The Malta Memorial District Nursing Association, or MMDNA as it is commonly known, has been providing home nursing and midwifery services since 1947, and the demand for the NGO’s services are forever increasing, as MMDNA director of administration Tony Attard and state registered nurse Sharon Cassar told Francesca Vella during an interview.
MMDNA director of administration Tony Attard explained that by means of an agreement with the Health Division, the organisation provides its services to house-bound patients, including people who would have just been discharged from hospital.
Its nurses also visit state schools, detention centres and open centres to provide services such as tablet administration, urethral catheterisation and supervision of tablet taking (psychiatric/TB). In addition, MMDNA has a number of individual and group subscriptions; members and their dependents are entitled to be visited at home or elsewhere, if arrangements are possible to receive nursing services as prescribed by a locally registered medical practitioner.
Nursing services include general care of patients, blanket baths, prevention and treatment of bed sores, toe nail cutting, injections (other than intravenous), enemas, wash-outs, dressing of wounds, catheterisation, nursing care and treatment of diabetics. The service excludes physiotherapy, chiropody and sitting in service with patients.
However, the association may help members contact a private nursing agency to provide a nurse for a patient, by day and night, against payment.
MMDNA has been investing in patient aides such as patient lifters, walking frames, commodes and backrests, which its members can hire.
Sharon Cassar is one of more than 50 full-timers – mainly nurses – employed with the organisation. A number of other nurses are employed on a part-time basis, and the number of visits have been on a constant increase. From 435,000 in 2007, the number of visits increased to 494,378 (plus 6,551 visits to subscribers) in 2011. When the NGO was set up in the mid-1940s, the number of visits was just under 12,000.
Talking about what it involves to be an MMDNA nurse, Ms Cassar said: “Like any nurse, you have to be very patient, organised and resourceful, but also adaptable. You need to have the ability to cope in certain situations. We’re constantly visiting patients in their own homes, so we wouldn’t know what you’re going to come across.
“We’re all assigned particular areas, so we are familiar with the streets and even the patients we visit. You’re faced with something new every day and sometimes you get attached to clients and their families, so it’s difficult when a patient passes away. ”
I asked her how she manages to cope, and she explained that there are times when she goes home after a day at work and she’d keep thinking about a particular method she would have used to treat a patient, for instance.
“You have to cut a line somewhere. You have to just switch off, also for the sake of your own mental well-being.”
Having to visit 30 or more patients every day, including about 21 in the morning (between 8am and 1pm), Ms Cassar said traffic and lack of parking are among the two main problems nurses have to face on a daily basis, and the traffic problem is only aggravated when it rains and the roads flood.
Mr Attard added that things can also get quite complicated when cars break down, as visits would somehow need to be re-assigned to other nurses.
The organisation currently has 54 cars, most of which are quite new, and all of them are inspected at least once a month.
“We have our own mechanic, but the cars have to be replaced every so often. Leasing is an alternative, and we wouldn’t need to deal with repairs ourselves. However it’s more costly than owning cars, also because we’re exempt from registration tax.”
Rain or shine, MMDNA nurses have to go out; working alone can also be a challenge and Ms Cassar admitted that she misses the teamwork sometimes. And with cancer patients, it can be emotionally draining. Seeing patients deteriorate can be quite stressful, and nurses naturally also have to deal with the family.
“On a positive note, most people are very grateful and appreciative. And it’s always nice to hear positive comments. Recently a doctor spoke to me about one of his patients, saying that without us, she wouldn’t be able to continue living at home. On a general level, patients’ conditions improve when they’re in their own environment.”
Despite the job being so stressful, Mr Attard said the staff turnover is quite low. Out of 90 members of staff on the payroll, not more than 10 people retire or leave the organisation every year, he said.
Is it difficult to find new recruits?
“There were times when it was quite difficult to find people, especially considering that the demand for our services was increasing. But things have improved over the last two to three years, and we have a team of very dedicated nurses.”
A brief history of MMDNA
The MMDNA was founded in September 1945 on the initiative of Captain Robert Ingham MBE, LLD (Honoris Causa Malta). An important resolution passed on the first meeting was that nurses would serve all classes of the community – a principle strictly adhered to until the present day.
Two houses in Sacred Heart Avenue, St Julian’s, were rented for four years to serve as a nurses’ home. Six nurses were brought from the UK and subsequently 10 Maltese girls were trained at the Blue Sisters’ Hospital.
The first nursing visit took place on 7 February 1947, and up till the end of that year, 11,696 visits to 529 clients had taken place. At the time only one car was available for the country areas, while the rest of the nurses and the students used the buses and ferry.
Since its beginnings, MMDNA has been associated with high quality nursing care. Back in the 1950s, the ‘Queen’s’ nurses brought with them high standards of care which at the time was a benchmark in nursing.
In 1973, the government contracted MMDNA to provide its services free of charge to those already entitled to free health service. The payment under this contract replaced the government annual subsidy, and the association then agreed to widen its services to assist the Maltese community in keeping its elderly and disabled people in their own homes.
Regrettably, the contract was not renewed due to a misunderstanding in the mid-70s and MMDNA had to limit its services to its members only.
In 1990 MMDNA entered into a contract with the government to provide home nursing and midwifery services throughout the Maltese Islands to people entitled to free health services. This contract is renewed and updated from time to time.
In July 2011, MMDNA launched a pilot project for family support with a view to assisting family caregivers to maintain their elderly loved ones in the comfort of their homes. The aim of the project is to help older people to continue living in their own community for longer, and seek admission to a residential home only as a last resort, support relatives in the care of their older loved ones, and offer some respite to the older persons’ caregivers.
MMDNA recruited qualified carers to cater for this service, and as always, the organisation is committed to deliver only quality care.