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My name is Kalin Ayuba. I am a nurse midwife employed by the Kaduna State Government, practicing at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan. I was employed by the state government for about thirteen years and have been working at the Sickle Cell Unit for the past two and a half years.

The opportunity to be a part of the ARISE project, is a rare one but an opportunity that I am most grateful for. Prior to my secondment, there were many challenges; physically, emotionally and financially. All of which led me to feel like giving up but God made it a reality.Praise be to Him forever.

My secondment was hosted by Guy’s and St Thomas’ NHS Foundation Trust UK under work package 4. My initial objectives were to have an appropriate protocol for the management of sickle Cell disease; routine Health maintenance therapy, to be conversant with how to greatly reduce the frequency of crises and complications and to help promote a healthy life style with positive self-image. The first day of my secondment will be a memory I hold for a long time, due to it being my first time experiencing the unusual cold weather, the wonderful tarred roads, the red buses that we used to only see in pictures during our primary school days which led me to remember a song we normally sing and it goes like this: London bridge is falling down, falling down, falling down, London bridge is falling down my dear lady”. Throughout my free time I was able to carry out some recreational activities by visiting different clothing stores, food and confectionaries which served as a psychological and emotional therapy.

During my secondment, I had the opportunity to attend a counselling session with Nkechi and Kemi at the wooden Spoon centre, where they gave an overview of the history of sickle cell and I was able to join a genetic counselling session. Following on from this, I visited Lola Oni and her Team at Central Middlesex Hospital, where I observed a blood Exchange on a patient with Thalassaemia Major and joined a counselling session with a couple whose pregnant wife was a thalassaemia carrier. From both Nkechi and Lola I learnt; how to create good rapport in order to gain their maximum cooperation, to maintain eye contact during counselling sessions, the importance of using images for illustrations where applicable, the need to use simple vocabulary and to remember to ask questions after the counselling session in order to be sure they have understood what you have been saying so far. Something I will try to implement at my facility, is the need for home visits with families, as this allows us to further build a relationship and understanding.

Following on from the counselling session, I visited Professor Eugene and team at GSTT where they gave us a tour of the radiology department, where we met with the radiologist who educated us and answered some questions  examples of such questions were:-At what gestational age do you detect foetal abnormality? And he said between 11-13 weeks. Secondly, is the pregnancy then aborted? According to him, the decision solely lays between her and the husband .

Despite the pandemic I was able to join the series of Arise virtual Teaching Programmes that were held in replacement of the face to face learning. These lectures  were very interesting, full of insight and knowledge for example – Covid 19 and sickle cell disease- the current scenario, classification and management of acute and chronic pain in SCD, Hydroxyurea therapy, Mental Health and covid 19, screening pathway and breaking bad news, Genetic counselling and community based follow up to name a few.

I also participated in numerous E-learning, which has increased my learning capacity, for example GCP which is used in clinical research trials. Other e-learning modules covered the aspects of understanding the complications of sickle cell, Haemoglobin and its types, splenic sequestration, Osteomyelitis and sickle cell.

As a result of my secondment, I initiated monthly Kafanchan conference calls as a way of improving care and initiating protocol that will improve quality of care to the sickle cell patients. We have made plans on how to implement the protocol of breaking bad news- by having a room, chairs and writing materials readily available and as soon as the pandemic is over and things return to normal we will kick-start.

I have had the privilege to spend time with the paediatric sickle cell team at Guy’s and St Thomas and shadow a blood exchange on sickle cell patients. This was my first time observing such a procedure which involved a machine called apheresis that is used for the blood exchange. This experience is something I will share with my colleagues at my institution along with all the other learning aspects I have acquired during this period. And will have a great impact on the wider community and patients we look after.

I would not end my blog without showing my profound appreciation to the Arise Project who have made my secondment a reality. I am indebted to Professor Baba Inusa who is a role model indeed.My sincere gratitude goes to Raleen who has been humble, accommodating and very supportive. I am also thankful to Stephanie, Sharon, Natalee and Fiona and I would not forget to mention Nkechi, Kemi, Lola Oni and their teams for all their support and help.

During the lockdown it was important to carry out some recreational activities by visiting different clothing, food and confectionaries which served as a psychological and emotional therapy.

In summary, I have been having frequent calls and at times meetings with my kafanchan team having an update on the situation of the clinic, finding out about the attitudes of the patients to attending to their appointments, the number of admissions so far and so on.

We have completed plans on how to implement the protocol of breaking bad news to newly diagnosed patients with SCD. We wish that implementing this should kick-off as soon as possible but the following factors may delay its implementation, they are thus:-inadequate manpower, language barrier, financial constraints to purchasing  of teaching aids. These among others.

We pray that as we table these challenges to the hospital management, prompt intervention will be given.