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.