Head nurse Tadele Mekonen is deputy CEO at Dangila Primary Hospital, a regional leader in Ethiopia’s push for safer surgeries, and senior member of the management committee.
An Ethiopian nurse cuts to the chase about his roles in surgery and hospital management.
Teruwork Gultie (TG): How have you been involved with Dangila’s efforts to bring safe surgery to the surrounding community?
Tadele Mekonen (TM): I’m involved as scrub nurse, circulating nurse and assistant to the surgeon as part of the surgical team. I’m also part of the hospital’s SaLTS [Saving Lives through Safe Surgery] committee. (Recognizing the unmet need for surgical care in Ethiopia, the Federal Ministry of Health has pioneered innovative methodologies for surgical system development with SaLTS, a national flagship initiative designed to improve access to safe, essential and emergency surgical and anesthesia care across all levels of the health care system.)
TG: What role do you most identify with?
TM: I identify myself primarily as a nurse but assume different responsibilities and positions: deputy CEO to the hospital, senior member of the management committee and a matron [head nurse].
TG: Could you have seen yourself being a deputy CEO back when you were in nursing school? Do you think those kinds of opportunities exist for everyone?
TM: I envisioned myself caring for my patients, and I started at Dangila as a nurse, but being a deputy CEO is not very surprising. The profession of nursing is growing, and there is now a career path for professional development, more nurses and diversified specialties. The latest curriculum is very specific, and nurses need to have comprehensive knowledge in all fields: OR [operating room], ob-gyn, pediatrics, etc.
Mentorship in nursing should be a routine activity, part of every task. Nurses need to be represented and engaged in decision-making processes at all levels—facility, regional and national. In addition to case managers and matrons, nurses must be part of the management and leadership team. They’re the ones carrying out the majority of detailed activities, and they are well positioned to know the ins and outs.
TG: Why did you choose nursing as a profession? Would you recommend it to others?
TM: I came to nursing by chance: The Ministry of Education assigned me to attend nursing school. But after joining nursing school, I got to adore the profession. I received a diploma in nursing 20 years back and, more recently, earned my Bachelor of Science degree, also in nursing, from Haramaya University in 2012.
I have three children, and I wish all of them would study something related to health. I even pushed one of my sons to study nursing, but he ended up studying clinical pharmacy.
TG: In your opinion, what makes nursing important?
TM: The role of nurses as patient advocates is immense. I believe nurses should lead patient-centered care.
When it comes to safe surgery, a nurse is like a mother. She’s always there with the patient, until the patient gets discharged. She’s responsible for the entirety of patient care. For example, an OR nurse—apart from pre- and intraoperative duties—postoperatively monitors vital signs, fluids, etc., in the recovery room until the patient is fully awake and stable, then transports the patient to the ward and hands the patient over to the ward nurse. They make sure the OR runs smoothly and ensure the environment is clean and safe. They manage the OR, preparing the necessary instruments and equipment and acting as scrub nurses, circulating nurses and assistant surgeons. They also work closely with the laboratory, pharmacy, laundry and other departments.
TG: How has surgery at Dangila changed since you’ve been here?
TM: Dangila Primary Hospital is about 47 miles from Bahir Dar [the regional capital] and about 300 miles from the Ethiopian capital, Addis Ababa. We started surgical services about 2 years ago. Even though I wasn’t part of the surgical leadership training at that time, my team oriented me on safe surgery. Along with my team, I defined the instruments and supplies required for common surgical procedures and collected different materials—like oxygen cylinders, surgical instruments including laparotomy sets, suction machines, Mayo trays—from nearby health facilities so we could start performing laparotomy surgery. Before the Safe Surgery 2020 initiative, only cesarean sections were performed at Dangila; laparotomies and appendectomies started after the training.
The Safe Surgery 2020 initiative also made us more efficient. Before, we were not well coordinated, but now we communicate and plan ahead during our regular team meetings, and that has improved team spirit. The other best communication tool we have is the World Health Organization’s Surgical Safety Checklist, which encourages you to interact with your entire team as well as your patient. For example, you confirm your patient’s identity and the functioning of the anesthesia machine and pulse oximeter with the anesthetist. You ask the surgeon what the expected blood loss is and how long the procedure should take. And you confirm with the scrub nurse if there are any sterility concerns and whether the instrument, sponge and needle counts are complete.
TG: Which parts of nursing do you like best and least?
TM: I love my profession, but nursing is the least paid job. Nurses are not well compensated. Your only reward is the satisfaction you get when your patient gets well. The best part is helping clients holistically.
TG: Can you share any stories about clients or incidents that left a lasting impression?
TM: The first memory I will share involves a severely sick woman who was brought in one day when I was working in the emergency room. Her condition looked like an advanced HIV infection. I tried hard to convince her to get screened for HIV, but she said she would rather die than get tested. I persevered and finally got her to consent. After the screening, she started antiretroviral therapy. Her condition improved, and now she is working. Whenever she comes in for follow-up appointments, she always tells me she is living a second life thanks to me.
And the second story is of a mother who went into cardiopulmonary arrest in the recovery room after undergoing a cesarean section. I immediately took her to the OR, put her on oxygen and started cardiopulmonary resuscitation. I kept calling her name, but she was not responsive. Still, I continued with the resuscitation. Just when I was about to give up, she responded. My delight was boundless. Whenever I remember that night, I feel immensely happy about being a nurse.
Editor Deborah Stein contributed to this article.
Teruwork Gultie, a senior operating room nurse and senior program officer in Jhpiego’s Ethiopia office, interviews Tadele Mekonen about working in surgery and hospital management.