How to teach in West Africa

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Specializes in PICU, surgical post-op.

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.

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Specializes in Nephrology, Cardiology, ER, ICU.

Wow!!

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Specializes in ER/Acute Care.

What an awesome experience! I can't wait to be able to do things like that :)

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Thanks so much for sharing! I am considering a mission in southern Africa right now and am excited about the opportunity.

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Specializes in Home Care.

I've been to southern Africa a few times as a tourist, my dream is to be able to nurse over there.

Thanks for digging up this post. :)

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Are you on the Africa Mercy?

I can't wait to return to Africa. She has my heart.

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Specializes in PICU, surgical post-op.
Are you on the Africa Mercy?

I can't wait to return to Africa. She has my heart.

I am indeed on the Africa Mercy! Well, not right now ... I'm home for a quick vacation, but I'm headed back soon. Have you been? Or are you coming? =)

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I am indeed on the Africa Mercy! Well, not right now ... I'm home for a quick vacation, but I'm headed back soon. Have you been? Or are you coming? =)

I lived in Swaziland for 6 months and grew up in Kenya for 4 of my childhood years. Anyway, we were accepted to join Mercy Ships and really wanted to go on Africa Mercy, but due to certain circumstances never went. We are planning on returning to Swaziland in a few years.

How is life aboard the Africa Mercy?

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Specializes in ER, ICU.

First, hats off to you. Your comment "The instructions are actually fairly simple" is pretty funny in light of your difficulties. It sounds like a great educational challenge. You need to frame the instructions so they fall within the paradigm of her life. If she doesn't have a sense of time, then time is off the table. Maybe you can find landmarks in her day like breakfast, when the sun hits midday, when the lions sleep, or whatever. Teaching her to understand your paradigm seems overly optimistic. Best of luck!

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Specializes in Med Surg.

Please tell me how you got involved with this. This is EXACTLY what I want to do with my life and have been searching for an opportunity with no luck. ANY information you give would help!!!!!!!!!

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