Dr Jacob McKnight is a post-doctoral researcher with an interest in health systems and reform. After working for Medecins Sans Frontieres, he completed a PhD focused on hospital management in Ethiopia. He used organisational and marketing theory to provide new perspectives on public health problems. Jacob leads the ethnographic element of the Nairobi Newborn Study.
Nurses in Kenyan hospitals are very busy, with high nurse to patients ratios. They face an extremely stressful enviroment, exacerbated by bad reports in the press.
Babies are particularly vulnerable during their first two days of life. A better understanding of the coping mechanisms put in place by those nurses could help us ensure a better survival rate for these babies.
Ultimately, medical research must translate into improved treatment for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Q: Can you tell us about nursing care for sick babies in Kenya?
Jacob McKnight: I am a small part of a big team in Nairobi and while I am helping organise, the people doing the hard work are out there and probably doing night shifts, last night in fact. What I can tell you about neonatal nursing in Nairobi is that these nurses are extremely busy. They have very busy working lives but also personal lives. In the hospital we see very big ratios of nurse to patients. Perhaps one nurse to 4-5 sick babies on the worst shifts. There is a lack of resources and a lack of appreciation as well. These nurses have families and sometimes they need other jobs to pay the rent. They are very busy and very stressed as a result of this particular situation. These are the most immediate issues but there are other things such as management styles, the way that the wards themselves are run, and more cultural issues about how these tiny, very sick children are seen.
Q: What are the ethnographic challenges?
JMK: The ethnographic challenges are quite significant. The first of them is this period of scandals in nursing, in Nairobi in particular, at the moment. The national press has covered significant scandals in some of the hospitals we are working in. In addition, there are strikes and legal cases, so nurses are very reluctant to talk. We are in these extremely busy wards, studying why nurses are so busy, and we don’t want to take up their time so getting the work done can be quite difficult.
Q: Can you tell us about your team’s research?
JMK: We are finding some very interesting stuff around the immense pressure that these nurses are under. But they still turn up for work. How do they do on their shift, how do they get through it? They put in significant efforts to cope with these extremely stressful environments, in this very emotional job. There are certain tasks they elevate within their job to give them some kind of a reprieve. This is ongoing research, these are all very early findings but it is a very peculiar and interesting field because of the stress that is on these nurses.
Q: What are the most important lines of research that have developed in the past 5 or 10 years?
JMK: I think what I am most proud of in this project, and the reason that I am involved really, is that we have given ourselves a chance to learn about the environment before we jump in with any particular intervention. This is a very particular situation: the nurses are very stressed, there is a lot of political context and economical context to their working lives. By conducting ethnography, we have the chance to learn about all of that before we devise a strategy to go in and help. I am part of a larger team which will draw together various strands of evidence to try and design something that fits, based on the best evidence rather than just something that we thought of or something that we took from the international literature and just dropped in to a new context.
Q: Why does your line of research matter, why should we put money into it?
JMK: It is quite novel in the field, and I think that the larger field of public health could do with a bit more of that. In particular with newborns, in sub-Saharan Africa we've missed quite a few of the millennium development goals and some of the other targets that have been set. It has been identified that in the first two days of a child’s life, they are particularly vulnerable. For children that are born in hospitals the survival rates can be quite poor. This is an area where if we get it right we could have a really large effect, which is what we are aiming for.
Q: How does your research fit into Translational Medicine within the Department?JMK: Some of the things how this project is different are also part of the larger trend of translational medicine. I understand this term in meaning that we need to be more careful about how you bring new ideas, new treatments etc., to the field. Here we are spending a lot of time in the field before bringing through interventions. I think this is very much an example of that, albeit in health system strengthening rather than in drug development, where that phrase is often used.