I’ve been meaning to write about clinical for a long time.
I’ve been waiting until I didn’t feel so much about it to post.
Clinical is fucked. At the very least it is a huge shit mix of emotions. Because it’s so hard to describe how I actually feel about it, I’ve taken three separate posts and put them into one.
In my heart, clinical here is so many things. It is terrible, it is beautiful, and it is real.
The terrible.
Sometimes things here hit you.
Some days, you just really see it.
Some moments, you are so aware. So aware of where you find yourself. The reality of this place. The reality of this life. The reality of their lives.
Some days, Rwanda breaks me.
And I see you standing there, wanting more from me, and all I can do is try.
And I see you standing there, I’m all I’ll ever be, but all I can do is try.
Looking around the room. Every single patient. Every single one.
You deserve better. You deserve the life I had. Have. You are deserving. You are deserving. You are beautiful. You are better than this. You are better than me. I know what you think about me. I think it too. I don’t know what to do. One step towards you, one step away from them. There are so many. You deserve.
Sometimes it just feels like you are falling. Some days, you are just waiting to hit the ground.
The beautiful.
I remember the first day I met Patrick.
I remember my first day in the hospital.
I remember the first time I cried here.
I remember the first person whose hand I held.
I remember the first time I really saw this place.
I remember feeling like I needed to run and never stop.
I remember looking again.
I remember seeing it again.
I remember the beauty of Rwanda.
I remember the way it makes me feel.
I remember the most painful kind of wonder.
I remember laughing.
I remember when she gave her last.
I remember the mystery she held in her smile.
I remember the indescribable feeling of my patients.
Their eyes. Their hands.
I remember sitting on his bed.
I remember looking at each other.
I remember feeling so privileged to be allowed into their lives. To be invited. To be there. To be only there.
I remember knowing that this was it.
I remember feeling love.
I remember feeling my heart beat.
I remember feeling the walls come down.
Rwanda saved me.
My patients saved me.
They let me out.
The real.
(I wrote this article for New Brunswick Nurses Association)
In April 2010, I completed a one month consolidation in Butare, Rwanda, working in various sectors of the regional hospital. When I got home in May, the reality of what I had seen and the things that I had done truly sunk in. Despite the emotional stress caused by practicing my chosen profession in a ‘developing’ country, I fell in love with Rwanda, ‘pays des milles collines’.
As a result, I am now back in-country on a six month internship with the Coady International Institute, as funded by the Canadian International Development Agency (CIDA). I have been given the daunting task of teaching nursing students, supervising clinical placements, and participating in community outreach programs. On paper, this sounds simply peachy. In reality, it is quite the opposite – neither simple nor peachy.
Teaching students here is, challenging. Everything from preparing a two week course (that should be taught in three months) with hit-or-miss power and internet accessibility to trying to explain the mechanism of heart failure to students in what is their third (and sometimes fourth) language is taxing. But this is the least of my stress.
My great strain and my great love: Clinical. I am realizing and appreciating more and more everyday how wonderful our education system is in Canada. Over four years, our professors manage to instil in us an unfailing sense of responsibility and accountability, coach us through endless skills and the theory necessary to perform them, and finally by some miracle they teach us how to think critically. These values are seemingly non existent in the majority of nurses here, and consequently my students are on the same bleak path. This is the foundation of my stress, and of my efforts.
Apart from the abysmal conditions, lack of basic resources, and intense diseases for which patients resist seeking medical attention until absolutely necessary, the health care system is in distress. The medical model is highly engrained into their practice, and most nurses would never think to perform any task that was not outlined by a physician, and are flabbergasted when I question an order. Furthermore, there seems to be no connection made between nursing interventions and the disease process. For example, it would be rare to find an upperclassman able to link the diagnosis of ‘diabetes’ to peripheral vascular disease, amputations, confusion, coma, neuropathy, or any of the associated assessments and interventions. Wounds on the foot of a diabetic are not attributable to diabetes, that patient simply has wounds for no other reason than they are just there. It is more frustrating than I can say. The discrepancy between their standard of care and that of Canada is monumental. To have the lives of patients under their locus of responsibility makes me extremely uncomfortable. So, I am working to try and ease this discomfort.
In Rwanda, progress seems slow. And that’s probably because it is. Change takes time, and real change takes a long time. It took Canada half a century just to move away from the medical model. Let us not dismiss what has been done here. Yes, Rwanda has problems, big ones. They can not be conquered easily, quickly, or simply. But it is worthwhile to recognize the reality of where these changes had to come from. Following the devastation of 1994, the country – which was ‘third world’ to begin with – had to be rebuilt from scratch. It means starting some semblance of an economy from scratch when your country is millions in debt and all productive land and infrastructure has been destroyed, dealing with the ongoing struggle of refugees and rebel groups, gaining the trust of a population who just witnessed one of the most gruesome genocides in history, trying those responsible in a fair way, and reintegrating killers with family of the killed, in a country so small that it is inevitable they will have to see each other and work together. To build peace in a country of war, to build love in a country torn apart by hate, and to build trust in a place where it is long gone.
While these tasks may not seem directly linked to the delivery of health care, we must realize that each and every item destroyed – whether it be a building, a piece of land, or a life – it all relates to the social determinants of health of the population, and the ability of the country to provide optimal care and education. Every aspect of health care had to restart in 1994, so this entire system is only 16 years old. Furthermore, the sheer weight of demand is more than any country could cope with. In a country roughly half the size of PEI, they have managed to fit over ten million people. Ten million. In half the size of PEI, they have squeezed almost one third of the entire population of Canada, the second largest country in the world. The thought alone is unfathomable. Unsurprisingly, Rwanda has the highest population density in sub-Saharan Africa. Furthermore, over 75% of the population lives under a dollar a day, and 90% of the population lives under two dollars a day (Human Development Report, 2009). The same report has ranked Rwanda 167th out of 203 countries on the development scale.
As a nurse, and generally as a human being, I know that a high population density coupled with high poverty rates present a seemingly insurmountable struggle. Health suffers, happiness suffers. The apparentness of this struggle is not lost on the people of Rwanda, but you will never see them stop fighting the uphill battle. There are wonderful things happening in this country everyday. I have so often seen families with nothing give what they have to other families who have nothing. That is rare in this world, and that is something of greatness. That is something that shows the power of this place.
Rwanda has made incomprehensible progress as a people. I feel confident that most other nations could not have done what Rwanda has done given the same circumstances. There is something here. There is a spirit and a strength here that I have never experienced before. You can feel it in the hills, and you can see it in the people. There is much to be done, but the catalyst for change is already in place – it is in the hearts of the Rwandese people. The change is possible, and they are able.
Rwanda is so many things. And I have not even scraped the surface. Rwanda is not simply my emotional experience. This is a real place doing real things. It isn’t a figment of my imagination. It is not here solely for me to experience. This place is actually happening. These people actually live here. They actually live here. This is real. I have to remind myself of this so often.
I’m always looking at this country and these people through my own eyes. Everything is affected by my life’s experiences and by what I’ve known and done and thought and not thought. Rwanda is not mine. It is not anyone’s. The longer I spend here the more I realize that I am not here, not really. So, please take my stupid blog posts for what they are – some random 22 year olds half-assed impressions and lack of impressions about a place she completely misunderstands.
