Thursday, May 12, was our first day in the hospital! For the two weeks that we worked at the hospital our schedule went somewhat as follows:
6 am - Emerge from under our mosquito nets to throw on some scrubs, get ready for the day, and head to the kitchen
My bed and trusty mosquito net
6:30 am - Breakfast! Most of us had brought a little bit of Canada with us to Zambia in the form of a jar of peanut butter, and we learned quickly to bring it with us to breakfast every day to add a bit of flavour and sustenance to the plain white buns that greeted us each morning. They weren't too bad on the whole, our breakfasts... the buns were often joined by oatmeal, yogurt, and sometimes eggs and/or fruit.
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6:50/7:00 am - Walk from the seminar centre to the chapel across from the hospital for morning devotions. Although they technically began at 7, we soon fell into "African time", arriving anywhere between 7 and 7:15. These devotions were refreshing starts to our days, consisting of a few songs from the Salvation Army hymnbook, sung in traditional African style and accompanied by a drummer. The songs were followed by a short message preached by one of the nursing students. Our very first day the message was from Joshua, and the theme was fitting: "Don't quit on day one". And so, with that on our minds, we were taken to our assigned ward for the morning.
The chapel
The hospital entrance
7:30 am - In pairs or trios, we were taken to a different ward each day. As we were not permitted to do any "invasive care", that is, we could not give injections, give any medications, change wound dressings, or do any of the typical nursing actions we would normally be able to do at home. This was a challenge, not only because it causes the nursing students to believe us incapable of doing anything, but because it forced us to focus on other ways of caring for the patients. Our time on the wards was spent observing, learning from the nurses and student nurses, talking to the patients, helping with other tasks such as cleaning and bed making, and demonstrating "patient-centred care". This patient centred care is a concept which is fairly drilled into our skulls at TWU, and yet is hardly to be found at the Chikankata hospital. Not that they do not care for their patients, but the role of nursing is very different there, and the very structure of the hospital is less conducive to the type of care we are accustomed to offering. For one thing, workload is not divided up into patients assigned to each nurse, as it is in Canada, but rather by task. For example, let's say a ward of 20 patients has four nurses. In Canada, each nurse would be assigned five patients. In Chikankata, however, one nurse might do all the medications, while another would do all the wound dressings, and another two might follow the doctor on his rounds and then do all that he ordered. Although there is a head nurse responsible for ensuring that everything gets done, it seems to me that this method is far less holistic, and is more likely to allow things to slip through the cracks. If there is not one specific nurse responsible for any given patient, how does the team ensure that all his psychosocial and teaching needs are met?
In addition to this, the hospital is very short staffed, and as a result is virtually run by the students. While they are very confident and competent, they are only students, and without the mentorship and instruction that we are blessed to receive, they cannot always provide the best possible care. I saw wound dressings with 'sterile' technique that made me squirm, with little or no pain medication given in advance. But I am getting ahead of myself.
Scrubbed up and snagging the chance to hold a beautiful baby
10:00 - If we were not too busy, we would walk down to the seminar centre for tea and sometimes a snack, and then back up to the hospital for the remainder of the shift.
12:00 - Lunch time! The common fare for us often consisted of rice or pasta, chicken, a cooked leaf-type vegetable, and the ever-present white buns. Or, we might be served sandwiches made of two pieces of white bread with some sort of unidentifiable spread and possibly one slice of tomato or a few shreds of cheese. After lunch we had a bit of time to nap, relax, or journal, before...
One of my journalling spots
14:00 - Speaker time. Most days, we would have two speakers come to the seminar centre, for one hour each. Theoretically. In true African style, many went a wee bit overtime, they were that eager to share with us about their topics. We heard about everything from nursing in Zambia to their home health care system to AIDS and orphans to leprosy. Many were very interesting topics, however I learned a very interesting thing about myself. Whether it was the heat, the time change, the time of day, or the room, I know not, but every day like clockwork I would arrive at 14:00 and by 14:20/14:30 I could not for the life of me keep my eyes open and my brain focused on the speaker. Try as I might I retained virtually nothing of what was said for about 25 minutes, until I would regain some measure of alertness around 14:50. For the last portion of the first speaker and most of the next, I was attentive as could be.
18:00 - Dinner! See lunch.
One of the stranger things I ate...
After dinner we would have devos/debrief, which involved singing, one of our team sharing a brief devotion, and then talking about our days. This would be followed by some journalling, maybe a shower and a bit of reading time, and then bed. Given that we were a group of university girls, you might be surprised that without fail, we were ready to hit the sack within a few hours of devos. Staying up until 22:00 was a late night; we could barely keep our eyes open to journal about the day. So we tucked ourselves back into our mosquito nets, said our goodnights, and were lost to the world.
