What Salama brought back to the neonatal ward

Ten babies. One nurse. According to Salama, that was the reality waiting on the neonatal ward in Zanzibar — tiny, fragile lives, far too many of them, and never enough hands.

In August 2017, Salama Khamis Mohamoud packed her bags in Zanzibar and travelled more than 8,000 kilometres north to Bergen. A paediatric nurse at Mnazi Mmoja Hospital (MMH), she had come to Haukeland University Hospital on a Norec-supported exchange to sharpen her neonatal care skills, to see how a very different healthcare system looked after its smallest, most vulnerable patients, and to bring whatever she could back home.

The language was a hurdle at first. It didn't hold her back. Salama followed the work closely, watching the Norwegian nurses move through their day. What stayed with her wasn't the expensive equipment. It was the routines.

– The exchange taught me how important routines are in the treatment of newborn and premature babies. It was an eye-opener to see how they plan the smallest things: cleaning, observation, and time for staff to reflect. These are things I brought home with me and emphasised once I was back, she explains.

She observed detailed routines and practices in neonatal care that were markedly different from those at MMH. Those structured approaches gave her new strategies to improve neonatal care in Zanzibar.

Bringing it home

Home was a harder place to put those lessons to work. According to Salama, the unit handled between 250 and 400 births a week, and one nurse could be responsible for up to ten babies. The ward also faced high rates of birth asphyxia and premature birth, with a fraction of the resources available at Haukeland. At Haukeland, one nurse could sit beside a single baby, two when a life hung in the balance. In Zanzibar, that same nurse had ten.

The difference in staffing and resources was significant. Back at Mnazi Mmoja, Salama and her colleagues did not try to copy the Norwegian model. Instead, they looked at which routines could work in their own ward, with the staff and resources they had available.

Together with the other exchange participants and her local colleagues, Salama set about changing what they could. Side by side, they built structured routines for cleaning and observation, and made training and reflection part of the ward's daily rhythm. Slowly, things shifted. The unit ran tighter. The care got better.

"In Norway there is one nurse for each baby — two if the baby is critical. Even with one nurse for every ten babies here, there are still practices from Norway that we can transfer to our unit, and these were the things I wanted to implement when I came back," she says.

Her colleagues saw it too. The changes the team set in motion, and Salama's part in driving them, earned her a swift promotion to head nurse of the neonatal unit.

"I learnt a lot at Haukeland about communication, new tools, diagnoses, treatments, and different ways of working. When I came back, they wanted me to become a leader and use the knowledge I had acquired," she adds.

A two-way street

What's easy to miss is that the learning flowed both ways. During her exchange, Salama shared insights from MMH's high-volume, resource-limited environment, offering valuable perspectives to her Norwegian colleagues. This exchange of knowledge enriched the understanding and practices on both sides.

The partnership between Haukeland and Mnazi Mmoja is broad. It spans internal medicine, addiction medicine, paediatrics, and neonatal care, and the exchange participants didn't only take knowledge home. They gave their Norwegian colleagues something too: a window into a busy, resource-stretched ward most of them had never seen up close, and more insight into how neonatal care is provided in a setting with fewer resources.

That's the quiet power of an exchange like this. Nurses cross the world, learn together, and carry that knowledge home, where it reshapes a ward, lifts a team, and reaches the babies who need it most.

Salama's experience underscores the importance of international exchanges in fostering professional growth, building capacity, and strengthening partnerships between healthcare institutions. Norec's commitment to facilitating such exchanges has proven invaluable in promoting mutual learning and development. Knowledge that travels with people, and keeps giving long after they've gone home.