The Dreaded OSCEs

The acronym OSCE triggers a certain reaction in medical and nursing students. I remember hearing about OSCEs from my nurse practitioner students and friends. The mere mention of OSCE would be followed by a heavy sigh and a dramatic story usually with fear as a theme. OSCE stands for objective structured clinical exam. When I was a student, our clinical exams didn’t have this lovely title.

Excited for OSCEs

The OSCEs were one of my first duties as a lecturer at KCN. Amber, a fellow GHSP volunteer, traveled down with KCN Lilongwe to partake in the OSCE fun. For this session of OSCEs, we were grading all 250 of the second year students. This is quite the production with lecturers from both campuses of KCN and several master’s students. 

Amber and I donning our lecturer uniforms (I'm rocking the Hopkins pins!)

 The first day, the students were tested on urinary catheter care and colostomy care. We had 20 stations set-up- 10 for each scenario. The second day, we were testing insulin administration, and thankfully, were able to have all 20 stations dedicated to this task. The students were given a scenario, for example: Mr. Basi is a diabetic who is on 10 units of soluble insulin daily. They were then responsible for demonstrating the procedure to administer insulin to Mr. Basi including proper documentation. As the examiners, we had a checklist in order to grade the student’s performance with two examiners per student. Each student was allotted 10 minutes to complete the procedure. We held the OSCEs at the Kameza campus, which was recently built, but the process of transferring the bachelor’s classes/students to this campus has not been completed. I heard there was an internet issue, but that is probably only part of the story. It is a beautiful campus located approximately 20-30 minutes outside of the center of Blantyre.

Kameza campus of KCN

Here is how the first (and longest) day of OSCEs went:

6:50 AM- Picked-up by KCN Lilongwe bus at my house. Make 2-3 more stops in Blantyre to pick-up other Lilongwe faculty.

7:45 AM- Arrive at Kameza campus and proceed to unload many of the supplies needed for the OSCEs.

7:55 AM- Realize that there is a lot of set-up needed before we can start. Proceed to wander around the campus looking for photo ops with Amber (see below for results).

8:30 AM- Wander back to the OSCE room and arrive just in time for the meeting to discuss the process.

8:45 AM- Divide into groups with two examiners per curtained-off station.

8:55 AM- Meet with everyone grading our scenario- urinary catheter care. Read the scenario and the grading sheet, and discuss proposed changes.

9:00 AM- Head back to our stations and await the first group of students.

9:10 AM- Grade the first set of two students.

9:35 AM- Meet again to discuss how the first set went. Discuss some more about the grading sheet, but make no changes.

9:45 AM- Grade more students.

11:45 AM- Tea time!!!

12:00 PM- Grade more students.

1:30 PM- Lunch

2:00 PM- Grade the rest of the students.

4:45 PM- Tea time.

5:00 PM- Head home.

Here is what would happen during a typical OSCE:

The student waits outside to be told to enter the area. When instructed, the student enters the room and is given 1 minute to read the scenario. A bell rings, which signifies the start of the 9 minutes. The student comes to the bedside of the “patient”, introduces themselves (usually in Chichewa), informs the patient of the procedure, and obtains consent. The next step is to provide privacy. In America, this is implied as our hospital rooms are set-up to already be either private or semi-private. In Malawi, there are sometimes 8 or more patients in a room (if there is a room) and no curtains. This was the one step in the checklist that I found most interesting. The student then continues the procedure describing the process to the “patient” (in English thanks to my fellow examiner). When the students finish (and hopefully after remembering to wash hands again), they document the procedure. Then, the bell rings again signifying for the student to leave and the examiners to finish grading. 

The full lecturer uniform

View from campus

Student dorm

The students did fairly well on their OSCEs. It was interesting that the students later in the day did better than the students in the morning. I was wondering if there were a bit of sharing on the part of the morning students- it is a communal society after all. The most frequent mistake during catheter care was not cleaning from the urethral meatus out. I could hear the voice of one of my nursing professors at Hopkins emphasizing this important point. Also, the students often forgot to assess not only the genitalia, but also the catheter. We have been told that the Malawian nursing students are very good at memorizing, but are challenged by critical thinking. Assessment is one of the most important roles of a nurse. I am determined to impart this on my students. I was overall impressed by the preparation of the students and sympathized with their evident nervousness.  What a way to jump into my role! I am now spending the requisite 4 weeks of orientation at a health center.  My next blog will focus on this experience- stay tuned.

Swearing in and Moving to Blantyre

I realize that I have been out of touch for the past several weeks. I would love to attribute this to lack of substance, but alas, I can only blame my procrastination. Since we last met, my life has transitioned from the living out of a suitcase/very structured life of a trainee to the being settled in my lovely home/more freedom existence of a GHSP volunteer. I am extremely thankful for the training we received- I can have a very short conversation in Chichewa, and have found myself thinking on numerous occasions, “I remember that from orientation.” I will now attempt to summarize the past few weeks into a somewhat manageable blog entry.

 The culminating event of our orientation experience in Lilongwe was our first opportunity to meet and interact with our counterparts. We had several sessions to acclimate us to working with each other (including how to work with very direct Americans) and to delineate expectations.  This was an extremely eye-opening experience as all of our counterparts have multiple roles within our institutions. The faculty shortage in Malawi translates to one individual doing the job of two or more. For example, my counterpart is not only a lecturer at the bachelor’s and master’s level, but also has several administrative roles. I am excited to share in her teaching responsibilities in order to lighten her load. The students are just now at the end of second semester; thus, I will begin teaching with the new school year in the beginning of November. I will likely be teaching first year students in community health, and possibly, master’s students in reproductive health. Kamuzu College of Nursing (KCN) has two campuses- Lilongwe and Blantyre. In Blantyre, we have half of the first year students (approximately 125), all of the second year students (250), and all of the master’s and PhD students. The rest of the students spend their time in Lilongwe. Chabwino (okay), back to the story of the past few weeks…

 After spending the day with our counterparts and a quick wardrobe change, we all ventured to the US Ambassador’s residence for our swearing-in. It was a wonderful ceremony filled with many inspiring speeches including two from my fellow volunteers- one in English and one in Chichewa. As I was reciting the oath, I was recollecting the previous occasion on which I spoke these same words, nearly fourteen years ago, when I swore-in as a volunteer in Samoa. The setting was vastly different, but the emotions and meaning behind the oath are unwavering. Following the ceremony, in true Peace Corps fashion, there was food.

GHSP Malawi 2015-2016 (Photo credit: Corey)

Taking the oath (Photo credit: Steve)

The next day, we packed up our suitcases and bid farewell to our colleagues/friends traveling to Mzuzu and staying in Lilongwe. The process to leave Lilongwe involved a stop at the Peace Corps office to pick up bicycles, PPE, water filters, etc.; a ton of shuffling of both belongings and passengers in order to accommodate all of our stuff, three GHSP volunteers, two counterparts, and two drivers; and a brief hiatus at KCN in Lilongwe to pick-up exams. We departed for Blantyre slightly off schedule, but had a smooth four-hour journey to our new home. The highway between Lilongwe and Blantyre is actually very nice. I have heard stories about the road system in various parts of Africa being somewhat treacherous. This is not the case (for the most part) in Malawi- I have been pleasantly surprised. One of the most interesting points along our trip was near Ntcheu, where the highway serves as the border between Malawi and Mozambique- on one side you can buy Malawian tomatoes and cross the road to the other side to buy Mozambican bananas. No documents needed to cross this border- oh how the US politicians would have a hay day with that.

 As the gate opened at my compound, I was stunned, and honestly felt like I was back in America. I absolutely love my house and could not have asked for a better situation. I guess I was somewhat expecting housing similar to what I had in Samoa, but was relieved to find I have tile floors instead of “carpet” (concrete floors covered with sheets of plastic flooring); a bathroom with a window and without “skylights” (holes in the roof of the ceiling that let in leaves, not light); hot water (I was not looking forward to doing the cold shower dance); and real closets with actual doors. I believe I am much more appreciative of my current accommodations having been a traditional Peace Corps volunteer. Have no fear readers, I am not immune to the realities of living in Malawi- power and water outages, insect visitors/roommates (although they don’t usually survive long thanks to the cat), washing laundry by hand, ironing anything hung outside to dry (thanks to Botflies), and the whole water treatment process- filter, boil, cool, drink.

My lovely house

My bathroom

My bedroom

Chichi, the princess/diva of the house

I spent the rest of the week and weekend settling into my house and exploring Blantyre. The city has a striking landscape as it is flanked by mountains. This translates into a great workout everywhere you travel on foot as there are a ton of hills. So far, I am enjoying Blantyre and thankful that it is more compact than Lilongwe.

Blantyre

I just want to give a shout-out to my dad for teaching me how to use tools. I had a broken closet door when I moved in, and decided that I could totally fix it. After multiple trips to acquire the necessary tools and a new hinge, I successfully removed the old hinge (with stripped screws) and attached the new one. During this process, I realized that whoever installed the doors made a major mistake by cutting into the door frame, which ultimately caused the hinge to break. Therefore, I had to decide between another potential broken hinge or a space between the closet doors. I now have a lovely space in the upper portion of one of my closets. For those of you who know me, you would not be surprised that I was super determined to fix this closet and didn't stop until the door could again be opened regardless of the gap. Such an accomplishment!

My handy work

It was exactly one month from the time I left Minnesota to the time I arrived in Blantyre. It feels good to finally be settled into my home for the next year- Chez Blantyre as we lovingly refer to it. Stay tuned for my next episode in which I jump into work at KCN with OSCEs.