— Alex Berland, Global Health and Nursing Education Specialist
"Nursing education in Bangladesh is very inconsistent in quality, with a few islands of merit but mostly poor results. Because professional practice in hospitals is weak, nursing students cannot learn from competent role models."
Alex Berland: The "power of practice" has always been very important to me. As an executive, I always knew that the people doing the front-line work, providing direct care to patients, knew more about that work than I knew. My responsibility was to support those workers to deliver the best possible patient care. I followed the ideal of "servant leadership" in my management role of setting priorities and keeping the organizational focus on care quality, mutual respect and ethical practice.
Alex Berland: Nursing education in Bangladesh is very inconsistent in quality, with a few islands of merit but mostly poor results. Because professional practice in hospitals is weak, nursing students cannot learn from competent role models. Even if they do have a reasonably good education, graduate nurses may not be able to practice modern skills due to prevailing standards of their workplace. Additional internal factors contribute to low competence: skill level of nurse educators; few opportunities for professional development of nurses or educators; weak regulatory standards and controls; lack of leadership to uplift the nurse training system.
Alex Berland: Immerse yourself in the possibilities. International work begins at home: I was engaged in projects in Bangladesh by a friend who was volunteering with me on a community health project in Canada. Read about the work of international NGOs to learn about areas of need, program activities and job qualifications. You can also explore opportunities through open access journals, conferences, web forums like Global Alliance for Nurses and Midwives, or academic programs such as the low-cost online courses at Next GenU.
Alex Berland: Margaret Mead summarized this so well: "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has." I am unsure about the second sentence, but I have seen the effect of the first: energetic pioneers, leaders, and collectives do change the world - for better or for worse!
Alex Berland: Much of my global health work focuses on human resource development, so I am very much "upstream" or distant from the impact. Therefore, my perceptions must be philosophical. Gandhi said, "Whatever you do will be insignificant; nonetheless it is extremely important that you do it." In the early days of the Bangladesh Health Project, a Bangladeshi told me, "These are our problems. We need your help so that we can solve them in our own way." I will let others assess the impact of my work.
Alex Berland: I feel very fortunate to have intellectual work that I enjoy so much: this is its own reward. Future plans are more of the same: continue building public health capacity in Bangladesh through education and professional development; contribute to advancement of health care policy in Canada; write scholarly and popular papers about what I am learning; mentor juniors and pass the torch. I would like to be more involved in the policy process to shape the professional determinants of health in Bangladesh, but I cannot create this opportunity myself.
Alex Berland: My professional role models have been people who demonstrate ethical behaviour, strong interpersonal skills and high levels of competence. These include people at all levels of organizations, not only leaders. I often tell Canadians about the positive attitude I encounter in Bangladesh. There are so many challenges, yet these colleagues remain optimistic, try their best to do a good job and behave nicely to others. That is inspiring – their commitment keeps me returning to this country to work alongside them.
Alex Berland: I recommend "Factfulness" by global health scholar Hans Rosling. The key insight is that we do not know what we do not know, and even our guesses are informed by our unconscious biases. Rosling explains these biases, shows where global health professionals are making progress, and provides hopeful advice about where we should focus future efforts.
Alex Berland: I have visited Bangladesh about twenty times since 2004, so there are many special memories. There are different kinds of smiles, too. There is the teacher's smile of pride seeing my students surpass me with their insights and capabilities. There is the wry smile of a cynic seeing miscreants and incompetent but few consequences. And of course, there is my smile of appreciation for the warm welcome of so many hospitable Bangladeshis, reminding me that our world is mostly filled with ordinary people who care about one another.
Interview conducted by Monaemul Islam Sizear
Alex Berland (RN retired, BSc. Nursing, MSc. Health Planning and Administration). After working as a bedside nurse, Alex served as an executive in several Canadian teaching hospitals, leading clinical redesign efforts as well as accreditation and governance activities. For BC Ministry of Health, Alex led reform of the provincial mental health system, during which time he was also CEO of an 800-bed tertiary psychiatric hospital. For UK Department of Health, Alex served as Head of Hospital Policy for England, overseeing several national initiatives.
Later as president of his own consulting company, Alex led policy and planning projects for hospitals, regional and national governments, WHO and the World Bank. Since 2004, Alex has worked with educators, NGOs and hospitals in Bangladesh as a volunteer adviser for numerous projects. Alex has authored peer-reviewed papers on topics including nurse education, transformational change, health human resources and he serves as a reviewer for several journals.
