Flexibility in Cross Cultural Nursing

Recently several of us were placed at the Old Naledi community clinic to work alongside UB students and nurses in their community health rotations. Old Naledi has been blogged about previously, when we spent time in a children’s program, and houses some of the lowest income residents in Gabarone. We spent our clinical day here with eight UB students, one of whom was already a diploma RN, and another who was a diploma NP (?). Many diploma-trained nursing professionals opt to return to nursing school for their nursing degrees. Our objective for clinical was to join the Old Naledi Home Based Care (HBC) RN in her home visits in the community. As mentioned in a previous blogs (Flying Missions), HBC involves meeting patients in their homes for any kind of assistance, which may include hygiene, housekeeping, transportation, groceries, and more. HBC provided by the community clinic, however, is different from Flying Missions in that a trained RN from Old Naledi Clinic makes the patient visits, rather than trained volunteers or caregivers. According to the center for HBC in Gaborone, the Old Naledi RN may be capable of seeing eight patients per day, depending on the acuity or level of need. These HBC RNs help improve patient healthcare in Botswana by providing care for patients who cannot stay in the hospital, do not have sufficient social support, or for other reasons. In the past, HBC was only provided to HIV-positive patients, but has now been expanded to all patients in need.

As we have learned, flexibility is important in the Botswana community, and our agenda for the Old Naledi clinic day changed. Instead, we spent time in the clinic itself observing consultations, injections and wound care. We also spent time at the center for HBC in Gaborone, learning about program standards of care. We also went to Princess Marina Hospital (PMH) for a tour of the wards. The various wards at PMH are very different from the floors at the hospitals in Philadelphia. Each ward was separated into a different building and contained 4-6 open areas with several patient beds in each. Wards were distinctly male or female and surgical or medical and there was also a pediatric ward, delivery ward, and NICU. The patients used communal bathrooms and were lucky to have a curtain to pull around their bed. Most wards did not have hand sanitizer dispensers on the walls and in the pediatric ward several of the sinks were in disrepair.

Our visit to PMH was eye opening, and highlighted many of the things that we may take for granted in the United States. Although the nurses we met lacked supplies we deem essential to daily nursing practice, the true spirit of nursing was visible and trans-cultural. We were welcomed with open arms as we moved throughout the hospital, nurses were able to attend to patients on a deeper level since the usual reliance on technology to monitor patient status is unavailable and patient care is truly the priority with the environment and materials available. Many American healthcare workers we have met ask us incredulously whether we can believe some of the disparities we have observed. The answer is yes-but perhaps we can all learn from the reminder we have gotten from our observations of Botswana nurses and value the cross-cultural ability of a nurse to recognize and respond to a patients’ physical, emotional or spiritual needs to maximize quality of life at unique moments in time.

Posted by Trudy Kao, Bridget Sullivan, Randi O’Neill, & Megan Rogers