Malawi is indeed the warm heart of Africa. I can’t believe that 7 weeks passed so quickly. When I think about my journey here, it breaks my heart to know that it has come to an end. Seeing the children in the village, the guardians taking care of their loved ones at the hospital and the many smiles that I have exchanged with the Malawians. All of this comes to an end. It’s even harder when you get used to the routine. This country has opened my eyes and changed me as a person and as a student nurse. Malawi, the warm heart of africa. I say that it has warmed my heart and become my second home.
For my last clinical day, I went to the operating room and most of the patients that were scheduled for a surgery were pediatrics patients. The first two patients were infants and they have hydrocephalus which is an accumulation of cerebral spinal fluid in your brain. The goal of the surgery was to create a shunt in order to drain all of that fluid so with time, the infant’s head would decrease in size.
The team was amazing. They created a positive environment by putting African music and the surgeon had a great energy. This is the first time I see a team of health care members working together as a team and not by themselves and they had the same goal.
Last week, I visited and worked at a palliative care center in Salima. The founder of this center is Lucie. A woman who is a nurse and had a training in palliative care in Tanzania and decided to open a center after being a witness of a person who was dying in a lot of pain. Her philosophy was that everyone should die pain free because that’s a human right. As passionate and devoted as she is, her work allows to bring life back into her patients and she believes that all of their worries should be left behind as soon as they enter her center. On top of that, she is doing this action voluntarily. She doesn’t expect anything in return. She is doing this with the kindness of her heart. Her dedication is an inspiration to me and her work truly defines what palliative care is all about.
I spent most of my time working on the male medical ward at Kamuzu Central Hospital. As I became more familiar with the floor, I was shocked to see that there were around 100 patients and only 1 nurse that was working the night shift. Even during morning shift, there are about 2-3 nurses working on the unit. It’s very hard for them to monitor everyone and that’s why the patient’s family member, also known as guardians, are the ones who have a huge responsibility for his/her care.
As I was following the doctors for rounds, I noticed a patient laying on a bed and his chest was not expanding. The patient was not breathing! I took a closer look and I was trying to feel for a pulse and I wasn’t able to feel anything. The patient had died alone and in front of other patients and guardians. I had mix emotions at that time. I felt sad and angry because there was no privacy for this patient. Was the family even aware that he had passed away? Were the 2 nurses that were on the ward aware that they have lost another patient? . Normally, every patient belongs to a team of doctors and it seemed that because there was a case that was more interesting than this patient, the doctors skipped him and didn’t take the time to see him. Sadly, due to the large amount of patients in the hospital it is hard for doctors to keep track of each and every patients. He was just there waiting to be seen and time took over his life. After this, my colleague and I decided to remove his catheter and IV line before the guardians came to see him. I had to cover his body with a blanket and bring him to the morgue with his family crying behind me. I found this experience very difficult and sadly, a lot of patients die on this floor.
Malawi the warm heart of Africa, they say. I think that warmth reached my heart and opened a door in it that can never be closed
Tionana and zikomo Malawi
As my time here in Malawi draws to a close, I find myself reminiscing over the past seven weeks and wondering where the time has gone. We have encountered many difficulties here, but we have equally experienced much joy. I think back on my experiences, grateful to have learned so much about a new culture and to have been challenged professionally and personally. I will definitely remember the things we did and the places we went, but mostly I will cherish the memories of patients and people I met along the way. Their faces, etched in beauty and pain, are forever ingrained in my mind. Even though we could not speak the same language most of the time, their eyes served as a window to their hearts and in that way we could share together in both suffering and laughter. They modeled strength of character, resiliency and positivity in the face of circumstances I can only begin to imagine after my short stay here. I hope I brought some small amount of physical aid through our nursing volunteerism, but the people themselves have given me so much more than I could ever give them. Malawians are strong and they are brave. I am thankful to have shared in some of their lives and I hope I can be more like them as I return home.
After spending a few days in the clinical setting here in Malawi, I have realized how powerless we can be at times. The lack of resources in this part of the world puts people’s lives at risk. Back home in Canada, we don’t even think twice about it given our modern healthcare facilities. We have access to virtually any equipment at any time, day and night whereas here in Malawi one oxygen machine must be shared by five children. Furthermore, medication is either too costly or unavailable here; not to mention there isn’t any public or private health insurance. Parents are forced to wait to bring their children to the hospital until they are almost unconscious from their sickness. As a student nurse I try to do my assessments as thoroughly as I can, and it leaves me in awe sometimes when I see a patient doesn’t respond. I think to myself, will they live to the next day? Despite all of it I still see the sparkle of hope in the mother’s eyes hoping for the best outcome for her child.
I spent time in the medical short stay unit last week, which is an intermediate stop between casualty/trauma and a regular ward. Many of the patients include asthmatics who come for nebulizer treatments, diabetic and hypertensive clients, and others with aches and pains. However, at any time the unit may have an influx of patients and suddenly the 10 beds will be full of patients who are seizing, screaming or crashing. There is almost no space to walk between the beds, guardians on the floor, and medication carts. I would be walking by when a clinician would stop me to ask, “can you push 2 g of ceftriaxone stat?”. Before I could ask what the person’s diagnosis was or what was the indication for the drug, the clinician would already be on to the next patient. In medical short stay, half the time is spent trying to track down charts to get a sense of what is happening with the patient. Everyone is trying to get patients out and in at the same time. This was frustrating for me because I felt like many people were not being adequately assessed and were sent away prematurely. Patients and their families were afraid and did not receive the attention that their conditions demanded. However, to avoid complete chaos and patient overflow, this set up seems to be a necessary decision. I tried to get to know some patients a little better, and found that even offering them a cup of water and asking if they were alright brought a smile to their faces (maybe they were smiling because of my Chichewa language skills!). Even as healthcare providers who are often overwhelmed with tasks, it does not require too much of us to take a brief moment to see the person in the bed for who they are, and not what brought them there.
This past week we came for clinical in another city called Salima to a palliative care centre. Unlike in Canada, here there aren’t any hospice care centres. Patients are usually seen on an outpatient basis where their problems, either social, physical or psychological are addressed. What struck me the most is the large number of female patients diagnosed with HIV or with cervical cancer. Consequently, their spouses have left them. These are women who are now living by themselves supporting their children. One of the patients we saw was diagnosed with TB of the spine which left her almost paralyzed. Not only did her spouse leave her but so did her family because she was “of no good anymore”. Determined to prove her family wrong, the patient has taught herself to walk again with a walker, dragging her left leg. She has four sons, and the sons who are ages 7 and 14 help her at home with bathing and chores. When I offered to help her get up from the chair she refused and despite the difficulty she got up on her own. I am in complete admiration of the resilience and strength of the Malawian women I have met.
Malawi, the place where five minutes means an hour, where 1 km away actually means 15 km away, where people’s eyes speak more than their words and facial expression; and where you’ll find the most genuine smiles. I’ve seen poverty and struggling here in Malawi and it would be a lie to say that there wasn’t a day that passed by where I was not frustrated nor angry at the system. However when I look back at the seven weeks that I’ve been here for and I reflect on what I’ve seen and I’ve learnt, this is how they’ve lived for many years, and frankly I don’t think it would be a bad idea to adapt some of their culture. Instead of rushing so much, we can take things pongono pongono (slowly), or instead of being so fixed on the future, we learn to live more in the moment. So instead of being frustrated and angry; and trying to find ways to change the culture, why not do as Samantha Ludick (owner of cool runnings and an active member of her community in Sangay Bay) says; “It’s about the people, for the people.” By working with the people, educating them, providing them with options and alternatives while allowing them to maintain their culture, a new seed is planted and pongono pongono, the people will learn and will become knowledgeable, and change may start to occur. However, as of for now, I may not have made any impact during my stay here in Malawi but Malawi sure did have a huge impact on me; on a personal and professional level, that I’m ready to take back home. So if there’s one thing that I will surely remember to tell myself more often is “Osadanlaula”(do not worry) as everything will fall into place.