My New Work and Career Position

Top of Bugando Medical Center Waiting for my ID. Know the view inside will not always be so Calm and Peaceful but enjoyed the view of Lake Victoria.

Some of my blogs are about my living conditions, some hopefully on my travels and fun, some feelings and growth, some to inform you about Tanzania, and some about my professional responsibilities. I may actually have to produce work here soon, get busier and not able to share about all my experiences as the year goes on. But remember I have no TV and don’t waste my air time on movies so for now I’ll share my school and work.

So where am I working and what will I do? Though it is getting clearer I am still trying to figure it all out. They have told us to take time to listen, ask questions and observe before we start into our role. This is hard to do as since April 18th I received the offer for Global Health Service Partnership. It was to maybe work in a new Pediatric Nursing Master’s program if it was approved and if there were enough students. But it might be in curriculum development, or skills lab development and maybe nursing education — could I be flexible. My reply was I’m going to Africa isn’t that flexible;) So 4.5 months later I might know a little more what I am going to do but still am patiently waiting.

Who will I work for and what nursing program?

In Tanzania, I am working for both Catholic University of Health and Allied Sciences (CUHAS) and Bugando Medical Center (BMC) School of Nursing. The Bachelors and Master’s program are under Catholic University of Health and Allied Sciences (CUHAS) and the Diploma of nursing under Bugando. So there are 3 nurses who will this year provide classroom and clinical instruction at CUHAS for BSN and MSN students and possibly clinical instruction and faculty support to the diploma program at BMC. The nursing programs are unique in that they are part government and part Catholic Church run in partnership with one another.

View of Bugando Medical Center from my House at Sunset

CUHAS was established in 2003 as a constituent university college of St Agustin University of Tanzania following a declaration made by the Tanzania Episcopal Conference (TEC). TEC made a decision to upgrade the university/college into a fully-fledged university maintaining its location at Bugando Medical Centre, a Catholic Church owned 870-bed capacity tertiary hospital which continues to serve as its teaching hospital. CUHAS offers a Medical degree, a Public Health masters degree, a Bachelor of Science in Nursing and a Bachelor of Science in Nursing Education. They will start a Masters in Paediatric Nursing program this fall semester which I will teach in.

Bugando Medical Center

Bugando Medical Centre (BMC) is a consultant and teaching hospital for the Lake and Western zones of the United Republic of Tanzania. It was founded in 1971 as a mission hospital. Today, it is a referral Centre for tertiary care that serves 13 million people, namely from seven regions: Mwanza, Mara, Kagera, Shinyanga, Tabora, Kigoma, and Simiyu. Patients travel by car, motorcycle, or by boat to get treatment at the hospital. They have ambulances that I have seen bringing patients into the emergency room.

I’d love to take a picture of the guards who regulate who comes into the hospital grounds and the college campus (think normally 7) at the gates for those on foot(2) and then in the guard house (2)and at the vehicle entrance(3). But I’m not going to try as so far I am trying to make friends and they are starting to say good morning to us and at least are letting us in with our ID and not having to show our passport copy ID each time. Sometimes now we can leave the hospital/college complex without having our bags searched and just walk out so they are beginning to know us.

The hospital is a high-rise building with nine floors and has an elevator. We went up to the top floor this past week to get our ID badges made and while waiting they let us go outside on a deck near maybe the IT department and saw a view of Mwanza we had not seen.

There are 870 beds with nursing, medical, pharmacy and lab students rotating through the wards. There are 18 clinical departments and six administrative departments. The wards are set up by clinical specialty with approximately 46 beds on a ward. There are three to four nurses per ward during the day and one nurse in the evening. The hospital offers orthopedics, neurosurgery, surgery, OBGYN, psychiatry, heart surgery, and pediatrics. Chemotherapy is also administered and the hospital also has a separate emergency room.

Other U.S. schools with associations here are Weill Cornell Medical College which has residents here under physician supervision. Rush University has a program in healthcare management here. The Touch Foundation, a non-governmental organization provides medical specialists and instruction here and in nearby rural areas. I have been looking at research done by some from these programs on HIV, malaria, malnutrition, TB, and Schistosoma ( a disease from snails in the lake:(

The street hill I walk up to work from my house and then down to town is even a longer walk.
Different Side of the City
New Classrooms just built -the green roof building below and the orange building is the hotel where I attend church until they move into their building.
CUHAS new classrooms and offices already in use.
Not sure what is hanging outside the windows of the hospital floors below?
New University Buidling under construction

Bugando Medical Centre, School of Nursing, is a government run school under the Ministry of Health. It offers a diploma and a certificate in nursing. There are two diploma tracks. The first is for nursing students who have a certificate in nursing, 2 years work experience, and are now working towards a diploma. There is a direct entry 3 year pre-service diploma in nursing. Due to a subsidy by the government, the tuition for the program can be cheaper than other diploma programs for some students. Faculty who teach in the government funded program can get called to Dar at the drop of a hat for work and meetings. We had heard of this with other government workers but saw it this week as a faculty counterpart who had just been in Dodoma was called for her Master’s defense on Thursday to be thee on Monday. Then she had just gotten home and was called back to Dadoma for her government teaching work.

The Government, para-statal organizations, voluntary organization, religious organization, private practitioners and traditional medicine all provide health services in Tanzania. In a previous blog I mentioned that the Tanzanian Ministry of Health, the Ministry of Education and the Tanzania Nursing and Midwifery Council oversee nursing and nursing education here.

University Library
Three of us Share the office next to the Staff Choo (and there is not a Western Style Toilet)
No air but the window Bekah at her desk
Outside the building where my office is

Course I will teach this fall

Many of the other GHSP volunteers have specific specialties they were hired under such as being a midwife, pediatric surgeon etc. so their path is more clear cut as I have taught Community health as a more general area for most of my career. So far I do have a Masters level course I’m to teach which has no prior syllabus but needs created as it is the first time it is offered. I like this kind of creative challenge as that uses my strength of developer. But really was the talk in Washington DC that you should teach something you are not an expert at true? So my fall course is “Ethics, principles and practice of paediatric nursing” in the first semester of the 2 year Masters in Peadiatic nursing”. I know health promotion of well children but am not an expert of sick children especially with African diseases. As of todayI do not have a textbook, schedule of the semester or an understanding of the courses in this new Master’s program and how they will build on each other. I have worked on a syllabus, schedule draft, a lecture on pediatric ethical issues and a pediatric physical assessment lecture. I hope to shadow a nurse on the pediatric ward later this week. My prayer is that these Master’s nursing students have some recent hospital experience with children.

Classes start October 3rd. Each week we make a little more progress in understanding the university, nursing department and programs and eventually the clinical setting. But how this understanding all comes about in this course I will be surprised in the midst of fear of the unknown. So I remain patient by listening, learning and asking questions. Do I feel capable in teaching about sick Tanzanian children with diseases I have never seen? Do I understand a health care system and hospital and language not my own. Probably not but I will work hard, ask questions and research topics until I can.

Dorms and parking lot of my office building

Sticking with a goal and passion:

Some have asked why would I do this and at times I have and do as well. My own reasons for this move includes some professional and some personal reasons. I started this journey when I was 19 when I attended San Jose Bible College for a year planning to be a nurse with some international organization and was going to attend San Jose State University for my nursing degree. That year both of my parents retired and staying in CA was no longer an option as I was going to pay my own way, so I returned to Illinois to finish my first of 4 nursing degree. My path changed from that point on. In my early years of marriage there were plans for both of us to work short term in an international setting using our respective career knowledge. Then over time supporting myself, raising children and caring for elderly parents, I changed dreams as well as my professional career path. I taught for 20 years Community Health Nursing with some areas of global health and the interest was there but other responsibilities took priority. So now 40 years later I am hopefully using my knowledge, skills, and mature compassion with that long ago dream. I will never regret any life experiences in between as they changed who I am as a person and led me down the path to Tanzania. Once you experience challenges in your own lives it opens your heart to look at how you can help others facing their own limitations. That looks different to each of us. I can say that though I have not had much international experience many other experiences I’ve had, I see as invaluable in making this experience successful.

Often I think of my own selfish motives for this year meeting new people, seeing new things, gaining global perspective which all focuses on me and what I gain. I try and remember that to be able to change the lives of others is what gives meaning to my being here beyond simply looking after my own life.

Where we have Chai or the faculty lounge- a must to do here aroud 11–12 each morning. We made Zuchinni muffins last weekend using my oven for the first time and contributed to Chai this week.

Professional

There has always been the desire to use my knowledge and experiences from my professional experience in giving back to others with limited health resources. I was able to do that in my 20 years of Community Health Nursing education. But over the past several years there has been a consistent nudge for leaving the known and comfortable life, expanding my nurse educator experiences, and renewed thoughts of those early dreams kept coming back where I could use my career experiences by giving back from all I have been privileged to receive over my lifetime.

Along the path of finishing my PhD I began to question what it was I wanted to do with the degree. The goals I had at the beginning of the program I began to question — things like tenure track teaching positions, higher advancements and pay. I had been challenged by and learned tremendously from my professors and coursework but I then was challenged to consider the outcome of my learning. Was it only my quest for knowledge that my learner strength needed, the challenge to push myself to complete a goal or was it to improve my abilities to understand and solve new problems as an outcome of the degree? As I struggled with whether I really wanted to finish the degree or be ABD (all but dissertation) I rethought what I wanted personally and professionally. I had sacrificed much time and energy working on the degree and I knew I needed a challenge of something very meaningful to do with the degree even though that was not completely clear. Though I cannot say 100% whether having finished the degree influenced my being one of the 60 chosen out of 240 applicants. I do know I will use my knowledge gained, perseverance and commitment learned from pursuing and finishing the degree with my work this year. Where it leads after this year I am unsure but I will take each day and experience this year and not worry about and try and plan the future.

I have learned over time that our life plans are never really our own and having to adapt our plans and desires can sometimes be the best plan where you can be used and fulfilled the most. I try and remember that this year is not about me but Tanzania’s and my college’s needs. This became apparent when my counterpart came in this week to talk about an idea he had for research on peer support for adherence to medications in Tanzanian HIV patients. He threw out his ideas and ask about resources we might have access to in terms of literature and grants. I was able to by the next day to do a quick search of the literature and access articles of what he might need for an experimental study he was interested in doing. And I actually enjoyed the search and evaluating the articles. What will it lead to? I don’t know but I’m here to use my knowledge and skills for the benefit of students, faculty, the institution and patients here. Though I will be challenged along the way I am sure but I look forward to how the year evolves, where it leads, and let you know the outcome along the way.

I met a Kenyon doctor at church last Sunday working for a non-governmental agency mission on the remote island of Kome called the Rural Island Community Health Initiative (where there are no health care providers). A quote from their webpage below inspired me to remember so many heroes in my life who have encouraged me and then in spite of my feeling incapable to be the hero in people’s lives that I work with and interact with this year.

“When human beings overcome one or more limitations, they are called to be better persons and to be much more prepared to deal with the next series of limitations. Once in a while a person touches our lives with words and actions that they change us forever. Those are people who extend our vision and inspire us to higher levels of personal achievement. They are our heroes! You will find them wherever the quest for personal excellence is practiced and wherever commitment to noble values is revered. Heroes personify the best of what we want to believe about ourselves and offer proof that our grandest goals are achievable. There is something within our spirit that longs to be elevated and nurtured to new heights of purpose. Extraordinary achievements never fail to inspire us to raise our own insights. May we remember that regardless of where you find yourself on life’s journey, you never travel alone; for there in your own heart is a hero of epic proportion ready at a moment’s notice to join you in the grand struggle to seek and claim the ultimate prize — the satisfaction of a life of purpose pursued with courage and passion.” http://ruralhealth.webs.com/