Light at the end of a very long, dark tunnel

To describe the clinical conditions at the hospital as problematic would be a huge understatement. Carol and I embarked on our first day of a required 4 week orientation for the Malawi Nurse s Council in order to complete the requirements to practice and teach.

After introductions to the Deputy Chief Nursing Officer and the Hospital Director we had a tour of the facility and were assigned our units for the next 3 days. Overall the hospital is clean, orderly, and fairly quiet, by Malawi standards, which was encouraging but I still didn t want to touch anything or any body . The rest rooms have running water but no TP, soap or hand dryer or towels, though everything seemed recently scrubbed and clean to the naked eye.

My first stop is the ER, a 6 bed unit, 4 stretchers in one room and 2 treatment rooms. I ll try to make this concise and to the point.     Of the 3 nurses on duty, only 1 was actively working, meaning the other 2 did not leave their chairs the entire time I was there except to get up and get food for lunch. There were 11 nursing students there (not my program) with no instructor.     The staff nurses offered no guidance, assistance or communication with either patients or students and were not at all interested in me being there.

The sickest patient in the unit was clearly on his way out. Sorry for you non-medical peeps but here s the picture: Unable to speak because too short of breath, RR 40, HR 120, BP150/100, no temp because there is no thermometer available, O2 sat 45-60%. On nasal O2. No IV, no fluids, no chest xray, no EKG. There is no EKG machine, defib or crash cart in the ED. If a patient comes in with chest pain he/she waits until admission for EKG as the only machine is on the medical ward. This patient had not been seen by the Clinical Officer (PA) in the 3 hours since his admission to the ED. The situation for this patient was grave .no pun intended.

I took the opportunity, as I was unable to take any other action, to reach out to the students who were unengaged and hovering behind a privacy screen. I began questioning them as to why his O2 sat was so low, what they observed, his history, physical assessment, lab values (only CBC done) etc. No one, including the nurse on duty had listened to his lungs or done any kind of physical assessment.

I could see the wheels turning as I asked them to begin searching their knowledge base for possible causes and reasons for some of the findings. A few wandered away but 3 stayed right with me and began to light up a bit as they brought forth ideas and suggestions. The nurse could have cared less about what I was doing so I didn t feel I was overstepping my bounds at all, especially since the students were engaged, thinking, and questioning now. The patient was ultimately admitted to the hospital, and the students that persevered with me thanked me for the time and attention and began to follow me around, looking to me for direction, for guidance.

Several hours later one of the students came up to me and said, Madame, the patient has died on the ward. She was clearly distressed about this and felt we (the ER staff) had not done enough to help him. She was right. A difficult lesson for a helpless student that can barely advocate for herself, never mind the patient.

The light in this tunnel is the student. Happily I have discovered that they are thirsty, eager, curious and desperate to be engaged in their education. Though these are not MY students, I will treat them as such for the next 2 days, both for their sake, and mine and will SO enjoy watching their lights go on.