How to teach in West Africa

I just have to share a story from my shift the other day. As background, I live and work on a charity hospital ship off the coast of West Africa. Two evenings ago, I was precepting a new nurse, and we were faced with quite the education puzzle...

One of our patients was a little old lady who just had surgery to repair an obstetric fistula. The card above her bed proclaimed her age to be thirty-five, but the lines on her face told a different story. I had to teach her how to train her bladder, to learn to control the urine that's been flowing freely for so many years. The instructions are actually fairly simple. For the first thirty days, go to the bathroom every hour. Increase that time by half an hour over the next two months, fifteen days at a time, until you can hold your urine for three hours. We had a chart printed out, with different coloured blocks and everything. But this particular old lady has no concept of time. When we say measure your time in hours, we might as well be telling her to perform backflips and cartwheels. She was born in a small house in a village way up country, and that birth was never registered so she never went to school. She's spent her life ruled by the rhythm of the sunrise and sunset, pounding cassava and washing clothes in the river. How on earth were we supposed to teach her? Through two translators, from English to French to Yoruba and back again, we had the following conversation.

Each box on this paper is one day. Here is a pencil; each time she sleeps, she should mark one box.
So, she should mark each time she goes pepe?
No, each time she sleeps. One mark for one sleep. Is there anyone in the village who has a watch?
Yes, she thinks there is one man who has a watch.
Can he read?
She's not sure.
Can anyone read in her village?
She thinks there is someone who can read.
Okay, these directions are in English. We will translate them to French. She should have the person who can read and the person with the watch help her. There are directions for when to increase the time. See? The boxes are different colors.
She doesn't understand. The person who can read will have to explain it to her. She won't remember.
All she needs to do is make one mark every time she sleeps. The man with the watch and the man who can read will tell her the rest.

The rest of the shift involved teaching another completely illiterate woman how to manage G-Tube feedings for her baby when they're eventually discharged home to their village. I love my life over here.