Lost and useless; a western nurse in Africa

I heard retching. A familiar sound. I turned to see the 17 year old with the stomach ulcer vomiting blood. First old, dark blood that could just be mistaken for an entire cup of coffee, that suddenly decided to expell its self from its host stomach. Then came the fresh blood. A familiar scene. This is a day like any other in the nursing profession.
Or it would have been if I was at home in London.
Nursing brain activated… Get a bowl, close the curtains, get clean laundry, a mop, a bucket, check observations, clean, call the doctor, speed up fluids, give medication, order blood, book endoscopy and throughout all, give a smile, hold a hand and look confident as you proclaim;


“everything is going to be just fine, don’t you worry”.

The problem was I was not in London and there was nothing familiar about my surroundings. But my brain works the same, It has been programmed in a western environment and it has been washed to act a certain way. As a nurse I function according to set guidelines and principles that have been created in the western world. I followed my new nursing colleagues around my new hospital in Madagascar and I felt the need to reboot. My brain needs to work differently. I am here as a learner. My job is to work along side these nurses, mentor them and teach them what I can: But as I follow, listen and integrate with the community here, I am at a loss.

The bloody vomit spreads across the dirty hospital floor… Nursing brain activated. There is no bowl, there are no curtains, there is no laundry, there are no mops, there are no buckets, observations lead to no intervention, no endoscopy, there is nothing to clean with, the patient can’t afford blood, the doctor has nothing to say, fluids are running and any medication will need to be bought by a relative prior to administration, if he has one. So my nursing plan of care shrivels up from a holistic and exuberant bloom to this; speed up fluids and hope he can buy more, wait for the relative to buy medication, hold his hand and throughout proclaim;

” everything is going to be just fine, don’t you worry”
But everything is not fine according to the western nurse. Her compass needs to catch up.
It is useless to take our set of values and knowledge from the western world and try and make that fit in to everyone elses world. History cries out and will echo far in to the future that one size does not fit all and never will. We have to provide something relevant, applicable and useful.

These nurses are strong. A western nurse deals with terrible situations on a daily basis, amongst staffing shortages and continual politics. The NHS is hard work … I can verify that. But in these last few weeks I have seen incredible strength and courage acted out amongst my new colleagues that is not found in the NHS.  They work 24hr shifts, with the help of students but no other nurses. One nurse, 24hrs hours, 50 patients and no supplies. I asked them what is hard about your job, one nurses response was heart breaking,

“With emergency cases sometimes I just want to cry, if they can not afford the treatment, there is nothing we can do”
Everything from a fractured femur, appendicitis, perforated bowel, and an obstructed labour comes through the hospital door and if there is not enough money then they walk/ hop/ or get carried back out. Those operations don’t happen and the questions that you are conjuring up are neither asked nor answered. As the pregnant lady walked away I wondered whether she will be in our next VVF schedule, as the baby with 25% burns disappears I wonder if she will require or be ready for plastic surgery by the time our plastic surgeon arrives.
We come because there is a need. We come to fix problems, and it’s beautiful to see the lame walk and the blind see, but it’s devastating to see the very problems we come to fix, actively break before your eyes, knowing there is nothing you can do.


Education hardly seems to scratch anything off the surface.
It feels like it can’t possibly even make a mark.
It seems useless when you focus on the scale of the problem, but we have to focus on the few things we can do, and not on the list of things that we can’t.
Otherwise we wouldn’t get up in the morning and start scratching the surface.

Sometimes you just have to scratch and hope you make a mark.

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