It’s 7 am and I am waking up. This whole week I have woken up at 7 am. Actually, I wake up at 630 then start to think about how I will be leaving soon…then my heart pounds faster and I can’t fall back asleep.
I hear the roosters in the distance, and the chickens. I hear music played at night that used to keep me awake, but not anymore.
At 7am the sun is up and I can see the light through a small window above my bed. The curtain is pink, so the light casts a pink glow on me through my mosquito net. I know I have to go to the latrine, and then brush my teeth, get dressed, and walk to another hut on the compound for breakfast.
For breakfast I have either white bread, pound cake, ndazi (fried dough), or chapatti. And sugar tea. So much sugar that I am afraid I have grown so used to it I will always have to have 8 teaspoons of sugar in my tea, and one day be diabetic.
The sun is hot already, and I know I will be sweating. I also know my feet will get really dirty from walking. These things used to bother me, but not anymore.
There is a magic here that I can’t explain. How can a place draw you in like it has to me?
The faces that I know, the fresh fruit from the market, the comfort of my hut.
Never in my life have I had such a hard time saying goodbye. At home it is different when I leave a place, say a job or a nursing placement, because I know I am still close. It is in the same town. And with nursing placements there have always been other students around, it’s not just me, so I haven’t felt as close with the nurses and other staff because I’m only there one day a week and we don’t get an opportunity to know each other well on a personal level.
But here it is different.
This is life how I have grown to know it and accept it. And while of course I miss so many things about home, I am perfectly content here where I am to live without them (except for my family who I couldn’t live without for much longer).
I haven’t cried in my time here about missing Canada, and that’s because I always knew I was going back. I could measure it in time and I could rely on my memories to bring me back there when I really missed it.
In the same respect I didn’t cry at my farewell party, because somehow I know I will be back here one day. I will see this place again and the people I have grown to be great friends with, and until then, I will keep it alive through memory and staying in touch with those who have made my life here such a joy.
So here I am, taking it all in, soaking it all up, and engraining each detail into my brain.
My blog is called An African Dream. When I created the title I thought it was a bit cheesy, but was very appropriate for what I was doing and why I was doing it. It was a dream of mine for 3 years, and my call to Africa only grew stronger in the three years. And now, upon leaving Africa in a short time, I know more of why I was meant to be here, at this time, in this place. It wasn’t just a coincidence. It wasn’t just self-directed determination and hard work. It is something more, something from God, which I can’t even explain, that brought me here and which will bring me back here one day.
There are places I'll remember
All my life though some have changed
All these places have their moments
In my life I've loved them all
Saturday, August 8, 2009
Under the sun
This international placement has changed my life in ways that go far beyond my nursing practice. I have learned and experienced things here in Kenya that I could never have understood from reading a book or listening to others talk. I have developed a firmer understanding of public health and community nursing, which is what I want to pursue in my career. I have a greater understanding of how the environment helps or hinders a person’s overall health and quality of life, and how determinants of health such as culture, gender, politics, and the physical environment are intermingled and must all be addressed in order to fully solve a particular health issue.
I use the word “understanding” intentionally, not to confuse with the gaining of knowledge. One of the most important lessons I have learned is the difference between knowledge and understanding. While in school I have learned a lot about HIV and AIDS. I have also learned quite a lot about the determinants of health and how they relate to poverty and illness. However, with all this knowledge I still did not fully understand these issues which I studied. Now, after spending three months in a rural community clinic, I can confidently say that I understand HIV and AIDS, the determinants of health related to poverty, and factors which lead to illness spreading through a community. I am positive that I could not have understood these things without being here. I would have continued to only have knowledge of those areas which I studied, but I wouldn’t have actually understood, and there is a big difference.
There have been a few common issues and themes that have arisen during my time here. One thing I have been thinking about and have had the opportunity to understand better is the importance of education and awareness. From my time working in the antennal clinic I have seen many teenage mothers come in who are married and have dropped out of school because they are pregnant. In turn, they don’t reach a high level of education and don’t have very good financial prospects. Also, being out of school, they miss out on essential education that can help them make healthy choices in life. This is a huge issue, and one that I contrast to my privileged life growing up with free education, and having no pressure to get married early, or be in situation where marriage and pregnancy seem like the only ways to stabilize one’s life in such an unpredictable environment. Education is perhaps the most important element to achieving one’s optimal quality of life, and that is a realization I have made based on what I have observed and experienced here. Obviously awareness is an important element as well, which kind of follows with education in the sense that the more educated a person is it is likely they are also more aware of services offered to them, and aware of how to take care of themselves mentally, physically and spiritually.
Another important theme I have picked out, which I became more aware of because of the critical component assignment, is the importance of prevention and interdisciplinary collaboration. I have been interested in working as a public health nurse since second year, and I have gone out of my way to learn more about primary prevention and how to become involved in this kind of nursing after graduation. So I would say before coming here I was fairly educated about the importance of prevention, as it has guided many of my decisions in nursing so far. However, throughout my time here I feel I have a more solid understanding of the importance of prevention. At the health centre I have seen so many people come in with diseases that are easily preventable such as malaria and the transmission of HIV. I have realized that these diseases are much more complex than a simple preventative fix – like nets or condoms. Their transmission stems much deeper to touch on culture, misconceptions, education, awareness and finances. Because these determinants are so linked, I feel as a nurse I must focus not only on providing the supplies for prevention, but also must tackle the big issues that undermine prevention efforts. Prevention is so much more than just giving health talks and handing out free condoms. It touches all aspects of a society or community, and therefore must involve everyone, not just nurses.
The final, and perhaps most important, theme I have identified is a person being confident in knowing what they know and knowing what they don’t know. I say person because this applies to all people in all professions, nursing included. It is so important to know what you know and be able to identify what you don’t know. Troubles and issues arise when you pretend to know something you don’t, or try to be confident in a skill or setting you aren’t fully comfortable in. it is essential to know enough about yourself to say, “yes, I am good at this, I know this, I can do this”, while also being able to say, “no, I don’t know this, I need help with this, I can’t do this safely by myself”. Principles of beneficence and malificence come into play in relation to this theme. You can really hurt someone, or hurt yourself if you aren’t confident in what you know and what you don’t know. This is something I encountered personally this term, and it really made me evaluate the importance of self-evaluation and reflection. You can’t know what you are good at and what you need improvement on without reflection and self-evaluation.
The experience of being most disconnected or disillusioned with my role as a nurse came in the first couple weeks here. I had not fully comprehended the language barrier, the difference in disease and illness, and the overall impact such a drastic change in lifestyle would have on me. In my years at McMaster I have always received the feedback that I am good at communicating. This is something I think is true, and I guess I have come to take it for granted. My first week at the health centre I realized I couldn’t talk to any of the patients without a translator. With communication being so important to me, I was stunned. This had never happened before. What is nursing without communication? I wasn’t a nurse at all, I was just a personal following around others blindly. It was such a strange feeling. I asked myself many times, “Why am I here? I can’t even talk to these people, how am I supposed to learn anything?” . Not only that but I didn’t understand the diseases and illness prevelant at the health centre. I didn’t recognize any of the drugs given out, I didn’t understand any of the treatments given by the doctor, I didn’t understand how people came to get the disease or illness that plagued them. Once I remember seeing a woman with the doctor who had hypertension and I thought ,” Finally, something I recognize!”. It was just so different and something I was so unprepared for. No matter how much you read about something, like malaria or HIV, you just can’t really get a handle on it or understand it without personally being around it and seeing it with your own eyes. I feel this is something I have been aware of before, but this placement made me more aware and more appreciative of this fact.
I have learned so much from my experiences that will help me in future clinical experiences. Many of the things I have learned relate to the career path I hope to pursue, which will be in public health hopefully in both a community and policy level. I know from first hand experience what community-led development looks like, and how it incorporates all aspects of health, not just the medical aspect which we deal with at the health centre. I can point out various determinants of health which influence a person’s health in a positive or negative way. I can identify vulnerable persons in the community, and can think of strategies in how to include them in health programs and initiatives. Overall, the experience has made me want to pursue a Masters degree in Public Health so I can have a more solid foundation of knowledge, so that I can help those who are disadvantaged in Canada and abroad.
One thing I feel proud of is when I helped to train some community health workers at St. Paul’s. These workers are being trained before they go out into the community and start doing healthcare in different households. They will be a great help to reach those who are in really rural areas, are undereducated, and who may have problems with mobility. One week I worked in the ANC and CWC alone because my preceptor was away at a training session. This week two community health workers came to observe and learn in the ANC. They were very curious about the documentation system, the immunizations I was giving, how to calculate gestation and the different medications we give out (malaria prophylaxis, ferrous sulphate, and folic acid). I was able to confidently teach them and answer their questions in all the above mentioned areas. Furthermore, I was aware of my teaching style as I went along, and made a point to make sure they gained practical experience there instead of just watching me. I thought of the way that I had been taught my various nurses in school, and reflected on what made a nurse a good teacher and what made them a not so good teacher. I tried my best to adopt strategies of a good teacher; such as patience, enthusiasm in role, and confidence, and in the end I received very positive feedback from them. So this is something I was very proud of. It really made me feel like I was competent and knowledgeable.
In summary, though I have tried my best to explain my experiences and feelings throughout the past three months, I still feel as if I haven’t even scratched the surface of all the things that I have experienced. Looking back, my nursing knowledge and understanding would have been so limited without this experience. It is my sincere hope that I will return to Ugunja one day to continue learning about public health, and that I can apply this knowledge to my practice in Canada and elsewhere.
I use the word “understanding” intentionally, not to confuse with the gaining of knowledge. One of the most important lessons I have learned is the difference between knowledge and understanding. While in school I have learned a lot about HIV and AIDS. I have also learned quite a lot about the determinants of health and how they relate to poverty and illness. However, with all this knowledge I still did not fully understand these issues which I studied. Now, after spending three months in a rural community clinic, I can confidently say that I understand HIV and AIDS, the determinants of health related to poverty, and factors which lead to illness spreading through a community. I am positive that I could not have understood these things without being here. I would have continued to only have knowledge of those areas which I studied, but I wouldn’t have actually understood, and there is a big difference.
There have been a few common issues and themes that have arisen during my time here. One thing I have been thinking about and have had the opportunity to understand better is the importance of education and awareness. From my time working in the antennal clinic I have seen many teenage mothers come in who are married and have dropped out of school because they are pregnant. In turn, they don’t reach a high level of education and don’t have very good financial prospects. Also, being out of school, they miss out on essential education that can help them make healthy choices in life. This is a huge issue, and one that I contrast to my privileged life growing up with free education, and having no pressure to get married early, or be in situation where marriage and pregnancy seem like the only ways to stabilize one’s life in such an unpredictable environment. Education is perhaps the most important element to achieving one’s optimal quality of life, and that is a realization I have made based on what I have observed and experienced here. Obviously awareness is an important element as well, which kind of follows with education in the sense that the more educated a person is it is likely they are also more aware of services offered to them, and aware of how to take care of themselves mentally, physically and spiritually.
Another important theme I have picked out, which I became more aware of because of the critical component assignment, is the importance of prevention and interdisciplinary collaboration. I have been interested in working as a public health nurse since second year, and I have gone out of my way to learn more about primary prevention and how to become involved in this kind of nursing after graduation. So I would say before coming here I was fairly educated about the importance of prevention, as it has guided many of my decisions in nursing so far. However, throughout my time here I feel I have a more solid understanding of the importance of prevention. At the health centre I have seen so many people come in with diseases that are easily preventable such as malaria and the transmission of HIV. I have realized that these diseases are much more complex than a simple preventative fix – like nets or condoms. Their transmission stems much deeper to touch on culture, misconceptions, education, awareness and finances. Because these determinants are so linked, I feel as a nurse I must focus not only on providing the supplies for prevention, but also must tackle the big issues that undermine prevention efforts. Prevention is so much more than just giving health talks and handing out free condoms. It touches all aspects of a society or community, and therefore must involve everyone, not just nurses.
The final, and perhaps most important, theme I have identified is a person being confident in knowing what they know and knowing what they don’t know. I say person because this applies to all people in all professions, nursing included. It is so important to know what you know and be able to identify what you don’t know. Troubles and issues arise when you pretend to know something you don’t, or try to be confident in a skill or setting you aren’t fully comfortable in. it is essential to know enough about yourself to say, “yes, I am good at this, I know this, I can do this”, while also being able to say, “no, I don’t know this, I need help with this, I can’t do this safely by myself”. Principles of beneficence and malificence come into play in relation to this theme. You can really hurt someone, or hurt yourself if you aren’t confident in what you know and what you don’t know. This is something I encountered personally this term, and it really made me evaluate the importance of self-evaluation and reflection. You can’t know what you are good at and what you need improvement on without reflection and self-evaluation.
The experience of being most disconnected or disillusioned with my role as a nurse came in the first couple weeks here. I had not fully comprehended the language barrier, the difference in disease and illness, and the overall impact such a drastic change in lifestyle would have on me. In my years at McMaster I have always received the feedback that I am good at communicating. This is something I think is true, and I guess I have come to take it for granted. My first week at the health centre I realized I couldn’t talk to any of the patients without a translator. With communication being so important to me, I was stunned. This had never happened before. What is nursing without communication? I wasn’t a nurse at all, I was just a personal following around others blindly. It was such a strange feeling. I asked myself many times, “Why am I here? I can’t even talk to these people, how am I supposed to learn anything?” . Not only that but I didn’t understand the diseases and illness prevelant at the health centre. I didn’t recognize any of the drugs given out, I didn’t understand any of the treatments given by the doctor, I didn’t understand how people came to get the disease or illness that plagued them. Once I remember seeing a woman with the doctor who had hypertension and I thought ,” Finally, something I recognize!”. It was just so different and something I was so unprepared for. No matter how much you read about something, like malaria or HIV, you just can’t really get a handle on it or understand it without personally being around it and seeing it with your own eyes. I feel this is something I have been aware of before, but this placement made me more aware and more appreciative of this fact.
I have learned so much from my experiences that will help me in future clinical experiences. Many of the things I have learned relate to the career path I hope to pursue, which will be in public health hopefully in both a community and policy level. I know from first hand experience what community-led development looks like, and how it incorporates all aspects of health, not just the medical aspect which we deal with at the health centre. I can point out various determinants of health which influence a person’s health in a positive or negative way. I can identify vulnerable persons in the community, and can think of strategies in how to include them in health programs and initiatives. Overall, the experience has made me want to pursue a Masters degree in Public Health so I can have a more solid foundation of knowledge, so that I can help those who are disadvantaged in Canada and abroad.
One thing I feel proud of is when I helped to train some community health workers at St. Paul’s. These workers are being trained before they go out into the community and start doing healthcare in different households. They will be a great help to reach those who are in really rural areas, are undereducated, and who may have problems with mobility. One week I worked in the ANC and CWC alone because my preceptor was away at a training session. This week two community health workers came to observe and learn in the ANC. They were very curious about the documentation system, the immunizations I was giving, how to calculate gestation and the different medications we give out (malaria prophylaxis, ferrous sulphate, and folic acid). I was able to confidently teach them and answer their questions in all the above mentioned areas. Furthermore, I was aware of my teaching style as I went along, and made a point to make sure they gained practical experience there instead of just watching me. I thought of the way that I had been taught my various nurses in school, and reflected on what made a nurse a good teacher and what made them a not so good teacher. I tried my best to adopt strategies of a good teacher; such as patience, enthusiasm in role, and confidence, and in the end I received very positive feedback from them. So this is something I was very proud of. It really made me feel like I was competent and knowledgeable.
In summary, though I have tried my best to explain my experiences and feelings throughout the past three months, I still feel as if I haven’t even scratched the surface of all the things that I have experienced. Looking back, my nursing knowledge and understanding would have been so limited without this experience. It is my sincere hope that I will return to Ugunja one day to continue learning about public health, and that I can apply this knowledge to my practice in Canada and elsewhere.
Sunday, August 2, 2009
I was busy, and can't think of a creative title
The last couple weeks…
Wedding – it was interesting. In a small tin-roofed and tin-bodied church in a small slummy part of Kisumu. Lots of dancing and praising God – the ceremony is also like a sermon. The bride Esther was so beautiful and her husband George seems to be a really great guy, even though I don’t know him at all. Fun, sweaty, tiring, eye-opening…all the usual feelings of new Kenyan experiences. I didn’t find a Luo fiancée unfortunately – maybe next wedding. I was the only mzungu as to be expected, so I had a lot of children who were hanging around the church rush up to me and ask for pictures. I took quite a few.
New friends – Two volunteers from Britain came, Peter and Lucy, who have great accents, and are really friendly in general. We are getting along really well, and they make fun of me for saying pants and pop – which to them is trousers and soda. Also, they make fun of my accent (though obviously I don’t have one, it’s all them) and how they think I’m American (which cuts deep). Last week I met Steven from Australia, who is gone now because he was only here for a week. But he was really interested in water and sanitation, which I think is great considering health is so related to water, especially here in Kenya. And then this week I met Oscar from Sweden, who was here for a week already, we just never met. He works with Peter trying to get this biogas digestor to work (something to do with cow dung, water and gas), and then he is off to another park of Kenya to work with forestry and agriculture. So, overall, really cool people and I have loved meeting and getting to know all of them.
The President – Last weekend the President and Vice President were launching some kind of district in a nearby area called Ambira (about 15 minutes from Ugunja). So the whole of last week people were cleaning and preparing and worrying. On Saturday a huge banner was erected on the road he was supposed to pass on. Most people I talked to said they didn’t like the President at all, even though there are pictures of him everywhere. Maureen the librarian said she was annoyed that people went to such great efforts to clean the town – the President should see the way the town really is and how desperate people really are. It was a big deal, and then it passed. I would be interested to see the President at the Hague. That would be great.
Love for Ugunja – my love and appreciation for Ugunja and Kenya in general has increased largely the last week and extending into this week. I am trying my best to soak in every minute and make every day packed with great friends and great experiences. I will genuinely be really sad to leave. I will probably be talking about it non stop for a few months, and people will start to get sick of my stories, and I will only start to miss it more.
The most useless to the most useful – looking back on my time here, which I’m trying to do so much because it makes me sad, I have realized I have made some amazing strides. When I first arrived and started at the health centre, I felt the most useless I had ever felt in my life. I didn’t know the language, didn’t know the people, didn’t know the issues, didn’t know the land. I questioned myself why I thought it would be a good idea to even come – what could I possibly do? This week I proved to myself what I could possibly do. I ran the antenatal and child welfare clinic by myself while the nurse was off at a conference. I did the documentation, antenatal assessment, handed out medications, gave immunizations to the children and the mothers, trained some community health workers, and most importantly was confident in knowing what I knew, and confident in knowing what I didn’t know. It was the smartest and most useful I have ever felt in my life, so I feel pretty darn good.
It’s hot. I’m sitting in the library sweating up a storm and eating peanuts and this corn-bread type thing for lunch. Tonight we are making fruit salad for the family – I am really excited! Tomorrow I’m going to Kisumu with Peter, Lucy and Oscar to explore and have some fun. This weekend I will probably be reading (White Fang by Jack London), doing laundry, and overall just chilling on the compound. I look forward to it greatly – this week has been tiring.
And that’s really all I have to say. I will be writing a lot next week as I go into reflection mode. For now I’m just trying to focus 100% on the present. Every minute, every hour, just taking it in.
Wedding – it was interesting. In a small tin-roofed and tin-bodied church in a small slummy part of Kisumu. Lots of dancing and praising God – the ceremony is also like a sermon. The bride Esther was so beautiful and her husband George seems to be a really great guy, even though I don’t know him at all. Fun, sweaty, tiring, eye-opening…all the usual feelings of new Kenyan experiences. I didn’t find a Luo fiancée unfortunately – maybe next wedding. I was the only mzungu as to be expected, so I had a lot of children who were hanging around the church rush up to me and ask for pictures. I took quite a few.
New friends – Two volunteers from Britain came, Peter and Lucy, who have great accents, and are really friendly in general. We are getting along really well, and they make fun of me for saying pants and pop – which to them is trousers and soda. Also, they make fun of my accent (though obviously I don’t have one, it’s all them) and how they think I’m American (which cuts deep). Last week I met Steven from Australia, who is gone now because he was only here for a week. But he was really interested in water and sanitation, which I think is great considering health is so related to water, especially here in Kenya. And then this week I met Oscar from Sweden, who was here for a week already, we just never met. He works with Peter trying to get this biogas digestor to work (something to do with cow dung, water and gas), and then he is off to another park of Kenya to work with forestry and agriculture. So, overall, really cool people and I have loved meeting and getting to know all of them.
The President – Last weekend the President and Vice President were launching some kind of district in a nearby area called Ambira (about 15 minutes from Ugunja). So the whole of last week people were cleaning and preparing and worrying. On Saturday a huge banner was erected on the road he was supposed to pass on. Most people I talked to said they didn’t like the President at all, even though there are pictures of him everywhere. Maureen the librarian said she was annoyed that people went to such great efforts to clean the town – the President should see the way the town really is and how desperate people really are. It was a big deal, and then it passed. I would be interested to see the President at the Hague. That would be great.
Love for Ugunja – my love and appreciation for Ugunja and Kenya in general has increased largely the last week and extending into this week. I am trying my best to soak in every minute and make every day packed with great friends and great experiences. I will genuinely be really sad to leave. I will probably be talking about it non stop for a few months, and people will start to get sick of my stories, and I will only start to miss it more.
The most useless to the most useful – looking back on my time here, which I’m trying to do so much because it makes me sad, I have realized I have made some amazing strides. When I first arrived and started at the health centre, I felt the most useless I had ever felt in my life. I didn’t know the language, didn’t know the people, didn’t know the issues, didn’t know the land. I questioned myself why I thought it would be a good idea to even come – what could I possibly do? This week I proved to myself what I could possibly do. I ran the antenatal and child welfare clinic by myself while the nurse was off at a conference. I did the documentation, antenatal assessment, handed out medications, gave immunizations to the children and the mothers, trained some community health workers, and most importantly was confident in knowing what I knew, and confident in knowing what I didn’t know. It was the smartest and most useful I have ever felt in my life, so I feel pretty darn good.
It’s hot. I’m sitting in the library sweating up a storm and eating peanuts and this corn-bread type thing for lunch. Tonight we are making fruit salad for the family – I am really excited! Tomorrow I’m going to Kisumu with Peter, Lucy and Oscar to explore and have some fun. This weekend I will probably be reading (White Fang by Jack London), doing laundry, and overall just chilling on the compound. I look forward to it greatly – this week has been tiring.
And that’s really all I have to say. I will be writing a lot next week as I go into reflection mode. For now I’m just trying to focus 100% on the present. Every minute, every hour, just taking it in.
Subscribe to:
Posts (Atom)
