There is so much to see, learn, and do here that I find myself often thinking about what is to come next before thinking about what has passed. Here in Mongu, my week taught me that adaptability, hope, and humility can help one to be successful in a new environment, even in moments when frustration, fatigue, and impatience can seem overwhelming. It can be emotionally and psychologically exhausting, seeing new things every day. I guess you could say it's what we're taught about 'culture shift'. While many facets of life and daily living are similar here, there is also much that is very different. Whether I am out in town with the locals, chatting up the taxi driver, or collaborating with the nursing students on the ward, each interaction has been a learning experience for me- good or bad. This past week has brought moments of sincere thanks for the kindness, openness, and genuine friendliness of the Zambian people. Other moments have made me scared and upset, even frustrated at times because I see so much that is new and feel like an outsider in my environment. I feel frustrated in the sense that I am a visitor here, not considered a part of this community in a permanent sense. Of course, how could I? I've been here for a week. Moving forward into this practicum, I want to continue to learn; learn as a person and learn as a student. I am keen to see all that I can in the little time that we have here. I came here wanting to work and to be involved and to help. I can't help but see some of that through a post-colonial lens as well, though I don't want to. Being the 'makuwa' ('white person' in Silozi) here, things are new for us while also being new for the local community. It's a lens that reflects from both directions, it seems. My passion for global health at home makes me all the more motivated to learn and do my best while I am here. How can I learn so that I may choose to begin seeing issues, particularly those related to health and health disparity, in a way that is useful to our patients here in Zambia? How can I truly help? As nurses, I think we often find ourselves wanting to 'help': How can I help? Do you need help? Do you have enough help? That sense of wanting to be a part of something collaborative to create change looks very different here, as I have learned.
Michelle and Rachel in the Post-Natal and Neonatal Care Units at LGH:
(After a long day of resuscitating neonates, we finally got a chance to have a break and enjoy the hot Zambian sun!)
We spent our first week on the Post-Natal and Neonatal Care Unit at Lewanika General Hospital....an exciting experience to say the least! Our first day began with learning what 'dumb dusting' is- a new nursing skill! This involved cleaning the patient areas with soap and water, the first thing we do in the morning each day! It's another way of checking in on each patient to see how they are doing, I suppose, just in a different way! Our first day brought many opportunities for collaboration and teaching with some of the student midwives and speciality nursing students. They were so open to teaching us how they perform assessments in the maternal setting while also encouraging us to share ideas and techniques about how nursing assessment may be different in Canada. I certainly learned a bit and saw how certain health issues are much more prevalent here. Assessment components such as checking the head for lice and bugs, palpating the axillary lymph nodes for infection, or checking the eyelid for anemia were integral components of the nursing assessment here that may have been missed or disregarded in Canada. Needless to say, it became quite immediately apparent that health issues and health disparity are a new reality for us working here as student nurses. It's not what we know it to be in Canada, therefore requiring a different approach and the openness to adjust, tailor nursing care and assessments, and learn! I felt so comfortable asking questions with the staff on the unit and found that to be so helpful in making our first day a positive one. We certainly felt welcome! Our second day brought us many more surprises and, in relation, learning opportunities. We began our day on the post-natal unit before heading to the NICU after morning care and assessments. In what many of us Canadian "makuwa" would call a 'sauna of a NICU', we were subsequently presented the opportunity to resuscitate 3 different infants on 5 separate occasions over a period of 3 hours (without relief) in the 38C degree NICU room. I describe it objectively to begin simply because the experience itself was something of substance, requiring much reflection afterwards. In the moment, we were in there helping out before resuscitating another babe while a full code (CPR) was happening with another baby. The intense heat and dribbles of sweat running down my soaked scrubs seemed to take a backseat in that moment. Michelle and I, as a team, were there with each other to provide guidance through the process- and boy were we thankful! Situations such as the few that we were presented that day certainly illuminate how one reacts as a nurse. Even between ourselves with Alex (Canadian Nurse accompanying our group), I found the responses to an acute situation such as neonatal resuscitation to be a bit different from our Zambian colleagues. After a short, yet very long 3 hours, we came out of the room to find Lisa and Jessica awaiting our reactions. "Was it okay? How are you feeling?". In the heat of the moment (with some certain adrenaline still pumping after 3 hours), we didn't quite know ourselves. Taking time to debrief after was helpful as we had a lot to think about. First, you think, "how did I do?", "what was the outcome for the patient?", "how can we ensure that this patient is well cared for and that follow-up is received?". As we spoke with Lisa and Jessica outside the door, a full code was still running inside, having surpassed approximately 1.75 hours of CPR already. I knew in my heart, it needed to end. We needed to let this small, small child pass peacefully. Michelle and I stepped away for a bit to rest, though the thought of wanting to advocate for the patient was still in our heads. 'I know this isn't protocol where I am from, but I know that we have done our best', I thought as we sat outside in the boiling sun. As Jessica said, we need someone to declare the end of the code, but that decision carries a weight of one thousand bricks when it's in your hands. I understood that, we needed to be patient and to allow things to progress how they would here. Upon our return, Jessica had found the physician and they had decided to stop CPR. It is sad; losing a life that young and innocent is never easy. To bear witness to such a beautiful moment and to know that the mother and the family had time to say goodbye and to love as all humans should be loved, was so very special. That's what is important to me: patient and family centred care. It looks different here as patients tend to be very stoic about pain or difficult issues to sometimes 'show strength', but emotions never leave us. We are human that way. Seeing the nurses work tirelessly through that resuscitation in collaboration with Alex while we worked as a student-based team to care for the other patient who needed resuscitation at that time was amazing to me. For us, it's a big deal. For them, it's very important, though they know and see this so much more than we do. It can be difficult to understand their reactions simply because the cause of patient and staff responses to acute situations is so multi-faceted. Sadness and grief are ever-present when health disparity is such a harsh reality like it is here. During the resuscitations, it was difficult to know that there was so much missing that could have been useful and beneficial for the patients. That's how it is here; you make do with what you have and use it to its fullest potential. To be resourceful is a skill that will never pass as useless. Here, the nurses are so strong and resilient. It's something we can look up to. At the end of the day, I felt so sad in thinking "this is hopeless", "how do patients even survive here?". But they do. That's the thing- they DO. Wow- how could I have ever otherwise known hope to be as powerful as it is here? Seeing hope in others is what makes these long days possible. That day, we saw hope in the nurses, in Alex, and in each other. You keep going because you have to try. No matter what, try. We are a team and we are here to do our best for the patient. That rings true no matter the situation or setting. While the environment, the resources, or the goals of care may change, knowing that we are there to care to the best of our ability is integral to nursing practice. Our worlds and different, yet the underlying similarity is what will carry us through this Zambian practicum. The knowledge built throughout these past four years will grow exponentially while we are here and I absolutely cannot wait to see what's in store.
(Our last day on the ward! We made educational posters for the staff as thanks for their support and as a way to promote continual education and best practice.)
(Handwashing tubs in the NICU)
(Patient supplies in the back room, including a wheelchair and many blankets.)
On another note, I was interrupted in writing this post by an amazing procession going on outside along the road. Apparently an important businessman passed away and the funeral was being held near the king's palace today, about 10 minutes down the road from our lodge. It looked like the whole town of Mongu was attending! We saw it as a good time to head into town and have the whole grocery store to ourselves...muahaha!
Here, it's all about celebrating the small things as a group. We had a little patio party on St. Patrick's Day to make things feel a little more like back home. On a completely unrelated note, having normal bowel movements is also something to celebrate here. Woohoo, thank goodness for probiotics!
Cheers to all of our family and friends back home! Until next week!
-Rachel Ollivier and Michelle Nurkowski