Thursday, January 5, 2012

Some lessons learnt in Malawi

Lessons learnt
1)    Lack of human resources plays a major role in care provision
a.     RNs are stretched between care and administration roles
b.     Students are not adequately supervised
c.     Care is brief, with basic skills sometimes being missed (i.e. vital signs), or others done without thinking about why (i.e. medications)
d.     Nurses are being called back after long locums, and this results in lack of skills
2)    Role of a nurse
a.     Possibly still viewed as a “physicians assistant?”
b.     Advanced clinical nurses are rare, and severely needed.
c.     Quality interdisciplinary dialogue is lacking.
d.     Spiritual care is culturally appropriate, and given more readily.
3)    Death is dealt with differently than in Western cultures/hospitals
a.     Nurses may not want to be associate with it, and this may cause withdrawal of care (both technical and emotional) when death is near
b.     Due to limited resources, interventions are specifically determined by prognosis of the pt.
c.     Different coping methods for families (more wailing and crying, often will not be together initially)
d.     Improved communication between departments may reduce deaths
4)    Limited human resources
a.     Essential need to ensure what you have is working, and readily available.
b.     Be creative!

1)    Don’t expect that your project will happen quickly.
2)    Communicate frequently, early, and clearly (often brief, in emails).  Also communicate if things change, to everyone involved
3)    Ethics:
a.     What we may view as Major changes/recommendations are viewed as minor;  virtually everyone will get major feed back.  Be prepared for it, and submit ASAP to COMREC.

b.    Use the human resources who are familiar with the process; take time to sit down, discuss, ask questions, and go over the proposal.
4)    Research your interests.  It makes it more manageable and exciting.
5)    Work will progress from feeling like nothing is happening, to everything happening at once. 
6)    The more specific the document, the better.   Language use is slightly different between Malawi and Canada.

1)    Malawians are a (in general) reserved culture, as compared to other African nations that I have gone to.  Despite being outgoing and exceptionally friendly, they are also quite introverted.
2)    Being more specific in communication, the better.  Don’t ask “when,” because they probably won’t know (or will give you a “soon.”).  Ask “will this happen in 15 minutes, 1 hour, or 3 days?”
3)    Email contact is fine.  Keep it brief, and specific. Phone is better.  Make sure you greet the person, before going into a request.   Personal contact is best. Don’t worry about just going and knocking on a door, even with no meeting… it’s not considered rude;  however, do be prepared for people not to be there when you expect them to be there, or, expect that they may tell you to come back at a later time, if not convenient.  Do ask if it is a convenient time.
4)    In general, the water is fine to drink from the tap.  Do take a prophylaxis for parasites (praziquantil) if you have swam in the lake, before you go home.  Buy it in Malawi for very cheap.
5)    Meet as many Malawians from different scenarios as possible.  Be willing to explore, and have conversations with strangers.  Normally, there is no risk.  Sometimes, you will meet people who you are uncomfortable with, but, let down your cultural safe-guard.
6)    Ex-pats are an interesting community~ some are super great quality, and worth being involved with.  Others are quite exclusive and “cliquey.” But, ex-pats play a large part in overseas cultures… they will teach you interesting lessons, and allow you to have quality inner dialogue.
7)    Speak slowly, and clearly.  Take time to listen.  Take time to joke.  Take time to share your own culture, and your own photos from home.  Talk about your family.  Relax.  Remember that stressing doesn’t solve much in Malawi. 
8)    The more involved in different activities that you are, the better your time will be.  It is the days that you do nothing, where you start feeling lonely, sad, and downcast.  Even if it just means getting out on those days to go buy fruit~  it will make you feel better, and will probably give you something to talk about when you get home.
9)    Remember to keep your eyes open.  Every day, there will be something that makes you laugh, or something that you can reflect upon, or something that becomes “normal” even though you would never see it in Canada.
10) The landscape of Malawi is more than worth exploring.  Get out.  Do not stay in the cities.  Get into the country side, and prepare to have your mind blown by the beauty.
11) It’s ok to spend “a little money” on things which are enjoyable.  Just remember that your life should change when you are abroad, and that the luxuries that you have at home, should not be the luxuries that you have abroad, when the people around you have very little.
12) It’s ok not to give money to everyone who asks.  Figure out what you want to support, and stick to that.  Be firm when saying no.  But, do try to work with someone to find alternatives.  Teach life skills (i.e. business plans, or money management) instead.  Hire people to do little tasks for you (like washing your laundry, or guiding you on a hike).

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