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

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

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

Ticket...FINALLY!!!

"And let us not lose heart in doing good, for in do time we shall reap if we do not grow weary." 

~Galatians 6:9~

Papi Tan Maravilloso,

According to the Mayan calendar, the world should have ended today :-) (regardless, we [I] should always be ready, for you are coming soon!).  However, Your mercy/Word/grace allowed an additional day to get our act together :-)

Exactly one week from yesterday, I'll be finally on a plane to Blantyre, Malawi!!! I can't say that I've always been patient or trusting, nor can I say the road easy, but I can say that You're faithful; You've been leading me all the way.

This week, especially, has been full of uncertainty.  Being that it was the last week before the school closed for the Christmas & New Year holiday, I was unsure if I would be able to get everything I needed to get done before the deadline or have to wait until after January 2! I needed to be financially cleared, get my BS diploma and transcript, ticket, TEP, and health insurance card all before the week ended!

To make a long story short, stuff happens when you show up in person (of course Your Holy Spirit being the main entity)!  When, it looked bleak with all the running around and discouraging small talk, You worked a miracle and parted the Red Sea!

So what happens now? In less than a weeks time, I'll be on a plane heading to someone's hospital; caring for patients.  It's easy to become nervous and scream, "WHAT DID I GET MYSELF INTO?!?!?", or, to think, "Am I really cut out for the job?... I hope I don't harm/kill any of my patients!"  (Though I've excelled academically,  I'm a brand-new nurse!) But, again, like my devotion on Prophet Elijah, You're not the kind of person who leave's His children hanging, especially when You've called them to a specific work.  You've made it more than clear that Malawi's exactly where I need to be. I am called. I pinch myself thinking that about to embark to fulfill one of my life-long goals in becoming a medical missionary!

I don't know what the future holds.  I can only see what's in front of me.  I am Jewel.  I am soon to be a volunteer mission nurse at Blantyre Adventist Hospital.  I am 20-something *clear throat*, single, no children, with desires to someday own my own rural clinic, have a non-profit, and travel the globe. I am very much interested in international/global health issues... so, when it comes to getting my maters, I don't know... something that encompasses women, infant's, and children, with a special emphasis on HIV/AIDS education/prevention....

There's a lot! As they say, "The world is my oyster!" Until next time!

Tu hijita,

Joya

Be Thou My Vision

"You will keep in perfect peace him whose mind is steadfast, because he trusts in You." 

~Isaiah 26:3~

Papi Tan Maravilloso,

It's Saturday, December 1, my latest departure date and still no ticket!  Since flights only leave out to Malawi one day a week, my next best bet is next week, but I doubt it.  Another hurdle to cross  before I can get the clear to leave.  First it was the TEP, then the loan situation, and now my BS transcripts/diploma and loan situation (On Wednesday I had to run around getting the documents I had notarized (though I know I already did that in June... -_-)! I owe the school over $8,000 and if I don't pay up, no releasing of my transcripts and degree, no ticket, no work!  

It's easy to focus on another hurdle and become frustrated and upset.  My bags/bins are packed, I have all my shots, anti-malaria pills and I've said my good-bye's... now I just want closer!!! There are times I feel that the knowledge I learned months ago is gone and will become useless when I start taking care of my own patients.  The other day one of my friends mentioned she was taking care of little baby diagnosed with Hirschsprung’s disease (congenital megacolon).  I recognized the name but had forgotten what it was (Hirshsprung's affects the large intestine and causes problems with passing stool. It's present when a baby is born and results from missing nerve cells in the muscles of a portion of the baby's colon)!  

However, all things happen for a reason.  I've done my part. I humbly ask that you help me to keep my eyes focused on You.  I remember jotting down all the miracles that I'd need to happen BEFORE I leave on this year-long adventure.  You've blessed me that all, except one, has come to pass; and that's my school bill.  So, perhaps, this is the reason for the delay.  You're just making sure that I have all my ducks in a row, because in Your infinite wisdom, leaving before all is finalized (though I was given the go ahead) will be troublesome to handle while in Malawi... it makes since :)  I am also sure that there are other things You're preparing in me and for me while I wait... patiently.  May You be my focus and vision, for I know You are leading me and You have called me to this special work in Blantyre.  

Tu hijita,

Joya