Vital Compassion
To be fair, everyone’s English is better than my smattering of Chitonga. Smattering might even be an exaggeration. Once we pass the hello stage, I’m mostly useless except to smile and apologize. But Kayaya’s English is excellent. He’s trilingual, as many people around here are. It’s impressive. Our conversation is comfortable and fluent. He is insightful. Heartfelt. Intelligent.
We sit in his office, labeled Patron/Matron. He’s the head nurse at Chintheche Rural Hospital. I have come this morning via a surprisingly un-crammed local taxi to bring a bag of dressings donated by a school in the UK that supports Ripple Africa. The door and windows are open, welcoming a cool breeze that is a relief from the intensity of the midmorning sun. Chickens run past the open door, kids scream in the courtyard outside, Kayaya’s cell phone dings with messages, and occasionally I hear a vehicle. Not the familiar sights and sounds of the hospital back home. And while by many standards you can hardly compare our work environments, we also have much in common.
He also got into nursing somewhat by accident. When I ask him why he decided to become a nurse, he laughs. “It’s a long story.” he says with a grin. “I never wanted to work in healthcare.” He has been a nurse for thirteen years, but his secondary school dream was to be a dramatist. He is an actor. He loves to write short stories and poetry. He is an artist at heart. Studying drama at college was not an option, but he did feel sure that securing a place at a university was important. A secondary school teacher encouraged him to apply to a newly started nursing program in Mzuzu. Not many people knew of it and because there were so few universities then, with fierce competition for admission, applying to a less popular program seemed a surer way of gaining admittance. He interviewed for both nursing and education, hoping to be picked for education, but he was only chosen for the nursing/midwifery program.
Kayaya tells me for the first few months of school, all he wanted was to switch programs. He watched his friends studying education and desperately wanted to be with them. But he stuck with it, and two semesters in, he was hooked. “Sometimes we say: I want this! But God has the final say. There is a purpose for it.” he says. He smiles when he talks about it. Things worked out just right. “The good part is I find it so satisfying. People are suffering. They need our help.”
His words resonate with me. People are suffering here. This is true of many places in the world. But here on this Monday morning, I feel it deep in my heart for this small town in Malawi, as I sit with this humble man who is openly sharing with a stranger that wandered into his office with a grocery sack full of gauze. He does so much with so little. And the most stressful part of his job? The days he knows he could have helped more if only he’d had the resources they lack.
I pepper him with questions. He is patient and thorough as he shares a picture of his reality with me. We talk about death. About how hard it is to lose a patient. About stress. About emotional wear and tear. About the tears we both cry. About staffing. About long hours. Night shift is 16 hours here and they all take turns doing it. Schedules rotate days to nights weekly. Shift differential doesn’t exist. They all work beyond their scheduled hours, and there is no overtime pay. Everyone works in every ward. There is no luxury of specialization.
When I ask how many doctors they have, he scoffs. “Doctors? We don’t have.” They do have three clinical technicians. CTs do three years of school to obtain a diploma in clinical medicine. They do a lot, but they desperately need a fully qualified doctor, too. If you need major surgery, for example, it’s a perilous journey on the Malawian road system to the nearest district hospital.
For the entire district of Nkhata Bay, there are only three fully qualified doctors, who do six years of school to obtain a bachelor's degree in medicine and surgery. Of those three, only two are doing direct patient care and they are based at the two bigger district hospitals. It’s simply not enough doctors to serve the patient population.
They also have three medical assistants here – who only work in the outpatient department - but it’s clear talking to Kayaya that the nurses are running this place. It makes me smile and think of my colleagues at home. We often joke about how the hospital would fall apart without us – no disrespect to our physician colleagues – and it seems that’s not an attitude unique to us.
You need skills to be a nurse here, he tells me, and they have to be sharp. I believe him. They suture wounds. They do minor surgical procedures. They resuscitate newborns with no help from a code team. There is no ancillary staff; no one to ask for help. You must be sure your skills will not fail. Kayaya might not know what to do in an ICU full of technology, but here on his home turf, I’d bet on him over myself every time.
Even though they do not have the luxury to specialize, Kayaya lights up when he talks about maternity nursing. It’s his favorite by far, and he tells me a story about one 24-hour period at his old hospital in Lilongwe during which they delivered 94 babies. I cannot fathom. He has delivered thousands in his thirteen years and his face is full of joy as he describes the feeling of handing a new mother her child after the work of labor. “You really feel you have done something good”, he says. “I love babies.”
Maternity is not always a happy ending, of course. Both moms and babies lose their lives. Kayaya tells me that he struggles a lot when this happens. He connects easily and deeply to his patients and it feels as though he is losing someone dear to him when they die. He tells me that in this hospital, it is rare for them to have one eight hour shift without a death.
He is proud of his work and the diversity of skills he and his fellow nurses have. He knows what they are lacking and how much they are doing despite it. And he is also hungry to learn. He has been studying to take the NCLEX because he would like to come to the U.S. to be a nurse one day. We talk about how hard he finds the U.S. tests. The conditions and diseases we treat are very different. But he’s determined.
As our conversation comes to an end, Kayaya thanks me for a suitcase full of supplies we delivered here last week and then tells me half of it was expired. They cannot use it. I feel sick and cringe with the knowledge that so much of what we throw away back home is un-expired and perfectly useable. Their list of needs next to our list of waste leaves me feeling uncomfortable. The inequity is too much.
Kayaya and I truly work in different worlds. In some ways they’re barely relatable. We would sink in each other’s environments without practice and training. But we have one vital commonality: compassion. He is brimming with it at every point in our conversation. At the end of every shift, no matter the outcome for your patient, no matter where you are in the world, no matter what the setting, if you can say confidently that you led with compassion, the day is a success. Perhaps if we applied that more widely as humans, we really could change our world.
