Some problems faced during the COVID-19 pandemic include the multitudes of sick and ailing patients and decreased patient bed capacity. In addition, frontline nurses experienced severe fatigue and overwhelming pressure working long hours, trying to save patients, and reassuring desperate relatives who are uncertain of their loved ones’ health outcomes.
COVID-19 remains a public health nightmare of enormous proportions globally. Although we are progressing to post-pandemic recovery, the COVID pandemic remains as the summer brings in new infections worldwide due to more transmissible subvariants. However, a flashback to the gloom of the immediate aftermath of December 2019 shows that we have managed to navigate our way out of the health emergency, which made us recalibrate, thus, enabling us to formulate new ways for continued improvements in future healthcare delivery systems.
In this Exclusive, Big Interview, TAT editor Sainey Marenah speaks with Gambian-born US-based nurse researcher and academic Dr. Veronica P.S. Njie-Carr, about the future of healthcare and lessons learned from the pandemic to transform nursing in the Gambia.
- You have just been awarded funding to strengthen capacity in health research ethics and methodology in the Gambia; what are the research venture’s broader objectives? Also, how will the award help boost research initiatives focused on the country’s healthcare sector?
The goal of our program, which is supported through funding from the Fogarty International Center of the National Institutes of Health, is to develop and strengthen leadership capacity and expertise in research ethics and methodology in the context of the Gambia. In implementing the program, we will contribute to the Gambia’s capacity development efforts and the research enterprise. We are keenly cognizant of the importance of utilizing best evidence in caring for patients to promote positive outcomes. The conduct of research studies supports the generation of new knowledge or validation of existing knowledge to inform evidence-based clinical practice. Our program will prepare trainees through the establishment of certificate and master’s degree programs, professional development activities, and formal mentoring activities to increase research activities.
The Gambia Research Ethics and Methodology Training Initiative (GamREMTI) program brings in multiple experts in health to the Gambia with partnership opportunities for the UTG, how will this important program impact young researchers in The Gambia?
Mr. Marenah, this is an important question as we develop the next generation of young research scholars and practitioners. Our program already includes young Gambian research scholars as collaborators. It was important to me that I engage Gambians in the Gambia during the conceptualization of the proposal to ensure program sustainability. Additionally, I was intentional in ensuring that most of our program advisory board and curriculum committee members are in the Gambia. It is all about and for Gambia for sure. Our plan for the program is to recruit promising young Gambians who aspire to be clinical and academic research scholars and practitioners. We will identify potential trainees through our Gambian partners on the ground, and the scheduled workshops. We will be holding a workshop on July 26th and 27th, 2022, which would provide opportunities to identify potential trainees. Workshop flyers will be disseminated in the coming days following the Eid-Al-Adha Holiday. Additionally, we encourage interested individuals to look out for our announcement in early 2023 when we start the recruitment process of potential trainees. We will advertise the program through media outlets and our website at https://www.gamremti.gm .
- Sahelian nations, including the Gambia, rank the lowest in a health service capacity, access, and delivery. How much of a challenge do we face in modernizing healthcare, and what will it take to realize goals to ensure nationwide coverage and access to primary healthcare?
I agree that we do have challenges with our healthcare system, and we can and should do better. Indeed, the current administration has made some progress, but the progress is indiscernible because there is so much work that needs to be done. We have the expertise not only in the Gambia, but in the diaspora to improve our healthcare system. I have spoken with many Gambian physicians, nurses, and other health care professionals in the diaspora who are ready and willing to support the development of the healthcare system in the Gambia to address the problems you correctly articulated as they relate to capacity, access, and delivery. From my perspective, the governance structures to facilitate the implementation of these innovations are inadequate, and in some instances, non-existent. Regrettably, the strong leadership needed to lead these efforts are limited. With the right leader in place, they will coalesce the right people, who have the experience and expertise, to work collaboratively to serve our Gambian people. The right leader would put the Gambia first and surround themselves with individuals of diverse perspectives, from different backgrounds who would ask challenging important questions to propagate innovation and progress. The right leader who would also be comfortable receiving constructive criticisms. The GamREMTI Team has worked hard and has come a long way. As a team, we have made it possible for every team member to feel that their contributions are valuable, to ask the tough questions, be challenged, and receptive to growing as research scholars. I can see how our team has evolved and grown, and the bar is always raised to do even better. We are a team and I pray that the camaraderie and high-level engagement continues. Leading is hard because of the different personalities, but when done right, it promotes successful implementation of any project or program in any sector. We can modernize our healthcare system and ensure nationwide access to quality healthcare with the right leaders.
- Your exceptional work in nursing research supporting capacity across low- and middle-income countries has been extensively recognized globally. What’s your message to young people, especially girls focused on venturing into nursing and health care?
I would present my message in four points: First, the youths, particularly young girls, should follow their dreams. In actualizing their dreams, they must focus on their professional goals and passion. What questions and issues keep them up at night? Second, they should connect with good mentors they perceive as role models and whom they trust and admire to emulate their good behaviors. That would be a great start to achieving their goals. They should have a community of mentors to address stated goals because oftentimes, one mentor may be inadequate to address their multidimensional needs such as emotional, professional, technical, and other needs. Therefore, a community of mentors should be assembled. Third, young Gambians should be receptive to constructive criticism, which would foster progress. One of our biggest challenges as Gambians is the notion that we know it all. We also tend to be resistant to suggestions because some might feel or think that they should not be told what to do. Because of this posturing, many young Gambians fail to open-up – be vulnerable – to think about asking important questions to allow themselves the opportunity to learn. My graduate students will tell you that I encourage them to ask questions because it speaks to their intellectual curiosity. Researchers and scholars must be intellectually curious – always asking questions to gain deeper understanding of the world. I would suggest that young professionals be receptive to suggestions and strive to do better and be open-minded. Fourth, in dreaming, they should dream big. As the former Liberian President, Ellen Johnson Sirleaf, stated “If your dreams do not scare you, they are not big enough.” They should dream big and then strategize to actualize their dreams in impactful and significant ways, and importantly, to enjoy the journey. When they set goals, it does not matter what other people do or say, they will stay focused, and success will follow.
You spent many years driving important research into nursing systems and healthcare development, what can governments and public health policy makers do to improve nursing and health care access to avoid the challenges faced during the recent global health crisis?
The COVID-19 pandemic had and continues to have negative global impact, not only in the Gambia. Even in the United States, there were enormous challenges when the COVID-19 started. Low- and middle-income countries that have weak healthcare systems experienced the worst economic and social challenges. Government and public health policy makers must therefore improve the Gambia’s healthcare system through the development of human capacity and strengthening governance structures. One of the important lessons we should learn from the pandemic is that we must strengthen the health care system we have to a level that would allow all Gambians to receive quality and safe healthcare. The government must invest heavily in important sectors such as healthcare if quality care is to be realized. Without good health nothing is possible, and the Gambian people deserve a strong healthcare system that provides the high-quality care so desperately needed.
- The ravages of the Covid pandemic are still fresh, and medical workers, including nurses, are trying to recover from the fatigue and depression of the health crisis. Do you think health policies are responding to the urgent need to modernize health systems and improve workplace conditions for nurses?
Indeed, there is much work that needs to be done to improve the healthcare working conditions to support the work of health professionals including nurses. Wages should be increased to reflect the important work nurses do. Nurses work hard even under worse conditions and providing the appropriate wages to commensurate with the important work they do may be difficult. However, increasing wages consistent with cost-of-living expenses would support their efforts. Investing in the necessary materials and equipment would also support conducive working conditions to keep nurses motivated and committed to do their best.
- In most regions, especially in Africa, nurses face difficult working conditions amid unbearably low wages; what’s the nexus linking nursing welfare to effective healthcare?
In improving working conditions and increasing wages for nurses, the government should make certain that the health sector has the largest budget. As I previously indicated, without health nothing is possible. As Winston Churchill noted, “Healthy citizens are the greatest asset any country can have.” We need nurses and other health professionals to perform optimally to keep the citizenry healthy and productive. With good governance, it is possible to increase wages as appropriate and improve working conditions for optimal performance of nurses. Wages of nurses should be increased to reflect the current economic demands and increased annually to account for inflation. This is possible if we minimize costs in other areas such as the monetary waste on unimportant and unnecessary costs such as travel costs, per diems, etc., activities that do not show evidence of positive results or national development. Mr. Marenah, it is not that our leaders do not know what to do, the important question is, why don’t they do it? With good wages and acceptable working conditions, nurses will thrive and be motivated to provide quality and safe care to patients, and by extension a better healthcare system with productive citizenry to be proud of, which in turn would mitigate the travelling abroad for healthcare services. Just imagine if the money used for international travel is spent on improving our healthcare system. Our leaders know what to do, they should just do it, to think of country and not self. I remain hopeful and optimistic.
You have significantly invested and continue to work towards expanding clinical nursing research in different areas. Are educational institutions transforming curricula to meet changing healthcare needs, and how does this impact nursing culture?
Great question. Nursing is an art and a science. I have enjoyed and continue to enjoy my journey as an academic nurse scientist. As a science, the nursing profession continues to utilize best practices in caring for patients. These practices evolve to reflect the changing needs of society and increased understanding of phenomena, which then informs clinical practice. One of the reasons, the Fogarty grant award is important, is because the funds will prepare nurses and other health professionals to conduct research studies with scientific integrity and rigor to generate new knowledge to inform evidence-based practice. It is the modus operandi at educational institutions to revise curricula and syllabi to meet societal changing needs and demands informed by best practices. In my over 26 years of academic work, I have participated in and contributed to such activities including the past 12 years as a visiting scholar at the UTG. I reviewed course syllabi to make the necessary revisions.
- What do you perceive as the biggest challenge and lesson from the pandemic that can transform nursing and global healthcare delivery between massive public health breakdowns and medical inadequacies?
In my view, these are intersecting and multifaceted challenges and must be addressed at multiple levels for effective and sustainable impact. Nonetheless, adequate resources for nursing staff to perform duties, the strengthening capacity of governance structures, and improving staff skills and competence to render quality evidence-based nursing care are critical elements to address. My graduate students at the UTG lament the lack of annual trainings necessary to stay informed of updated evidence-based information. As I mentioned before, nursing is a science and to keep up to date with the science, regular training is critical in the form of professional development and continuing education activities. In my capacity as a visiting scholar at the UTG, these are important practices I instill in students to grasp the importance of nursing as a science. These graduate students are leaders in their own right – managers, senior nursing officers, regional officers, etc. and could lead the efforts to make transformative healthcare changes. I also engage the graduate students at UTG to collaborate with students and faculty at the University of Maryland, Baltimore, which further exposes them to the global platform and diverse views and perspectives. Sharing these with them encourages the implementation of good professional practices and behaviors to transform the Gambia’s healthcare system with global reach.
- How important is research and training in modernizing health care systems?
Research is critically important to contribute knowledge to the state of nursing science by generating new knowledge to gain a deeper understanding of our world and how we deal with diseases and illnesses. Think about the progress we have made over the years in healthcare regarding the prevention, diagnosis, and treatment of communicable and non-communicable diseases. Research studies conducted with scientific integrity and rigor produce quality data important to informing nursing practice. Our GamREMTI program will train aspiring health professionals and scholars to conduct research, participate in professional development and continuing education activities by attending workshops, conferences, and seminars where relevant and timely best practices will be disseminated. Trainees will also publish peer-reviewed, data-based articles in journals to inform practice.
Many thanks for the opportunity to participate in the interview. It was quite a pleasure.
Who is Dr. Veronica P.S. Njie-Carr, PhD, RN, ACNS-BC, FWACN?
Dr. Veronica Njie-Carr is an academic nurse researcher and an associate professor in the School of Nursing at the University of Maryland, Baltimore. She has 37 years of clinical nursing experience, which began in the Gambia before she immigrated to the United States in the 1980’s. Her academic experience spans 26 years in universities in the Baltimore-Washington area including Howard University and Johns Hopkins University. Her teaching, research, and scholarly activities are in the areas of cross-cultural research, HIV and global inequities.
Dr. Njie-Carr’s teaching, scholarship, and program of research has evolved over the years to reflect the changing trends in HIV prevention and care, and the needs of marginalized people. Her funded research studies are designed to 1) leverage technology to addressing the needs of aging women with HIV infection, 2) investigate the experiences of immigrant and refugee women survivors of violence, and most recently, 3) a Fogarty grant award to strengthen leadership capacity and expertise in research ethics and methodology in The Gambia.
Dr. Njie-Carr is engaged in teaching, mentoring, and supervising master’s nursing students at the University of the Gambia (UTG) where she serves as a consultant on curricula and research-related activities. She contributes to building faculty, and nurse leadership capacity through collaborative initiatives with academic nursing faculty and nurse leaders practicing in the clinical area. Dr. Veronica P.S. Njie-Carr in collaboration with faculty members from the UTG, and a researcher from the Medical Research Council, Gambia Unit, received a 5-year grant award from the Fogarty International Center of the National Institutes of Health in the United States (U.S.).
In addition, Dr. Njie-Carr’s contributions toward providing academic resources and strengthening the nursing library, began in the late 1990’s when she started her academic career in the U.S., facilitated the establishment of the master’s nursing program in 2011 at the UTG. She provides support, guidance, and thesis supervision to graduate nursing students.
Dr. Njie-Carr is a Co-Founder of the Gambian Diaspora Experts Initiative, Inc. (GDEI), which is a non-profit organization registered in the U.S. to support the national development efforts in The Gambia. She serves on national and international organizations, and is a Fellow of the West African College of Nursing. Dr. Njie-Carr is a board-certified clinical nurse specialist. She received a nursing diploma from The Gambia College in The Gambia in 1985, a baccalaureate degree in nursing from Howard University in 1992, a master’s in nursing education and adult health in 1996, and PhD in nursing science in 2007 from The Catholic University of America in Washington, DC. Additionally, she received a postdoctoral fellowship training in 2008-2010 from Johns Hopkins University in Baltimore, Maryland.