Sunday Morning~Blantyre

February 19, 2017

Sunday Morning~ Blantyre

Mitimba Sifalala  ~  Hearts are different      Malawi Proverb

The past few weeks have been a bit of a blur of work activity, entertaining, eating too much, drinking too much, and feeling like I’m not doing enough to save the planet from destruction. I’m a bit overwhelmed.

It baffles me how often the student’s schedules get rearranged and how slap dash the method of informing them can be. They are often sitting waiting for class to begin, only to find out the lecturer for the day has been called away to a meeting and the class has to be rescheduled. But since there is no place to put the makeup class, it gets whittled off of the clinical rotations at the last minute. That means the ward staff, who are supposed to be mentoring the students have no idea when the students will be there. This drives me crazy. Everyone else just seems to roll with it.

My first year students, fresh out of secondary school, started their first clinical rotation last week after four months of theory classes. They are working on the gynecology ward. I was told the skills they would be expected to have mastered for the first days are very basic: vital signs, bed making, bed baths, and what they call “dump dusting”. I asked a fellow faculty member what “dump dusting” was? I’d never heard of it. Was I supposed to be teaching them how to do this? She told me they should already know how to do it. It’s basically taking a wet cloth and wiping the patient’s shelves and beds. Oh! DAMP dusting. Aha! Now I understand. I was confused when I saw a sign in the ward that read: “Don’t Dump Dust the Oxygen”.

I was a nervous wreck about them starting clinical. I didn’t work on the gynecology ward when I did my orientation and I didn’t know the staff, where anything was, or how the ward functioned. If I was supposed to be orienting the students, I was in trouble. I was afraid there would be very sick surgical patients and my poor green students would be charged with skills they didn’t know how to do. We had tested them on vital signs and I was pretty sure they could be trusted with that, but reminded them that major medical decisions will be made based on the readings they’d get and if they record an incorrect blood pressure it could mean that patient gets the wrong medication! This is serious!  There were lots of giggles when I said that. I wasn’t amused. I snapped at them, “What’s so funny about hurting a patient?”  They hung their heads in shame. They were nervous, too. They were just expressing it differently. I asked them to talk about what anxieties and questions they had. They told me they were worried they would do something wrong or being asked to do something they didn’t know how to do. I was so relieved by this. I wanted reassurance that they were serious and was glad to have them be honest about how they felt. I told them their feelings were completely justified, that I do not expect them, or want them to do anything they are not comfortable with. I have seen nursing staff completely dump work on unqualified students so their fears were warranted, but I reassured them I would be there and if anyone was asked to do anything they weren’t comfortable with, they were to find me and I’d do it with them. I later learned I was an idiot to tell them this. I have had to eat so many of my words these past two weeks it isn’t even funny.

I am one of four faculty members assigned to supervise these twenty-one students for these four weeks. On the first Monday morning we all showed up in uniform at 7:30 sharp. We were to have the first morning be in skills lab where they would practice making beds and doing bed baths before doing them on actual people. At 7:35 we learned we couldn’t use the skills lab that day because the second year students were using it for testing and would need it for the following three days.  I was like, “You are kidding me, right? We had that set up.”  Oh! Sorry. They forgot to tell us about the second year students. So there we were all dressed up with no place to go. I suggested we at least go over to the gynecology ward to get a little oriented, and then Tuesday we could just begin there doing vital signs. Everyone agreed, good idea, and that way our first day wouldn’t be wasted. So we went enmass and did a walk through the ward where we met the staff, and informed them the students would be there the next day. Then we all traipsed to the head matron’s office (the equivalent of our nursing director) and introduced the students. There were formal greetings and words of welcome, and then we sat them down to discuss what we’d seen. The class leader raised his hand and said, “We aren’t allowed to start clinical until we get our hepatitis shots. We haven’t gotten them yet.” I looked at Ursula (our dean) confused. What? We are sitting here in uniform all ready to start and they haven’t had their shots yet? It was news to her too. Apparently, they’ve been waiting since school started in October for the clinic to get the vaccine for them, and they waited until we were ON THE WARD, in uniform, to drop this little tidbit. I asked, “Did it cross anyone’s mind to let us know this on Friday? Or maybe even a week ago?” No one answered. We let the students go to lunch and Ursula and I went over to the clinic to see about getting the vaccine. I thought it would be great. We would get the vaccine and then have them give each other the shots. They needed practice on something more realistic than the tomatoes we’d been using, and it would give us something to do for the afternoon. Ha ha. Silly me. We were told they didn’t have any vaccine and didn’t know when it would be arriving from Lilongwe. It hadn’t even been purchased yet. I was flipping out. I couldn’t understand why Ursula wasn’t more upset. I asked her, “What are we going to do with the students? When do you think this will come? Can’t we just go buy some?”  She shook her head. She said quietly, “This is very frustrating.” in the way you would say, “This is very sad.” She said she would use the afternoon to give them a lecture she’d had to cancel because of a meeting she’d had to attend and I spent the afternoon in my office writing exam questions for the final exam. They were due to be submitted to the head of the department by the end of the week. That was another bit of news I received that day: a mere hundred questions had to be submitted in four days. The four days I was supposed to be with these students.

Tuesday morning, at 7:30 I showed up thinking we would have to find some skills to practice for the day, to discover that they had all received their hepatitis shots on Monday night. I asked Ursula where they had gotten the vaccine? She said she didn’t know and wasn’t going to ask. I was thrilled to know we could get going with the clinical rotation, but a little bummed we couldn’t have them give each other the shots. Medication administration was a skill they were expected to have, and in my opinion, were no where near qualified. Just ask those tomatoes.

Now, no one explained to me what my responsibilities would be once the new students started clinical. I assumed I would be with them teaching the basics of nursing and figured I could handle it. I was mostly worried they would do something without supervision or I’d be stretched too thin trying to be with twenty of them at once. I was relieved to know they’d be four faculty. I was looking forward to some peer support and thought it would be great to have someone there to answer my questions as well as the students’. Again, silly me. I haven’t seen another faculty member on the ward since the first day.  But, then again, I haven’t been there much either. On day two, just after I told the students we’d meet at 3 pm to discuss any problems they were having, I learned I had a faculty meeting that afternoon. Ok, I had to apologize and tell the students I couldn’t do the support session I’d just told them about as I had a required meeting to attend. (They hear that line a lot but this was the first time it came from me.) I reassured them I would be with them the following week, all day, every day, and we would do a debriefing each afternoon so they didn’t feel they were being abandoned…and off I went to the faculty meeting….to discover that the entire following week (which was this past week) would be taken up with vetting the final exams. I had no idea what that meant. I looked at the schedule and saw that from Tuesday at 8am until Friday at 5 pm we would be sitting and “vetting” five one-hundred point exams. Okaay. That gave me from 7:30 until 8 each day with the students, which didn’t seem like a whole lot of time to spend with brand new students doing their first clinical experience. But, it was more time than they got from anyone else. I don’t expect them to believe anything I say from now on. I must start rephrasing things.

Now for the vetting. Let me just say that this is my first experience with writing exams. I’ve taught a few courses as an adjunct faculty at home, but I never gave exams, only assignments and papers, and no one vetted those. This is a whole new world for me. I dutifully submitted my hundred questions for the course I was responsible for, and dutifully showed up at the vetting meeting, being the first on the schedule. It was Valentine’s Day and will now go on record as one of the worst days of my life. The way this works is the seven Blantyre faculty and two more from Lilongwe sit around a table and critique every single question on every single exam. I felt like I was defending a thesis for a course I never took. It was torture. Did I know that “none of the above” is not acceptable? No, I did not. I seem to remember a bunch of those on tests I took thirty years ago! Ok, so things have changed. Who told me?

The day went like this:

Questioners: “Why did you put in this question about anatomy of the respiratory track? The students take a separate anatomy course.”

Me: “Because the respiratory track was part of the module I was asked to teach.”

Questioners: “But they will get these questions in the other class.”

Me: “Oh.”

Questioners: “You’ll have to write questions to replace these”

Me: “Oh.”

Questioners: “Where are your answers for the short answer section?”

Me: “In my head. Was I supposed to put the answers on the test? Aren’t we supposed to know the answers to these?”

Questioners: “We need an answer sheet.”

Me: “Oh.”

Questioners:  “Is this question supposed to be testing the application or synthesis?”

Me:  “Uh, application? Is that the correct answer?”

This went on for eight hours. I thought it would never end.

After it was over, feeling like a pile of crap, I walked to meet George at our Chichewa class. I thought we’d have a chance to talk on the way home, then have a nice dinner and celebrate Valentine’s Day, which, is always a set up for disappointment. I should have known better. Without the bombardment of advertising, Valentine’s Day was not even close to George’s radar screen and I was too depressed to even tell him when he asked how my day was. Then, to make myself feel worse, I looked at Facebook to see all the postings of bouquets of flowers and messages of love from adoring partners, and went to bed.

Wednesday it was someone else’s turn to be interrogated and I didn’t feel so bad. I even joined in the questioning and started to see the point of it. If I hadn’t been first and had seen that everyone has to go through the same process, my day in court would have been emotionally easier. By Friday I was thinking it was a great exercise and the exams are really much better for it. And by the end of the week the students told me they were drawing blood, starting IVs, changing wound dressings and all kinds of shit I didn’t do until graduate school.

I’m telling you, every time I think the universe is imploding I see people do stuff I never thought possible and have hope. When Jameson gave us our proverb for the week I thought, right, hearts are different.

Love to all,