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Helsinki to Delhi by Prof Wendy Graham

This has been an unusual overseas trip – my 3rd this year, and now – on the return leg, I can reflect on the experience and its link with the work of Soapbox.

The title refers to the temperature separation between the two destinations I have just visited – Helsinki at 3 degrees and Delhi at 37 degrees! This made for a round trip – Edinburgh – Helsinki – Delhi – London – which was challenging not only in terms of acclimatization and jet lag, but also suitcase packing – boots and flip-flops! But there was a strong common thread to the trip which also lies at the heart of the purpose of Soapbox – quality of healthcare.

In Helsinki I had the enormous pleasure of examining a PhD on access and quality of care at birth, and, in the Finnish tradition, involving a public viva and a dinner in honour of “the opponent” – the examiner. The thesis revealed the impact of poor quality care on early newborn mortality across a large number of low- and middle-income countries. The preparation for the exam and three-hour conversation which comprised the viva prepared me well for the next stage of the trip.

In Delhi, I was one of a small group of experts invited to a WHO consultation entitled “Promoting cleaner and safer facilities in the South East Asia region”. This two-day event brought together diverse disciplines and professions to identify opportunities to increase awareness of WASH & IPC in healthcare facilities and so catalyse change as part of broader quality improvement. It was exciting to see the relevance of Soapbox’s work – including in three countries in the Region (Bangladesh, India and Myanmar) through its needs assessments and by developing the TEACH CLEAN package for training facility cleaners. The consultation was by-way of preparation for a much larger meeting in July, and a further opportunity to disseminate the lessons we have learnt and the tools prepared.

What was striking from both the viva and the consultation was the huge diversity of healthcare settings in which women deliver, with some achieving high standards of quality and others in which the risk of harm rather than benefit is significant. These degrees of separation can sometimes be explained by different resource bases – of the population and the health service, but the human contribution in terms of the leadership, the clinical and the caring skills of providers plays a large part. In Delhi, the consultation highlighted the key role formerly played by the matron of the facility – the chief nurse, with oversight of infection prevention across the facility including standards of hygiene and cleaning. And at this time of the Nursing Now campaign, the low status sometimes accorded to this critical profession in many LMICs must be challenged. In raising the profile of nursing, a cascade of benefits can be expected to quality of care, including the status of cleaning and infection prevention.