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…
Sunday, July 25, 2010
Sunday, June 27, 2010
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??
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…
Wednesday, June 2, 2010
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)
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)
Saturday, May 22, 2010
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!
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