how to teach in west africa

Yesterday I had one of those shifts that remind me so undeniably that nursing is my vocation.

To start with, I was orienting a new nurse. On any given day, I'm a big fan of orienting; I love being the one to introduce someone to this crazy floating hospital that feels so much like the only thing I've ever done. Yesterday is was even more of a bonus, because the name next to mine on the assignment sheet was none other than Suey. She's been working out in the communities as a palliative care nurse for the past months, but with a summer shortage of nurses, she was called in to the wards to help out. She's also hands-down one of my best friends here. Throw in the fact that she's a pediatric nurse from one of the top two children's hospitals in the country, and you had the two of us in precepting heaven for eight hours.

We only had four patients to worry about, two of whom were getting ready to go home this morning, so task-wise it wasn't a terribly demanding shift. We had plenty of time to go over paperwork and find things in cupboards and practice putting IVs in brown arms. I've always said that I must have been a teacher in a former life, because I love educating. There's something so satisfying about taking someone who's in the dark and being the one to turn on that little light, opening their eyes to something new. It was fun enough teaching Suey, but we quickly realized that there were some teaching needs far more profound on the ward.

One of our patients was a little old lady who just had surgery to repair an obstetric fistula. The card above her bed proclaimed her age to be thirty-five, but the lines on her face told a different story. I had to teach her how to train her bladder, to learn to control the urine that's been flowing freely for so many years. The instructions are actually fairly simple. For the first thirty days, go to the bathroom every hour. Increase that time by half an hour over the next two months, fifteen days at a time, until you can hold your urine for three hours. But this particular old lady has no concept of time. When we say measure your time in hours, we might as well be telling her to perform backflips and cartwheels. She was born in a small house in a village way up country, and that birth was never registered so she never went to school. She's spent her life ruled by the rhythm of the sunrise and sunset, pounding cassava and washing clothes in the river. How on earth were we supposed to teach her? Through two translators, from English to French to Yoruba and back again, we had the following conversation.

Each box on this paper is one day. Here is a pencil; each time she sleeps, she should mark one box.
So, she should mark each time she goes pepe?
No, each time she sleeps. One mark for one sleep. Is there anyone in the village who has a watch?
Yes, she thinks there is one man who has a watch.
Can he read?
She's not sure.
Can anyone read in her village?
She thinks there is someone who can read.
Okay, these directions are in English. We will translate them to French. She should have the person who can read and the person with the watch help her. There are directions for when to increase the time. See? The boxes are different colors.
She doesn't understand. The person who can read will have to explain it to her. She won't remember.
All she needs to do is make one mark every time she sleeps. The man with the watch and the man who can read will tell her the rest.

And if we thought that was difficult, our next task was to teach yet another illiterate woman (Maomai's mama, Pelagie), how to manage her baby's new g-tube when they go back to their village. It's hard enough for someone who can read the numbers on the syringes she uses to measure milk, who can run to the hospital at the first sign of trouble, who can jump on the internet and Google solutions to problems. Pelagie has none of those luxuries. All she has is an incredible love for her baby, a baby we've all fallen just a little bit in love with too.

So Suey and I kicked our teaching mode into high gear. Armed with the supplies we could muster (gauze, cardboard, some gloves and tape) we constructed a little "practice tummy" so Pelagie could start to get comfortable with the procedure for replacing the tube. She looked absolutely terrified, so we made sure she knew that she had as much time as she needed to learn. We gave her visual cues on the bottle so she knows how much milk to measure up for each feeding, and we cheered enthusiastically every time she did even the smallest thing right. We stopped short of teaching her how to use the alarm clock that someone gave her; that's a lesson for another day, and my Beninoise sister looked slightly overwhelmed.

Nursing isn't just handing out medicines and checking off boxes in a chart. So much of what I do is connecting with people, finding ways to help them learn how to take care of themselves, concocting mad schemes for getting a skill to become second nature. It's a job that can so often be incredibly hectic, but yesterday my heart was singing because I actually had the time to teach.