Operating under pressure: training student nurses in Malawi

Malawi’s hospitals are oversubscribed and understaffed, with student nurses arriving ill prepared for the challenges that lie ahead. As well as striving to improve the training facilities at Trinity Hospital Muona, VSO volunteer Hiram Njuguna’s job is to help equip these new recruits with the skills, experience and confidence to embark on an intense but rewarding career. 

Laying the foundations

Having taught Registered Nurses for three years at home in Kenya, Hiram travelled to Malawi with the goal of helping student nurses adapt to the challenges of clinical practice in rural hospitals. But to work as a clinical instructor, he first had to be registered by the Nurses and Midwives Council of Malawi, which entailed a four-week rotation at one of the country’s four major hospitals.

“I did my rotation at Queen Elizabeth Central Hospital in Blantyre,” recalls Hiram. “This hospital is the largest in the country but it is chronically understaffed. I noted that even second-year students were struggling to apply theory learnt in class. I never met a single tutor or clinical instructor supervising the students. Apparently, this was quite normal – they were used to learning on their own.”

Straight to the heart of the action

Upon arriving at Trinity Hospital Mouna, Hiram quickly discovered that there was more to his role than met the eye. “My VSO volunteer counterpart, Elly Bos, oriented me to the job,” he explains. “The hospital was severely understaffed and sometimes the wards would be full to capacity, especially during the malaria season. My job was to ensure that students are competent and equipped with basic skills before allowing them contact with the patients. However, I experienced several challenges: the tutors took so long to finish classroom teaching that sometimes we could not teach practical skills; the practical room was small and had little equipment; and I found it difficult to communicate information that required the local language.”

Hiram and Elly set about making changes. “Elly had designed a master plan that provided a schedule for the teaching of specific skills,” says Hiram. “We introduced it to the rest of the school faculty. Four of the six tutors in the college had come straight from university and they formed a good team to share skills with. We took them through the plan for the first and second years, allocated clinical areas to be supervised and set about our task.”

Making progress

While Hiram and his colleagues began taking the training of student nurses in hand, he realised that certain essential items were in short supply. His response was to apply to VSO’s placement support fund. “We received £2,500 and these funds helped us acquire a new practicing doll, an intravenous infusion arm and medical supplies,” he recalls.

Over the ensuing months, Hiram and his team worked in pressurised conditions to prepare successive intakes of students for hospital life. In due course, a new, larger practical room opened for business and more supplies were provided by VSO Malawi. As standards improved, so did Hiram’s optimism, and in 2010 an entire intake of students passed the demanding practical tests required to begin working with patients. This breakthrough occurred towards the end of Hiram’s time in Malawi: “It was one of the highlights of my placement,” he reveals. “I was really encouraged by the teamwork we achieved and I hope it will continue long after VSO's presence is no longer needed.”