Caring for Special Needs Patients in Kom Ombo, Egypt

Caring for Special Needs Patients in Kom Ombo, Egypt

A nurse communicates with a patient with sign language. 

In the kidney dialysis unit of Kom Ombo District Hospital in Upper Egypt, dedicated nurses prepare for the monthly treatment of a regular patient. They have assured the proper functioning of medical equipment, stocked the dialysis room with necessary supplies, and prepared staff for the dialysis process. However, the patient is missing.

Meanwhile, the patient---a young man named Kasim---stands alone outside the hospital entrance. Kasim has impaired mobility resulting from an amputated leg and relies on a prosthetic limb or the help of relatives to accomplish daily activities. Having traveled through the suffocating summer heat along the uneven, unpaved roads of Kom Ombo to receive his monthly renal dialysis support treatment, he encounters his greatest obstacle at the hospital’s entrance. Having arrived alone at the hospital, he struggles to climb the steps and then seeks assistance from hospital staff to reach his treatment room. Though he is surrounded by nurses and doctors, all are too busy to notice Kasim’s disability or his need for help, and he is left unattended.

Frustrated and discouraged, Kasim begins his trip home, without receiving his treatment.

Kasim’s plight was a common one for patients with special needs---the deaf, the blind, and those with impaired mobility---at Kom Ombo District Hospital one year ago. “The patients with specials needs suffered,” Kasim recounts. With a diminished ability to advocate for health services, patients with specials needs had difficultly accessing complete medical care.

This gap in services was not only felt by the patients, but was also of deep concern to the nurses. Safyia, a nurse in the renal dialysis unit, noted that deaf and blind patients often did not know what services were offered in the hospital and where they could be reached. Patients with impaired mobility relied on the assistance of relatives to carry them through the hospital---a long and arduous process. “The patient’s relatives would often become very angry with the nurses for their struggle,” she said. “They would have to carry their family member up the stairs then wait for hours during the patient’s treatment. This would make the situation very hard for everyone.”

Safyia noted that she and the other nurses were also frustrated that they were unable to communicate directly with deaf patients: “We wanted to be able to communicate with the patients themselves, to learn what they were feeling and care for their needs.” Instead, the family members accompanying the patients served as translators, and the patient’s direct will was rarely expressed.  These challenges facing patients with special needs at Kom Ombo District Hospital motivated nurses in the hospital to make changes to improve their care.

That change began when the nurses enrolled in the Leadership Development Program (LDP), as part of the U.S. Agency for International Development-funded the Improving the Performance of Nurses in Upper Egypt Project, led by Management Sciences for Health. 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.

The nurses set clear goals related to the care of special needs patients, such as increasing patient communication by training a small group of nurses in using sign language with the deaf; building ramps at entrances, exits, and other locations to increase hospital accessibility; and increasing the number of wheelchairs for patients with impaired mobility.

Over the past year, nurses from various units in Kom Ombo District Hospital united to reach their goals, motivating each other as a team to achieve a higher quality of care for all of their patients. As a result of their efforts, the hospital now has one sign language trainer to work with staff on communication with hearing-impaired patients, five ramps at various entrances and exits for patients with impaired mobility, and the number of wheelchairs has tripled from four to twelve.

Kasim is now a hospital volunteer who works with special needs patients.  He noted the change in care by exclaiming: “Patients are flying with happiness now!”

Around the hospital, improvement is evident---from the sign language pictures marking the names of various wards to the attentive nurse guiding a patient on a wheelchair through the hospital’s corridors. “The nurses now know how to help all patients,” Safya said with a big smile.  “Nurses can feel proud of the work they are doing, and patients and their families are happy with the care they receive now.”

Simi Grewal was the Program Coordinator for Health Systems Strengthening and Results Management at MSH. She worked as a fellow in Egypt from January 16-February 5 and again from April 15-30.