Saturday, July 26, 2008

Show Us That You Care

2 July 2008, Wednesday

After chapel we joined Catherine Ndolo, a nurse midwife technician who is rotating through the operating theatre. Wednesday morning is the time for scrubbing down the OR from top to bottom. (They also do it after every procedure.) I think Catherine was a little surprised that we wanted to go into the operating room to document the scrubbing but we assured her that's what we wanted to do and so suited up in gowns and rubber clogs. And from 9 AM to 10:30 AM, Eileen took photographs and I recorded the sounds of the scrubbing, mopping, splashing of water, etc.

After lunch I recorded the audio interview with Catherine Ndolo. She seemed rather shy but she has quite a story to tell. After being a nurse for a while in various urban settings, she came to the Embangweni area to care for her ailing father. And then when she wouldn't leave him, he said she'd better get a job at the hospital. She saw what good care they took of her father in his last days, so felt very grateful and continued even after he died. Then later, when some U.S. friends raised money so she could go to San Francisco to get a carotid tumor removed from the left side of her neck, she figured she had better stay with the hospital. So she's been here for 14 years.

There are drawbacks, of course. Transportation is a big issue and food. It used to cost 50 kwachas to get to Jenda on the dirt road, Ndolo says. Now it's 700 kwachas. By comparison, the whole trip from Jenda to Lilongwe on the tarmac road is 700 kwachas, she said.

Alas, I made a mistake in downloading the audio file and didn't double-check to make sure I had actually backed it up before I erased it from the card. And so will have to do that interview over again. Also, I realized I should try to get a quieter room next time. That could be a bit of a problem around here. Always everywhere, somebody is talking and the sound carries through all the open windows.

Am struck by the sense that Ndolo stays because this is a place that cares for her as a person. How do you put that sense of caring for people—for patients as well as staff—into a strategic plan? The message was pretty clear when I saw that miniscule bar of soap at Kamuzu Central that somebody didn't care what the nurses had to wash with—either there wasn't much soap to begin with or staffers were stealing it.

Of course, not everyone will feel obliged to repay a debt of gratitude. Catherine Mzembe, who is head of nursing or matron at Embangweni Hospital told me the story of three male staffers who were sponsored by the hospital for further education and left before completing their bond—basically an agreement to work for several years after advanced training—and two female nurses who left—one to get married and the other who was hired away by an NGO, which paid for her bond.

Evelyn Chilemba and Diana Jere at the Kamuzu College of Nursing told me two weeks ago they had re-introduced a requirement that all nursing student candidates be interviewed in person as well as pass an entrance exam because they wanted to weed out those who saw nursing as just another paycheck.
And of course, there is a prisoner's dilemma aspect to all of this. You can be the most caring person in the world, but if enough people around—and above you—don't care, then for your own survival you probably should stop caring as well. Otherwise, everyone around you will just take advantage of your compassion. But that just makes a bad situation worse.

(NB: This post was written on site in rural northern Malawi and posted now that I again have internet access.)

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