Wednesday, February 27, 2013

Orientation


“If any of you lack wisdom, let him ask of God, that giveth to all men liberally, and upbraideth not.”
 ~James 1:5~



I began my first week of orientation at Blantyre Adventist Hospital (BAH) last week Thursday and my current location is on the "Old Wing".  My interest is in pediatrics, however, because BAH only has 4 pediatric beds (if that number's exceeded they'll stick them on another unit), Old Wing is also combined with obstetrics and gynecology.  Though much quieter and less hectic than the large government hospital down the road, Queen Elizabeth Central (nurse to patient ratio is somewhere around 1:35 or 1:40), it can become very busy and I can feel as though I bit off more than I can chew...especially as a newly graduated nurse!

BAH is one of the two private hospitals that serve the 700,000 population of Blantyre (the other is Mwaiwathu—phonetically <my-wah-too>).  It’s a Type 4 institution under SDA General Conference Policy… meaning it’s a self-supporting institution that doesn't receive any church subsidies. It was founded by an American couple, Dr. Elton and Dr. Rheeta Stecker in 1974, as an offspring of Malamulo Hospital to help raise revenue for Malamulo Hospital operations. In order to generate enough income to cover expenses and pay salaries in a very unstable economy, BAH tries to provide quality facilities and specialties that are not only offered at competitive prices, but that are unique to the country.  For instance, BAH houses the only cardiologist and head and neck doctor, and it also has one three OB/Gyn doctors in the country.  Other departments include, a 7 bed adult intensive care unit (there are only 2 other hospitals with ICU’s… but their bed capacity is less than that!), oncology, infectious disease, pediatric, outpatient clinic (it’s main operation),  2 operating theaters, dental clinic, optometry (I should have got my glasses here!), bakery (the bread’s A-MAZING!), and much more!  BAH caters more towards the middle and upper middle class clientele, who travel from various parts of the country to, even from neighboring Mozambique. It does pretty well for a small 40 bed hospital!

So, like I mentioned before, in comparison to Queens, I have it pretty nice… and other international volunteers are not shy of mentioning that to me, after I tell them I’m working for the "Adventists" (that's our nickname)!  However, it still isn't the US and there's lots of room for improvement. That’s why I’m here.  Don’t get me wrong, as brad new nurse and as someone coming from a country that has EVERYTHING at ones disposal, I have a lot to learn! For instance, I’m still learning how to juggle timely medication administration, assessments, and documentation on multiple patients.  Even with passing boards the first time in just 75 questions (the minimum is 75 and the maximum is 265 questions!), receiving a bachelors of nursing degree in 2 ½ years, making Deans List every quarter, or graduating nursing school with a 3.6 GPA (NOT trying to brag… just emphasizing a point!), there are many days when I feel like I know nothing!  There are diseases/illnesses I've never heard of. For example, today I learned of Black Water Fever.  It’s basically hemoglobin that’s released into the urine after an adverse reaction to the drug Quinine (Quinine is one of the primary drugs used to treat malaria).  I have to also relearn the medications and medical abbreviations , because all of Malawi is heavily influenced by the United Kingdom (i.e. FBC= full blood count, instead of CBC=complete blood count).  I keep wondering how long it will take for me to become comfortable in connecting the dots...the signs and symptoms for “this” is “that” and this is how you treat it.... I know, it will come with time... :)   

So, being that I am again in the position of learning, what kinds of the things am I learning in my orientation process? For one, I am learning the value of the “Systems Model” form physical assessments.  Using the systems approach, when giving report/hand-over, helps the nurse understand everything that is or isn't going wrong with the patient by looking at all the major systems of the body (ie. Circulatory, respiratory, integumentary, etc).... Not particular value here... <sigh> I miss that! :-)  I've learned, from the moment I landed, that due to the shortage of doctors, nurses are expected to do more... including deliveries.  I've grown tired of explaining to Malawian nurses why I am not a midwife when I have a bachelors degree! Paper charting still isn't my best friend. I was spoiled in the States with the computer! I’m now having to write down everything descriptively, praying I’m the whole time that I’m spelling correctly!  I’m also learning some innovative techniques on "improving" quality patient care (some are safe and then there are some that are not so safe :) ), especially when things are in short supply… which is the story of Malawi’s life! And, one of the most valued lessons I’m learning, not just in orientation, but in the country of Malawi, is the value of community.  I've witnessed very few people suffer alone.  The old African proverb of, “It takes a village…” proves true to its name! For example, when someone dies in hospital, the community comes out to grieve with the family.  At Queens, every time there is a death (sadly, which was often), you can hear a harmonious choir of strangers singing hymns to comfort the bereaved family members.

Like I said, I’m still learning.  I haven’t arrived.  Yet, I know, because God has placed me here where I too contribute knowledge and skill. I know He will give me wisdom to do that which is required.

Tu hijita,

Joya

Looking through the charts

One of the fellow BAH nurses and I on duty... btw, one of the things Africa must improve on  are these ugly WHITE uniforms!!! Through back from the 80's! Yuck!

Assessing one of the newborns under the infant warmer 

For further information on Blantyre Adventist Hospital, visit: http://www.bah.mw

Monday, February 11, 2013

Lesson of Contentment


“Not that I speak in respect of want: for I have learned, in whatsoever state I am, [therewith] to be content.”

 ~Philippians 4:11-12 ~


I've been more than blessed while living in Malawi these past 6 weeks. My first introduction to international missions and global health was with the National Association for the Prevention of Starvation (NAPS- AWESOME ministry www.napsoc.org), living in tent in a rural village in Zambia.  There was no electricity and no running water, so when it came to toileting, you used the “squatie” (an outhouse with a hole in the ground; hence the name J) and prayed it was either really cold so the flies and smell wouldn't get you; and on a good day, depending on the water situation (there was always a water situation), we bucket bathed (for the other days we used baby wipes…we all ended up smelling the same by the end of the 5 ½ mission J).  We used the same coal as those living in the community and cooked our food outside on a brazier.  Yes, by most people’s standards, “We roughed it!”  However, these were some of the best and happiest days of my life!  As in Zambia and many countries that followed (India, Zimbabwe, Madagascar, Botswana, and Guyana), living simple and among the people, I not only learned to depend on God, but I was able to experience contentment on a whole new level!  I formed friendships for a lifetime and from all over the world! I gained a deeper appreciation for the country, the province/region/state/district, city, village, and for the families/individuals that occupied them.  It was like I could feel the pulse of the land.  Those countries became a part of me and I became a part of them. 

NAPS Zambia and America-Natukoma Village outside
our thatched wall compound (Zambia 2004)

Ernest and Regie- the tent where they slept for 5 1/2 weeks (Zambia 2004)


Keeping warm- the cooking brazier (Zambia 2004)



Fast forwarding 9 years later from my first overseas experience in Zambia, the scenery has changed.  Granted, it’s not home, but I can’t in the least bit complain! I’m not living in a tent in a rural village in the middle of “Nowhere” (yes, I know I’m being redundant… just emphasizing a point).  On the contrary, I live in a spacious guest flat (the British word for apartment) in the heart of Malawi’s city of commerce.  I don’t have to worry about flies attacking me when I want to use the restroom (not to mention the hike you have to take to get there… a beast when you have to go REALLY bad and it’s night!), I can get out of my comfy twin bed (not a sleeping bag!) and walk to my flushing porcelain toilet; then turn on the tap to wash my hands (Did I mention there’s running water???). And, yes, there’s hot water too!!! Yes, God is good!!!
my bedroom- very grateful for my mosquito net!

Variety of food choices and a table to set it on!

Yet, one would think that with my 9 years of NAPS training and 10 plus countries I've visited surely I wouldn’t have the remotest seed of discontentment when moving to my current residence in Blantyre, Malawi, right??? Sad to let you down, but yes! However, that quickly changed when I went to visit my bachelor’s earned account friend, Mary, this past Sabbath. 

Mary lives within walking distance of where I’m staying and we both work for the same Adventist hospital.  Like me, she could have chosen work anywhere else, making a lot more (Accounting is one of the top paying professions in the country), but she wanted to serve.  Like me, she is young and single.  Yet, unlike me, she lives in a very tiny, two room flat (one room’s for sleeping and the other’s for everything else; eating, washing clothes, cooking, etc…. by the way, there’s no indoor tap, fridge, or stove <she cooks on hot plates>). She has electricity (thank God!), but her toilet and shower are outside (and she has no hot water). So, considering that we are in the middle of Rainy Season, one can only imagine! Yet, despite the stark difference between our places of residence, Mary’s content.  Her tiny corner of a home (that’s probably the size of a standard American living room) is her space and she’s genuinely happy because she’s serving her Lord.  When I asked her if she ever considered moving (her mother lives nearby and is a very successful large-scale business owner), she said, “Yes, but, I know God has a purpose for me being here. Solomon was one of the wealthiest men of all time. David was a king and a man after God’s own heart. I’d like to think that there were other men/women, who had much less but, severed God just the same; people like John the Baptist, lived in the wilderness, wore camel’s hair, and ate locus and honey.   The prophet Jeremiah severed God while being beaten, jailed, and thrown in a cistern! He’s working on me and I want to be faithful” (basic summary of what Mary said). 


Humbled again!


“Not that I speak in respect of want: for I have learned, in whatsoever state I am, [therewith] to be content.”  Philippians 4:11-12


Tu hijita,
Joya