Nursing outlook
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Quality of care at rural health centers in Rwanda is often limited by gaps in individual nurses' knowledge and skills, as well as systems-level issues, such as supply and human resource management. Typically, nurse training is largely didactic and supervision infrequent. Partners In Health and the Rwandan Ministry of Health (MOH) collaborated to implement the nurse-focused Mentoring and Enhanced Supervision at Health Centers (MESH) program. ⋯ The program targeted 21 health centers in two rural districts and supported implementation of MOH evidence-based protocols. Initial results demonstrate significant improvement in a number of quality-of-care indicators. Emphasis on individual provider and systems-level issues, integration within MOH systems, and continuous monitoring efforts were instrumental to these early successes.
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Nursing values include diversity and a commitment to the elimination of health disparities. However, nursing comprises predominantly white, female nurses. The authors explore structural and interpersonal sources of disparities experienced by black persons, including white privilege. ⋯ Topics include postracialism, colorblindness, institutional racism, white privilege, health disparities, clinical encounters, subtle racism, and racial microaggressions. Suggestions for open dialogue, historical awareness, education, research, and practice are highlighted. Difficulties involved in confronting racism and white privilege are explored.