My first Day on Assignment

I woke up this morning and began my day with a workout session at 6AM in my room (I brought my workout DVD's with me and play them on my laptop)and watched the sunrise over the mountains. The country is very mountainess and the hotel we are staying at is high up looking down on the valley. I took a picture of the view from my room but I am not yet able to upload them here (I will figure this out). After breakfast we were driven to the Nazarene College of Nursing and the Raleigh Fitkin Memorial Hospital (RFM)which are both on the same campus along with several other primary schools and of course the church.

The College of nursing was first established in 1928 by Rev. Dr. David Hynd and the missionaries of the Church of Nazarene. They only admitted women students unil the early 1970's when men where admitted as well. It is the major school of nursing here in Swazi and has two nursing program. The General nursing program which is a 3-year diploma program and the Midwifery post qualification program which is one year after your general studies.
The current students:
1st years: 94 (about 30 are men)
2nd years: 88 (about 40 are men)
3rd years: 83 (about 39 are men)
The students come from all over swazi and some from other countries as well. Most have taken a test to be admitted and the government pays their fees which are about
E30,000/year in total ($3,000 in U.S funds). This amount includes all fees for instruction, books, uniforms, and board. The average nurse here that is dual qualified makes about E8,000/month which is $800 U.S. dollars. It is estimated that on that amount each nurse is supporting about 5 people since many of them have the only stable job in their families.

The school Administration and Faculty: The principal (the equivalent of the dean) of the college is one of only 3 PhD prepared nurses in the entire country. Her name is Whinney. The Deputy director position is currently vacant and has been so for almost two years. There are then three coordinators in the General Nursing Program. A first year coordinator, second year, and third year. These thress women all have Master's degrees and are Senior Lecturers (also called Sister's). On the same level is the coordinator of the Midwifry program who is also Master's prepared and a Senior Lecturer. In total the college has 13 faculty members and only three of them are men (Adam, Simon, and Sownyboy). One of the male faculty members is currenlty pursuing a PhD at the University of South Africa. All of the men are "Mister's and Lecturers".

RFM Hospital: We took a tour of the RFM hospital as well today and wow are things drastically different here. The hospital is a series of interconnected single level buildings (the wards) and one connected two story building (with administrative offices on the 2nd floor). You have to walk outside to get to each building as well. The following wards and department at RFM include:
1. The lab
2. X-ray dept
3. Pharmacy (with outpatient and inpatient sides)
4. Labour and Delivery: The women deliver (about 19 -25/day)rest for 4 hours and leave with the bady.
5. Post-partum: This where they rest. In this ward is a Pre-mature baby room, Isolation room for mothers and babies who may have communicable diseases, and a resuscitation room.
6. Female surgical ward, with the Gynae ward
7. Female medical ward
8. Male medical ward
9. Supply area
10. Laundry area
11. Mortuary
12. Childrens ward (very full today)
13. Male surgical ward
14. Out patient clinic area (Open court yard with designated exam rooms (Medical follow-up, Eye room, cast room, etc).
15. Private Ward (Patients with money and who can pay are treated better)
16. Private Out-patient dept: Again if you can pay for it (nicer waiting area).
17. Emergency Dept: Very busy with an observation area
18. Maternal-Child Oupatient clinic: by fare the busiest and most crowded area. Women line up and sit on benches and wait for hours to be seen. It is first come first serve and some are sent away at the end of the day. They do not triage the patients so people have died while waiting in line to be seen.

I can not fully describe the conditions, and I do not mean this a bad way but the conditions are not anything that we would tolerate in the United States for a hospital. The smells in some the wards just took my breath away. There is so much need and so much to do I can see how one can easily become overwhelmed as to where to start.

So where will I start and what will be doing:
1. I will be doing some work on teaching physical assessment to the the student nurses, the staff nurses in RFM, and the faculty at the college of nursing. It will be general physical assessment with an added emphasis on what to assess for related to HIV/AIDS. The nurses do not do much actual hands on physical assessments and most do not use a stethoscope at all. So I will helping to build there capacity in this way.

2. Research concept paper: I will be assisting the principal (dean) of the college of nursing to complete a paper on how the college can integrate research concepts into their curriculum. They hope to get funding to do this so the concept paper will help them write a proposal for funding.

3. Staff nurse preceptors: I will be role modeling in the wards for the staff nurses how to be preceptors to the student nurses. The students are currently left on the wards unsupervised for a great deal of time in groups of up to twenty sometimes and this is of course not working. The groups have been cut to ten but with out enough faculty (remember there are only 13 faculty members)they can not supervise them all them time. They have to rely on the nurses already on the wards whom for the most part have never been taught how to precept a student.

4. Student leadership: I will be assisting with helping the SRC (Student Representative Council) with some leadership development skills. The students need to learn to help each other and they are not organized to do it effectively. The male students will also be brought together for a special session of just the men.

5. New bachelors program: The principal (Dean) has also asked if I would take a look at their proposal to establish a new BNMS degree program. The BNMS (Bachelors of Nursing and Midwifery Science) will be a 4-year university degree program. They are attempting to become a university themselves but until then will partner with the University of Swaziland to offer this new degree once it is approved. I will review the proposal and give her back any comments I may have about it.

Ok that is a lot in only 3-weeks but I did come here to work so here I go. I am so excited about the possibility of being able to make even a small difference is how nursing is done here at this college and hospital. It will be small steps but a bunch of small steps over time add up to great distances.

More, Later