Case Study- George Agot Nyadimo

Workplace: Pumwani Maternity Hospital

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George, the Nursing Services Manager at Pumwani Maternity Hospital, attended Kenya Medical Training College Kisumu for a Diploma in Health Nursing. When he graduated in 1997, he was posted by the Ministry of Health to the National Spinal Injury Hospital in Nairobi. Then he studied for a Diploma in Advanced Nursing at Kenyatta University and took classes in leadership, management, governance and hospital operations among other subjects in institutions in Kenya and South Korea. From 2012 to 2014, he studied a Master of Science degree in Health Economics and Policy at the University of Nairobi while he worked at the Nairobi Remand Prison’s health centre where he partnered with Maltesa International in renovating and constructing new buildings – one for the general public and one for the prisoners.
He enrolled at AKU for a Bachelor of Science in Nursing (BScN) in 2007. In 2008 George was posted to Pumwani Maternity in the position of lecturer (nursing and midwifery). After seven years, in 2015, he was appointed to his current position.

“When I took up this position, it was after the 2015 strike that had 60 nurses sacked. The ‘paralyzed environment’ and press stories dented the hospitals image. My appointment was viewed as part of the management solution to the difficulties,” George explains.
 
George says he was well prepared at AKU for the task. “The first thing I did was study the environment and carry out a skills audit of the hospital after which I reshuffled departmental managers, rotated nurses and changed the admission process in wards. I also focused on transforming the working environment by increasing inter-departmental communication and faculty feedback. The impact of the changes is reflected in the work output. Before I took over, deliveries per month were at 900, now they are at 1,800 and new born extended stays fell from 90 to 40.  This is because now when mothers arrive, they are taken in immediately and assisted. This move has also reduced the neonatal mortality in the hospital. Maternal mortality has gone down from two per month to two in the past seven months.”
According to George, it was not easy because initially, nurses were suspicious about his motives – rotating nurses, coming in early and looking at all reports. But now the working environment has been transformed and the improvements recognized by the county government. “The AKU unit called ‘clinical practice’ prepared me to bring the public sector to a higher level,” explains George.
Pumwani Maternity offers a myriad of services including training and development (nurses), midwifery and obstetrics, maternal child health and family planning. The Comprehensive Care Centres (for HIV and Aids) handle counseling, testing, treatment and prevention of mother to baby transmission. An adolescent clinic offers reproductive health services and counseling on HIV and Aids. This ensures that adolescents do not mix with adults and, to promote communication friendly services, they are served by young health workers. Pumwani Maternity’s main population is pregnant mothers -  Kajiado, Kiambu, Naivasha and Nairobi especially the mostly low income Eastlands area. There are 265 beds, 150 cots and two theatres. Nurses handle around 200 out-patients daily.
“My day starts at 6 am when I start my rounds in the labour ward - the epicenter of the hospital. I get reports (overnight), patients’ status and challenges. After discussions with nurses, I go to my office and address pending work. At 7.30 am I look at night reports and catch up with my studies.  I head to the labour ward at 8.00 am and listen to handover reports and make decisions if there are problems. I work until 5pm. I do some more private studies before I go home,” George reveals.  
During his final year at AKU, George took an elective unit, ‘problem solving’ that had him seconded to Mbagathi Hospital. He says, “It made me grow. I learnt that not all problems have a solution. The 170 nurses and all the patients have different personalities and backgrounds and I have to work with them all,” he states.
George owes much to AKU, the only university in the region that offered a nursing degree in his time. George who is married with three children, like other students with families to support, could not afford to pay his fees with his meager earnings. AKU came up with payment plans that allowed them to pay in installments giving students time to concentrate on academics which he describes as “not easy.” He enjoyed the ‘teaching and learning’ unit where he learnt that adults will learn when they want. This motivated him because he realized it was up to him to achieve what he “came for at AKU.”
At AKU, one of the things that stood out was the conducive learning environment. Also AKU lecturers were always available for face to face consultations - including heads of departments – unlike in other learning institutions he had been to. Meeting nurses with various titles changed his mind-set and motivated him because he realized that he could advance his career.
His main challenge at the moment, is human capital. The 170 nurses are not enough for the busy facility and he says 300 would be a more realistic figure. Currently, when a nurse misses work, there’s a crisis because someone has to do their work. Pumwani depends on funds from the county government and George says that from the point of view of a health economist, the hospital could do with more funds.
Apart from his administration job at  Pumwani, George is a researcher, author, consultant and  part time lecturer in health economics, health financing and maternal health at the Jaramogi Odinga Odinga University of Science and Technology in Kisumu.
His personal goal is to complete his PHD on the Economic Evaluation of Health Care Programs in the Region. His goal for Pumwani Maternity is to take it to another level - to make it the maternity hospital of choice for all mothers, not just mothers from low income areas.
When George picked the nursing option after high school, fellow villagers could not understand how a man can study nursing, a predominantly female profession. His success has inspired young men in his community to take up nursing as a career and he has encouraged many Pumwani Maternity nurses to enroll at AKU and currently there are four. New nurses at Pumwani Maternity call him ‘role model’.