WHAT IS DEBBIE DOING HERE?

So now it is my turn to try and tell you about my day. I work for Good Shepherd Hospital about 3 or 4 days a week, but some of the days are working at home on the computer. On a typical day that I go to the hospital, I leave the apartment about 8 AM to be greeted by the students here on campus. They all smile, wave, sign hello, and I get an occasional hug. Some are pretty affectionate and I guard my white lab coat as I walk (remember all laundry is done by hand). It is a 25 minute walk. Some days, if it has rained, it is a slip and a slide in the mud, guarding my lab coat, until I get to the tar road. At the tar road I am joined by Swazis either walking to work or school. There are a lot of exchanges of greetings and smiles. The walk is pretty and I enjoy the scenery on the way to work as I know it will be much hotter on the way home.

At the hospital I am greeted by, “Sawubona, Siphiwo.” Some of the doctors call me by my American name but mostly I am Siphiwo at the hospital. I am working with the Senior Matron (Director of Nursing) and the Quality Improvement Department. There was a flurry of activity in the last couple of years because a South African Accreditation Agency was brought in by the Swaziland Government to help improve quality. GSH has been reviewed 11 times, going from a score in the 20s to a score in the 60s, the second best in the land. I am so impressed with what they have done, with no training except for what they could find on the internet, and a lot of hard work. It is hard to believe that in this land of HIV and TB, they didn’t have an Infection Control Nurse at the hospital until 2008. HIV education was just added to the Nursing curriculum in Swaziland this year, so what the Infection Control nurse knows, he got from the internet, as well. But I digress. I have been told, “I am a gift from God” (how intimidating is that!) as now they have someone in the flesh that can help them out. The problem is where to start, although I guess that was decided for me as the Senior Matron wants the policies organized and meeting accreditation standards. So currently I am working on an electronic policy data base as it is not really known what policies they have nor what they need. So, part of my day is spent going from department to department figuring out the current state of things. Sometimes the policies I find remind me I am in Africa, like the one from Maintenance on how to make crutches. Sure enough, I was in Maintenance Dept. the other day, talking to the Director, and in the corner of the room was a bunch of wooden crutches made from tree branches. I was rather impressed by their quality. Another part of my current work is helping the QI department produce a realistic work plan for the next twelve months. High on my list is a TB infection control program as it is the second most frequent diagnosis and I worry about staff contracting the disease as I often see them in the TB wards with inadequate masks. Hopefully, I can persuade the QI team that it should be high on their work plan. Lastly, I am starting to work with Home Based Care to improve discharge planning from the hospital to their service. All this work goes by fits and starts as often meetings are cancelled, a problem throughout Africa, and operating on Africa time, which means no one arrives on time to the meetings we do have. It is frustrating, but my main job is to build on something that is sustainable, so I have to accommodate to their work pace and culture. This means, among other things, 10 AM tea breaks, even in the busiest and hottest of days, and hour lunches at 1 PM.

The hardest part of my job is to keep everything in perspective. It is so easy to be paralyzed with the sadness of 4 year olds with TB and HIV, or a mother’s tears when her toddler is just diagnosed with HIV. It so could have been me or my children born in this country, plagued with remnants of colonialism, corruption, gender inequality, disease and poverty. But instead, I am healthy, well-educated, and in eighteen months, I will fly back to my suburban lifestyle and not be afraid of what disease might catch my grandchildren. I can’t be angry and sad for the rest of my stay here. But I also don’t want to get to the place where I don’t see the suffering. Finding the balance and being okay with what I can accomplish will be the challenge of my time here.

So at the end of the day, I take out the umbrella to keep the sun off my mhlope skin, and hurry home to the noise and smiles of the students on campus. This time I don’t care how rumpled my lab coat gets.