OkaZHI: Okanagan-Zambia Health Initiative

Reflecting on the Woman’s Ward- first week of clinical

The first day on the ward felt like being blinded by a bright light. The orientation, smells, condition of the women was a lot to take in, however, I have grown so much from that initial day and able to see how this floor provides the best care with limited resources.
This week I have reflected on the patriarchy that appears to be a part of the culture. I struggled with the interactions that some of the female staff members and students would have with some of the male staff members. On a particular day, I had witnessed some of the patriarchal behavior from a doctor towards the female nursing students. When the doctor had asked me if this was how I handed gloves to a doctor, without even thinking I replied with saying in Canada we don’t hand gloves to them and went on to explain how rounds work and the role of a charge nurse in Canada. Things were smoothed over and I politely and respectfully provided my point of view. I am a feminist and I have been pushed here several times, and have respectfully kept it to myself as I realize I grew up in a different culture. I think in this moment I was able to be a role model. I did use of my position to show that I can be intelligent, independent and be empowered. I hope that I was able to demonstrate empowerment to the others that witnessed this moment .   
However, even though I have struggled with this, I have the most respect for the women that I was able to care for and work with. These women are so strong and stoic. The women that have young babies are caring for them while on their hospital bed. The woman would have another family member, usually a female, however we did see some men at the woman’s bedside helping to her care. On our first day Shawnel and I witnessed a MVA (manual vacuum aspiration) of an incomplete abortion. There was family planning counseling, but under no analgesic was the procedure performed. I found this very hard be in the room for. I am in awe of how this woman and other women are to keep back from expressing the pain they are experiencing. I just know I would be screaming and this woman was minimally expressing her pain. From that moment and for other patients on the ward I would try to advocate for pain medication. I come from a place where the minute you have pain, it needs to be taken care of and the idea that one shouldn’t be in pain. I realize this and want to have conversations about providing some relieve to promote healing and ambulation. I have learned there is a strong fear towards analgesia because of the fear of addiction. 
This week I had conversations with Jess and Jackie about how I felt like really I wasn’t making any sort of impact or slight change. I didn’t expect to fix or create a huge change, but wanted to be purposeful. I built on our conversations and chose that teaching the importance of a blood pressure. I explained the importance to have a blood pressure and what it can tell you about your patient’s condition. I also demonstrated how to do a head to toe assessment and talked about how it provides a picture of the patient’s status. I hadn’t felt like I got anywhere, but Friday morning I reflected and changed my attitude and mindset. I decided that I would complete tasks and my interactions to be enough. On Friday there were two nurses for approximately 56 patients. While taking a patient to the operating theater I talked with a nurse around the challenges of this ward and the blood shortage. I felt in that moment I was building solidarity, and told the nurse to please put me to work and let me help.  I felt like I helped these nurses that day as much as I was able to and grew further in this experience.  I have learned so much from doctor’s rounds, from the staff and will be looking for ways to contribute back for everything that I have been gaining in this experience. —- Aileen
Hello Mama Africa!
First and foremost, Mongu is a beautiful place filled with wonderful, welcoming people.  From the moment I entered this town I felt accepted with open arms.  The Lozi people always ask how you are doing and are patient when us, Makuwas, attempting their language. When working on the Female ward with Aileen this week, these characteristics really came to light.
It is very hard, if not impossible, to relate this experience to Canada, but there was one continuous trend that, in my opinion, is universal.  Respecting our patients and allowing them to feel safe in our care should be a universal trend.  The patients on the Female ward were extremely trusting of us.  From day one, they showed us their appreciation through holding our hands, traditionally clapping ‘thank you’, and allowing us to obtain personal information even through the obvious and sometimes frustrating language barrier.  These patients are in vulnerable positions when coming to the hospital and this is where respect and providing safe care comes into play.  
There are many incomplete abortions on the female ward.  These abortions may be due to the women taking herbal medicines or performing other measures to stimulate an abortion, since having intercourse before marriage is frowned upon.  These women then come into the hospital with severe uterine bleeding and in need of an MVA, which Aileen has explained above.  Furthermore, they are often embarrassed, ashamed, and in many ways ridiculed when they are seen by the doctor (this is done on the ward, by the way, so most patients can hear the doctor getting mad at the patient for stimulating an abortion or having sex without being married).  
Contraceptive use is discussed before an MVA and is also covered by the Zambian government (this is great!).  But again, contraceptive use is not widely used until after an abortion due to the fact that having intercourse before marriage is highly discouraged.  This makes for a complicated cascade, but I believe it could be helped by empowering these women to accept contraception and not making them feel bad about themselves.  By embarrassing them and making them feel ashamed forms an unsafe environment, thus possibly making them refuse going to the hospital or ashamed to take contraception.  I feel that there is already an evident stigmatization of the hospital in this part of the world, which can be detrimental in many ways.  At the end of the day, these women are having sex and we should be supporting them with their life choices and encouraging them to value their health.  
Although I have struggled with this, I have learned so much about the importance of psychosocial care.  I feel that Canadian nursing is very much geared toward tasks and relying on diagnostic tests that we lose touch with the environmental safety and emotional health of our patients.  I can confidently say that I will always remember this week on the Female ward and how it has encouraged me to not only rely on tangible objective findings, but to relate to my patient and motivate them to strive for their own health in whatever way that my look like.  
Thank you to all the staff on the Female ward at Lewanika General Hospital.  Sefula Clinic, here I come!
—Shawnel Macdonald 

One Response to “Reflecting on the Woman’s Ward- first week of clinical”

  1. Unknown

    Dear Aileen and Shawne,

    You have covered a lot of ground this week on the Women’s Ward, that is very clear from your posts. Yet, you are already reflecting on it and integrating what you have experienced into who you are becoming as nurses. And in reading your thoughtful posts, your stories also inform who I am as a nurse as well – and who I want to be. You have sensitiviely navigated some very challenging ethical waters by staying close to what matters to your patients – your presence, respect, and compassionate, knowledgable care. Lucky them and luckier you,

    Tricia

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