Monthly Archives: February 2015

Return to Malawi moments 3

Well this is our last morning in Malawi. Jane and i separated company last Sunday. Jane headed north to Msuzu while I headed south to Zomba. I arrived in Zomba on Sunday evening to find my accommodation was near the top of a mountain overlooking the Zomba plateau. Unfortunately, as this is the rainy season, for the majority of the time I was in the clouds. However, on the rare clear moment the view was stunning across the plains. Lake Chiwa was full and vast, however, I’m told that by June – August it will have shrunk considerably, possibly even dried up completely, which is incredible given its size at the moment.

Zomba is a stunning area in Malawi. Extremely green with plentiful vegetation. It is much wetter and quite a bit cooler than Lilongwe, although still way warmer than Aberdeen. The mosquitoes were out in force though.

The two and a half day programme teaching Emergency Obstetric and Neonatal Care (EmONC) skills to the qualified Community Midwife Assistants (CMA) was yet another success. Our Malawian colleagues Andy, Mary, Dora, Ruth, Bertha, Susan and Sally (who had been at the training in Lilongwe last week) were all superb delivering the programme. It was a great pleasure to work along with them this time.

We had 25 CMA’s at our session. Initially they were quiet but as the days progressed they should all the enthusiasm and energy we have experienced of the Malawian people when they participate in training sessions. The CMA’s had come from all around the Southern region for their first CPD update since qualifying 18 months ago or so. Feedback from them was positive wanting more and regular updates and refreshers which was wonderful to hear. A suggestion from one of the CMA’s was to come back to Scotland to see how midwifery is practiced in our communities.

There were a couple of surprises during the programme though. On our first day it became apparent that five of the CMA’s had brought their babies with them along with a nanny to look after them while they were in the training. Speaking with the mother’s I discovered that one baby was only a month old and she had traveled some distance to attend the training, another mum had a 7 month old. Of course they had to bring their babies with them as they were still breastfeeding.

The second surprise was the monkeys. I had not expected to see nature so close. At the hotel on the mountain were the big monkeys. There was no shyness about them, they shared (or perhaps owned) the hotel with the guests. While they ran the grounds and over the roof freely they also new how to open doors and frequently attempted to do so, especially the dining room doors. As we left the hotel for the last time yesterday morning a troop of 20-30 monkeys were there to see us drive off.

Down in Zomba itself at the training centre there were smaller black flat faced monkeys who often entertained us as we finished in the afternoon. Indeed one young mum suckling her baby as if demonstrating her mothering skills for our programme.

Well its time to pack and start heading home this morning. I’ll see you all in a couple of days time.


Day 1 skills demonstration

Day 1 skills demonstration

Day 2 EmONC training

Day 2 EmONC training

Day 3 CMA presentation

Day 3 CMA presentation

Zomba group Photo

Zomba group Photo

Some of the mountain monkeys ensuring we left

Some of the mountain monkeys ensuring we left


Return to Malawi moments 2

Well we are now at the end of our first week across here in Malawi. It has been a fast and full on week. We are glad of a rest day today. Since our last blog we have now run our pilot training on Human rights in relation to respectful care. Once again we had a fantastic 2 days working with our Malawian colleagues. The programme was officially opened by Dr. Phoya along with a number of dignitaries, including the guest of Honour, the Minister for health principal secretary Mr David Kandoje. Opening remarks were provided by the coordinator of the Malawi-Scotland partnership, Mr. Makala. This was followed by a group photograph and coffee where Jane and I were able to meet and speak with the officials.

Following the official opening the programme was warmly received by all participants with some excitement. Participants constantly commented that this training is badly needed in Malawi, they felt it was an eye-opener, especially when everyone discussed examples they were aware of in their own areas. This was further reflected in their evaluation of the content and delivery of the programme.

Despite a few setbacks over the two days such as no projector for the delivery of the presentations and a flood in the conference room on the second day everyone participated enthusiastically, welcoming this training and wanting to promote Human rights and respectful care across Malawi.

Jane and I are now honorary members of AMAMI (Association of Malawi Midwifes)

Jane and I are looking forward to a relaxing day this morning before we split up tomorrow and head our separate ways for a couple of days.

Jane and Donald
Skills demonstrationHelping babies breathEclampsiaEmONC Skills participants

Return to Malawi Moments

Thursday 12th February.

Jane and I have been in Lilongwe now since Sunday. We arrived to a hot, cloudy, and humid day. Escaping from the icy north of Aberdeen. There have been a few thunderstorms and torrential downpours. The scenery is very different from last December, there is lush green vegetation all around with a blast of colourful flowers and a lot less dust.

On our arrival there was no internet connection at the hotel. At last though we have connection. So here is the start of our Malawi moments for 2015.

Our week so far has been full on. We have delivered our Emergency Obstetric and Neonatal Care train the trainer programme to our Malawian clinical and college tutor colleagues. This was an enjoyable and fun experience for all. There was a lot of shared learning. At the end of the 2 days we supported 12 colleagues, 6 from the south and 6 from the north to plan the delivery of the programme to Community Midwife Assistants. We plan to deliver these sessions Monday, Tuesday and Wednesday next week. Jane travelling north to Mzuzu to support our colleagues there and me to the south in Zomba.

In the meantime we are delivering for the first time our new programme on Human Rights in relation to respectful care. Stay tuned for an update.

It has been great so far to be able to meet with friends from previous visits and catch up with news as well as forge some new friendships.


Donald & Jane

ENTER conference success

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In November the School hosted a prestigious two-day national conference showcasing nursing research. A national collaboration between nine of Scotland’s nursing universities, the Enhancing Nursing Through Educational Research (ENTER) Conference brought together 130 delegates from nursing education and practice.
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The conference featured keynote speakers, Professor Brendan McCormack from Queen Margaret University, Edinburgh, and Professor Anne Marie Rafferty from the Florence Nightingale School of Nursing and Midwifery at King’s College, London. In a first for this national conference, Professor Rafferty delivered the Inaugural ENTER International lecture entitled: ‘Educating nurses for patient benefit’ via live web stream to a world wide audience of over 100 participants.
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Conference Chair, Dr Colin Macduff  said: “Feedback on the ENTER Conference was very positive indeed. It was great to bring educators and clinicians together in the very conducive surroundings of Riverside East. At a time when nursing has been under particular pressure, it was important to assert again the value of educating for person-centred care. In particular, Professor Rafferty and colleagues’ international research involving almost half a million patients provides some of the strongest evidence yet that well educated nurses working in sufficient numbers foster major positive impact on clinical outcomes. Our nursing students, staff, and NHS colleagues work closely together day in day out towards achieving this impact.”
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Mentalization-Based Therapy Skills Training and Borderline Personality Disorder by Dan Warrender

I recently completed my MSc Nursing at the University of Aberdeen. This involved undertaking a research project which was directly influenced and inspired by my area of practice as a staff nurse. Working in acute mental health can be challenging for staff, but also for patients, none more so than people with a diagnosis of borderline personality disorder (BPD). People with BPD constitute an estimated prevalence of 20% within inpatient settings, with crisis presentations often involving suicidal and self-harming behaviour. Whilst admission to inpatient services is done primarily with a view to assessing and containing risk of harm, the acute mental health environment can present further challenges as patients can paradoxically deteriorate in hospital. Understanding BPD can be simply described as ‘understanding misunderstanding’. People with BPD often have significantly unstable interpersonal relationships as they can assume other peoples mental states and misconstrue their intentions. These misunderstandings are often triggers to manifestations of crisis. In this way, people with BPD are incredibly fragile, and admission to 28 bedded mixed sex wards, with different staff on opposing shift patterns provides ample opportunity for misunderstanding. This entails a situation where a patient may be admitted on the basis of one crisis, only to experience further crises within the hospital environment. Mentalization-Based Treatment Skills Training (MBT-S) is a two day workshop which teaches mental health staff nurses about BPD and it’s development, before moving on to a role-play based skillset which promotes empathy and exploration of thoughts and feelings. The aim of mentalization is to increasing the patient’s ability for self-reflection and awareness of other peoples mental states. MBT-S was first introduced to staff nurses in Royal Cornhill Hospital in June 2013. My study utilised 2 focus groups to assess staff nurse perceptions of the impact MBT-S had on their practice, with the findings capturing 7 key areas.

  • Common Sense Approach
  • Consistency of Approach
  • Empathy
  • Flexibility
  • Empowerment of Staff
  • Tolerating Risk
  • Limitations

Staff found MBT-S to be a common-sense approach which allowed a consistency of approach between themselves and colleagues. There was also increased empathy towards patients as a result of an increased understanding regarding the nature of BPD. MBT-S had a flexible use in structured sessions or ‘off the cuff’ instances and staff felt empowered to make real visible changes in patients mental states. Staffs ability to tolerate risk was also increased, this avoided unnecessary use of constant observations and the mental health act through an increased ability to make changes through MBT-S based discussion. Limitations were not around MBT-S, but around the limited opportunity to engage with patients in incredibly busy environments.

Although a small scale study, this piece of work has significant implications for practice given the prevalence of people with BPD and the associated challenges admissions can involve. Now in a post at RGU as a lecturer in mental health, I am committed to continuing my research, and increasing awareness and understanding of BPD as a condition which can improve with the correct approach.

Dan Warrender