So Tracy, why Malawi?
I knew that I wanted to do something different the moment we started talking about our clinical placement options earlier on in the study year. I thought it would be great to see the nursing care offered outside of South Africa.
Friendships developed this year with Malawian APFP nursing colleagues, Mtisunge Joshua, Chikondi Chimbatata and John Mhango made Malawi an easy choice.
Tell us about your travels:
I flew to Johannesburg on Friday 20th June 2014 and met up with Mtisunge and Chikondi. We spent the night in Johannesburg and met up with John the following morning at the bus station. From there, Chikondi caught a bus to Lilongwe in Malawi, while John, Mtisunge and I boarded a separate bus and began our trip to Blantyre. The picture above is of the three of us on the bus.
Our two-day bus ride took us through the rest of South Africa, Zimbabwe and Mozambique, into Malawi and onto Blantyre.
On arrival in Blantyre, I went straight to the Beit Cure International Hospital residence to settle in and rest from the long bus trip. Mtisunge went home to her husband and son in Blantyre and John travelled onwards to Neno to be with his wife and son.
On my first morning in Blantyre, I visited the Kamuzu College of Nursing (KCN) to process my final registration with the Malawian Nursing Council and to meet with Associate Professor Angela Chimwaza, Mrs Miriam Simbota and Mrs Maureen Majamanda , who are co-ordinating the Masters in Child Nursing programmes at KCN.
What were your first impressions of Blantyre and Malawi?
To be honest, I expected Blantyre to be a bit like Johannesburg, so I did get a bit of a culture shock when I arrived, as it is more rural and less built up than a South African city. Being in Blantyre (and Malawi itself) is like being back in nature; it was an awesome experience! Seeing how the Malawians live so simply helped me to appreciate the little things.
Tell us about your clinical placement
I did my placement, with Mtisunge, at Gateway Clinic. Gateway is a government funded clinic situated down the road from the Queen Elizabeth Central Hospital, one of the biggest hospitals in Malawi. Gateway was built to relieve some of the demands felt by the main hospital and provides primary and secondary level care.
The clinic staff team at Gateway is comprised of three nurses and one professional nurse, who are assisted by clinicians.
While Gateway is a newly built facility, it is very busy and sees about 100 patients a day, mostly for malaria screenings, severe malnutrition (which was a real eye-opener for me), pneumonia, and immunisations, and for minor ailments.
Screenings, observations and triage of patients are done in one room (see above picture) by a team of nurses, each one responsible for one of the activities for the day.
The first point of contact for a mom and her child is at the door at the weighing station. Moms and caregivers know to wait outside until their child has been weighed. Once inside the room, moms/caregivers are directed to benches, where they wait their turn to consult with a nurse or clinician.
I took a turn working at each of the stations – weighing patients, doing patient observations, sitting in on consultations/triage and helping with referrals to Queens Hospital.
What were some of the challenges you faced at the clinic?
Most valuable was that I learned to improvise at the clinic with the little resources available – I had to make a plan. That is what nursing is all about.
I naturally experienced communication barriers while working with patients. While many Malawians can speak English, we saw patients from rural areas who only spoke their local dialect. But I knew that I had to go to Malawi with an open mind and to expect things to go wrong or to be challenged. Working with Mtisunge was a great help; when parents were noticibly uncomfortable about being helped by a foreigner, I simply called Mtisunge over to help me.
The Queen Elizabeth Central Hospital
In my second week in Blantyre, I had chance to visit the paediatric ward at Queens Hospital, thanks to arrangements made by Professor Chimwaza from the KCN. It was a very sad experience for me – the hospital felt very rural and the building was very old. In the high care cubicle, wooden shelves with a mattress make space for two or three children. There are very few nurses to care for patients who are ill, with malaria, severe malnutrition or other illnesses. Some wards had a ratio of one nurse to about 30 patients and that was very alarming to me. On a very postitive note, unlike in South Africa, every patient had a caregiver at the bedside and breastfeeding appears to be a norm.
While Queens Hospital definitely lacks resources in the forms of monitors and equipment, what was clear was that nursing in Malawi is a PASSION. While many nurses in South Africa may do nursing for money and to have a job, you can see that nursing is a calling in Malawi. Nurses are nurses because they want to be – despite the many challenges. I really admire them. Back home, we are so quick to complain about the workload when there is a shortage of staff. I have learned to appreciate what true nursing care is actually about. Nurses in Malawi are coping despite the shortages – they just do it! It became clear to me that, in South Africa, we actually have nothing to complain about…
Did you eat some interesting food and see some of the country?
Yes! I spent my weekends sightseeing. I visited the Mangochi District on Lake Malawi with Mtisunge, where I had my first Malawian meal - Chambo, a popular fish to eat in Malawi.
I also visited the Nursing College in Zomba, which is a satellite college for the KCN, to meet Mtisunge’s brother who is training as a nurse there and to have lunch with her and her family.
I tasted mouse! I ate locusts, pumpkin leaves (which I originally thought was spinach), cassava, the sweetest bananas ever and nsima which is ground white maize flour cooked into a type of porridge or ‘pap’ and a Malawian staple.
I bought six large mangos only to find out that they were cucumbers! (Made a complete fool of myself, but I guess one learns when you travel that you should not always expect to find things like they are back home.) It's all about having an open mind.
I was also lucky to be able to visit John and his family in Neno, which is a 3 – 4 hour drive from Blantyre and is situated on top of a mountain. Both John and his wife, Mercy, are nurses who work for the district hospital in Neno.
My two days with John, Mercy and their son felt like the holiday part of my trip – it was a highlight! I got to collect water from a borehole, see how maize was milled, and experienced the simplicity of Malawian living, while being completely surrounded by nature. It was wonderful!
Recommendations for future students?
Two weeks in Malawi was really not enough! I wish I had been there for a month. Future students should plan to stay longer, if they can.
I strongly recommend that other students do their clinical placements in another country. It was just so nice to see a different side of nursing.
How much did it cost you?
Total cost: R1, 955.00 + R1, 980.00 + R1,780.00 = R5,715.00
Total value of the experience: Priceless!
My stay at the Beit Cure Hospital residence only cost me R1, 315.00 for all the time I was there, and included breakfast and supper each day. I was very impressed with the accommodation: it was lovely and clean, I had a room to myself and lots of space in which to make myself comfortable.
Tracy Ann Castle is a Professional Nurse from the Mitchell’s Plain District Hospital in Cape Town. She has worked for over 20 years in the nursing profession - seven of these as a Professional Nurse and 18 of these with children. She has a passion for working with kids and so it is not surprising that she has chosen to further her nursing training with a postgraduate diploma in children’s nursing. Tracy is currently completing the diploma through the University of Cape Town’s Child Nurse Practice Development Initiative and Department of Nursing and Midwifery.
Jane Vos - Programme Manager
Tel: +27 (0)21 658 5492