Member Spotlight: Fiona Stephenson
May 17th, 2018
Ms. Stephenson studied both nursing and midwifery at the Royal Devon & Exeter Hospitals (UK) and holds additional qualifications in education (University of Westminster, UK) and international community-based rehabilitation (Queens University, Canada), as well as postgraduate diplomas in management (Institute of Management, London) and quality assurance. She is studying for a Master's Degree in Health Sciences at The University of Southampton (UK). Her career has included work with the Royal College of Nursing, including the International Reference Group, International Committee, Nursing Continence, Nursing Neuroscience, Education and International Forums. She was a Core Member of the World Health Organization (WHO) Rehabilitation Medical Teams and Spinal Cord Injury (SCI) Cell (Emergency Medical Teams) Working Groups. She helped to create and publish the WHO guidelines on the minimum standards for rehabilitation emergency medical teams responding to a sudden onset disaster (2017). She worked extensively in SCI healthcare capacity building in Haiti: for “Hope, Health Action" (formerly known as the Haiti Hospital Appeal - HHA) and Healing Hands for Haiti; and in Nepal: the Spinal Injury Rehabilitation Centre (SIRC) in Sanga. She is a founding member of the Haiti SCI Working Group and remains its international coordinator since its inception in 2010. In 2016, she became a Fellow of the Royal College of Nursing, achieving the Royal College's highest award for her contributions to the art and science of nursing. In 2017, Ms. Stephenson won the Cavell Nurses Trust International Impact Award and was a Nurse of the Year finalist (Nursing Times UK).
Currently, Ms. Stephenson is working as the Registered Service Manager at The Livability Spinal Injury Centre in the UK. She has been assisting in the set up of the new spinal injury centre in the heart of the Dorset countryside, which concentrates on ‘real time rehabilitation’ for people who have sustained a SCI. The aim is to assist people in reintegrating to the community in a supported, but realistic and pragmatic fashion, away from a typical hospital environment. The facility is set in 350 acres of wetland, woodland and heathland. She is responsible for the centre’s physical site, as well as the staff and people that the organisation supports. She is particularly involved in the recruitment and training of staff.
Ms. Stephenson has been an active member of the ISCoS Education and Disaster Committees and is assisting in the implementation of The ISCoS Nurse Committee (in progress). Outside of ISCoS, she is co-founder of The International Network of SCI Nurses, which now has over 500 members from all over the world. The network is involved in sign posting and training nurses internationally in SCI care. To date, Ms. Stephenson has volunteered in countries such as Mongolia, Madagascar, Nepal, Tanzania, Botswana, Haiti, India, Bangladesh, Indonesia and Jordan. In 2018, her volunteer work will take her to Sri Lanka, Mauritius, Zambia and Myanmar to provide training related to SCI nursing care.
Please tell us about a great success story you've been involved with in your work and travels.
I volunteered to respond to the Haiti Earthquake in 2010 with a UK/Haitian charity. There, I helped to create the first dedicated SCI unit in Haiti (with Haiti Hospital Appeal) and outpatient rehabilitation clinic in Haiti (with Healing Hands for Haiti). I helped to train the first SCI peer support worker in Haiti. I am really proud to say that all the patients that we cared for are still alive - 8 years later. In the poorest country in the western hemisphere, this is no mean feat. In 2010, we went from zero to 15 patients with SCI in two days, which soon went up to 25. Over 80% of those admitted had massive, grade 4 sacral pressure injuries that went down to the bone. These were healed conservatively by the Haitian nurses carrying out a wound care regime that I implemented. We carried out 3 and 7 year follow up studies that were presented as posters at ISCoS. I am so proud of everyone’s achievements. I regularly get feedback from some of the former patients: having babies and becoming employed. It is not all roses though. Haiti is a tough place to be.
Please tell us about your experiences working at the Spinal Injury Rehabilitation Centre (SIRC) in Nepal. Were there lessons learned in Haiti that you were able to apply in Nepal?
Immediately following the earthquakes in Nepal in April 2015, I supported SIRC from the UK. Given my skill set in disaster management in low and middle income countries, I was then deployed as a member of the UK Emergency Rehab Medical Team – a UK Government initiative. I served in country at SIRC, which is just outside Kathmandu, for over 18 months. Part of my early work involved rapid health care capacity building at SIRC to accommodate the substantial increase of patients with SCI following the earthquakes (from 38 to 200 people with SCI). This was an unforgettable time. I will always remember the incredible support provided by the local peer counsellors to the survivors of the earthquake. I have a vivid picture in my head of fifty plus people doing their stretches, yoga and music therapy together.
I created a register of international SCI specialist volunteers and organised them to support the local nurses, physios, doctors, psychologists, occupational therapists, and wheelchair technicians. Initially, the main focus was recruiting regional SCI specialist volunteer teams from nearby countries, and then to expand internationally. Countries in the region are culturally similar, more likely to speak the same languages and have similar styles of care and understanding regarding resources. Neurology and urology nurse specialist positions were introduced to the team, and proved to be extremely helpful. I am particularly proud of all the local nurses, as they significantly limited the incidence of urinary tract infections, fecal incontinence and pressure injuries. This standard of care has been maintained since then. I used and enhanced systems that were developed following the 2010 Haiti earthquake, including telephone follow up support. A questionnaire was developed to holistically address the needs of patients after hospital discharge. The questionnaire covered areas that included mental health, skin integrity, bladder and bowel management, equipment availability, transport and social integration. We monitored our results and the audits showed consistent improvements.
Supporting the staff and patients in Nepal was very different to my work in Haiti. Nepal already had an established SCI centre at SIRC. The Nepali culture is also totally different. The country is politically more stable and has a stronger health care system. There is also a lower incidence of violence. After almost 3 years of experience in Haiti, I became very aware that a quick visit and input for a week or two could be extremely counterproductive and disruptive to the local staff, if not managed effectively. I learned that it is so important to have consistency and continuity. In Nepal, specialists did also visit for a week or so, but with specific purposes in mind, and on the whole, this worked very well.
What interventions, e.g., medications, equipment, or education, do you feel have the most practical impact on improving the lives and health of persons with spinal cord injury in low resource settings?
Education. The “training the trainer” approach. Education empowers local health care professionals to provide support to people who have sustained a SCI within their local healthcare system/infrastructure.
What are your favorite moments of your career so far?
Gosh, they are so varied, to be honest. Each day is a new experience! I love the work I am able to do in low and middle income countries, as I do feel that I am able to share knowledge and skills with my colleagues.
What have been your favorite experiences related to ISCOS?
Meeting like-minded people. I really feel that the people I have met are part of the SCI family. I am very proud to be part of this. I love the camaraderie.
What keeps you busy/busiest these days?
ISCoS activities, SCI nursing activities, helping to set up the Livability Spinal Centre, and expert witness work.
Where are you traveling next? Where will you be traveling in the next few years?
France, in July for the International Society of Physical and Rehabilitation Medicine Congress. Australia, in September for ISCoS. Zambia, for AFSCIN (the Africa Spinal Cord Injury Network). Haiti. Myanmar, in November for the Asian Spinal Cord Network Congress. Nigeria, by personal invitation to provide SCI nurse training. And South America, hopefully to assist with SCI nurse training in the next year or two.
Please tell us about a skill or skills that you have that would surprise us.
I had a string of polo ponies and played polo for fifteen years in the UK! And I worked with the most ‘winningest’ polo player in the world for two and a half years, travelling to the USA, Mexico, Argentina, China and through Europe. I also have a Heavy Goods Vehicle driving license, for 17.5 tons.
Who is the person(s) you would most like to thank and why?
My mother, who encouraged me to go into the nursing profession and my family and close friends who have unconditionally supported me whilst working and living in low and middle income countries such as Haiti and Nepal.
I am also indebted to the local healthcare professionals in the countries I have visited, who have embraced the knowledge-sharing opportunities.