Ugandan Clinical (a work in process...)

Today, I went to clinical with the 2nd year nursing students. Getting all 33 into the bus was a bit of a process, but eventually, after several stops & restarts they all made it on (though one had to chase us down via motorcycle taxi so he wouldn't miss the ride into clinical). Riding into Kampala at 7 am was a slow and methodical. With no traffic this trip would normally take 30-40 minutes. However, at 7 am you are in the thick of traffic, weaving through unmarked lanes --which meant a 1 hour and 45 minute bus ride to clinical!  Sometimes, I heard,  it can take well over two hours. Upon arrival, I broke off with a group of five students and followed them to their assigned ward. Along the way I talked with them some, trying to get to know them better. Since I have interact with this group the most consistently, I really want to learn more about each of them.

The students are divided into 4 different wards (nursing units): male and female medicine/ICU, male and female surgical. Around eight students are in each ward, rotating wards every three weeks. The hospital is a private, catholic hospital with around 25 beds per ward and I think about 2 nurses per ward (one more for the ICU). Before my fellow nurses from the states start to balk, let me say a couple things. First, much of the assistant-type nursing care is done by the family, who also are in charge of meeting many of the personal needs/nutritional needs of the patient. Second, the nurse to patient ratios at this facility are actually pretty good, especially when you take into consideration the couple other ancillary staff that I would see around. Because this was my first time, I still do not have a full grasp of everyone's role. I am sure this will change as the summer progresses and I will be able to fill in more details.

My day was mostly spent learning the role of the clinical instructor in this setting. Grace, the UCU clinical instructor I am following, does such a nice job with the students. She really works at getting them to touch the patients and practice their skills as well as getting them used to reporting off on patients. As the day progressed, I was able to observe how Grace created rapport with the nurses and patients on the unit.

Typically, the day on the ward starts with ward rounds, were doctors round in a group on each patient on the ward. The nurses will follow and help write down the plan of care and usually anyone else on the care team listens in as well. In many ways, this is a great assets because it can ensure that orders can be immediately clarified, nursing questions can be answered, and everyone is in on the plan of care. As in all hospitals, though, this is the ideal and various issues come about preventing this from perfectly occurring. While going around, one thing I really tried to emphasize with the students is the importance of patient education. Often ward rounds focus on talking about the patient, but forgetting to educate the patient. This is an issue in the states as well. Having the students there, however, created a great opportunity for the patient to have a lot of available teachers and for the students to get in a lot of practice with teaching.

Even though on the surface it is easy to identify the differences between health care in the states and in Uganda, the more you analyze some of the issues, the more you identify similar care problems (though perhaps on a different scale at times). There is so much more I could write about this experience, which left me feeling exhausted and overwhelmed, but I feel I am still processing much of it. Since I want to do justice to the experience, I will write more at a later date. In the meantime, please be praying for me and the students as we care for the patients each Thursday this summer. May we work with the grace of God and touch others with the love of Christ.