Sunday, March 23, 2014

Maternal and Neonatal Nursing at Lewanika

I was so excited to be placed in maternity, my nursing passion, for our first week of clinical here in Mongu. I don't know exactly what I was expecting but the week ended up teaching me so much more about life, death, myself, and the unwavering strength of Zambian women than I would have thought possible. An immediate eye opener for me was the cultural differences in maternity between Canada and Zambia. Women in Zambia are expected to "be strong" which means keeping quiet during both labour and delivery....this is also without the use of any pain medication. Women are instructed to hold onto the metal bars at the head of the bed and squeeze when things are getting rough. Then, shortly after delivery, women must climb off the high delivery bed and walk back to their bed on the ward, carrying their suitcases & bags with them. Incredible. The midwives on this ward are also amazing human beings. On an average day, two midwives care for at least 3-4 moms in active labour and another 5-6 who are on their way. One morning we had 5 babies deliver in a time span of less than 2 hours. There was literally a line up for a delivery bed. I was so happy that we were there to help but I have no idea how these women manage these large patient loads on a daily basis. They also have to be constantly adapting to a limited amount of resources. One day a woman came in needing an urgent c-section (or "ceasar" as they are called here). Savanna & I started to prep this patient for surgery, which includes inserting a urinary catheter. Sounds simple enough, but this turned into a hospital tour for me as I was directed from one ward to the next in search of the elusive catheter (finally found one on my 6th stop). At the time I found myself really frustrated with this situation but I am already starting to learn that this is just a part of nursing in Zambia - and I will need to continue to learn to be resourceful and adapt to the situation (like later in the week when we used the cardboard from a glove box to make splints for the premie quadruplets). 
Before we started on this journey, Jess & Jackie promised us that this experience would be full of high highs and low lows. I definitely began to understand this feeling this week in maternity - there is something so euphoric about witnessing the emergence of new life, but it is so profoundly heartbreaking when things don't turn out as hoped. There were some moments this week when I didn't think I wanted to go back to the ward, but looking back now I am so thankful that I was able to have this experience and I think it helped to mentally prepare me for this upcoming week, when Caitlin & I travel out to the "bush" to work in a rural village clinic with minimal resources (we're talking no electricity, no running water, no stethoscope) . The journey contiues...wish us luck :)


Maternity is my passion, as I will be starting a position in maternity post grad I could not have been happier to receive my placement last sunday to work on the maternity and post natal wards here at Lewanika hospital. I anticipated heartache and frustration and thought I was well prepared for the experience but looking back I don't think anything could have prepared me for the challenges I faced other than the experience itself and support from staff and other students. I realize how hard it is to come from a healthcare system where everything is at our fingertips, technology, supplies,staff, policies and procedures, evidence based best practice and so much more then to immerse myself in a healthcare setting where the previous things we take for granted are slim to none. I found it so beneficial to be forced into a situation where I really had to think critically and go back to the basics. I performed neonatal resuscitation on my second day and cared for the baby and mother throughout the week as the baby's status declined, when I left the ward on Friday I was so upset and angry that there was nothing else I could have done for that family when in Canada we would not have been faced with that situation as there are so many interventions available. I heard numerous times this week that you do the best you can with what you have, and I had to remind myself of that so often to be able to move forward and not carry guilt.  I was reminded by my instructor that we don't have to be okay but we can just accept and appreciate the experience and learn from it. The nurses and doctors were so helpful with explaining the practices as well as cultural norms and translating for us, I felt so welcomed and comfortable on the unit because of the wonderful staff. There are so many differences nursing here compared to home but I had to remember a quote I had heard "comparison is the thief of joy" which is so true in this situation, I had to look at the positive here and try and focus on how best I could care for these people with what is here and now instead of what could have been if I was back home. I still can't believe how much I have learned in the last week, the women here are so strong fighting through complicated deliveries with no medication available to them, all on their own as family and friends are not permitted to be in the delivery room or on the ward for infection control. Even after a week of multiple deliveries a day there is nothing more beautiful than witnessing a baby come into the world, I am so thankful to have had the experience of working with these tough little babies and moms and I am so excited for my outreach placement in a more rural village this week. 

Caitlin Robertson

1 comment:

  1. Dear Leah & Caitlin,

    You have certainly awoken us with your stories to experiences that you will likely never repeat in Canada - or forget from your time in Zambia. I have no doubt these days are building you into stronger, better nurses than you may have imagined yourselves - and there are many more days to come. Your teachers are so wise to remind you, and all of us, that we both "don't have to be OK" with inequities and still can contribute so much - and learn sp much - as honored temporary members of our Zambian host health care teams. Good on you both for seeing through your commitments on the tough days - what every good nurse is made of, anywhere in the world.

    Take care,