clinical supervision

My day starts at 5 a.m. when my alarm rings to through me out of bed. By this time its just starting to dawn and the birds are already busy talking to each other, especially the crows which is not the nicest music. So I get up and turn the water heater on. It takes about 20-30min to heat up the water for my morning bath. While this is happening I prepare myself some breakfast, usually toast with peanut butter and jam and a cup of tea (all Malawi-made of course), fills you up and is quite tasty! I iron my uniform and clean my shoes. Then I start to fill the bath with water. Its not exactly that it comes out in a stream, its more like a little trickle so I start just doing bucket washes which is not so time consuming. A real long bath then in the weekend.. Besides the usual washing procedure I often need to wipe up the water in my bathroom coming from the window and other holes in the wall. During rainy season this never really gets dry so every morning and every evening I find a bigger or smaller pond in my bath. Hello fungus!

Usually by 6:30 I leave the house and walk the 30min along the streets of Mandala (which I found out means “money” in one of the tribes languages, so I basically live in money, fine for me) while the sun has already risen up and making me sweat.
At around 7 a.m. I reach the campus just to find.. usually no one. There is arrangement made with one of the college drivers to pick the students up from their hostel just around the corner at 7 a.m. but reality looks different. First of all the driver has to collect the off campus students, usually clinical officer students or nurse students, but they don’t need to be at the college before 7:30 a.m. so they don’t need to hurry. Even though there is one middle size bus and one minibus available it seems not to be possible to pick up two lots of students in the same time, they say because of the fuel or because usually one of the vehicles is broken or needs to be cleaned or something like that.

So I walk to the hostels to wait for the bus together with the students. On the way there I ask myself why I still come here for 7 a.m. every morning but I convince myself that it’s a good example maybe someone notices. At the hostel is a lot going on. Students leaving or coming back from night shift, having breakfast, playing music, getting ready for work. I stand outside with some of them and chat about last days shift. I think they´re still not quite used to having one of the lectures in their part of campus but they seem to enjoy and ask me a lot of questions about Europe and my work there.

Every single one tells me that he wants to go to work in Europe once. Some are surprised when I tell them that in Germany we don’t speak English, that the official language is German. Hard to believe for someone brought up in Malawi it seems where English is more like an official sign showing you are educated and well off then just a language. Although everyone is proud of their Chichewa and I think they can be!

The bus arrives around 15min past or 20min past 7 a.m. but yet we can not leave (by the way duty starts at 7:30a.m.): the kitchen is not ready preparing the lunch boxes yet. It wasn’t communicated to them that they have to be ready by 7 so we have to wait. I don’t know who is responsible for that but they promised to be ready by 7 tomorrow. So slowly the bus fills up with about 20students, some going to Zingwangwa, some to Limbe, some to Ndirande and some to Mlambe Mission. We also collect the students who are on nights this week (and already waiting for our arrival) so there s not enough space for all. So arrangements have to be made who´s going first and who´s going later, discussions start and all gets a little bit out of control until somehow the students have organized themselves and we can leave. I think to myself we should make a list of everyone who goes first, who gets collected first and who´s second and so on. There should be a list for everything, for the food arrangements, the transport, tick who´s present, tick who´s late and how late, tick, tick, tick. How can you ever get this in order. We stop at the college again, its 7:45 by now. The students need to collect Sobo (an orange squash, they´re entitled to one bottle for 10 students per day) which is kept in one of the lecturer´s office who hasn’t arrived yet. Also gloves need to be collected but its only one box a week and no one kept record who has already collected and how much. Again I wish there was a list, but the person who keeps the gloves in the office doesn’t have a list so I just hand them out, trusting the students and thinking as long as there´re still boxes we should use them. Someone tells me that Mlambe is a special case because it’s a private hospital and they have to get a box per day, as the patients have to pay for that otherwise. Sounds fair to me. We´re waiting for the key of the “sobo-office” after another 10-15min we can finally leave. Note: now its past 8. We start our trip to Zingwangwa where we drop the antenatal students. Yes I was in Zingwangwa for the first placement but it got complaints that there are not enough deliveries for the amount of students who are located there so they have taken the labour ward students from Zingwangwa and split them up into one half going to Limbe now and the other going to Ndirande as these are the more busy hospitals. All 24 students who were on the antenatal ward in Queens now got sent to Zingwangwa, yes 24!

Here ae some pictures from my week with the students in Limbe:

Limbe Health Centre before the madness starts

Maria, Jack and Davie

labour beds

the equipment

the madness aka antenatal clinic

postnatal/antenatal ward

the whole Limbe crew (from left to right: Eunice, Justina, Charles, Maria, Jack, Davie, Patrick. front: me, Simock and Grace)

Anyway. After dropping these 24 in Zingwangwa the bus is nearly empty so we go to Ndirande where I hop off with the 5 students I am supervising in labour ward this day. The poor students on nights are already waiting for now nearly 1 hour to be collected. The bus goes back to the college to pick up the Limbe and Mlambe crew, until the last group reaches their placements it will be almost 9, meaning the night students have been waiting for almost 2 hours and the day shift is almost 2 hours late on duty. Only because there´s not enough transport and if there were there would be not enough money for fuel. So it is just the way it is.

Starting my shift with the students is a bit easier in Ndirande then it was before in Limbe or Zingwangwa. First of all the group is not so big anymore as half of the group is doing nights, second of all they actually have a table and some chairs in the labour ward so it is possible to sit down and have a proper hand over. The official handover has already been given so we have to do a little one for ourselves as the midwives have already vanished. Helpful here is the report book where usually every patient in the ward is written in. So the students get allocated to different clients, the clients who are initially just behind the curtain and could listen to the whole handover if they speak English. So the babies get born and I am busy trying to make the students document everything, not to forget about the vital signs and the importance of 4th stage of labour blablabla. The Malawian women are amazing! Not a peep, not a complaint, absolutely natural they go through this long path of giving birth and often without a scratch on the perineum. I try to teach the students to encourage them in speaking out their concerns or ask if they have any questions but the women are just quiet, they have too much respect it seems. It is easy to take advantage of this power you have as a care giver so this is one of my goals to teach the students that it is possible to work hand in hand with the women. It is so motivating to see one of them just taking the woman´s hand or showing her another position where it´s maybe not so uncomfortable.
Midday we have an hour break, but often we´re too busy to take the full time. I try to introduce the system of relieving each other because someone should stay with the woman but that only works when I am actually around and say who relieves whom it seems.

The Ndirande crew with newly delivered mom (from left to right: Emanuel, Doreen, Thandizani and Nelson) William is taking the picture

By 5p.m. the shift is over but it usually takes up till 6:30 p.m., after dark, until I am home because again we have to wait for the bus and then collect other students. So it’s a long day but when I am home, had my dinner and am off to bed I feel that bit by bit it actually works and little by little we can make it a little bit better. I also learn a lot for myself. Patience first of all but also how strong a woman in labour is, how tough a baby. How to trust your intuitions when you don’t have anything by hand, like a CTG or Doptone, not even a sterile delivery pack sometimes. It doesn’t mean its better but it makes me understand what it actually means to be a midwife. It means to be mid (=with) the wife (=woman). I now can feel almost every position of the baby just by abdominal palpation, can tell the size much better, if its maybe twins and in which position they are, can hear the heart beat with the Pinard and can tell almost by the minute when the baby will be born. I love my job and Africa inspires me!