What I’m learning as a nurse in Malawi

By Brittney Sullivan
May 12, 2014

Joining the Peace Corps and Global Health Service Partnership (GHSP) seemed like a natural progression in my nursing career. I have had a growing interest in global health since high school, and with each trip to Central America or Africa my passion intensifies to serve those most vulnerable. The opportunity to build capacity, rather than be a “Band-Aid” solution during short stints providing care to patients, is what really intrigued me about joining GHSP as a lecturer of nursing at a Malawian university, where I’m now working.

As a GHSP volunteer, I’ve mostly worked in the clinical setting in inpatient pediatric wards teaching third-year pediatric students. Sharing my experience in pediatrics and adolescent medicine with students has been humbling. Understanding their thought process, encouraging critical thinking and improving physical assessment have been my main focus.

Functioning in a teaching capacity in Malawi is quite different from my role as a direct care provider in the U.S. The major differences I’ve noticed here come from the low ratio of nurses to patients, which impacts how each nurse treats each patient.

In the U.S. nurses take on incredible accountability for their patients’ care: They are aware of every change in lab values and vital signs, and have an intimate relationship with each patient. In Malawi, where the nursing ratio may be six nurses for 271 patients, that kind of attention is impossible. So instead of being responsible for a certain number of patients, here each nurse is assigned a duty: medication administration, patient rounding, admissions, discharges, etc. and all nurses care for all patients in the duty they’re assigned. Teaching patient- and family-centered care is quite different because of the lack of so many resources, most notably human resources.

My knowledge of the health care and education systems is one of the biggest experiences I will take home with me. I’ve gained a real understanding of the complexities of working in a developing country because I’ve spent the time to integrate and learn about my community. This time has allowed me to identify many challenges: a lack of inventory leading to medication shortages, a lack of health care professionals with solid educations leading to less-than-optimal care, a lack of diagnostics to properly diagnose a patient, a lack of transportation to bring a patient from a rural clinic to a central hospital. I would never be privy to these understandings if I was here for only a month.

Not to mention some of my personal challenges: access to the Internet, electricity and decent transportation has been a constant struggle. Getting this on-the-ground experience helps me prepare to undertake research in a developing country and has given me realistic expectations of some of the challenges.

Even so, one year seems so short. However, knowing I am part of the inaugural cohort of GHSP Volunteers, I hope each year builds upon the one before, leading to a sustainable program. Soon I’m returning to the U.S. to pursue my PhD in pediatric global health nursing. I am confident my experience working in Malawi for a year will provide me with incredible experience to rely upon when deciding where and how to complete a dissertation for my PhD abroad.

Brittney Sullivan