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Case Study - Alison Knowles

One of our Child and Adolescent Mental Health Services staff went back to her paediatric nursing roots when she volunteered in Rwanda for six months. Nurse practitioner Alison Knowles had decided to take a sabbatical and started to explore the idea of doing voluntary work overseas.

Donated goatsShe said: "It has been a dream for many years yet I have never felt quite brave enough to take that leap but the time felt right so I approached our Trust Chairman Peter Mount because of his links to Uganda. I hoped he would have a few ideas regarding volunteering opportunities. I think it all snowballed from there really!"

Alison works in CAMHS (Child and Adolescent Mental Health Services) which is usually not an area that lends itself to helping in a practical way in developing countries, but her  background is paediatric nursing. Most agencies offering voluntary work prefer a commitment of at least a year and/or a substantial financial contribution, but Alison opted to go for six months.

Mr Mount told Alison about a little health centre he had visited in Rwanda which was asking for volunteers. She only had a map and a very brief job description, but after a considerable amount of thought decided to take the plunge. Gituku Health Centre was established by Sister Martha Mukashema and they started to correspond by email and text. The health centre was established six years ago when Sister Martha was working in the nearest town which was 30 minutes away by car. She had realised that people had to walk for many hours to seek medical assistance, some in extreme circumstances such as in labour. Gituku Health Centre manages the health care of 42 villages which is a total of 29,071 potential patients.  This includes the training and supervising of Community Health Workers and local birth attendants. The nearest hospital is 32km away.

The health clinicAlison said: "My role was to work within the World Health Organisation guidance on early detection and management of health care in the under fives. I worked in the consultation area. Not going as part of a large organisation had its positives and its challenges. I was able to say exactly when I wanted to go and negotiate my length of stay. But I had to decide where to stay and unusual as it may seem I opted for staying in the convent. I am not a Catholic but this wasn't a problem, I kind of fitted in around the nuns' routine and they were so welcoming. It felt safe and much easier than staying in the village on my own. I was the local celebrity and didnt have a moment's peace once outside of the convent walls."

Despite the obvious differences between her life in England and Rwanda, work at the health centre was as Alison had expected. She did part of the Tropical Nursing Diploma at Liverpool University before she went which was so useful, and felt prepared for the level of poverty from a previous trip to Uganda.

She usually worked until there were no more patients, which could be until 3.00 pm on a busy market day with the clinic consultation open from 8.30 am. Many patients had walked for many miles to the clinic and they were the gateway to the local hospital. Alison saw a variety of illnesses and problems from pneumonia, worms, infections and some malaria, to chopped off fingers and cow horn injuries! They offered a 24 hour service but it mainly operated between 8.00 am and 5.00 pm.

Alison and DianaThe health centre could process basic laboratory tests, there was a small pharmacy and a few in-patient beds for up to a 24 hour stay, but was very simple. There was not as much choice with medicines as at home. There was also a maternity unit with two birthing chairs, Nurses had just two years training but were adept at delivering babies with little intervention. There were also weekly immunisation and malnutrition programmes held weekly and lots of outreach work in the community ie with HIV patients.

Alison said: "My trip is full of happy memories of lovely people and wonderful scenery, however naturally there were a few things I found a bit difficult. One of my most trying days was when we had a really poorly baby whose parents couldn't afford the £2.50 for him to be transported to hospital. It's hard to comprehend that a child's life could hang in the balance for less than a price of a cappuccino.

"I really struggled with issues not dissimilar to this and knowing at what point to intervene when culturally life is so different was a challenge. On a lighter note the extremely poor internet access in the country at the time drove me potty. Luckily I had so many wonderful friends and family who kept in touch throughout, doing a blog I think is also a good idea.

Local children"I was so sad to leave, it took a while to get to know people and really after month four I had just started to feel accepted as a member of staff and had made some friends. The fact that it is so hard to keep in touch is difficult, there is only one computer in the village at the health centre and although most people have a mobile phone, the network isn't reliable. The nearest post office is an hour's drive away and post takes anything from 4-8weeks to arrive. I would absolutely recommend this kind of trip to anyone after a change and wanting to 'help out'. It took a lot of preparation and I have had fabulous support from family and friends as well of course as from the Chairman. It was so worth it for me personally and I feel I have learnt about myself in the process.

"If I had stayed longer I would have liked to have done more of a project and had a goal to work towards, but that's just me. Readjusting to coming home has almost been harder than the transition to African life and I am still a bit there I think. Certainly the walk to work with cows, goats and farmers as well as a whole host of beautiful smiling children beats rush hour traffic any day."