Merry Christmas

This month, instead of telling you all how much I miss you, how different the weather is, or how it is impossible to find a turkey in Zambia, I’ll instead share with you some Christmas cheer – things that have/are making us happy, and why this year has been so important and amazing for us.

Discovery. Entering a different culture is exciting. Sharing knowledge and experiences is so rewarding, and eventually, after a LOT of learning, you reach a point where you can finally relax and (almost) fit in with the people around you. Things aren’t as hard as they were, and little things like not hesitating to greet everyone you pass on your way to work, and drawing water every day for your bath are just another great part of your day. Yesternight (a Zambian saying), a co-worker told me how impressed he was with my language, and said, “you even speak like a Zambian now”. That made my day. You also discover things about a different prace and people (like constantly mixing up ‘l’s and ‘r’s), that are hirarious, and you eventually do the same things without lealizing it, only until someone from home catches you.

Patience. Is a common name here. But also, it really IS a virtue, and no one knows it better than Africans. Take it easy, relax, things will be okay. Though I do think this can be a bit detrimental in some situations, Ben and I have learned a lot about this word. I waited months and months to finally be registered with the nursing council. As I write this, we’re waiting for our neighbours to come by so we can go help them buy school uniforms. They’re already an hour late. Nothing comes on time, and you just deal with it. If things don’t fall into place like you have planned, it will still be okay. Maybe even “better than okay” (another Zambian saying).

Laughter. Say something remotely funny, and you’ll get roaring laughter and hand slaps, especially from old women. Show any sort of interest in a group of kids, and you’ll have an entourage of under-10’s wherever you go, ready to turn and run screaming if you give in and play with them.

Community. Walk anywhere at any time of the day, and you’ll see people sitting in the shade on their reed mats, chatting as their hands busily shell groundnuts or maize. Walk past a church group practicing their music, with drums and shakers and dancers – and they gladly welcome you to join or just listen. Visit anyone, anytime, and always receive the warmest welcome. Have 40 neighbour kids know your name as Uncle/Aunty Stephan, every elderly person is grandma/grandpa, and your closest neighbours treat you like a brother and sister. It’s more than community, it’s family.

Hope. Another common name here, along with Mercy, Gift, Joy, Peace, …Fatness (not kidding). There is poverty and malnourished babies, young people die from AIDS, and things really are stacked against people who want to have a better life than this. Despite all the obstacles and adversity, there is a lot of hope. A lot of determination and tenacity as people try to overcome corruption, disease, financial hardship, gender inequalities, and traditional expectations. People have innovative ideas, ambition, and a lot of optimism about the future of their country, despite the struggles of their past/present. It’s so encouraging and wonderful.

We’re both so lucky and happy to be here, words and pictures aren’t enough to tell you what it’s like for us. Thank you for all your support and thoughts and prayers while we’ve been in Zambia, we both really appreciate it and always look forward to even the smallest email or facebook message.

This Christmas, we’re celebrating in Lusaka. A friend has graciously let us stay in their house and look after their dog and cat and pool while they are traveling. So we’ve been “out on the town” here, going to the movie theatre to see Harry Potter, eating ice cream and muzungu food, and enjoying the sun by the pool. On Christmas Eve, Ben and I and a friend had a nice lamb dinner here, then joined two friends and went midnight mass (at 9pm) at a huge Catholic church with 500+ other people. It was so great, we sang carols, there were 2 choirs, and we danced our way out of the church 2.5 hours later. Ben and I came home and watched a bit of The Polar Express and opened one gift. On Christmas day, we were happy to see that Santa had come, then we relaxed by the pool. We had 9 people over for Christmas dinner, and we ate and ate and ate and played games and drank wine. It was nice to celebrate with friends and have a traditional Christmas. Zambians do celebrate Christmas, but there aren’t any big traditions, and to most people, especially in rural areas, it’s not a big celebration at all. Only when you get to Lusaka and enter the big new fancy mall will you see decorations and hear Christmas music. It’s nice if you don’t like the commercial part of Christmas, even though you lose some of that Christmas-y feeling. The tropical surroundings don’t help that either, but I’m not complaining!

MERRY CHRISTMAS!!

Flying Ants!

It’s the first big rain of the season, and I try (unsuccessfully) to stay dry on my walk home, jumping over puddles like a not-so-graceful kangaroo mouse. I arrive home completely drenched and muddy, but entirely happy. I was the kid who had to be pulled out of her rubber boots in the middle of the biggest puddle on the farm.

Later that evening, I’m called from my house by my neighbor, Katie. “Staphy!! Come and see the ants!” I’m puzzled as to why she sounds so excited – ants are everywhere, always, and there are plenty of fascinating insects to take your attention away from an ordinary ant.

Regardless, I am intrigued, and dash outside to see what the excitement is all about. I’m met with millions of flying ants zipping through the air, and Katie in the middle of them, a huge smile across her face. All you can see is flying ants, all you can hear is flying ants, all you can feel is flying ants! I nervously venture out my door to join her in this amazing flying frenzy, and feel as though these insects could at any moment coordinate an organized attack and lift the both of us right off the ground. I resist the urge to run inside and hide under my net. Katie explains to me that this happens once a year, after the first big rain, and everyone is so happy to see these little creatures. I ask if she eats them. “No, these are just the small ones, but I’m still happy to see them!” “Do they bite?” I ask. She assures me they don’t. We chat a bit more then go back to preparing supper.

A few minutes later, Katie calls again, this time not really making any words because she is running and laughing. I run outside, and she is awkwardly trying to catch some flying thing outside my door. She is successful, and brings her trophy to show me. “This is the one you eat”, she explains breathlessly as she shows me the inch-long flying ant (termite) in her hand. She tells me that she personally doesn’t like them, but makes them for her husband (it’s his favourite). This is followed by a sharp yelp, as the “non-biting” flying ant bites her thumb. She throws it on the ground, and we both burst out laughing.

Attitudes

I often start my morning at 0730 on St. Monica, the female medical ward, helping out the nurses and tagging along on the ward rounds with the doctors to ask questions, learn, and offer any input I may have on patients. Mornings are usually quite busy until 11, which can be a great way to start a day if you are efficient and have a good team working with you. Sometimes, it can be a bit overwhelming, if you’re short-staffed, or have staff that would rather sit at the desk and watch things not happen.

Often in the mornings I come across things that have been missed from the previous shifts, so I try to organize a bit and bring everyone up to speed. It may be a diabetic patient who has not had any glucose checks since admission, and is now nearly unconscious after her morning insulin, it may be a young woman in renal failure who is hugely edematous and currently receiving her third liter of fluid, it may be a gasping pneumonia patient lying flat on her back with no oxygen in sight; any of these situations (and more) are possible when you report for the early shift. So you quickly prioritize and send for the oxygen concentrator, draw up some IV dextrose, and stop the fluids, then survey the ward again to see if there’s anything else you missed. After/during this, I pull the first year students aside, drag them with me, and quiz them on nursing care, and help them out with some lacking information. ‘What do you think is our top priority here?’ ‘Tell me about diabetic management’ ‘Why is fluid balance important in renal failure?’ Really, some days I just want to yell at them and the night nurse for missing such obvious, basic things, and failing to call for help when a patient is deathly sick…
Which brings me to a question. What motivates us? I’m asking this because I’d really like to know the answer. I’m not sure how many people read this, but please offer any insights you have on this.

Why do we do things the way we do? What makes us want to do things well; what drives our pursuit of excellence? Why do some of us always strive for more, while some of us are more than happy to settle with ‘enough’ or average’?
Are our motivations based solely on incentives, or is there some greater, more noble reason? Or perhaps some balance of the two?

Here are some observations I’ve made, and I have to stress that these are personal opinions, and you are more than free to disagree with me, as I realize that I still have a lot to learn.


a) 49 first-year nursing students. On the whole, this group shows a lot of ambition and enthusiasm for the nursing profession. They are eager to learn, always looking for opportunities to apply theory in practice, asking questions constantly, and studying in their spare time. They are super inquisitive and absorb as much as they can in this short time they have of being students. When the students are in the hospital, the wards are spotless, the patients are bathed, and treatments and orders are done (usually) on time. They are starting to think outside their procedure manual, asking me thoughtful ‘why’ questions, showing that they are beginning to think critically.

b) Staff Nurses. Although there are wonderful shining exceptions to this, on the whole staff nurses couldn’t be any more opposite. They trudge through their shift, taking 2 hour breaks, falling asleep with head in hands at the nursing station, getting up to give medications or take a couple blood tests. I hear a lot of complaints about nursing care (from other hospital staff), lack of clinical judgment and reasoning. It seems as though once you have completed school, once you are a qualified nurse and have your white uniform, you don’t have to learn anymore (after all, you already know everything), you don’t really have to try anymore. You’ve landed a government job, and even if you occasionally miss something (even if that something is BIG), you won’t suffer any major consequences, and you definitely won’t get fired.


I asked a student about this, after she finished telling me how she wakes up at 3 or 4am to study every day, then works a full shift and comes back later to do extra procedures. “Maybe nursing isn’t their calling,” she told me, “maybe they just don’t have a passion for it.”

Okay, that makes a bit of sense to me, though I still struggle with the fact that human lives are in play here. But maybe that’s because I care about my job, I have a passion for it. Maybe if I was stuck in an office typing Excel spreadsheets all day, I’d do the absolute minimum I had to, because I really don’t care about Excel spreadsheets, even if the success of your business depended on it.

As Mrs. Seya, our nursing administrator, keeps telling me while we hammer out an Action Plan for nursing workshops and try to overcome the incentive obstacle, “Attitudes are hard to change.” Hard to change, hard to understand.

Bike Taxis

How is it that I always seem to get the drunk bicycle taxis?

I sometimes take a bicycle taxi (jinga) home from work if I miss the hospital transport, or if I’m traveling somewhere far enough to dissuade walking but close enough not to need a vehicle. It’s a great way to get around. Usually…

Most of the time, the drivers are not too bad – they work hard for their 50 cents and get you to your destination safely. The interesting bit comes some afternoons, especially on the weekends (Sundays are the worst), when your bicycle guy has had too much Shake-Shake. A usually calm, scenic 2 km bike ride becomes a harrowing near-death experience as you dodge and dive dogs, goats, women carrying water or produce on their heads, other cyclists, and the dreaded passenger buses careering by at 120 km/h. The bicycle that is normally a rickety old contraption is even more shaky as you swerve and hit potholes and bumps, and your stomach is sore at the end of the trip from keeping your balance for the past 30 minutes.

Sometimes, however, the opposite can be true. Instead of an exhilarating trip, your driver can be as slow as the old women carrying their goods to the market. You are being passed by kids, women, men, even oxcarts, and this doesn’t bother your driver in the least. I now take these moments in stride, forget about why I’m in a hurry (usually doesn’t matter anyway), and take a good look at the scenery around me. I see Mphangwe mountain in the distance, the setting sun reflecting bright oranges and pinks and reds off distant rain clouds. Beside me is a heron fishing in a puddle in the middle of a wide open field of tall grass. Six small kids are running at me from a village on the other side of the road, huge smiles on their beautiful faces, shouting “How are you?!” at the top of their lungs. All these things are part of this beautiful country, this beautiful town – and though there is poverty and death and suffering, it is good to be here. Life is simpler in many ways, happiness is easier to find.

Student Reflections

Below is one of the first-year student’s reflections after a particularly tough clinical day. I was impressed with his honesty and would like to share his thoughts with you. Feel free to leave any comments or feedback if you have any thoughts, I can share them with the class.


Nursing, a noble career that demands one’s commitment in enhancing proper way of living of the people. It is paramount to note that Nursing is involved in all aspects of life, thus from birth till death of an individual. Being on the wards has been a great experience despite the challenges faced along the way. This journal however depicts a scenario that I fully participated in trying to save the life of an innocent woman named Yaona.

It was a Friday during the late shift when Yaona was brought to Mukasa gynae ward as a trans-in from St. Monica’s female ward with the history of per vaginal bleeding. This patient was pregnant in her 7th month when she miscarried, she bled for two days and suddenly stopped. History recorded that she later continued bleeding yet the family hesitated to seek medical advice. Yaona was brought to St. Francis Hospital when the condition was actually worsening. Fact still remains that her life was in danger because she lost nearly 1000mLs of blood. I could see her gasping and I said a little prayer to God to have mercy in her. It was unfortunate that the in-charge nurse was out for her tea break.

Bearing in mind that my role was to check her vitals, I quickly checked her blood pressure, temperature, pulse, and respiration, everything was abnormal. I could sense death yet I realized my duty was to save her life. I then decided to take up the roles of my in-charge; I got the Doctor’s orders. The orders were for an oxygen concentrator and withdrawal of blood for cross-match and haemoglobin.

I gathered courage and withdrew blood and rushed to the laboratory. I managed to find the oxygen concentrator and, for the first time, administered oxygen. I could see Yaona slightly relieved though she still seemed dyspnoeic. She spoke in a local language “Nalema ine”, translated as “I am tired”. I felt like I was not doing the right thing yet I was. I could see her dextrose drip finishing. Then I decided to rush back to the laboratory for her blood; it was not ready then, I was helpless, my mouth was numb but my mind told me I could do something.

All what my reasoning could tell me was God was in control and that she will live. May Her Soul Rest in Peace. Yaona died at exactly 9pm, I was broken-hearted and the only thing I could do was to pray for God to welcome her.

I’m listening to a group of eight girls singing and laughing outside. They must be around 8-12 years old, and they even have choreographed steps to the different songs they’re singing. The sun is setting and everything is so peaceful, simple, beautiful.

When you move to a different place, at first it’s all so new, so different, even overwhelming at times. After some time, this foreign place begins to feel like home. You begin to dread all those adjustments you’ll have to make when you move back, and things that used to shock you and amaze you are more normal. You look around at the people beside you and you realize you’ve become part of a community, part of a family, and you love these people. This place and these people have made a bigger difference on you than you could have imagined, and as you think about all these things and look back to where you were even 6 months ago, you realize that you’ve changed. You’re still the same person essentially, but you’ve become shaped by everything around you, and you look at the world in a whole new way. It’s quite the thing.

I walked into the classroom to the group of 50 first year nursing students, notes in one hand, projector and laptop in the other, and readied myself for the exhilarating fluid therapy lecture I was about to give. As I organized myself and my notes, I heard quite a bit of shuffling from behind me. A great way to start, I thought, they’re already distracted. As I turned around to greet them and start the class, I realized that every single one of them was standing, now quiet as I face them. Surprised, I ask why everyone is standing. “To show you respect, madam” came the reply from one of the girls in the front. A bit embarrassed now, trying to hide my blush, I quickly tell them to sit down and we begin the class.

After another class, as I tidy up my demo equipment, a student comes up to me, apologizing for the giggle she let out during the class. She explained herself and that she was rude to do that, it won’t happen again. I’m again surprised, and can’t even remember the event; it certainly was not disruptive by any means. I laugh and tell her it’s not a problem, but thank you. I think about how often I would daydream in class and not pay attention, or doze off during a boring lecture, and I look at the concentration in these faces, pens on paper, busily scribbling down any bit of information I throw at them. Here is a chance to get an education and a proper job to make a proper living, and these students aren’t wasting a single second.

Students are becoming more relaxed around me, taking me up on my offer to come see me if they have questions or just want to talk. One afternoon, I escape to my small lime green office after a particularly difficult morning on the wards. I bury myself in the pile of papers to mark on my desk to busy my mind. A few students are gathered outside, and soon make their way in and sit down to chat with me. I ask one why he decided to go into nursing. I’ve asked this before, and the main response is “to save lives” or because it’s a decent-paying steady job and they can provide for their family. This one was different. He told me that he grew up with his aunt and uncle, who was chronically sick and constantly in and out of hospital. He would do basic care for his uncle – bathing, feeding, even toileting. He described how he could see the difference it made to his uncle, and the relief it provided his aunt. He felt satisfaction and joy in helping out as much as he could, and he started thinking about how he could do this for more people, bring this comfort and relief to more families in their difficult times. He was so sincere as he told me this and, after the morning I had just had, I was fighting to hold back tears. It gave me a burst of hope and renewal to hear such a real, well-thought, from-the-heart answer.

A woman I know was in the female medical ward, looking after her younger sister. She was there all the time – when I left in the late afternoon she was there, and when I arrived early the next morning, she was still there. She looked tired - she had slept there, on the floor, but was up all night with here breathless sister. I commended her on her dedication, told her she was a good sister. She just shook her head and said it’s just what she should do. “I’m the older sister, so if she falls sick, who should care for her? If she can’t walk, who will help her? If she soils the bed, it is me that is embarrassed, not her.”
Often it is easier to just walk by, or throw a rope down, or tell someone else to do it, than to get down in the mud yourself to help someone else up.

Grace

I’ve had many days like this one. I’ve cared for many sick patients, many sick young patients, and seen many of them die. So why was today so different?

Grace was about my age, HIV positive, and was in renal failure. This morning she was very sick. Sicker than yesterday; sicker than ever. There was nothing else we could do, fluids wouldn’t help, and no medication could heal her body. Her mother had been by her side constantly since admission, and diligently and lovingly had cared for this young woman, feeding her, dressing her, doing all the things Grace needed her to do, without a moment of hesitation or objection, and not one utterance of complaint. This morning, we had to tell Grace’s mother that there was nothing more we could do, and that Grace is most likely going to die. I’ve been here before, heard this story many times. What got me was the look on Grace’s mother’s face. I saw the moment of realization that her child was going to die. I felt like I could physically feel her heart breaking, and I felt so much sorrow and helplessness in that moment. She was looking from side to side, like she was looking for someone to help her, someone to tell her this wasn’t real. She clutched her heart, asking how? why? As a few tears rolled down her cheek, she looked pleadingly at us and then back at her daughter. There is nothing I can say in this moment, and I reach for her, touch her arm, and mumble something like “I’m so sorry”. As we move on from her bedside, Grace’s mother begins to cry. She leans near her and starts to pray. Though I don’t understand her prayers, I join her silently from where I am standing, asking for comfort and peace for them, and a bit of strength for myself right now, and I let a tear fall.

Not quite 2 hours later, I am helping to prepare Grace’s body and we walk down the long outdoor corridor to the mortuary, mother and fellow bedsiders following behind, wailing for her loss.

Later that day, I think about what would have happened in Canada. Well, first, Grace would have had more medical support available to her, but aside from that, I think things would have been slightly different. When someone dies in the hospital at home, it is very private. For starters, patients often have their own rooms, not just a mobile cloth screen separating them from the 40 other patients on the ward. Family is present, but not as constantly, not as actively. When the deceased is taken away from the ward, it’s done very discreetly, often waiting for a quiet time when no one is in the halls. Here, we make an announcement for the other bedsiders to join the family as we travel to the mortuary together. These other women have been with Grace’s mother since she arrived, caring for their own relatives, chatting about family, health, and other daily things. There is no judgment, whether someone has HIV or not, whether they are rich or poor, they are all here for the same reason, someone is sick and needs their help. And when someone dies, they don’t turn away, not for a moment.

My chains are gone, I’ve been set free
My God my Saviour has ransomed me
And like a flood, His mercy reigns
Unending love, Amazing Grace

Zambian Trees

Zambian Trees

Do we all live two lives? It seems so common that what people see on the outside and what’s really going on the inside are two entirely different things. Think back to school, we all knew how to please our teachers; heck, we were experts at writing completely different essays depending on who was marking it. At work, we put up a good front when the boss comes by, we sit up a little straighter, our face changes to one of concentration rather than boredom, and our energy level miraculously jumps from 4 to 10. We change our clothes, our body language, and our behavior to impress others, to make them think we’re a little bit better than we really are on the inside. And because people often judge others by outward appearance, our deception often works, that’s why we keep doing it. We even do it when we’re sick – really play it up so we get some sympathy care.

This false front idea has been around for ages. Religious people prayed grandiosely in front of crowds, flailing about, some even strapping Bible verses to their foreheads. People must surely be thinking, “Wow, these guys are committed. They are really in touch with God, they are full of the Spirit.” Full of something, I agree.



What would happen if we lived in a world free from these pretenses? Sometimes I look around at the people I run into at the hospital, my lovely neighbours, a village community, and I am so inspired. These people are solid. They wear their hearts on their second-(or fourth or fifth)hand sleeves, their inside matches the outside; in fact shines brighter than the clothes and “stuff”. They invite you in, give you food, give you gifts, take time out of their day just to visit with you. They are full of love, and you see it clearly in their eyes and hear it clearly in their voice. There is no deception, no façade. They’re not worried about how they present themselves to others, and really, why should that be any different from the way they appear every day? I’m not saying there isn’t judgment and superficiality in Zambia; people do dress to impress at times, but I’m meeting people who are really living for others, for God, rather than for themselves.

Old habits die hard. It is difficult to reconcile two opposing sides of yourself; we’re all afraid of being judged by others. And sure, what does that matter, right? Right, but it still affects us. Constantly. And maybe in some ways, we’re a bit afraid of seeing “the real me”, and really afraid of letting everyone else see it. But I’m thinking that if we spend less time worrying about our clothes, shoes, and how other people see us, we can focus more on the inside, and that part can then only grow and improve. Let your paint match your foundation. People will then start to recognize you by your actions and your attitude – they’ll recognize the tree by its fruit.
Zambia has some good trees.

5 Months in Zambia

Time goes by so quickly, doesn't it?

In two weeks, Ben and I will have been in Zambia for 5 months. In some ways, that's a long time, but in other ways, it's not really long at all, in fact, it's quite short. For example, it's a long time to go without a proper toilet, let alone a proper toilet seat, but in 5 months I still haven't been able to carry a full bucket of water on my head with no hands and no spilling.

In 5 months, my little neighbour boy has come to love me (and me him) and even cries sometimes when I leave for work in the morning. I know he's only 1 and has the same reaction when someone takes away the rock he's chewing on, but it still makes me feel good. In 5 months, I've learned enough local language to start a conversation, ask about basic bodily functions, and understand every third word from a worried bedsider or chattery passerby. I've also become amazingly good at charades, and can successfully act out how to care for and feed someone with a nasogastric tube. I've ridden 2km side-saddle on a bicycle taxi without falling, and bathe from a bucket in the dark with a candle, under the supervision of about 20 spiders. I've seen amazing sunrises and sunsets, gazed at millions of brilliant stars shining through a jet black sky, and felt the refreshing shade of a mango tree in the heat of the day. In 5 months, all these things have become normal, they are just another part of my day.

Other things have also become normal and part of my day, though they are not as romantic. In 5 months, I have lost count of the children who have died from malaria, diarrhea, and other preventable illnesses. I've met families with 9 children who will never be able to afford to send them all to school. I go to the hospital every day and see someone wasted away to nothing because of HIV and TB. I care for women in severe and often fatal kidney failure because of a toxic abortion cocktail given to them from their traditional healer. I've had to explain to families that the only thing that will save their daughter is blood, but we don't have any today so she's most likely going to die waiting. A nurse I work with proudly brought me to the special care baby unit meet his wife and first baby, and the very next day I watched his heart break when his new baby died. In 5 months, I have witnessed such incredible anguish and grief, I have seen the up-close-and-personal effects of poverty, seen pain in more forms than I thought could exist, and have even at times hoped for death in order to ease suffering.

The fact remains that all these things are part of my day. Suffering is part of everyone's day, it's part of life, it's... normal. Normal doesn't mean good or bad, it just means normal. Life is full of laughter, love, pain, hurt, death; life is full! If life wasn't full of these things, it wouldn't be life, would it? I guess what I'm getting at is that I can't change these things - these things that are a normal part of life are not in my power to change. I can't stop suffering, I can't get rid of poverty, I can't "save the world". I am experiencing life, and it is full.

Now I feel I should clarify a bit. Normal does not mean good or bad. Good or bad comes from interactions. Like name-calling. I call you an idiot and that makes you feel bad; the end result of that interaction is negative, therefore that has been a negative interaction, and I would say that was bad. Or conversely, I tell you how much I enjoy our friendship, that you are a great person and I admire your intelligence, and then I hug you; that makes both you and I feel good, the interaction was positive, therefore I think I can safely say that was good. We can extrapolate to bigger things like corruption, wars, environmental destruction, genocide, it all has to do with interactions. Same with the good - love, laughter, helping each other, hugs - interactions are the common factor. Dying a long painful death is still sucky, losing someone you love still hurts like crazy, but it's not necessarily an evil and unnatural thing. It's part of life, all the happy and sad parts. I don't have a "better" life than my neighbour in Zambia because I have more money, my family is still well, and I have enough tomatoes for dinner. We just have different lives. I'm not happier then her, and her not me. So what's the point then? If things that are good come from interactions, how can I make life better for us? I can give her a tomato for dinner. I can ask her to help me learn chichewa. We can help each other out. That makes sense to me, that seems right.

It's all pretty simple actually, but it has changed the way I look at life and the world. I feel as though I understand things a bit better now. I'm not really sure if this will change the way I do things, but I guess we'll see. It's been an interesting thing to think about…

An Idea

So I have this idea. I want to somehow help improve nursing practice here. Okay, I'm not any kind of expert on organizational change… I don't even have enough experience to justifiably make judgments and suggestions on practice improvement in a hospital I've only been in 3 months, in a country and continent I've been in for less than 6. However, … I do think I have to start somewhere and I do think things can change for the better, regardless of whether I'm in Canada or Katete. I've talked about some of the issues happening here, some nursing-specific issues among others, and I've heard the same complaints over and over again from the physicians and other staff. And I've always thought that complaining is absolutely pointless unless someone decides to do something about it. So that's where I am. I've talked to people, done some informal mini-surveys to get a feel of the situation and what could be helpful, and here's my idea: create a series of educational sessions for nursing staff. The goal is twofold: 1) provide a process that supports quality nursing care to the public and 2) support nurses in a commitment to lifelong learning. An example: Topic - cardiovascular system. We would discuss this system, go over a nursing assessment (demo), talk about common conditions, and go through case studies (Mr. Banda is 1 day post-op, here are his vitals and complaints, what would you do in this situation?). The hope is that this kind of interaction will get nurses thinking, get them talking, maybe get them excited to learn more, perhaps even on their own time. Maybe eventually there can be a more formal continuing competence program, but since there's nothing of the sort at the moment and nurses don't do anything work-related outside work time…I think we need to take baby steps.
Talking about this with nurses on the wards was exciting - people were interested, telling me this is definitely needed, gave me suggestions, told me they'd come to these meetings, blah blah blah. I learned that sometimes you have to offer an incentive to get people to come (money, snacks), and most people don't like 'work stuff' unless it's part of work…but still, I felt fairly confident and excited about the whole thing.

So, I had the first meeting today. The agenda was basic - talk about the idea, get some feedback, make a timeline. I had spoken to some nurses before to remind them of the meeting, and distributed a memo to each of the wards in advance. Again, I got a good response, the memos were taped neatly to the desks by the charge nurses for everyone to read. Even this morning nurses talked to me about it, said they'd be there. You can see where this is going, right? Yep, nobody came. Not one. Okay, there were three of us, but not one Zambian nurse. What the heck?! Honestly, I'm not super surprised, and it did turn out to be a productive meeting with the three of us, so I'm not that disappointed, but still. Why didn't anyone come? How can I get people interested in their work? Am I looking at things the wrong way? Maybe I'm making too many assumptions, and my thoughts on nursing just don't fit in this setting, and continuing education isn't something that's wanted. Or maybe it just needs to happen in a different way. Thoughts??

I Love Grandmas

Grandmothers are amazing. I say this from my own experience with my own grandma, and from watching grandmothers work tirelessly to make sure their children and grandchildren have a place to sleep and food to eat. I look at an older woman here and can only imagine what she's been through. How many children has she lost, how many grandchildren? How many orphans is she looking after right now, and how is she able to find enough food to feed them all? And yet these grandmothers always seem to be smiling. I met an old woman in a village, all but one of her children had died, and she was looking after her 8 orphaned grandchildren, on her own, with no income at all, and their food coming from the plot of maize a short walk away. The unfortunate part is that her story is not unique, or even the worst one I've heard. However, she's doing the best she can with what she has, and she is showing those kids love that they may not have known otherwise. And she greets us with a huge smile and proudly shows us around her home, even offering us some fruits or groundnuts if she has any handy. She is quite inspirational in many ways, and I learn a lot from her, things I never could have learned in my comfy developed country. I look at the grandchildren she's raising, wearing tattered clothing and walking barefoot. An older girl greets me in English, and I learn that she has just completed grade 7. She won't be going to school this year, there's not enough money for that. She's 18 now, it won't be much longer until she is married and a mother herself. Her options are limited. Does she even have options? I remember being her age; worrying over what clothes to wear to school that day, finishing applications to university, driving home from basketball practice in my very own car. How different our worlds are…

Culture of Jealousy

Status is everything. There is a definite culture of rank here. People occupying positions of power or prestige know it, and they make sure everyone else knows it too. If as much effort was spent on maximizing efficiency as is spent on maintaining authority, a lot more things would get done. A lot. There is no emphasis placed on teamwork, and a very absolute hierarchy exists in any organization or group. Villages have headmans (chiefs), tribes have Supreme Chiefs, everyone knows who’s superior to them, and who’s below them. It does have a purpose, and for all I know, the system may not run as well without them, but it seems to limit certain things. Gender equality is one of those things. Sure, behind every headman or chief is a great woman…or two or three, but her job is to produce children, cook, and work in the fields. Not involve herself in politics or money.

People in positions of power tend to create rules that limit competition and diversity, and eventually I think this kind of structure leads to an imbalance of opportunity, widening the gap between haves and have-nots. Lower-level employees focus on their responsibilities and tasks, rarely (if ever) offering suggestions to the higher-ups, as this would be disrespectful. The flow of information is not very fluid, one must follow the correct protocol. I’m realizing that it is perhaps unrealistic to think that change can happen from the bottom-up.

Interestingly though, this hierarchy is based more on social status than income. In fact, good businessmen who have made quite a good living are often accused of being “Satanists”, and people blame all sorts of misfortune on them. My neighbour was telling me about a woman in town who went into labour, had complications and lost the baby, and died two days later. I sympathized with her and said childbirth can be dangerous if there are complications and no midwife or doctor, and she told me that it was because of one of the wealthy “Satanists” that the woman and baby died – he had placed a curse on her. This is not unlike the Salem witch trials. Where does this come from? Perhaps a myriad of factors; poverty, jealousy, ignorance, deep-rooted traditional beliefs, isolation. The bigger question is, will such accusations ever stop? Can you stop jealousy?

This culture is everywhere. It doesn’t take long to figure out who’s in charge, who’s a bwana. They have an arrogance about them, and are able to look down at you with noses in the air despite being nearly a foot shorter than you. I attend weekly clinical meetings, not often attended by nursing staff as they are busy on the wards. Often, the only other nursing representative is two or three nursing directors or tutors, all of whom regularly arrive 10 minutes late, disrupting the presenters as they shuffle about and move chairs, then sit smugly through the remainder of the meeting with an all-knowing look on their face. I caught up with one of these women to ask if the information from these meetings makes it to the general nursing staff. I explained that many of the issues brought up concern nurses directly, and improving care and outcomes begins with them. She mumbled a vague answer, not meeting my eyes, about how someone is supposed to attend these meetings and pass the information on to the morning staff, who then should pass it on to the evening staff, and so on. She admitted the information gets lost along the way, and stated very matter-of-factly that the staff need to do a better job of this. I hesitated asking her what exactly her purpose of attending the meeting was, and what exactly her role was, as “Director of Nursing”. Perhaps something to do with directing the nursing staff, but I may be out on a limb there.

So…why? Why is it like this? Why do people care so much about status, even when it knowingly gets in the way of efficiency? Is it because getting to that level is difficult, and once you’re there, you feel that you’ve earned the right to be treated a certain way, and to treat everyone else a certain way? You deserve the best seat, the first and biggest plate of food, and there’s never any question about this? The current President of Zambia has travelled more in his first 8 months than the first President did in his 27 years of office. Zambians say he’s been out of the country more than in it. His mode of transport while in Zambia? Helicopter, of course.

Stay keenly aware,
Of the Culture Of Jealousy,
It tears humans apart,
The Culture Of Jealousy…
How much will it hurt us,
And where can it lead?
No one has the answer,
On the Culture Of Jealousy …
(T. Martin)

Another day goes by

Hey folks!

Since it’s hard to really capture the essence of Africa without experiencing it yourself, I’ve decided to give you a few snippets of my experiences here, in the hopes that you can get a feel of what it’s like!

Scenario 1

I am interrupted between seeing patients in the HIV clinic by a fellow nurse, stationed in a nearby room. He approaches respectfully, and somewhat timidly. “Can I ask you a personal question?” I smile gently and tell him of course, and agree to find him in a few minutes. As I walk into the room he’s working in, I prepare myself for some sort of embarrassing medical question , or perhaps even a proposal. I sit down, and he comes right out with it. “How can I come to work in your country?” Ah, this question. It’s not the first time I’ve been asked, and unfortunately it won’t be the last. I talk with him for a while, and as we discuss healthcare and politics, I try my best to encourage him to remain in Zambia, while inside I feel deeply for him and am angered and frustrated by how unfair his situation is, and how fortunate mine is…

Scenario 2

It’s Friday and I’m exhausted. It’s been 2 weeks and the hospital still has no blood or blood packs. I struggle to fix the oxygen concentrator so I can at least feel like I’m helping one of our many severely anaemic patients, praying she’ll make it through the weekend and we can get blood on Monday. The national blood shortage is taking its toll, a shortage caused by (I’m told) a scarcity of the glucose water given to donors post-donation. I find this hard to believe to say the least. A few beds down, another patient is vomiting due to the pressure built up around her brain from cryptococcal meningitis. It’s easily treatable by a medicine that the hospital ran out of 2 weeks ago. So she’s getting daily lumbar punctures to relieve the pressure. Not fun, but better than the alternative. Bad timing to get sick here…

Scenario 3

I say goodnight to my “nieces”, lock the door, and settle into bed. A few hours later, I am awakened by some sounds. I lie still and look around, fearing another 2 inch cockroach has made its way inside the bug net. I glance up to the (open) window, and see an outline of a face, looking back in Ben and me. I am frozen, my mind spinning with thoughts of what to do. The figure at the window strikes a match to get a better view of the room, and I quickly and loudly shout something, waking Ben up, and making the intruder disappear faster than he could blow out the match. I decide to bear the heat and sleep with the windows closed from now on.

Scenario 4

I walk home as the sun sets, passing familiar faces along the way, making sure to greet everyone as I go by. A truck pulls up beside me, the back FULL of people. They are returning from a village trip and dropping Ben off. Through all the greetings and chatter in Chewa, one voice greets me in English – “Hi Steve!!”. I can’t help but laugh as I wave back. I’m most widely known as Stephen or Staff here (somehow the ‘ie’ doesn’t carry over), but am also commonly called Mrs Ben or Madam Ben (by Ben’s friends), Sister (in the hospital), or Mrs Tembo. More recently, I was given Tambiwe as a first name (it means ‘fetching water’), but it hasn’t stuck yet. I love the confused looks on people faces when I introduce myself as Stephanie Tembo, or as they ask Ben, “Your wife, his name is Stephen?”.

I’m sure people are equally or more amused by the strange things us mzungus do, but here are some of the interesting things Zambians do:

- Men hold hands occasionally, as they are talking, as they are walking, even interlocking fingers sometimes!

- They mix up ‘l’ and ‘r’ regularly (wrestling becomes ‘lestring’) It’s not arways predictable, but it is common and often amusingry confusing.

- They exchange he and she; “my wife, he is a great cook”

- Wrestling (WWE, the fake stuff) is incredibly popular, and is played everywhere (buses, restaurants, everywhere)

- You haven’t eaten unless you’ve had nshima. Even if you’ve eaten an entire pumpkin, or are prepared an “authentic” Canadian spaghetti dinner by your new friends, you will have another full meal of nshima immediately afterward.

I do have moments of frustration, discouragement, annoyance of the constant “How are you mzungu!?”, but all in all, the past month has been great. I love the little town we’re in, I’m learning a lot at the hospital, we’re meeting great people, and staying healthy and safe. I’m building relationships and feeling more “at home” here, which I fear will make it that much harder to leave, but I didn’t come here to live in isolation! We bought a mini-oven, and are able to bake in it, which is more than amazing, and a welcome change from the usual nshima and beans. I’ve been making banana bread, and it is a huge hit! One neighbour borrowed the recipe and baked 36 loaves in one night!! She’s selling them at the market and a guesthouse, and everyone has been asking me for the recipe. It is very exciting.

Please keep the updates from home coming!