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