The truth is that this blog is my story, my egocentric ethnocentric version of what I see. What I don't see or don't understand has no place here. Unfortunately those of you who read this hoping for some window into what it must be like at Bottom Hospital or in Malawi or in Africa are peering through a very very small window where I am the protagonist. Keep that in mind and your grains of salt close at hand.
I'm just feeling down today. A low grade kind of down that doesn't do any real harm but just leaves me a bit uncomfortable in my skin. I don't believe my life's extreme highs and lows have ever cycled with comparable swiftness and frequency. I find it difficult and exhausting to be present with heart. I find it difficult to comprehend and satisfactorily file away what I witness. All in all yesterday was a good day at the labor ward, all the women and babies I assisted left the ward healthy and happy. But, even on good days there is so much that blows through my mind making chaotic pathways as visions rip through old assumptions and carefully protected "truths".
The list of shocking events is endless and ranges from watching a very experienced clinician brutally execute a vaginal exam to the absurdity of categorizing all laboring women as high-risk (including the obviously low-risk, the rational being that anything can happen at any time in labor), but then not carrying out necessary interventions with the truly high-risk women to avoid devastating consequences. Although I know that I will continue to write about these events and although it is certainly therapeutic for me to release all these stories on to these pages, I also doubt the absolute value in doing just that. I wonder if in some way I am also perpetrating an injustice by painting such a clearly lop-sided picture. After reading these stories, can you still have compassion and openness in your hearts not only for the women and babies but also for the nurses and other clinicians?
Despite the frustration I feel when I witness the way in which some of them practice, I do have hope that practice will change. Not only in the distant future, as the next generation of clinicians rises to take posts, but soon. I do have hope that the clinicians practicing now will also improve. A couple weeks ago the charge nurse (the only clinically practicing registered nurse in the entire hospital) told me, "Joanne, I hope that when you go back to your country you will tell them how hard we work. People are always coming here and then saying horrible things about Malawi and our work here." I'm sure she would count my blog among those horrible things. So let me say now, that the nurses and midwives here work HARD.
That is the truth. There is no one who sits and chats the day away. These women do work. And, the charge nurse, in particular, is someone I respect. At one point yesterday morning, as we were getting the handover from the night nurse, we stood around a bed with a recently delivered mom trying to breastfeed her screaming baby. The charge nurse picked up the baby comforted him and then put him on his mom's breast without saying a word.
I met Clement for lunch today and told him the most recent stories that left me tearful and frustrated. He listened and then told be about the source of his own motivation for becoming a clinical officer, which helped bring me back to the fundamentals. He said it comes from the experiential knowledge of being a patient here . . . knowing what it is to feel true hunger, knowing how much effort it took to get to the clinic, knowing how it feels to stand most of the day in a long que, believing that you are truly dying, watching clinicians move unhurriedly by, and then when you finally reach "help", having the clinician hand you a prescription for a simple over the counter pain killer without doing any type of exam, before you even finish telling him about your complaint. After saying this, he said he knows he will not change the system, but that he can still provide good care within the system and that is the goal. Personally, I have never experienced any those things, but I suppose if I can prevent a few others from also experiencing them, then I will have done something good.
These days too many of my stories are sad. I want to laugh until my belly aches.
No comments:
Post a Comment