Saturday, March 28, 2015

Life Lessons in OPD

I have spent my last week in the OPD, which is the Zambian equivalent of our Emergency Department. I have never had a chance to experience emergency medicine back home so this was an entirely new experience for me. 
Walking through the OPD looks like pure chaos. Patients are crammed together on benches waiting to get their vital signs taken, another swarm of people fill the hallway clutching their crumpled files as they wait, and healthcare professionals call out for patients in what appears to be an order without rhyme or reason. I remain bewildered at the lack of triage and don't understand how  patients know which room to go to or which clinical officer to see, but I quickly realized the staff in OPD is extremely efficient and amidst the chaos they manage to spend quality time with a very high volume of patients. 

Here I am performing a knee tap on a patient with extrapulmonary TB in his knee joints. This was awesome - I would never get to do this in Canada! 

The x-ray board was smoking so we were unable to properly read any films. The staff at Lewanika are very good at figuring out solutions in low resource settings. 

I spent my week with a medical officer named Kwibisa who is one of the best teachers I have ever worked with. He quizzed me, pushed me, observed me, and coached me through a myriad of situations. Under his guidance my knowledge and confidence in myself grew exponentially. All of his work was done with genuine compassion capped with a huge smile and observing him as he worked was a powerful reminder of the kind of healthcare provider I have always aimed to be.

Still, despite the experience I was having, I began to grow frustrated. I was observing great things but I wanted to be doing! I kept thinking that I came here to help and to make change, yet I was doing neither. Sure I was advocating for my patients, lending a kind hand in a scary moment, or donating items to those in need, but that is no different than what I would do as a nurse at home. I struggled with these emotions all week. 

In an attempt to shake my frustration and dive into "the experience" head on, I decided to work a night shift in OPD with Danielle (she was in OPD last week). We ended up having a very tough shift and dealt with some situations that only perpetuated my frustration. 

We were taken to the male and female psychiatric wards, which we were blissfully unaware of until then. Seeing the conditions these patients were kept in was traumatizing. The ward resembled a prison and all patients are kept together in a dark cement room behind locked bars. Some had mattresses and clothes, some did not. I could not fathom how any patient would be able to heal in such an environment and we were informed that some patients are there for so long with nowhere to go that they become "property" of the hospital. I struggled to process what I saw and again grew frustrated that I was unable to help change this. 

The second part of the night was spent on the maternity ward with a mum in labor. I have been told by my peers that the situations for women in labor is very different here than in Canada yet I still had a hard time seeing the mum all alone, naked on a bed in the back room, without so much as a kind word of encouragement or a hand to hold. Provision of holistic care is a large aspect of nursing in Canada, but I have learned that I cannot judge the practices here and say they are wrong simply because they are different. However,  what I cannot accept is the way the woman was treated throughout her birthing process. She was repeatedly pinned down on the bed to get her to stay still, she was shamed, and she was physically forced to lay in positions that were clearly causing her discomfort. I did everything in my power to make her feel loved and supported and I believe I helped make her birthing experience more positive. I may have made a difference for one woman, but patients will continue to be treated this way and I realized it is my inability to change the big picture that frustrates me so much. 

Through a lot of personal reflection and some powerful conversations with Jackie and Jess I have come to terms with my frustration and sorted through the emotions I was struggling with. Yes, we are here to help where we can, but we are not going to be able to change the way the system works. That takes years of effort at many different levels and unfortunately change is slow. I have to do my best with every patient I interact with and know that I've still made a difference - an effect on some lives are better than none! Jessica and Jackie are working hard to help implement change on a bigger scale, and I have realized that for now I am just a piece of the puzzle.  

As Jessica reminded me, it is important to bear witness to these global issues. I  am participating in healthcare on a global level, which is the underlying reason this practicum is an option for us. My frustration has subsided and instead I find myself inspired and recharged. I am ready for the next challenge that lays ahead. 

- Marissa 


  1. Dear Marissa,

    Your anguish over what you witnessed is real and palpable - and now as you reflect on it, I feel that anguish with you. Your stories remind me that healthcare is cultural - and whether it people with mental health issues, giving birth, or other contexts - that the care you witnessed, just like back home, is culture bound.

    What really struck me too, is that when I think about my 40 years in nursing (hard to believe but true!), cultural change in our system can be just as slow. How many decades now have we been trying to get health care providers with much better resources at their fingertips to wash their hands the right way, every time??? How much progress have we actually made so far in changing health care in Canada form a "shame and blame" culture when mistakes are made to a "reporting and learning culture" that benefits us all? How much progress have we made in Canada over the past several decades in supporting patients and families to take as active a role as possible in their care decisions? Some progress for sure - but hard won and not near as much as could be.

    It's true. We humans are slow to change. As a cherished colleague of mine once said to me when we asked her to just change how she documented her schedule to enable the entire team of 5 to schedule meetings (with a smile, and she did change): "Well alright ... I can change.... if I have to ..... maybe". We all know we need to change and grow as individuals and as practice communities - and as health care organizations - and as health systems - and as societies. Each of us has the power to contribute to that, every day. So I think that is what Kwibisa is doing, every day - offering his part to changes that none of us should just wait for, and all of us should help happen, how we can and where we can. With respect and compassion for what is, and hope for and commitment to what could be.

    I think that is what you and your team mates are doing right now - committing to change - and it is what I hope you will take with you into the future, wherever you nurse,

    Tricia Marck

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