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* News / Nigeria Nursing Council Increases License Verification Fees from #8750 to #53500 by Idowu Olabode: Today at 03:04:52 PM
Nigerian Nurses seeking better life outside the shore of this country now have more hurdles to cross as the Nursing and Midwifery Council of Nigeria has increased the license verification from #8750 to #53,500 Nursesarena.com has learnt.

In an internal Memo from the head of account to all departmental head dated 14th of November, 2018 and obtained by Nursesarena.com the upward review of the verification fees is to take effect from Monday 29th October, 2018.

Speaking under condition of anonymity with Nursesarena.com, two members of staff of the regulatory body confirmed the development. One of the sources said the consent of the Honourable minister of Health was sought earlier on who gave his express approval for the upward review.

Another staff however added that a courier fee has been captured in this new fees adjustment. Pressed further what the fate of those who want to verify 2 or more licenses would be, the source said the new verification fee has captured this as they only have to pay #53,500 for all their licenses to be verified.

Ever since the Brexit vote forcing UK to open her border wide open to foreign educated Nurses, there had been a dramatic increase in the number of Nigerian Nurses seeking verification from the regulatory body forcing the board to require applicant to bear the cost of courier fees. This development jerked verification to above #25, 000 before this new development

* News / Malawi: Midwife Suspended Over Labour Ward Selfie by katty: Today at 12:48:41 PM
A nurse in Malawi has been suspended pending further investigation after a selfie of her in a labour ward was posted on social media.

The selfie was widely shared provoking uproar on social media.

Joshua Malango, public relations officer for Malawi's Ministry of Health, told the BBC Focus on Africa radio programme the photo was shocking.

But he said the case had been referred to the Nurses' Council, which was investigating to see who took and circulated the photo.



Source: Uganda Monitor
* News / Malawi Nurse Under Fire for taking Selfie with Naked Pregnan Woman in background by katty: Today at 12:43:32 PM
A nurse at a hospital in Blantyre, Malawi, has reportedly been suspended, pending further investigation, after she took a selfie with an unsuspecting naked pregnant woman in the background.

According to Malawi24, the picture, shared on social media, showed the pregnant woman lying on a bed in the labour ward.

The selfie had since provoked an uproar on social media, with some saying this was "totally disrespectful".

A BBC report quoted the country’s ministry of health as saying that the photo was "shocking".

Investigations into the matter were still under way, the report said.

Source: News24
* News / Kenyans to access information on NCDs from their phones by katty: Today at 12:39:06 PM
Kenyans can now access information on Non-Communicable Diseases (NCDs) directly from their mobile phones.

This follows the launch of an SMS and USSD service called Fafanuka which is Swahili for ‘to be enlightened’ which was announced during the World Diabetes Day celebrations at Emusire primary school in Vihiga County.

The Fafanuka platform which is powered by Safaricom in partnership with the Ministry of Health and the Non-Communicable Diseases Alliance of Kenya (NCDAK) aims to address the information gap on the prevention, management and care of Non-Communicable Diseases.


 
“Fafanuka will leverage SMS & USSD to educate public, patients, nurses, Community Health Workers and caregivers on how to prevent, screen, diagnose, manage and follow up various non-communicable diseases which include diabetes, cardiovascular diseases, cancer and epilepsy.

To register for the service all one needs to do is dial *215# from their Safaricom line and follow the instructions,” said Dr. Joseph Kibachio, Head of Non Communicable Diseases Division in the Ministry of Health

The content has been developed in partnership with various organisations who are part of NCDAK including Kenya Cardiac Society (KCS), Kenya Network of Cancer Organisations (KENCO), Kenya Welfare of People with Epilepsy (KAWE) and the Kenya Diabetes Management and Information Centre (DMI). The platform’s secretariat is run by the African Institute For Health and Development (AIHD)

According to the World Health Organisation, non-communicable diseases (NCD) contribute to over 50 percent of inpatient cases in Kenya and 40 percent of hospital deaths.

Meanwhile, the Aga Khan University Hospital will offer free diabetes awareness and screening initiatives during this year’s World Diabetes Day to sensitise the public about the disease, its treatment and management.

The hospital will hold a free diabetes awareness and screening open day on Friday November 16, 2018 at the hospital from 9:00 am -3:00 pm.



This year’s World Diabetes Day themed ‘Diabetes and the Family’ focuses on increasing awareness on the impact that diabetes has on the family and social support of those affected and promote the role of the family in the management, care, prevention and education of diabetes.

Screening will include blood sugar, blood pressure, body mass index, waist circumference and advice on nutrition. Adults and children are highly encouraged to attend the public awareness forum and screening for early detection that will ensure better management outcomes of the disease.

A team of specialists including diabetologists, diabetes educators, nurses and dieticians will be available for a one on one free consultation with the specialists.

Source : KBC News
* Inventions / Google Is Making An “AI-Powered Assistant for Nurses and Doctors” by katty: November 14, 2018, 08:16:10 PM
What Google wants, Google gets — and right now, Google wants the Streams app.

Streams is a mobile healthcare app developed by DeepMind Health, a subsidiary of AI research company DeepMind, which, like Google, is a subsidiary of Alphabet.

As part of its efforts to snag a slice of the $3 trillion healthcare pie, Google is absorbing DeepMind Health, and according to a DeepMind blog post, the move could transform Streams into “an AI-powered assistant for nurses and doctors everywhere.”

Streaming Lives
The Streams app is currently helping medical professionals in the U.K. address the problem of “failure to rescue,” a term for what happens when a patient dies from a preventable condition because they didn’t receive the right treatment in time.

The app does this by consolidating all of a patient’s medical data. Everyone treating the patient can enter information into their file directly from the app, and the app can then send alerts to healthcare workers as soon as signs of a potentially life-threatening problem arise.

The Majors
Streams is currently used under very narrow conditions: only by workers at specific U.K. facilities and only for the detection of acute kidney injury. With Google’s full support, though, the app could very well become the go-to medical tool of healthcare professional across the globe. And seemingly nothing would make the DeepMind team happier.

“This is a major milestone for DeepMind! One of the reasons for joining forces with Google in 2014 was the opportunity to use Google’s scale and experience in building billion-user products to bring our breakthroughs more rapidly to the wider world,” they wrote in the blog post. “It’s been amazing to put this into practice in data centre efficiency, Android battery life, text-to-speech applications, and now the work of our Streams team.”

Source : https://futurism.com/google-health-deepmind-streams-app
* News / Botched Exam: Nurses Slam N5m Suit On Enugu Psychiatric Hospital Management by katty: November 14, 2018, 01:05:20 PM
Nurses on special training at the Federal Neuropsy­chiatric Hospital Enugu have slammed a N5 suit on the hospital management.

Orient Daily had reported that the nurses, penultimate Tuesday, carried a mock coffin against the management, a situation that crippled activities in the hospital for several hours.

Trouble started after they could not write their nursing council examinations owing to the management’s alleged in­ability to forward their payment for the requisite accreditation to the nursing council and refusal to refund the alleged 600 thou­sand naira they paid.



As a follow-up to the protest, they have now filed a suit filed before the National Industri­al Court, Enugu Division, with number NICN/E/36/201. It has Obi Chibuike Otito and Amadi Chizoma as claimants, on behalf of other students.

Joined as defendants are the medical director of the hospital, Dr. Jojo Onwukwe and Dr. An­drew Orovwigho. The students are, among other reliefs, praying the court for “general/aggravat­ed damages of five million naira (N5,000,000.00) for loss of time, academic years, strictures and discomfitures.

“An order of this honourable court directing the 1st defen­dant to stay all actions aimed at imposing the 2nd defendant as the Head of Training and Re­search by ousting Dr. Bakare out of office as the current Head of Training and Research, Federal Neuropsychiatric Hospital Enu­gu without due process thereby subverting and destabilising the administration and manage­ment of School of Mental Health Nursing, Federal Neuropsychi­atric Hospital Enugu, pending the hearing and determination of the substantive suit.

“An order of this honourable court directing the defendants, their cohorts, surrogates and other principal/administrative officers of the Federal Neuro­psychiatric Hospital Enugu not to foment any industrial strife, frictions or dissensions capable of causing industrial disharmo­ny or a total collapse of academic and routine labour activities at the School of Nursing, Feder­al Neuropsychiatric Hospital, Enugu, pending the hearing and determination of the substan­tive suit. “An order restraining the defendants acting by them­selves, agents, cohorts or surro­gates from further harassment, intimidation or any sort or vic­timization of any of the plaintiffs, staff and students of the School of Mental Health Nursing, Fed­eral Neuropsychiatric Hospital Enugu, consequent upon this present suit pending the hearing and determination of the sub­stantive suit.”

The claimants told the court that the board of the Federal Neuropsychiatric Hospital Enu­gu or the first defendant “has no right whatsoever under any law or the institution’s organogram to alter, change, or unilaterally modify the system of administra­tion in the school.” No date has been fixed for hearing the matter
* Articles / Increased Investment in Nursing is Key to Achieving Health for All by katty: November 14, 2018, 08:38:07 AM
A new report published today by the World Innovation Summit for Health (WISH) Nursing and UHC 2020 Forum at the WISH Conference 2018 states that countries that invest in and develop their nursing and midwifery workforce can achieve a rapid, cost-effective expansion of high-quality UHC.

The report, co-authored by Lord Nigel Crisp, Co-Chair of Nursing Now, Professor Sharon Brownie, Dean of the School of Nursing at The Aga Khan University, with support from Dr Charlotte Refsum, Lead for Evidence and Research, Nursing Now and Global Healthcare Clinical Manager, KPMG, argues that unless nursing and midwifery is rapidly expanded and developed, there is no possibility of achieving the World Health Assembly goal of a billion more people benefiting from Universal Health Coverage in five years.

Entitled Nursing and Midwifery: The Key to the Rapid and Cost-Effective Expansion of High-Quality Universal Health Coverage, the report includes new data on public perceptions of nurses and midwives in seven countries. The data shows strong public backing for nurses playing a greater role in health services and strengthens the report’s further argument that nurses are in pole position to manage the defining health challenges of modern times.

“The world is facing a shortfall of 18 million health workers needed to deliver and sustain universal health coverage by 2030.” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, writing in the foreword of the report. “More than half of that shortfall is nurses and midwives. This report makes a persuasive set of arguments for investing in nursing and midwifery as part of a multidisciplinary, people-centered workforce.”

Speaking at the launch of the report, Lord Nigel Crisp said, “To date, discussions on the delivery of UHC have focused on financing and access to service without sufficient consideration of investment in the health workforce. Our report shows that by redesigning health services at a national level to make better use of nurses and midwives, countries can achieve high quality, cost effective Universal Health Coverage and maximise their existing human resources.”

Building on the success of the Nursing Now campaign, which aims to empower nurses worldwide and has generated support in 67 countries since its launch in February 2018, the report breaks down the argument for investing in nursing and midwifery into the following headlines:

Rapid expansion The report suggests that countries can achieve rapid expansion of Universal Health Coverage by adopting a strategy that combines investment in the workforce with changes in service delivery and practice. In practice, this means enabling nurse and midwives to work to their full potential through the creation of more nurse-led clinics, more specialist nurses and more midwifery services.
Cost-effective expansion Evidence in the report shows that cost-effective expansion of Universal Health Coverage will heavily depend on enabling and training the existing workforce, including nurses and midwives, to work more effectively. In addition to the examples listed in Rapid Expansion, there is enormous potential for nurses to expand their scope of practice through task-sharing. One study cited in the report estimated that advanced practice nurses can complete approximately 70 percent of a GP’s workload.
High quality expansion There is evidence of the impact that nurses and a patient-centered, holistic approach have on quality, including studies that show that physicians and nurses generally achieve equivalent health outcomes for long-term NCD management, though nurses often score higher for patient satisfaction and for treatment adherence. Nurses also often provide more health promotion and disease prevention advice at the same time.
“The research conducted in this report shows that the vast majority of patients do not mind whether they are treated by a nurse or a doctor and hold both professions in equal regard,” said Lord Darzi, Executive Chair of the WISH. “These results suggest that there would be widespread public support for nurses making an even greater contribution to healthcare in the future, so we strongly encourage governments to adapt their national programmes accordingly.”

Commenting on the report, Professor Sharon Brownie said, “Current global policy on UHC barely mentions the workforce, let alone nursing and midwifery. There would be a profound effect on how quickly and effectively UHC could be rolled out if a significant part of the workforce were enabled to work more effectively or to take on new roles.”

"ICN is pleased to welcome this new report on Nursing and Universal Health Coverage," said Annette Kennedy, President of the International Council of Nurses and Commissioner on the WHO High-Level Commission for NCDs. "Several studies have found that midwifery- and nurse-led services are delivering positive and high-quality outcomes for patients, especially those related to non-communicable diseases, and are cost effective for health systems. ICN supports the recommendations of the report and calls for investment in nursing and midwifery for rapid, cost-effective, high quality UHC."

"ICN wholeheartedly supports the recommendations of this report," said Dr Isabelle Skinner, ICN's Chief Executive Officer. "Many nurses already work in advanced and specialist roles, and many midwifery- and nurse-led services are currently providing new and innovative models of care, especially for community-based maternal, child health and adolescent services. ICN believes that midwifery- and nurse-led services should be the foundation for a rapid, cost-effective expansion of high-quality UHC."

This report has been published in coordination with the Nursing Now campaign, which has a three-year mission to promote and empower nurses and midwives worldwide. The campaign will culminate with the Florence Nightingale Conference in 2020, an event marking the 200th birthday of the woman considered to be the founder of modern nursing.
* Articles / Where There is No Doctor: A Clarion Call to All Nigerian Nurses By Williams M by katty: November 14, 2018, 06:25:25 AM
It was a very hot afternoon in one the communities sited in the creeks of Bayelsa state. I just stepped out of the health center in hunt of a chilled drink to quench my thirst. Surprisingly, one of the community members who recognized me as a “corper nurse” posted there, ran towards me alerting me of a friend in the neighboring community who already notified her of their coming to the health center for an emergency. I hurriedly aborted my mission and rushed back.

While still at the entrance, I sensed danger on my sight of drips of blood littered along the entrance of the health centre. It was a case of matchet injury to the hand. The patient reportedly mistakenly cut deep through his hand on an attempt to carry out his routine farming work. The client already laid on a couch, was bleeding profusely as some arteries were affected. The environment was already tensed as the client was obviously anxious and humbly pleading with us to help save his dear life; relatives and well-wishers who accompanied the client were heard calling on their gods and God to intervene. A battle between life and death!

Unfortunately, the doctor on call was temporarily unavoidably absent. Decision-making automatically shifted to we; the nurses on ground. It was a tough choice between “promptly referring the client to a decent hospital in town for expert management by speed boat” which would take about 50 minutes and “instituting emergency treatment to the best of our abilities”. We chose the latter option as it was apparent that the client would give up the ghost from hypovolaemic shock if treatment wasn’t commenced immediately as he has lost so much extracellular fluid. A choice between a greater and lesser evil! We swung into action.

As God may have it, the health center was quite equipped with emergency drugs and supplies. While applying pressure at the bleeding site to control the bleeding, intravenous line was secured and infusion set to boost the fast depleting plasma volume. Within few minutes of attempt to irrigate and suture the injury site, client ran into hypovolaemic shock. Client became unresponsive and pulse rate difficult to palpate. The environment was thrown into chaos as the cry from the relatives tripled which attracted a large crowd which was difficult to disperse. At that point, for the first time in my life I felt helpless and overwhelmed but I struggled to remind myself as I was thought in school, “to always remain calm in an emergency to be able to deliver effectively”.

With the help of my able colleagues, Cardio-pulmonary resuscitation (CPR) was initiated, artificial oxygen apparatus set and emergency drugs administered. To God be the glory, within few seconds, client was revived and was stabilized after some minutes of battling to suture the bleeding site. Client was afterwards, referred for further expert management. Theories learnt from the fore walls of college were put into practice. What would have been a life-time nightmare and post-traumatic stress to me turned out to be a good feeling of accomplishment and source of encouragement to go deeper and learn more.

TO MY DEAR NIGERIAN COLLEAGUES


While waiting for any slightest opportunity to fly out and join our colleagues in the Western world; where the society and government appreciate well our good works; where everyone is recognized and respected for the vital role they play in the society; where the hospital working conditions are health-workers friendly; where there are abundant opportunities for personal and professional growth and advancement, it is pertinent we have these at the back of our minds that:
 You may not always be lucky to have a doctor who by the Nigerian bureaucratic system, is responsible for leading the health team in the medical management of clients. Hence, the need to equip ourselves with the necessary practical skills and knowledge to deliver effectively mostly in an emergency as such. In such situations, your actions and inactions will mean so much in saving a client’s life who may be your loved one, relative, friend etc.

 There is gap between theory and practice and should be bridged. Having being exposed to the theories in courses like Anatomy, Physiology, Med-Surg, Biochemistry, Pharmacology etc. in the course of our training as students, the onus is on us to practice and build on these to boost our competence.

In Nigeria, mortality rate is already very high and life expectancy is low. Your competence and emergency readiness can help checkmate this. As I was taught in “Medical Jurisprudence”, life is sacrosanct and as such, should be conserved and protected at all cost.
I will be quick to suffix that I am victim of Nigerian system but won’t continue to let it negatively affect me in the practice of my vocation and passion.

BY Williams Maduka
* Articles / Nursing Internship in Nigeria-What You Must Know by Princewill Aghedo by Idowu Olabode: November 13, 2018, 10:13:31 PM
On Reception of the circular from the Head of Service of the Federation to the Hon. Minister of Health (Ref.No.HCSF/EPO/EIR/CND/100/ST dated 7th,September 2016), the Nursing and Midwifery Council of Nigeria (NMCN) concluded arrangements for the commencement of the Internship for University Graduates from January 2017.

The Nursing Internship is a paid one year work-in-training programme put together to enable University Graduate Nurses match their theoretical and clinical knowledge with practical Nursing Tasks and practices in a hospital setting.

▪BENEFITS OF INTERNSHIP

-provide interns with the chance to use thorough clinical judgement and critical thinking skills throughout patient care process

▪it afford interns the opportunity to implement learned knowledge and behaviours into real -world scenarios

▪To collaborate in care services across multiple healthcare departments.

▪it afford Interns the opportunity for self development through improvement of communication skills, building confidence and gaining new perspectives.

▪Opportunities to partake in quality care initiatives.

▪it helps interns develop delegation and time management abilities

▪provide an insight of what the future jobs entail.
 
▪Nursing internship enhance leadership skills in management of conflict resolution and ethical issues.

WHO SHOULD GO FOR INTERNSHIP?


Nursing internship is a Programme specially designed for University graduate nurses for a period of Twelve months to enable them have exposure and opportunity to implement the learnt theoretical knowledge on real life scenarios.
The program afford university graduates an opportunity to gain mastery,gather experience, get exposure to real life scenarios and give them an insight on career path..

Unlike the School of Nursing graduates, the University graduate Nurse must complete this programme before they can have access to a permanent licence to practice. Hence, it is usually advisable for new graduates to take every opportunity of internship openings in the country as there is a stiff competition amongst more than 1000 Graduate nurses for slots usually less than 50 per institutions.

REQUIREMENTS FOR INTERNSHIP


Requirements;

- Application letter or form, depending on the Hospital.
- CV.
- Passport
- First school leaving cert
- SSCE
- Degree cert or testimonial or statement of result or attestation
- License
- Oath (for some institutions)
- Birth cert
- LGA identification
- 3 recommendation letters
- And any other necessary doc.

DURATION FOR INTERNSHIP


The duration for internship is twelve months as approved by the Nursing and Midwifery Council of Nigeria.

WHO CAN'T APPLY FOR NURSING INTERNSHIP?

Only university graduates from January 2017 can can apply for this programme. Hence, those that graduated in November or May 2016,2015,2014 and above are excluded from internship.

CAN SCHOOL OF NURSING GRADUATES APPLY?

"NO". Only university graduates are allowed to apply for internship in Nigeria.
School of Nursing graduates are expected to have gained at least 14 months clinical training as stated on the curriculum of the Nursing and Midwifery Council of Nigeria (NMCN), hence, don't need to go for internship as they have been exposed to majority of the clinical settings and specialty in Nursing practice.

WHERE CAN INTERNSHIP BE DONE?

University graduate Nurses can apply for internship in any of the following institutions :
-Federal Medical centers
-Federal teaching hospitals
-State teaching hospitals
-Industrial Organisations
-Military hospitals and many more.

TIPS ON HOW TO FIND INTERNSHIPS

When looking for a BSN nursing internship, it is important to look early because there is often strong competition for a limited amount of spots.

A general rule is to conduct the search at least one semester ahead of time since many deadlines are around August -November. Networking with senior colleagues, professors, and classmates may help students find the right internship. BSN nursing internships are commonly posted on Nursing and medical blogs like Nursingworldnigeria..com MEDICALWORLD.COM, Parcelmedico, nursesarena.com healthinfocorner.com myschoolmag.com and many are seen on bulletin boards,  newspaper,Whatsapp and telegram groups as well as  the employer websites.
 
LIST OF SOME INSTITUTIONS THAT HAVE STARTED ACCEPTING NURSING INTERNSHIP IN NIGERIA

-Federal Medical Centre Owo
-Federal Medical Centre Owerri
-University of Benin teaching hospital. (UBTH)
-Federal Teaching Hospital Abakaliki (FETHA)
-Nnamdi Azikiwe university teaching hospital (NAUTH)
-University of Calabar teaching hospital
-FMC keffi.
-University of Uyo teaching hospital
-Enugu State Teaching Hospital
-Bayelsa State Health service

HOW TO GET HELP FOR INTERNSHIP APPLICATION

While many Graduate nurses have risked their lives and spent money travelling from one city/State to another, some have successfully secured internship positions from the comfort of their homes without travelling any distance.

There are E-parcel organisations that help submit internship applications to the Applicants desired institution/Organisation  for as low as #2,000.

All these E-parcel service do is ensure you submit the right documents to their various emails and print and submit on your behalf. One of the most trusted organisation offering this service is "Parcelmedico"(+2347069646143).
Parcelmedico is an online platform with over 15,000 medical subscribers that assist Interns,House -officers and Residents to submit their applications.

CHALLENGESS OF NURSING INTERNSHIP

--Poor and wrong placement of graduate Nurses as compared to other healthcare professionals.

-Exclusion of Nurse interns from Many internship Advert.
-Non -provision of accommodation for Nurse interns when they finally get a place to do their internship.

-Corrupt practices in selecting Applicants for internship

RECOMMENDATIONS

-
-Proper placement of Intern and already employed graduate Nurses who entered service with first degree in Nursing should be the major focus of stakeholders

-Nursing Associations such as NANNM, UGONSA,NUNSA,MINAN should ensure that any organization/institution that ommited Nursing in a medical internship advert should be corrected and given a deadline to revert
.
-Federal and state NANNM Executives should ensure that the hospital management provide a living quarters that is comfortable for the Nurse interns.

-Measures should be put in place to check corrupt practices in selecting Applicants because of their financial strength to pay for Internship slots as Internship slots should only be given based on merit.
-A good number of Nurse intern should be engaged in comparison with best international ratio of Nurses to other health care professional. A case of employing 10 nurses when other health care professional are employed in their 50s'  should be resisted.
However, worthy of commendation are the Chief Medical Directors that have commenced internship in line with federal ministry of health directives. Indeed they are doing a great service to our Nation.

Also to University graduate of Nursing Science Association (UGONSA).who have been in the fore front with NUNSA(Nigeria University Nursing student Association) to ensure the commencement of internship in Nigeria and fighting against the wrong placement of Graduate Nurses in Nigeria.

CONCLUSION
Nursing is a profession of high repute both nationally and internationally and it's our responsibility to foster interdisciplinary collaboration with all the relevant stakeholders in education and health sectors in other to take the profession to the highest pedestal of excellence. Thank you.

Princewill Aghedo (RN, DNI)

DESCENDANT OF NIGHTINGALE.

DIRECTOR OF NURSING INFORMATION
 Princewillaghedo@gmail.com

To join a platform where you can get help with internship, kindly click on the link below.
https://chat.whatsapp.com/5Jeq8mQFjPw2pdRwpOtRc2NURSING INTERNSHIP IN NIGERIA - What You Must Know

* News / Nurse Under Fire After Taking Selfie With Unclad Pregnant Lady In The Background by katty: November 13, 2018, 08:16:53 AM
A nurse has sparked outrage among internet users following a viral picture which is making the rounds on social media for obvious reason.

The yet-to-be identified nurse took a selfie in the ward of a general hospital as she also captured a Unclad pregnant woman who was laying down on a bed.

The controversial picture was posted on a social media platform - causing outrage among netizens who feel it's disrespectful for the patient and unethical for the health personnel to have taken the picture with the pregnant lady in the background.



A Facebook user identified as James Moses shared the picture and didn't give the exact location where it was taken as he called for the nurse's sack.
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