Looking past the inequities

Hi everyone! I (Alana) was able to spend more time on the Labour & Delivery ward at Lewanika General Hospital this past week. This week I was joined on various days by McKinnley, Ali, and Kristen. It was wonderful to be able to teach the girls a bit of what I learned about the unit, the processes and protocols, the staff and their roles, and the intended care during the antenatal period.

This week I was able to engage more with some of the mothers and their family members, as the unit itself was a lot busier than it was last week! On Friday there was not even enough beds for all of the mothers being admitted - and there's already 19 beds and 3 delivery beds! Regardless, the staff seemed to deal with the flow of patients quite nicely, as there was a balance of new admissions and labouring mothers throughout the day. It still continues to amaze me how strong some of these women are. Due to a lack of resources, there really is no option for pain control during the active phase of labour, and the mothers may receive Panadol (equivalent to Tylenol) after they've given birth if they are expressing continued pain. As well, these mothers are having to endure labour basically alone. The staff are there as medical professionals to ensure the safety of the mom and babe(s), but no family members or support persons are allowed on the ward or in the labouring room. This is a great role for us to fill and demonstrate to the staff the comfort measures we like to implement, such as cool cloths and back rubs. It is evident that the mothers appreciate it and the reassuring words that everything will be okay, the baby is coming, etc. I think it's really important for us to recognize that each mother is still a unique individual and will need care and support in her own way. It has been nice to speak with some of the mothers before they are actively labouring, and then connect with them again once they're in bed cuddling their babies. Having these conversations really reveals the inequities in the population in Mongu. You start to see the variations in education (some only up to grade 2, some university degrees), living circumstances (close by, very far away, support persons), and access to food and water. But it seems no matter the differences between these women, they all connect with one another, offer each other their food or extra clothes, and help translate from English to Lozi if they hear us makuwa struggling which helps us with our assessment pieces and helps the mothers receive the care they need.

Many of the supplies we have brought have been put to great use already! I have seen many mothers come in without necessities - baby blankets, hats, and clothes, so being able to provide them with these items has been wonderful. The staff have also been utilizing the penguin suctions for every delivery, and there are enough to properly clean and sterilize each suction between uses which helps promote infection control greatly. I was able to assist in the delivery of twins this week (two beautiful, healthy girls brought into this world by a strong and caring mother). For extra precaution we had the babies assessed by the doctor who has been working in SCUB this past week. He questioned us about their vital signs, APGAR scores, reflexes, etc., and decided to send them to SCUB temporarily just to help warm them up. In this instance, we were also able to utilize the feeding cups we donated to the unit and get the mother to express some colostrum to finger feed to the babies. The head nurse had asked me to make some posters for the unit as well, so this week they received one on the stages of labour and how to care for the mother during each stage, as well as a one on breastfeeding. In a developing country, formula feeding is not really an option as it is costly and not readily available. It also involves adding water, and sometimes heating the formula in a specific way, which can pose risks to the infants health. It was great to see eye to eye with the nurses that breastfeeding should be encouraged and supported in every mother that is able to. This weekend I will also work on a newborn assessment and vital signs poster to put in the primary delivery room to encourage an assessment to be completed asap and have the "normal" vital signs readily  available for the nurses and midwives.

I've really enjoyed these past two weeks in labour and delivery, I've learned a lot and developed trusting relationships  with many of the staff. Next week I will be at Save a Life which will be an entirely different, but I'm sure equally rewarding experience!

Best wishes to everyone reading this - see you soon! - Alana

"Makuwas"

Hello! Emma here :) We are almost half way through our Zambian adventure and I continue to be impressed by the humble and kind nature of the people we have been able to get to know.

Playing the line between tourist and professional has been much more of a challenge than I originally anticipated. I am torn constantly between my professional responsibilities here in Zambia and my desire to explore each and every day. But a tourist and a professional can both take a moment without shame or too much thought to enjoy the beauty of this county.

The first few days here in Zambia I became immediately and intensely aware of my whiteness. This had a lot of contributing factors I am still working out. My ease to travel, purchase groceries, receive genuine greetings and beautiful accommodation, among other things, can be attributed at least in part to my skin colour. The mumbling of adult conversations and giggles and shy awestruck look of the children around the town made sure I knew I was white.

The very first Silozi word (the language spoken here in Western Province) I learned was 'Makuwa' - it means white person. From the time that we left the bus station in Lusaka and finished off our gruelling (although it could have been worse) 10 hour bumpy bus ride and arriving in Mongu, I had heard bits of conversations with the word Makuwa strung throughout them. Not yet realizing that it was just the start of how most of the people in Mongu will refer to me. Because of where I had the privilege of growing up this was my first experience being identified primarily by the colour of my skin. It caught me off guard initially but I have grown quickly to get used to it because most of the context is genuine, friendly, and most likely out of innocent curiosity. We often go for walks down the street that we live on and you can't walk 15 metres without hearing, sometimes from a distance, Makuwa, Makuwa! How are you? How are you? Makuwa! coming from these jumping, waving, ecstatic little bundles. You seriously can't help but beam from ear to ear at the site of them. The other side of this is the stares you receive and the children who sometimes run away from you when you approach. This side of constantly being reminded of being a Makuwa does not feel as friendly. It was a bit of a reality check that I can't escape some of the oppressive a'nd historical connotations of my whiteness. It was also a reality check in that I can by no means doubt that this is a similar experience that some Canadians will have in Canada.

After a whirlwind week full of learning to navigate absolutely everything, we finally started clinical. I put on my scrubs and felt my professional responsibilities take over the fear and tourism. Day 1 I was in the Out Patient Department (OPD) which is a mix between our Canadian emergency room and five different walk-in clinics happening all at once in the same space. The Zambian nursing team had me sit out front at the triage table to be the first point of contact with the patients in the waiting room, take vital signs and triage to the appropriate clinic. Hello being totally out of my comfort zone. As I sat there with a blood pressure cuff, thermometer, and over 50 strangers eager to be processed through, I needed to give myself a little pep talk and remind myself that I could totally do vital signs, and Lozi can't be that hard, right? Wrong. I can thankfully say that after 4 years of nursing school I can definitely do a set of vital signs but what an experience it was triaging patients who you can barely communicate with, let alone with conditions and complaints you are largely unfamiliar with. I put my brave face on and picked up the patient files (the patient is responsible for keeping them most of the time - not a record keeping system I am used to). As I called the patients names to come up to the table, giggles could easily be heard all around the room. Lozi is not an easy language. Expecting the hesitancy and unfamiliarity I experienced with my 'Makuwa' status in the community, I was pleasantly surprised to have this experience of separation completely evaporate. The second the patient sat down at my table, and we greeted each other, we were simply a nurse and a patient. No complications. I was there to help them and they were eager and ready to let me, regardless of where I was from or what I looked like. They were exhaustingly patient with me as I struggled with intertwining English and the 'Silozi for Medical Professionals' reference sheet provided to us. The smiles on their faces as I tried to pronounce words and phrases and then my intent to decipher a response made it worth while. The Lozi and Zambian people are incredibly kind.

My role as a nurse seemed to neutralize any differences between us and for that I am incredibly grateful. Our interactions are human to human, not colour to colour. My practice as a growing RN has me striving to make sure that I continue to allow people to simply be human, with no constraints in any circumstance regarding who we are and the opportunities we are given.

Zambia has stolen a piece of my heart and I expect that the remaining few weeks will have amazing things in store!

An Inside Look

Last week we (Rylee and Kristen) were placed at the Save a Life Clinic, which supports families with malnourished children. Patients and their caregivers come in weekly for "clinic days" where they are consulted and provided with extra food for the week. Home visits are also completed by the Community health workers (CHWs) to follow up with families on the program. Not only was the view from Save a life impeccable, as it is overlooking the flood plains, but we both made connections with the 'Save a Life' staff that exceeded our expectations. While many of our peers navigated new experiences in the hospital and clinics, we had the opportunity to explore nursing in Zambia from a different perspective. We feel privileged to have worked with locals in their homes, as we were provided with a deeper understanding of their circumstances, challenges, and values. We are grateful to have had this experience as it strengthened our understanding of where people are coming from when they arrive in hospital or at the clinic. On our first day at the clinic, we were surprised to see that many of the toddlers at the clinic had a flat affect and appeared unstimulated. This caused us to reflect on how the Zambian and Lozi culture impacts how parents interact with their children. We were informed that it is common for parents to minimally interact with their children until they are able to verbally communicate. This concept was rather troubling for us as it caused us to consider how this impacts their child's development. Before discussing this with our instructors, we neglected to consider that for many of the families here, playing does not always make the priority list. Many of the parents we met are hardworking farmers, applying the majority of their time and effort to simply provide enough food for their families. On Wednesday I (Kristen) set out to do my first home visit with two CHWs. At first, this situation was somewhat unsettling as it was the first time I had been apart from any of my peers. Being in this situation caused me to trust the CHWs who I was working with and in doing so I formed a bond with them that I didn't expect to occur. The connections we have made here and elsewhere throughout Mongu has created a bittersweet feeling in anticipation of the day that we depart for home, as our new friends will be dearly missed. Our favorite part so far about this practicum is the connections we have made with others, and in doing so, learning about and appreciating their culture and way of life

-Rylee and Kristen

Culture Shift

Last week was my first week of clinical practice and boy was it ever an eye opener! Talk about a major 'culture shift' experience. .. I have travelled to third world countries and seen poverty and sickness before, but I have never worked in it. I wasn't aware that I had any expectations of what working in a third world hospital might be like. However, after my first shift, it was evident I did because my experience wasn't anything close to what I had expected. I had the opportunity to work in the Out Patient Department (aka emergency room) and observed clinical officers diagnose and treating cases, such as malaria, tuberculosis, HIV, and malnutrition. In addition, I practiced basic patient triage. Going into this clinical placement I hadn't taken into account how challenging it would be to communicate with patients who didn't speak english and who's culture I wasn't accustomed to. I like to think that my previous travel experiences would give me a bit of a leg up in being able to communicate, but trying to get answers from my assessment questions and needing a translator often proved to be a challenge. On top of the language barrier, cultural differences, and new environment, this hospital runs their outpatient department (OPD) very differently from what I am accustomed to. Although different, I am amazed by the nurses and clinical officers' ability to assess and diagnose without the use of many diagnostic tools. Their observation skills and knowledge of tropical diseases put me to shame...they truly are professionals at what they do. 

Upon reflection the majority of the challenges I experienced adjusting to my new environment came from having the mindset that what I had learned back home was the proper way of doing things...and anything other than the 'best practice' I have learned is not good enough. I caught myself thinking..."if I was in Canada this is how it would be done...". I quickly realized that this is dangerous thinking. I am not in Canada and the nurses and doctors are doing the BEST they can with what they have, and let me tell you, they are doing a fantastic job. As my instructor said during a debriefing session, "we tend to think that the North American way is the best way of doing things, but often it isn't." She is 100% correct. For some of us it is so ingrained in us to do things that are familiar to us. If we don't check ourselves, we can end up with our priorities skewed.

I strive to remain open- minded and willing to learn, because I believe the people I am working with can teach me so much more than I could ever read about in a book. I have been here one week and I already I very humbled. The line ups of people requesting medical attention seem never-ending. The medical officers work non-stop from start to finish everyday. Despite their heavy workload and staff shortages, they remain kind, welcoming and willing to teach. I am grateful to have met these fine professionals and humbled by my experiences with them this week. 

This week I will be in a rural clinic as well as assisting with data collection. I look forward to working in these different setting and continuing to practice my Losi (one of the Zambian languages).

-Carolyn

Kicking it with Dr. Suess

This past week was filled with a multitude of emotions and new experiences. We began our week by touring the Lewanika General Hospital where we had the opportunity to see the different wards and clinics the hospital offers. It was overwhelming to see the differences in patient conditions, units and the overall cultural setup of the hospital; yet we were still very excited to begin our practice experiences. 
We were lucky enough to be placed on the children's ward for our first week. This came with a bundle of nerves and excitement especially since we haven't had much time working with the pediatric population since last year. Overall we felt that the nurses, physicians and other staff were extremely welcoming and inclusive. The level of acuity was much higher and more complex compared to our previous experiences which was definitely intimidating. However, having three students placed on the ward at a time made us all feel more supported and comfortable. There was a particular patient that resonated with all three of us through our interactions and play therapy throughout the day. It really became challenging when we had to assist her with a dressing change that was unlike anything we have ever seen before. Unfortunately she had deep burn wounds that covered her entire chest and torso which required daily dressing changes. Under normal circumstances the patient would be under anesthesia due to the severity, but in this case it was not an option. We assisted the physician with handling the supplies while I (Nikki) tried to help the patient. This consisted of telling her to squeeze me hands, recite her favourite animals and colours and asking her simple math equations (which she nailed every single question) in an attempt to distract her from the excruciating pain. Her wounds were very infected with moderate amounts of pus and blood, and despite her screaming, her resilience and strength was remarkable. We found all of the children on the unit possessed the same level of courage which was inspiring to us all. 
Since our first day there was another patient that stood out for Steph. He was in the hospital working through complications from a serious burn which left his right hand unusable. He had rods placed into each finger in an attempt to prevent complete loss of his hand. It was nothing we had ever seen before and once again we were amazed by how tough this toddler was. Steph made valiant efforts to bond with him during the first two days, but he was very shy. At the end of the second day Steph gave him a toy car because of how brave he was during his dressing changes, but it seemed little progress had been made. However, by the third day a miracle happened. When Steph walked onto the unit, he came racing to her with his arms stretched wide and his toy car in his hand and jumped into her arms. She picked him up and they embraced one another and it was a moment that none of us will forget. Moments like these make us remember how important and valuable working with children can be. Despite the difficulty working with sick kids, it makes it all worth it. 
We also spent a great deal of our time working on a program called play therapy. This entails trying to engage and play with kids as much as possible to not only help build rapport and relationships, but also decrease pain and stress. We attempted to implement play therapy throughout the week, but on the third day we began to see the difference. We had the biggest turnout of kids attend, including parents, and it was amazing to see how beneficial simple play can be. They especially enjoyed part of the session when we would read to them, and they began to participate and thrive when we asked them to count or recite the alaphabet. We are excited to see the play therapy program continue to grow and we will observe if any children request green eggs and ham (Seuss, 1960) for future meal times. -Steph and Nikki