APRIL 2017 EMERGENCY FUNDAMENTALS

It’s eight in the morning in Mongu, and it is hot. Four women are in a cafeteria at the Zambia Enrolled Nursing School, setting up for the day. There is no air conditioning. No cool breeze seeping through an open window, just the thick, stagnant, hot air touching their skin. Danielle’s hair is huge and frizzy. Victoria has a spot of sweat on her back. Anna, as always, is smiling while blinking the sweat out of her eyes, and Beth has a shiny glaze on her face while she tries to set up the projector. Do you feel like you were there with them? Good.

A few moments later, students start to trickle in. They are a mixture of nurses, physicians, and clinical officers, all of whom are dressed in their best for the occasion. It is, after all, an honour to be chosen to participate in such a course by the medical superintendent and nursing supervisors. They check themselves in at the front desk, printing their name and their lunch order for the day on a blue piece of paper. They seat themselves at a school desk, settling uneasily into their creaky metal chair. In front of them, a pile of notepaper, a few spare pens, and a notebook reading “OkaZHI Emergency Fundamentals Course” sits, neatly aligned. They fit in a few last greetings with their coworkers in Silozi before beginning their first day. Nervous chatter fills the air. How did they find themselves here?

Suddenly, the four young women are standing at the front of the class, with white cotton t-shirts that read “OkaZHI” sticking to their skin. “Who would pick cotton shirts to wear in the Zambian heat?” the students thought. Slightly shifting nervously in their position, the girls begin to introduce themselves. Two have been to teach in Zambia before at the Emergency Course last year, two have never been here before. They all are experienced, specialized emergency nurses from Canada. And they are here to teach. Emergency medicine, they say, is important. Emergency medicine, they say, can save lives. Emergency medicine, they say, is life or death. The students sit up a little straighter in their seats.

Sick patients. Really sick patients. Coming, to the Lewanika General Hospital Outpatient Department. “What would you do?” the girls in white cotton continually ask the students. “How would you save them?” At first, the students are nervous to answer. “Do I know how to save someone?” they think. “I know a lot of things, but what if my answer is wrong?” Questions are repeatedly asked to nervous learners. “Emergency medicine sounds tough”, they think. “What if I don’t have what it takes?”

Day 1: they learn the alphabet. But not the alphabet that kids like to sing. This alphabet deals with life and death. “Who is sickest?” the teachers ask. “Who needs to be seen first?” The students think hard, they prioritize. They have learned this alphabet before, but not in this way. Case scenarios are presented in front of them. “Who would you see first? Who can wait? Who are your Emergency, Priority, and Queue patients?” the women ask. Nervous chatter fills the air again. “Will I ever get the hang of triage?”

Next, the women corral the learners in to an even hotter area where mannequins are laying on gurney. The learners are whispering – it’s been so long since they practiced on mannequins. And then they start – pumping hard, pumping fast – on the mannequin’s chests. “Really?” the students think, “In this heat?” Cardiopulmonary resuscitation is draining everyone’s energy levels. But they must learn to work as a team, the girls say repeatedly. Everyone must know their role. This is, after all, life and death.

Day 2: Bright and early, the learners begin to file in for another day. Just as hot as before, just as nervous. Their heads are swimming from all the information they were taught yesterday. “How,” they think, “can we learn anything more?”

But today is all about teamwork, the teachers say, and if the Lozi people know anything, it is how to work together. The students learn what makes an effective team. They learn how teams can be effectual, and what holds a team back. “Who knew there was so much to it?” they think.

The afternoon is devoted to Trauma. “Great,” the learners think, “maybe we can discuss the emotional trauma from the stress of this course.” But instead, the teachers show them how everyone on a trauma team has a role, and when everyone knows their role, lives can be saved. The students watch a demonstration of an ideal trauma team, and then are put to work. “Will we ever be able to get it right?” they think. All afternoon, they practice. When the teachers finally dismiss them for the day, the students slowly pack up their supplies. They are tired, and their minds are swimming. “We’re only halfway through?”

Day 3: It’s still hot. This shouldn’t be a surprise; every day in Mongu is hot. Danielle has still not learned how to tame her hair. The locals are offering her hair products. The teachers set up again for another day, and the learners sit purposefully in to their seats. Despite the load of information, they know they are learning important material. And they return for another day, resolute. “Here we go again,” they think.

Today, the learners are taught about mental health. Their mental health, patient’s mental health, and identifying mental health crises. This lecture is followed by learning how to read heart rhythms – an especially entertaining lecture, as the students get to watch the teachers act out the heart rhythms through a kind of weird, spastic dance. “Makuwas, they are crazy.” the students think. But before they know it, the squiggly lines of a heart tracing on a page that were meaningless before are now helping them decipher important clinical information. “Maybe,” the learners think, “we are getting the hang of this.”

That afternoon, the learners are brought back in to the practice room. They know what is coming, but this time, they are ready: more practice with cardiac arrest and trauma scenarios. “Are we starting to actually look like a team?”

Day 4: “This is it. This is the last day.” the students think, as they eagerly pile into the classroom. “I heard there was going to be cake, and certificates!” they whisper excitedly. The teachers walk up to the front of the class, in the same cotton t-shirts, and begin the day with a smile.

Today, the learners are taught about a very special population – paediatrics. Everything seems so much harder, so much more important on something so small. They practice the task of cardiac resuscitation and trauma care on tiny mannequins. Though it is a hard situation to imagine, they realize as they go through that they are drawing skills and information from lectures earlier in the week. “We can actually save them,” they begin to think.

More and more, they practice. The students take turns in each role – Trauma Leader, Airway, Breathing, Circulation, Disability, Medications. What once seemed uncoordinated is starting to come together. The teachers are seeing smiles on the student’s faces. Smiles and sweat, of course.

And now comes the final test. The students once again shift nervously in their seats. They are broken in to team, and each given scenarios. Their victims vary, each one played by a teacher. The goal is simple: Save them.

But now, the students are ready. What at the beginning of the week was apprehension and hesitancy is now knowledge and confidence. Together, the students work through each scenario. And at the end of it all, they realize how far they have come.

“Maybe,” the students think, “emergency medicine isn’t so scary.” “Maybe,” they think, “we can really do this.” Excitement is palpable in the air. “The possibilities,” everyone thinks, “are endless.”