Because They're Burning Bricks

Posted By Sika on July 30, 2007

I didn’t have surgery today because the power went out at the hospital and so my surgery got rescheduled for tomorrow. I know that people at home will probably be upset about the power, but to be perfectly honest, that doesn’t concern me. Maybe already I have been here too long; gotten complacent about the lack of services; look at a power outage and think, “eh, zimatchitika (these things happen).”

I continuously have to remind myself that there are lots of hospitals and healthcare workers in America that don’t meet my standards. I have to remind myself that there were many days when *I* didn’t meet my standards. The fact that the healthcare system here in South Africa doesn’t actually find actual informed consent to be all that important is more worrisome to me, as is the fact that in Malawi the nurses didn’t know why they were supposed to do things the way that they were supposed to do them, and so often did them wrong.

The good thing is that this experience has really made me see how I could do some good at Zomba. I would like to get a grant to get some skills textbooks that include the rationale for why we do the things we do and then have some labs where we do things wrong on purpose to get these students to start thinking in more of a scientific method-y way. The way the education system works in most of Africa is that teachers write about the subject at hand on the board and the students copy those notes. Full stop. That’s it. Not only that, but the classes are taught to exams that are ridiculously hard and irrelevant (who here thinks that a Malawian high-schooler needs to know how to use radiation in order to change the properties of aluminum?) and instead of making the exams relevant and full of important information, they compensate by making the score needed to pass these exams as low as 35%.

This makes sense when you consider that many classrooms are lacking in electricity, books, chairs, and desks. There are 60 kids in many high school classes, and when the ratio is 60:1, those kids need to be taught to shut up, sit down, and memorize the facts. Anything other than that would lead to chaos, and certainly if we discussed *why* things happen there wouldn’t be any time left to learn how to change the properties of aluminum using radiation.

To come in during college and try to change this style of learning will be nigh on impossible, and I realize that despite my jokes about undoing the ravages of colonialism in my 2 years here (with 1 year, 8 months left in my service, natch.) But I think if I can get the students to start playing a little more I can teach them how to learn from experience, and teaching them how to learn from experience is one of the first steps towards real critical thinking skills. If I’m lucky, I’ll leave a horde of pain-in-the-ass loud-mouth nurses in my wake.

There’s a mandatory ethics portion of the nursing syllabus as well, and I’m really hoping I can teach that at least once in the next two years. (I told Dr. Max that I wanted to and he said that he thought I’d be really good at it, to which I had to reply, “Why? Because I’m a nitpicky pain-in-the-ass?” Dr. Max says Africans don’t say things like that; it’s too blunt.) Nancy pointed out that nurses here aren’t even taught about the ethics of compassion–that nursing requires any more caring than collecting trash. And while I think that nurses in the states should be encouraged to reserve a little more of their compassion for themselves, giving compassion is still an integral part of being a nurse and I don’t think that the job can be properly done without it. In addition, choices in the approach to HIV/AIDS prevention and treatment are made in Malawi that have huge ethical repercussions without those repercussions being explored. Life is too complicated to assume that making decisions for other people is ok just because they’ve been trained not to complain. There is certainly no dearth of real life situations I can use to explore basic ethical concepts.

All of this, of course, means that I’ve got no time for this little South African vacation; I need to get back to Malawi so I can get to work. It also means that to those of you who think that mom should be dragging me back to the States by my hair if necessary: tough.

Categories: Malawi, Work
Tags: nursing, teaching