The COVID-19 pandemic and draconian cuts to UK aid funding have had a major impact on international health partnerships (Buse and Hawkins, 2021; UK Research and Innovation, 2021). However, throughout the pandemic, despite these challenges, the health partnership between Lusaka College of Nursing (LUCON) and Birmingham City University (BCU) has continued to operate in Zambia, providing both in-country and virtual support from nurses working in the NHS and higher education in the UK.
This article presents the work undertaken during this challenging time through the Health Education England volunteer placements programme administered by the Tropical Health and Education Trust (THET) initiative, through which UK-based clinicians can volunteer in Africa.
Since the start of the partnership in 2015, it has operated using a ‘hub and spoke’ model. To support and enhance the partnership, BCU has acted as the hub. Its role has included seeking and gaining project funding for activities, providing project leadership, co-ordination and governance, taking on financial responsibility for projects and providing educators to support strategic activities in Zambia, with LUCON acting in parallel with BCU as the in-country lead/hub.
The spokes of the model are made up of emergency, trauma and critical care nurses working in acute NHS hospitals who provide their Zambian peers with specific clinical practical expertise, as required.
This hub-and-spokes model increases the number of and broadens the experience base of faculty members, enabling access to a range of technical experts when requested by our Zambian partners. In addition, when international travel allows study tours, UK faculty host our Zambian counterparts, providing them with an insight into UK education and practice.
Early on in the pandemic, the partnership decided to include virtual volunteering, offering opportunities for UK faculty, who would not have been able to travel internationally, to become part of the health partnership (THET, 2020). However, it is important to note that, although virtual teaching increases knowledge, it has a limited effect on practitioner competence (Carter and Notter, 2021). Consequently, both virtual and in-country support are crucial and together we think our project has the ability to apply theory to practice and, through that, enhance patient care delivered by nurses in Zambia.
Placements
The use of a blended learning approach, which includes mentoring, role modelling and ‘on-the-job’ training, has enabled us to build capacity in emergency, trauma and critical care nursing in Zambia, taking it to a new level. The establishment of a virtual community of practice has enabled the lecturers and students in the participating institutions in Zambia to participate in professional discussions.
The project has also involved offering nursing placements: one place for 6 months in critical care, another for 6 weeks in neonatal intensive care, and a further three short-term placements at University Teaching Hospital in Lusaka. In addition, 10 UK critical care nurses and lecturers volunteered to deliver 24 hours of virtual lectures to critical care nurses in Zambia and also to colleagues in Malawi. The recently developed Bachelor of Science in Emergency and Trauma Nursing curriculum at LUCON was peer reviewed by seven UK nurses to support the Zambian validation processes.
Collaborative practice-based projects have included working with partners to develop low-cost, highly sustainable enteral nutrition for critically ill adult patients in the intensive care unit at University Teaching Hospital. Another project involves supporting a newly upgraded general hospital to renovate its emergency unit and to develop a high-dependency unit.
Continuing professional development activities have included a senior clinical leadership programme delivered over 6 weeks and lectures on renal transplantation, as well as resuscitation training for nurse anaesthetists, clinical officer anaesthetists and physician anaesthetists. Other activities have included neonatal life-support training and a 6-week clinical skills programme for registered nurses working in critical care to enable them to enhance their clinical skills.
‘The establishment of a virtual community of practice has enabled nurses across Zambia to participate in professional discussions’
Volunteering
Although there were international challenges and restrictions (eg social distancing, mask wearing and observing preventive precautions to ensure staff and patient safety) imposed by the COVID-19 pandemic, our partnership has been able to adapt and respond to our partner's identified needs of working within this ‘new norm’.
Reflecting on the past 2 years, virtual volunteering has enabled committed NHS nurses to offer advice and support to our projects and their nurse peers in Zambia. The UK-based virtual volunteer team were keen to participate, but accepted that they could not be released from their NHS duties. Nevertheless, they were able to identify a realistic time commitment to make valuable virtual contributions to nurse education and practice in Zambia.
The UK volunteers have had to work in challenging situations, recognising that, while in the UK restrictions have been lifted, Zambia continues to have strict government-imposed restrictions at peak times. These rules are essential because, although Zambia has had lower rates of COVID-19 cases than the UK, it has also had much lower levels of COVID-19 vaccination (Commonwealth Innovation, 2022).
The UK volunteers have also had to balance commitments to working in Zambia and in the UK, seizing the opportunity to travel when they could. All international health partnerships have faced the same challenges, and our solution was to work with volunteers using blended learning to structure, underpin, maintain consistency and momentum of activities. This approach has proved successful and with the rapid advances in technology and understanding of COVID-19 has now become embedded in our projects, as a way to sustain the partnership.