The WHO CC UTS acknowledges use of key language from The WHO Global Strategic Directions for Nursing and Midwifery (2021–2025).
The tiny Pacific Island Republic of Nauru is the world’s third smallest state – after the Vatican and Monaco. The island is only 21km square and hosts a population of 10 670 [1]. After its phosphate deposits ran out, it accepted aid from Australia in exchange for housing an offshore immigration facility.
Moralene Capelle is Director of Nursing at the country’s only hospital - Republic of Nauru Hospital. Nauru has the world’s highest level of Type 2 diabetes with more than 40% of the population affected. Healthcare is free but there are shortfalls, which means the facility is providing what Capelle describes as the
minimum care that we can … This is just an impact of the shortage of not just the nurses and midwives but doctors in the facility that we have,” she says. “You can't deliver a quality service that you're supposed to because you don't have the people, you don't have the equipment, you don't have the space, you don't have the proper infrastructure to do so.
Patients often have to fly overseas to see a specialist or a specialist will come to the hospital to do treatments. As there is currently no school or institute to train nurses and midwives, nurses go to Fiji for training. Some have gone to Papua New Guinea.
Despite the challenges, Capelle has a number of plans. She is keen to establish a national nursing registration system and to get nursing assistants recognised. She hopes to establish a professional association. She feels the broader health strategic plan lacks a nursing element but is planning to add one in. “Nursing is still a hidden, a cost-cutting service,” she says.
One initiative is to strategically set up nurse-run health clinics in the community. "We have the buildings in place now,” she says. One is functional and two are in the process of getting up and running. Capelle hopes to see more nurse-led clinics as she says, “there's always a long queue of patients at the hospital in our out-patient clinics”.
This busy Director of Nursing has also been building partnerships in the Solomon Islands and Kiribati, countries that she sees as geographically and culturally similar to Nauru.
I'd like our nurses to work in the regional hospitals, just to expand those skills and expose them to … different types of patients. To work in different hospitals … it motivates them and fills them up and they can come back and say, ‘Oh, this is what's happening in the region’ and start thinking about new services or changing our services to include this and this and this.
Capelle regularly experiences nurse shortages but hopes to get her nurses better trained so that they can improve overall healthcare in Nauru, highlighting some of the unfinished business in the region.
[1] World health Organization, NAURU–WHO Country Cooperation Strategy. 2018.