The Power to Create Change: Lessons from a Nurse in Upper Egypt

The Power to Create Change: Lessons from a Nurse in Upper Egypt

Simi Grewal is the Program Coordinator for Health Systems Strengthening and Results Management at MSH. She worked as a fellow in Egypt from January 16-February 5.

Protester in Aswan, Egypt

Although it has been more than three weeks since my return from Egypt, I am still reflecting on how I saw conflict in the community foster change at various levels. At 4 am on February 2, 2011 I sat in my hotel room in Aswan, Egypt watching a live feed of Tahrir Square in Cairo as shots cracked in the dark night. The sound of gunfire is unmistakable and its meaning inevitably ominous. February 2 was the eighth day in a nation-wide demonstration against the ruling regime and had become the most chaotic and one of the most violent days in the citizens’ stand again President Mubarak and his government. For one night, the square---a symbol of liberation in the bustling capitol---had become a barricaded battlefield for an entire generation of Egyptians seeking a brighter future.

As I watched the TV screen and saw bullets fly, I was certain that the heroic uprising against Mubarak and his regime was sadly at an end. Later that day, however, and every day thereafter until February 11 the square repopulated with resilient demonstrators. Their message, too, was unmistakable and rose above the clamor of any firearms: “Threaten a group of thousands, and we will gather in the millions. Attempt to undermine our willpower and you will find our resolve strengthened. Bring upon us a fist of political corruption and we will trust in one another to govern. We will endure, we will prevail, we will progress.”

Only a week before I heard those gunshots ring out, I had been seated in front of Sara---a young nurse and participant in the Leadership Development Program (LDP) in Upper Egypt that aims to improve the performance of nurses. The LDP introduces leadership practices and skills in a series of participatory workshops which workplace-based teams then use to address real challenges and produce measurable organizational results. As Sara spoke, her bright face glowed in the recollection of how her peers came together as a team to determine the greatest health burdens facing their patients and resolved to improve their personal skills and their hospital’s capacity to achieve quality health outcomes.

Health Center in Aswan, Egypt

Over the course of the past year, Sara’s team has successfully reduced the rate of post-surgical hospital infections, their selected challenge. However, several obstacles had to be overcome along the way. For Sara, the first step in addressing the team’s challenge was to create an improved method of following-up with patients post-surgery. The new procedure initially revealed that more patients were acquiring infections than had originally been reported at the site. When Sara presented this crucial health information to her superiors she was immediately punished by her direct supervisor for her negative portrayal of the hospital, and her pay was suspended for one month. Without pay and without the support of top management, Sara still continued to serve her patients and to seek an improved quality of health care for her community. Her method of patient follow-up is now being adopted by the Ministry of Health in the governorate.

When I asked Sara what she was most proud of, in terms of her achievements during the LDP, she said “I am most proud of creating a conflict. Our work made people defensive. If we were not doing anything, if the numbers we saw were not real, they would not have reacted. But the numbers we reported were real and soon high senior officials saw that a nurse could bring a change.”

In every level and in various sectors throughout Egypt, people are realizing that change is not only possible, it is inevitable and necessary. The ability to change lies is in the hands of those that challenge their current circumstances and behold a vision of a better future---in their communities and in their nation.