Why Malawian nurses are callous
Posted By Sika on October 2, 2007
Malawian nurses have a reputation for being uncaring and callous. To be perfectly honest, as much as it disappoints me that it is so, I can’t see how it could be any other way given the health care system. On the pediatric ward, there are 100 beds. There are 200-300 children and all of their azimayi (mothers. Occasionally there is a father instead, but usually it’s the mom who stays in the hospital.) Luckily, the children are usually quite young and many Malawians are “stunted” from poor nutrition growing up, and so there is usually room for more than one child (and sometimes their mothers too) on one bed. There are mosquito nets for each bed, but since they do not cover the floor, where there are always people sleeping, the mosquito nets remain curled up into royal blue art nouveau sculptures suspended from the ceiling.
Most of the children have Malaria and/or pneumonia. Or, rather, I should say, most of the children are diagnosed with Malaria and/or pneumonia. Clinical Officers, which is what we have here to make up for the lack of doctors, are rushed and undereducated, and perhaps too firmly follow the old medical saying, “When you hear hoofbeats, don’t assume zebras.” There are 6 nurses on day shift and 4 on nights. Well, there are supposed to be. They are generally short by a nurse per shift when the schedule comes out, but luckily the nurses aren’t paid much and so they are willing to work overtime to pay the bills. Because there are so many patients and so few nurses, the nurses don’t have patients, they have assignments. One nurse passes all the meds. One nurse records all of the doctor’s notes into the ward round books. A couple of nurses do admissions. Unless a child is there for a very long time and/or is very critically ill, none of the nurses gets to know him or her as an individual.
A child dies on this ward every single day. This is important. When for 24 whole hours no child dies, you can pretty much bet that 3 died the day before or the day after. On some horrible occasions the day without death is just the eye of the storm, framed by multiple days of multiple deaths.
In America, you have your own patients, for whom you are responsible. On most days, this fosters a kind of responsibility on the part of the nurse. Malawian nurses don’t have that connection enforced in their work lives. And you would have to be fucking insane to foster it under these circumstances. Why would anyone who had any kind of compassion for their own selves take the extra effort to reach out to patients who are probably going to die on them anyway? That’s just asking for a battered heart and burnout in 2.5 seconds.
There are simple things the nurses could do for their patients without making their own lives horrible, but it takes an outsider to see where these things are, and outsiders are automatically suspect because how can they possibly understand how it is? And of course we can’t. I get to hold on to the choices that I’ve made to keep my heart open because my time in the hospital is limited and I will not be broken so quickly. But given a sentence of 20 years to work in this system (and what’s the alternative? It’s not like jobs are abundant here.), remaining empathetic and open would be a stupid choice. Just that, straight up: stupid, self-destructive, possibly suicidal.
When I held the wasted hands of a child with TB, HIV, and osteomyelitis (bone infection) while he had a deep dressing change done without the benefit of any kind of pain medication (because there is nothing but Tylenol), I wanted to cry. When I watched another child, all signs of gender and age eaten away along with the rest of her body by TB and HIV, sacrificed along with her right arm to disease, I almost did start crying. Both the charge nurse and my APCD told me that they hoped I would get over that sadness. They were not being cruel; they just recognized that once started there is an endless supply of things about which to cry. To cry is to be paralyzed in this world. I told the boy he was brave, and the girl she did a good job, even though they cried out. Obviously I was the only one, including the patients, who thought they were strong and amazing. I did not cry and I was proud and saddened at the same time. If we lose our ability to cry over tragedy, what happens to us as human beings? I have not lost my ability to cry, but how far is control from suppression? And yet, lack of control helps no-one, not me, not them. . . a fact I learned long ago.
It is not the fault of the nurses that it is so horrible to be a patient here. They should not have to sacrifice themselves in order to do a good job. It is not the fault of the patients that it is so horrible to be a nurse here. They should not have to be sacrificed for the nurses’ self-preservation. And then it turns out I have no answers, no solutions, nothing but an endless supply of empathy and a few tricks that may make a hideous situation just a tiny bit more tolerable.
This is also important: the situation here is not unrelieved by joy and humor and the job of living. There are the nurses who joke with the boy coming to get his medication. There are moments that are achingly sweet: the small crying child hoisted by one arm and twisted onto his mother’s back and tied in place by a chitenje, his cries softening as he rests his hands on her shoulders and nestles his head into the space between her shoulder blades, where he just might be able to hear her heartbeat and feel the rhythm of her breath flowing in and out; the bright look in a giggling baby’s eyes as her amayi blows raspberries on her cheek and proudly says, “akusangalala” (she is happy); the quiet strength of a girl enduring what she should not have to endure and the love and fear in her father’s eyes and hands, supporting her while she does this thing. These glimmers of humanity have nothing to do with the many failures of the system, which shine brightly because as humans, that’s what we do.
No comments yet.