Kimberly Baltzell, RN, PhD, MS, associate professor in the UCSF School of Nursing and faculty affiliate at the Institute for Global Health Sciences, recently received a multimillion-dollar gift from the Wyss Medical Foundation to support the development of nurse leadership in Malawi, Sierra Leone and Liberia, with a focus on reducing the risk of complications and death during childbirth.
Malawi has the highest rate of preterm births in the world and high rates of newborn death. Sierra Leone is the single most dangerous place to give birth in the world.
The Wyss Medical Foundation funding will dramatically expand Baltzell’s Global Action in Nursing (GAIN) project.
The project already provides Malawian nurses — who, like many in developing countries, don’t receive mentored practical training after graduation — with directed training followed by year-long intensive mentoring with expert nurse midwives. The gift will launch similar programs in Liberia and Sierra Leone, where the sheer number of healthcare providers is particularly low after many died or quit during the 2014 Ebola outbreak.
The funding will support additional work with the national ministries of health and nursing councils to develop educational pathways for more skilled nursing roles. Local nurses have limited opportunities to move into more senior clinical roles by building on education already completed. To advance in their careers, nurses often have to move into non-clinical managerial roles, depriving newer nurses and patients of their clinical expertise.
GAIN expects to produce 1,000 new nurses and provide additional pregnancy and delivery training for 500 practicing nurses, each of whom will deliver, on average, 25 babies a month. In Malawi, the statistics suggest that each provider will have at least one opportunity every month to save a baby who would otherwise die.
Baltzell’s focus on nursing in Africa began one day in June 2006. In sub-Saharan Africa for the first time — ostensibly on vacation — Baltzell had arranged to visit a couple of health clinics to chat with the nurses about what it was like to practice there. What she saw would change the course of her career.
Nursing isn’t easy anywhere, but in many rural areas, with just one health facility for hundreds of miles, the burden on nurses is that much greater. Globally, 8 in 10 patients are seen by nurses, not physicians. Nurses have to treat and diagnose everything that walks through the door — even during a power outage, even when sterile conditions are nearly impossible to maintain.
Baltzell’s interest in global health was piqued. Having seen its impact, she began researching malaria. (Malaria continues to take 430,000 lives every year in Africa alone). She added a Master’s degree in global health sciences at UCSF to her preparation, traveling to Africa several more times.
The nurses remained a powerful part of the picture. They diagnose and treat most cases of malaria. In 2016, Baltzell traveled with Sally Rankin, RN, PhD, former associate dean for global health in the School of Nursing, to the Neno district of Malawi to consider how they could help develop nursing there.
The nurses would show them what was hiding in plain sight. It wasn’t just malaria that needed more concerted attention. There was something even more common: pregnancy.
Baltzell recalls a woman who walked for hours to get to the clinic, arriving when she was already in stage 2 labor. One woman with a post-partum infection rode on the back of a bicycle along miles of rutted dirt roads to get the specialized care she needed.
“You know these things happen,” Baltzell reflected, “but when you see them with your own eyes, they stick with you and become part of what you think about as you make your own contribution.”
Baltzell and Rankin co-founded GAIN to expand nursing education and mentorship focused on safe childbirth, which they piloted in Neno in 2017. Soon they started looking to expand to other parts of Malawi and to other countries where they knew the need existed.
The new funding will expand to Sierra Leone and Liberia programs that give nurses the expertise and mentorship they need “to handle, or more importantly to recognize, when something is going to go sideways and refer patients to higher levels of care. You don’t want to wait until someone is in the middle of a hemorrhage to transfer them,” Baltzell explained.
Local nurses have responded positively. “I work confidently because I have all the skills and resources to be used. When I am not sure, I refer to my GAIN guidelines to be sure of the answer,” one participant said.
More than a decade after that June day took Baltzell into an unexpected conversation with frontline African nurses, GAIN and its partners now have the funding they need to implement, at scale, the programs they’ve built with the nurses to help them practice at full capacity in settings where they are the backbone of the health care system.