Unconventional Education

“If any of you lacks wisdom, he should ask God, who gives generously to all without finding fault, and it will be given to him.” 

~James 1:5~

The thing about living and working in a developing country is that you learn to make do with what you have.  Queen Elizabeth Central Hospital (QECH) is the largest government hospital in the southern region of Malawi, servicing close to six million people.  Yet, it struggles and in the 2 ½ weeks I've spent so far orienting, I've seen how the lack of resources brings out the creativity of people! So when I was prepping a patient for theater (the OR) and had to insert a foley catheter (mind you it was ANYTHING but 100% sterile… had no choice, granted on what was available!) and we ran out of catheter bags… one on the Malawian nurses handed me a surgical glove (we later changed it out for a tube feed bag J ).  When you run out of chucks (the blue, flat absorbency pads placed under patients in the hospitals), one uses a large adult diaper. Or, when your orthopedic patient is in Bucks traction and there are not enough metal weights… can you say bricks and, by the way, who cares if they’re touching the bed…right???

In my 2 years of AMERICAN nursing training, I’m discovering that I am having to  be “re-educated” on how to adapt what I've learned to not just a brand new culture , but to diseases I've never seen (like malaria) and to conditions that are so far advanced, that one wonders why someone wait so long to come to the hospital (many die)! Not to mention that I’m learning, very quickly, the importance of triage and prioritization with an overwhelming nurse patient ratio at 1:20 or 1:30 (sometimes 1:45… at least on the TB ward!).

Malawi is one of the poorest nations in the world.  At times it can be exciting to combine critical thinking and improvisation but, there are dangerous setbacks. The other day, for instance, a patient admitted for diabetic ketoacidosis (DKA) needed IV fluids. Ignorant of the admitting diagnosis, a nursing student saw that her IV was running low and decided to hang another bag. However, there was a problem; the ward ran out of normal saline and hung 5 percent Dextrose instead. Now, one can get mad at the student however, one has to remember the registered nurse to patient to ratio… who’s following up (the nurses are sometimes not available)?  Thank God, one of the doctors caught it and brought to their attention!  There are other challenges; lack of equipment (ex.  ONE ultra sound machine for the entire hospital!); lack of materials, like glove when there 80% of the patient population is HIV positive; lack of trained medical personnel (due to the shortage, nurses rely heavily on the guardians to inform them on a change in the patient’s condition and medication administration); lack of space (with some wards having more patients than beds, some patients sleep on the floor!) and of course, there is the problem with follow-up.

There’s apparent need and I’m just grateful I can be here to observe, learn, share, and, hopefully, make a difference!

Tu hijita,

Joya

Why are you here?

"Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy." 

~Proverbs 31:8 & 9~

Papi Tan Maravilloso,

I just completed my first week of orientation as at the government hospital,  Queen Elizabeth Central, in Blantyre, Malawi.... A lot to take in for an international nurse... I'm exhausted physically, mentally, and emotionally and the one question I was met with over and over again was, "Why are are you here?" "Why did you choose to come to Malawi, one of the poorest nations in the world (when so many Malawian physicians/nurses/health care workers would jump at the chance at leaving to work in the U.S. or U.K. and not return!)?"   If anyone asked me that perhaps before I came or when I arrived, I'd come up with a very politically correct and spiritual answer of what it means for a Christian, a woman, a person of color, etc.  For instance, Matthew 28:18 & 19 commissions all those claiming to be Gods followers to be active participants in the plan of salvation.  Christ doesn't say, "Go... when you've got at least 2 years of experience behind your belt" or "Go... when all your 'finances' are in order (when you think about it, it will never be how we'd like it...10, 20, 30 years later, we're singing the same song!)" He simply says, "Go!" Our job is to obey and have faith that He'll take care of the rest (I can testify!!!).  

As a woman, living in a culture that in many ways is patriarchal, where less than half the female population is literate (http://www.theodora.com/wfbcurrent/malawi/malawi_people.html), I have the rare opportunity of empowering Malawian women to dream big and pursue higher education (many times this can be a challenge due to poverty).  It's a rare thing for them to see to see women educated women, let alone with two bachelors degrees and working independently by choice.  I can also mentor young girls and women to be assertive.  Many are victims of sexual abuse, because they're too afraid to say, "no".

As a black American... well... I can just say there even FEWER in this category. Out of the 20 or so Adventist missionaries in Malawi, I only know of two African-Americans... that includes me.  I am not trying to say that we should ship all the volunteers with African ancestry to the Mother Land.  It's only that there are too few of us volunteering internationally, period! Since, most of the volunteers are from Europe or from North America and Caucasian, I can't count the number of times I've been called "Mazungu (Chichewa/Swahili for White person)"  based on association (some have never seen a black American before)... and we can't continue to solely blame "The Man" or lack of opportunity. I've met several well educated, affluent,  black, Seventh-day Adventist Christian Americans who'll travel to Europe or the Caribbean for vacation, but won't step on the African continent (though they'll send their money) because they deem it "unstable".  However, it means a lot to see people who look like them coming to help (most have skewed, and sometimes negative,  stereotypes of African-Americans based on pop culture).  

But, the question remains, why did I come to Malawi?  Why did I come to a country with so few resources? Just working in the high dependency unit (HDU= special care unit/like a step down ICU), the other day,  I felt overwhelmed by the sheer number of patients, lack of professionally trained man power, and lack of resources.  I've seem images and clips of over crowded hospitals in Haiti or Lybia on CNN or NPR and I'm like, "I wish I could help save lives!" Well... I'm here and it's no joke! For instance, there's one nurse  (me) assigned to care for 6 patients... that may not seem like a lot. However, when you consider that you have one patient diagnosed (Dx) with diabetic ketoacidosis (with no sight of a glucose monitor!), one patient with a GCS of 7 (Dx. ocular cellulitis.... mind you, EVERYONE is all the SAME room... can you say "Isolation!!!") and another with a GCS of 4 (Dx with TB meningitis secondary to AIDS...she died on my watch), then an admit with a pulmonary embolism (now deceased), and two CVA patients (one in which who's vital signs are showing signs of possible hemorrhage )... not to mention the shortage of doctors who are mostly unavailable... you get my point!

Soooo, again, "Why did you come to Malawi?" if it seems impossible to "save" people or, that your hard work, your American nursing training, astuteness, documenting, open communication with doctors/nurses, and advocating seems to not matter to the point where a patient dies... "How do you think you're going to make a difference???" The truth is, if I came here simply to "save" Malawi I'd get burned out quick! I know I'm here in Malawi for a Divine purpose. God has placed me in Blantyre to  introduce those patients to Christ and remind families, in stressful times, of His eternal love; spiritual healing is the only thing that  is  forever.  Yes, I could have been a nurse in the U.S. and done similar ministry but, honestly, I'm happy and loving what I'm doing and the best place to be is in the Lords will.  I have always had a passion for global missions and now that I'm here, fulfilling one of my life-long dreams (I'd like to one day establish my own rural clinic overseas and have my own non-profit), I wouldn't trade it for anything in the world!

Perhaps, I may never see the fruits of my labor here on earth.  However, I long for the day Christ says, "Well done, good and faithful servant! You have been faithful with a few things.... Come share your masters' happiness!" (Matthew 25:23)

~Joya~

Double rainbow on the way to Blantyre

Arrival

"For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you a hope and a future."

 ~ Jeremiah 29:11~

Leaving JFK on South African Airways

Papi Tan Maravilloso,

It's been a week since I've arrived in Blantyre, Malawi and the anticipation/expectation is monumental! Besides trying to physically adjust from the obvious jet lag, I spent this past week orienting myself with my future colleagues at Blantyre Adventist Hospital (BAH); soaking in the monsoon of information regarding BAH's history, issues, and needs; trying to get settled into my flat/home; welcoming in the new year; and maneuvering around the city; and swallowing in the fact that I'm officially a medical mission nurse!!!

Blantyre (Mandala), itself, is the second largest city in Malawi.  It's also the center of finance and commerce. Keeping this in mind, the majority of the clientele for BAH come from this bracket; meaning that BAH (a private hospital) services the upper middle class and wealthy (there is a HUGE gap between the poor and rich, as with all developing countries).  This small, 82 bed hospital also provides services to a smorgasbord ethnicity's and religions (with that said, there's a very large Muslim population).  It's equip with functioning adult ICU, cardiology department, OB/Gyn department, theater (operating room), out patient department, ED & ambulance, oncology department, lab, radiology department, etc. 

With all that BAH offers (it's one of the best hospitals in the nation), it's easy to think, "... what EXACTLY am I needed for again???"  However, there are plenty of opportunities for growth, improvement, and learning, on both parts.  I am certain that You have brought me to Malawi/BAH for a divine purpose.  My only prayer is that I do not disappoint You.

Tu hijita,

Joya

The tarmac at Chileka International Airport in Blantyre
I prohibited from taking pictures of the actual airport...

Malawian countryside 

The city of Blantyre