending Keith Barrington's blog to many nurses who are trying to develop themselves further.
• Access and support to attend conferences to stimulate and excite nurses in their field
• Understanding the critical role stress plays on the neonate and the God given gift of the mother to counteract this. Kangaroo mother care and developmental/ family centred care should be core to the care of neonates at all levels and settings and is often missing where focus is placed only on survival.
• Excellent, passionate clinical leadership. Both doctors and nurses need to have strong mentoring by a leader that is present and committed to teaching by example. As nursing leaders have been forced to become administrative leaders (removed from clinical supervision and teaching by paper work and meetings) clinical leadership, teaching and oversight have suffered.

For newly graduated colleagues around the world - what would be your best advice for their future professional development?

• Don't loose your passion in the face of disillusionment and challenges - your patients are depending on you to be their advocate and skilled provider when others have given up.
• Don't follow bad examples- if people around you are lazy and uncaring try not to join them
• Look for and seize every opportunity to develop yourself- don't wait for it to be offered you on a silver platter.
• Look for and learn from colleagues who put their patients first, don't think themselves too special to change a nappy (diaper), who treat you with respect and value excellence in care above their own careers.
• At whatever level you are practicing remember that you are a nurse first and foremost which means that care, compassion, healing hands and time spent nurturing your patient and their family are just as important as administering the correct medication, skilfully adjusting the ventilator or gaining yet another academic qualification.

What are your own future plans?

To live a life with a higher meaning.

To continue to strive for excellence in all that I do.

To continue to try and make a difference for the neonates and families, colleagues and friends with whom I interact.

To share passion, joy and hope.

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"Photo taken a small district hospital during one of my outreach visits. It had recently been renovated and we were discussing appropriate admission and discharge criteria to ensure the unit didnt become overcrowded."

"A small district hospital. In the picture are the doctor and nurses working in the unit. We are discussing a guideline in the standardized guideline book developed in the province."

"The view of my old unit. It no longer exists now as the hospital has a newly built neonatal unit and the old unit has been converted to house a  high care KMC unit-the first in our province (offering nasal CPAP in 24hr KMC), on call rooms, a donor  milk bank and seminar room."

"Me in my younger years as a unit manager."

"Photo taken in winter at Njasuti in the Drakensberg Mountains. They are a world heritage site famous for their scenic beauty and the San Rock Art found in isolated caves.  Archaeologists believe that the San are descendants of the original Homo sapiens and that modern Khoe-San have the oldest gene pattern dating back 80 000 years. All other peoples on earth descend from this gene type."

"View of our beautiful Kwa- Zulu Natal coastline which can be very wild and isolated in places or packed with tourists and development in other places. We are proud to have a number of Blue Flag beaches."

"Me standing next to the Red Cross Air Mercy Service airplane thats flies me and other outreach doctors to outlying hospitals that would otherwise take hours to reach. The purpose of these outreach visits is to try and increase capacity at these small hospitals and also to bring expert consultant care to patients that might otherwise not be able to access this. The airstrips we land on are often owned and maintained by farmers and may only consist of a mown grass strip in  a field. The Redcross are paid by the KZN Dept of Health for this service."