Racism and inherent bias in health. a patient safety issue? Navigating healthcare while black part 2
Growing up, going to hospital was a very serious affair. It often meant that one was very sick or that something was very wrong. You would often get people going to visit relatives or friends to check on them because they heard they had gone to hospital. I have often joked that we Africans only seek medical help or go to hospital when we are dying ie when things are serious! Other times we relied on herbal medicines and remedies or over the counter medication and just got on with life. I had not realised that this ideology was deeply rooted in myself, why go to hospital when a paracetamol here, an ibuprofen there, a little Vix/Rob could help ease the pain, plus there are more sick people in the world and so long as the pain was bearable, life went on. In fact I took pride in the fact that i was not a frequent visitor to the GP and surely that alone must have earned me brownie points and that if I finally came in for a consult they would look at my records and see that I had not been in to see them for near on 11 years and that for me to have come in, means things were serious- the dying African analogy thing! I mean my work sickness records matched my not visiting GP records, if that earned you brownie points at work surely it applied to my GP as well? How deluded i was! But before i explain my delusion and crash to earth moment, i need to highlight another issue that in my opinion is a huge determinant in the quality of healthcare we receive as Black and marginalised communities. These are my observations and experiences through the years and by sharing them i hope i start a conversation where we as individuals can look within ourselves and check our biases and maybe we can understand that sometimes the system is stacked against certain individuals making them invisible and that by the time they become visible, it is not because they were neglectful with their own health or that they did not try hard enough, it just got too exhausting trying to get the help they needed and finally they gave up and that those racist views and practices at the top that we constantly deal with at work, school, in life, have a knock on effect that then affects society as a whole.
Before moving to Birmingham in 2005, we lived i a quiet mainly white neighbourhood within a small town. The GP practice was a small family practice with a handful of doctors and a lovely pair of receptionists who even while talking to you in person or over the phone, getting more information before sign posting you to the right service, did it with kindness and patience more often than not. You always felt welcome, never rushed and every concern was dealt with in house or via referral. Slowly the town started to grow, the independent shops were knocked down, a huge Tesco was built and new apartment blocks started springing up and the GP surgery got busy. The town was growing and changing, a natural progress. The area we moved to in Birmingham and indeed Birmingham as whole was much quieter and laid back than London, the traffic was almost none existent, it seemed like by 12 midday, especially on weekends everything just died, it was way to quiet but on the up side we could afford a bigger house with garden and the neighbours seemed nice. We registered with the local GP surgery, which was almost like the one we had left in London, despite the incident with the practice nurse or occasional gaffe by one of the GP partners who upon seeing the children during a consult said: “ what fat children! Very different from the ones I have been seeing in South Africa this last month” ( She had just come from a volunteering programme in South Africa), overall you felt heard and more importantly you saw your named doctor and the continuity of care was there. The receptionists were kind and you could walk in to make an appointment . The streets were clean, we knew the local street cleaner and would stop for a chat once in awhile. A year in we started to notice for sale signs cropping up, the white folk in the neighbourhood were moving out. Not long after, the local street cleaner left, said he was retiring and for a week a two we had a replacement and then nothing and they would be cleaned as and when. The area started to look neglected and derelict. Various take away shops started to crop up. Our corner part of town was changing and growing and not for the better it looked and the GP surgery was not spared this growth. We were getting an upgrade, a bigger and better service, it looked like but looks can be deceiving and not all change is good, especially when an area is changing and becoming more derelict and unkempt and phrases like ‘ deprived area ‘ start being banded around. When an area is now mostly inhabited by marginalised communities and it looks like the local council has all but given up and services such as litter picking, rubbish collection, housing and the community surroundings as a whole take a back foot, you start to realise how all this connects to healthcare provision, schooling, policing and life in general. A two tier system comes into play.
A year after my life altering surgery, i was back at work navigating the pitfall that is the extreme sport of nursing while black, especially in a new town, environment and work culture and all the changes going on withing the neighbourhood largely went unnoticed or took awhile to notice as most of my time was spent at work and the only time i went to the GP surgery was to take the children for their immunisations etc. I had been told at my hospital outpatient follow up after the surgery that i would experience some lower abdominal pain which was normal due to scaring and so i managed my pain when it became unbearable by taking paracetamol and ibuprofen and occasionally buscopan. My local pharmacy was great and between myself and the pharmacist we always managed to puzzle stuff out which meant i was helping the GP service as well as the hospital service by not using up time that can be used by more urgent cases. Years went on and the pain slowly got worse but i put it down to scaring and work/ family pressures. More and more people were coming into hospital and complaining about their GP’s and access to services, from rude receptionists, seeing different doctors if you were lucky to be granted an audience and no continuity of care, it was easier to come into A&E. One chap had been to his GP ( one of those mega practices) several times complaining of chest and joint pains and each time his was given pain killers, then stronger ones which were eventually on repeat prescription! After a year of frustration and increasing pain and breathlessness he turned up in A&E and was diagnosed with TB. Another elderly chap had to go into A&E at the request of his GP’s receptionist at the frustration of the A&E doctors. His old GP had retired ( White Exodus) and the surgery had been taken over by another GP ( South Asian ) who only operated on a Thursday and worked the other days at his brothers practice in Solihull. This meant that his patients could only book appointments to see him on the Thursdays otherwise if they fell sick outside of that given day, then A&E was their only choice! He finally had to change GP’s to a bigger practice, when it took almost 4 months to fix a medication error with his diabetic medication, where he was previously on a combined tablet of Metformin 850mg/ pioglitazone 15mg but later changed to standalone tablets but with Pioglitazone at 30mg, when this error was later highlighted to the surgery( taking months to sort out) , the only explanation was that the standalone tablets were cheaper than the combined tablets! No recognition of the drug error/ potential harm caused to patient nor an apology. This is what care in a so called ‘deprived’ area had come down to!
After more than 11 years since my major surgery and managing the related pain on my own, it got to a point where the pain was massively affecting my quality of life. So i decided to seek the services of my GP to help find out why the pain was getting worse and also why it was mainly on the left side and not the right where the Fallopian tube had been taken off, also why i was needing to empty my bladder more often. My GP practice had under gone a huge change and had become one of those major practices with around 8-10 doctors. It was a mission getting an appointment and i was informed that i would see a duty doctor as opposed to my named GP as that would take weeks of waiting. So i turned up for my appointment with my husband ( he was not letting me go to hospital alone ever , since i almost never came back last time he did) , the doctor asked why wanted to see him, i told him i had given all that history to the receptionist but i could tell him again, so went to explain why i was there to his completely disinterested self. He then asked what is it i wanted him to do? and that i had been dealing with it for 11 years, so what did i expect him to do? I was stunned into silence, i tried to explain that yes i had been dealing with the pain for that long but i had come in for help because it was getting worse and affecting my quality of life and my work as well and that something didn’t feel right and that if he looked at my records he would see that i was not a frequent visitor to the surgery and that the fact that i had come in meant that i was not coping and needed help. He casually googled the medical term for ovulation pain, then proceeded to tell me that i was suffering from that and that i should would write me a prescription for Ibuprofen which i should try and that would sort out my pain and that i can not expect him to help me when i have no records and do not seek help and that if i need help i should fight for it and bang the door more and then i would be taken seriously as they would then wonder why i was frequenting the surgery and was not getting help/relief from interventions prescribed and so would take matters further. in other words, i had to be a problem patient to be taken seriously! I was gobsmacked and just sat there starring and not believing what i was hearing. I could see that if i stayed and continued arguing my point the situation would escalate into something serious, so we left. I don’t know who was more livid between myself and my husband.
I could tell you how after weeks of banging on proverbial doors I finally got an ultrasound and MRI scan, which showed fibroid growth and bulging disks, further banging led to useless misogynistic gynaecological referral and a most eye opening Orthopaedic appointment where I was being warned to look out for signs of Cauda Equina and to get myself a female gynaecologist. At this point I was just tired 😫. Not that the story ends there nor does my experience of bad healthcare even after changing Gp's ( still same area with super surgery ) and i’m sure mine is not the only story of struggle in getting proper healthcare as a black person not to mention as a woman ( indeed the black practice nurse at my new surgery was leaving due to racism at the surgery! Not to mention that a serious drug error almost occurred because my records had zilch on them, no one had bothered to populate my online GP records! Being a nurse saved the day.)
Historical and all through colonialism with attitudes that still extend to this day, Black people have always been at the bottom of any hierarchical structure, our value and worth was and is still considered below that of the Whites and South Asian and these biases exist in everyday lived lives of Black People no matter your standing in life. How many black Owned and led GP services are out there? I am yet to see a black doctor at a gp surgery! Maybe if there were it would at least be a start in evening out the playing field of healthcare navigation for black patients? Just a thought. All I know is that i’m tired of constantly fighting to live while Black, be at work, I'm school/University, access to healthcare not just bare minimum healthcare and tired of being blamed as a whole for health outcomes while the system is verily rigged and stacked to the rafters against any positive outcomes.
Meanwhile, when you see me at the hospital looking alot worse for wear with conditions that could have been treated had they been caught earlier, please don’t fall into that judgmental trap of “ why are these people so neglectful with their health while it’s free” ! Try to listen and get their story, you maybe the only one who cares enough at that point!
Independent Patient Safety Organisations:
Plan4ZERO- Patient Safety Movement: https://patientsafetymovement.org/product/plan4zero-pin-magnet/
Patient Safety Learning Hub ( U.K based ) : https://www.patientsafetylearning.org/the-hub
Racism in Health: A Patient Safety Issue? Mine and my family’s experience navigating healthcare: Part 1
First Published May 27 2021
Snap shot of racism issues raised in the last few weeks.
The last couple of weeks and days has highlighted the issue of racism in the NHS against Black African healthcare workers as shown above in a limited snapshot not to mention the fact that the COVID19 pandemic has also highlighted the health inequalities experienced by Black, Asian and Ethinic Minority people in the UK, be they patients or healthcare workers.
While we have grown vocal in calling out these inequalities and racist practices within the NHS and as black african healthcare workers we have developed systems amongst ourselves to help us cope within our own work environments, where we warn each other about certain colleagues or wards and what to do if you find yourself in an uncomfortable situation. In a sense inorder to continue working, we have had to develop so called thick skin, but what we have forgotten is that these racist colleagues, who more than often are in senior positions or authority, be they senior nurses/midwives/matrons, clinical nurse specialists, practice GP nurses, GPs, hospital consultants or even junior doctors also look after patients and make decisions on behalf of patients who look like us, the colleagues that they are racist or biased against, i.e Black African and their racist attitudes affect the care these patients receive!
Nursing while Black on the NHS is a skill i had mastered but nothing had prepared me for being a patient while Black on the NHS and how the system is stacked against you and how lonely, frustrating, anxious, helpless and dare i say angry you feel while also wrestling with the guilt of essentially raging against your employer and not wanting to cause a fuss because it is the NHS, you love the NHS, you are constantly reminded how lucky we are to have the NHS, so it would be in very bad faith to complain.
Most of the racism and appalling care as a result that i have experienced as a NHS service user has been via their maternity services where i felt that was always viewed as an oppressed, uneducated Muslim Black African woman who should be grateful about receiving any care at all, and it came as no surprise to me when statistics show that Black mothers and their babies are more likely to die or be harmed while accessing maternity services! While all experiences have left their mark, one way or another, there is one particular one that has had a lasting effect trauma and health wise not only for me but for the whole family.
After a couple of years of being married and not a getting pregnant, despite having had a child, who later died at nine months in a previous marriage, our doctor made a referral to gynaecology and after some tests, we got referred for assisted conception and funded for 2 cycles. The first cycle resulted in over stimulation of my ovaries which resulted in having to have regular scans just to make sure none of the eggs burst.It was during one of these scans that we discovered that we were pregnant. At 35 weeks my water prematurely broke and i was advised to come in for an assessment. It was late in the afternoon when a decision was made to admit me as i had lost almost all of amniotic fluid and i was to be induced. I was handed over to 2 South Asian midwives who were not too pleased at the prospect of looking after me and between their bigoted selves, within earshot, decided that they would pawn me off to the male midwife who was coming in later for his shift. So i sat in the waiting room until Andy, came on shift and he cottoned on as to what was happening and proceeded to inform them that, i will be his only focus throughout his entire shift and he was brilliant and stayed with me through out the failed induction up until an emergency cesarean had to be performed and at then handed me over to the postnatal team and to the worst care ever! I was alone and in pain in a side room having had surgery, with a premature baby on a temperature regulating cot. My call bell was never answered and was switched off at the midwives station and when i mastered the strength to walk to the midwives station to ask for some milk for the baby as i could not breastfeed, i was told that i was to bring in my own! So i called my husband who then brought it the bottles steriliser with some bottles and a some formula milk. No one came in to change my sheets or make the bed or even clean the room, so the first day i changed rotated the blood stained sheet from top to bottom. Day 2, was shouted at by a midwife ( afro-Caribbean) , who proceeded to call me ‘ you filthy people’( not sure if she meant us Muslims, or Black Africans! ) because i had been sponge bathing as no one had told me i could have a shower given my surgical wounds. She continued to berate me about not showering and how my lack of personal hygiene would cause me to have a infection then proceeded to rip the bandage off and order me into the shower! At this point i was just bone tired and saved my tears and frustrations for visiting hours when my husband came. On the 3rd day which was a Monday, the ward manger( White lady) came into my room while i was making the bed, this time using the top sheet, that was less stained as the bottom sheet, and she was shocked as to why i was making my own bed while i should be resting and why on earth i had a bottle steriliser in the room? I told her it was because no one had been in to change my bedding since i had been put in the side room and that i was told i had to provide my own milk and bottles as the hospital didn’t provide any! She immediately got clean sheets, made my bed and told me the hospital did provide milk and proceeded to get several bottles for me. I just sat here and cried and later that day i got discharged. My husband wanted to put in a complaint but i discouraged him, telling him that the NHS was wonderful and caring and that this was just one bad experience. It was the health visitor, who later picked up on how that experience had really affected mentally, especially given that i had lost a child previously and she would go out of her way to support me mentally, by suggesting walks with her and the baby, keeping a dairy of how i was feeling and also provided a symptom diary via CONi PLUS scheme that helps bereaved parents care for subsequent babies.
We fell pregnant again after four months, and there was concerns that because it was so soon after my cesarean section, the risk of a natural birth was high and that i would probably have to have another C-section. Due to family reasons we moved from London to the West-Midlands so didn’t have the same antenatal team that knew my history and looked after me. I soon found out that things in the midlands were done quite differently and there was not much support. At 37 weeks i went into labour and called the labour ward but was advised to only go in once my contractions were closer together ( no mention or worry about uterine rupture/ trial of scar) , by the time i got to the labour ward, i was bearing down and was promptly taken to a delivery room where the midwife was in no rush, so i told my husband to be ready to hold the baby as it was coming. Just as i was crowning, the maternity support worker burst into the room panicking and shouting that my online records had an alert on them and that i was not to deliver without a whole team being present which included an Obstetrician and a paediatrician, which made sense as i was a high risk even for trial of scar and could quickly bleed out, a fact that didn’t seem to bother the lone midwife who was in the room with us! By the grace of God, i had a normal delivery and went home the next day. There was no mention from anyone within the healthcare team about the near miss that had occurred. Once again, my husband thought i should say something but once again i declined, citing that maybe because i had moved they didn’t have all my records and the NHS is great and all had ended well.
You know how you wait for a bus and then 3 come at once? Well someone had turned my life into one of those bus analogies because four months later we were pregnant again! After the shock and lots of tears, i finally embraced the fact that i was going to be a mother again. 1 was assigned a community midwife and things seemed to progress well. 8 weeks or so into the pregnancy i started spotting and called my midwife who advised me to go the local hospital emergency department as she was off duty, so that i could be checked out. Later that afternoon after my husband had come home from work, i asked if he could look after the kids while i popped into hospital for a quick checkup. So i walked to the hospital emergency department, got checked in and waited to be seen. An hour or so later i was called in to see the doctor. I explained why i had come in at the recommendation of my midwife. He then told me that it was not hospital policy to admit cases like mine but since it was his last day at the hospital as he was moving to Newcastle where his dad had bought him a house, he would admit me so that i could have a scan to see what was going on. But before all that he needed me to provide a urine sample so that a pregnancy test could be done to confirm pregnancy. As i was giving the sample a stream of blood came out and i informed him and he then said i should wait in a cubicle while he sort opinion from the Gynaecology team. After a very painful examination by the gynaecology doctor who confirmed presence of products of conception, i was transferred to the gynaecology ward. it was a rocky ride by internal ambulance to the ward block and eventually onto the ward and immediately i got onto the ward, i had this sharp lower abdominal pain. I was allocated a bed and assigned a student midwife who upon taking my vitals noticed something was wrong and i was switched to the bed across as it had an oxygen point. I was feeling really faint and breathless. The nurse in charge bleeped the doctor who finally appeared after an hour or so at which point i was in increasing pain and very breathless. I decided to advocate for myself this time and went on to inform him that i thought i was bleeding internally and that maybe he should carry out an abdominal tap to check. His reply was that, such procedures are only done in third world countries! He then left with the plan that i should be monitored more regularly. The next thing i remember after is the overwhelming pain i was in and the feeling of drowning, at which point the doctor had been bleeped several times and had not bothered to show up and i remember the charge nurse shouting and threatening legal action if no one came . I was now being cut out of my clothing. Then everything went blank. The next part is now told through my husbands witness experience, who upon waiting for my return home, got worried that something had happened, put the kids in their double buggy, went up to A&E and tracked me to the ward where upon arrival, i was being resuscitated a third time with an abdominal tap being carried out and blood spilling and the consultant shouting as to why it was let to get to this stage! While he was standing there confused and scared, they managed to bring me back and told him that they had to rush me to surgery as i had lost almost all my blood and that they were not sure if they could save me but they would try. He was asked to leave but he refused and said he was going to wait whatever the outcome. He sat there waiting and witnessing while lots of blood had to be blue lighted in, wondering how i had left him at home only hours ago, walked to hospital and now was likely to die because once again somebody somewhere had decided that i did not matter. Hours later the consultant came out, scolded the doctor in their language ( both south asian ) then went on to inform my husband that they had managed to save me, and had to take out my right falopian tube and that the surgical site is not pretty as the had to cut into me very quickly given the emergency. I was later transferred to HDU and later on back to the ward i had originally been admitted to. Here i was again looked after by the student midwife who had originally been assigned to me. No one ever came to apologise or explain as to what had gone wrong. On discharge day, the student midwife wheeled me to the lifts, and told me to stop getting pregnant as i was killing myself and that i needed to go on some form of contraception! Years later, i still have that discharge summary with her signature on it. I was to go to my GP surgery to get the staples removed in a couple of days.
On the designated day, i went to my GP surgery as asked and was taken in to wait for the practice nurse. This nurse was very annoyed and kept asking me why i had come to the surgery and why i could not have gone to the hospital to have my staples removed? She also wanted to know why the hospital had not given me a staple/stitch remover? She left the room in a huff, came back and continued to tell me how she only had one stitch/ staple remover which she was now going to have to throw out once she had used them on me! At this point i was trying soo hard not to cry or give her the satisfaction of seeing how her tirade was affecting me. I lay on the couch as instructed and she went to use as much force as she could muster to pull out the staples and when i made a wincing sound, as all this was very painful, her response was, what did i expect! it was meant to be painful.
That was the end of this chapter for all the healthcare team involved. We will never know if they continued to put other mothers lives at risk, if they went about their work or indeed if the still go about their work with their racist and biased views unchecked. I probably played a part by not calling out their actions. As a family we still live with the trauma inflicted by their actions and inactions and the health complications that have since followed. Years later, my husband and i are sat down in the evening watching Grey’s anatomy and it’s the episode where Meridith Grey is in and out of consiousness due to COVID and she is on a beach with Derek and O’Malley, and my husband takes my hand and quietly asks, “how was it? “ and it takes me a moment to realise that he is asking about how i felt when i had to be resuscitated. I tell him i really can’t remember and he squeezes my hand with tears in his eyes and says “ i have never prayed as hard as i did on that day” .
That is why i am glad that campaigns such as Fivexmore exist and launched the Black Maternity Experience survey and are “ Committed to Highlighting and Changing Black women’s Maternal Health Outcomes in the UK.” Visit their website: www.fivexmore.com to see more of their great work.
Of Crossroads and Pivots
To be at crossroads.
Most of us over the course of our lives have experienced some form of toxicity in a relationship be it at home, work, on a personal or professional level and have probably asked ourselves how did we get there or how can we leave or have recognised that we need to leave but are scared of what happens next! Fear of the unknown coupled with the uncomfortable comfort of the known. These concerns or thoughts become more profound when you have had a long relationship spanning years or even decades with whomever or whatever situation you are trying to leave behind. Most people when asked will tell you to just leave, but it is never that simple especially if it is all you have known as an adult and have a love/hate relationship. Over the last couple of years, I have found myself asking these same questions. How do I leave given the love/hate relationship I have, not to mention that my whole adult identity is tied to this very thing that is sucking the life and soul out of me? How do I leave the toxic profession that Nursing has become, when it is all that I have known but is no longer excited about, more so as a Black Nurse?
I have gained a lot in being a nurse and from nursing but at the same time nursing has taken a lot from me, sometimes I think more than I have gained. I recently came across a post on LinkedIn by a nurse, a proud one at that, who stated how nursing was and still is his whole identity and will forever be and I was conflicted because I understand his sentiment, as a nurse your whole life and identity revolves around nursing, how you act within and outside of work and how you are expected to live and interact with society. It's all consuming and the reason I am conflicted is because I currently have a love hate relationship with nursing. It's like that toxic partner that you are trying to leave but they keep reeling you back even though you know they are not good for you. Not good for your physical and mental health not to mention your financial health but they are comfortable, all you have known, familiar. Nursing doesn't love us Black nurses, be it our places of work, those we care for, our unions and even our governing body! That's a lot to deal with and one can't unsee the disdain and contempt and the appalling treatment we get. It's disheartening when you give 110%, when you look around and equitable healthcare, health services and work conditions are not afforded to those of us who are Black especially Black Women. Nurses be everywhere and that is a good thing given the diverse unique set of skills nurses have that are transferable to lots of industries. I can only be thankful for the opportunities, people and friends that I have had and met through my work as a nurse, the lives that have impacted mine and those that I have had the privilege of being a part of even though there have been days when I have questioned why I became a nurse. From the inequalities witnessed while training to the experience of racism and how widely it is embedded in everyday life, nursing notwithstanding.
Once again I find myself at a crossroad, needing to forge a new path ahead. I walk in grace and have faith that whatever path I choose at this season of my life, I will still advocate for nursing and nurses to be valued, especially Black nurses, as we are witnessing in real time the decline in health care services and patient outcomes due to how nursing and nurses and the brilliant work they do has been undervalued not only here in the UK but worldwide. As a service user myself having witnessed the health inequalities Black Patients experience firsthand, I will also still be a loud advocate for equity in healthcare for Black patients. Because racial weathering is a thing and racism does kill and should be a public health emergency, it's only fitting that I end with the words of Bossbabe.Inc:
“ I’m shifting from my hustle era to: My balanced era. My soft era. My ‘nervous system is calm’ era. My ‘work smarter, not harder’ era. My ‘know my worth, regardless of results’ era.”
Nothing to celebrate here!
It is getting harder and harder to celebrate being a Nurse.
I don’t know about you but life just feels Meh ( if that’s still a term) at the moment. Everything feels off and it is getting harder and harder to find the little joys in life with so much going on in the world right now. Yesterday was the culmination of Nurses’ week celebrations culminating with celebration of International Nurses’ Day which ironically ( for us Black Nurses) falls on Florence Nightingales birthday! There is a lot to unpack there but that is a rant for another day even though it could be argued that it does fit in with the sentiments i am about to express which is that it is getting harder and harder to find anything to celebrate about Nursing or being a Nurse more so a Black Nurse.
Nurses, who are the backbone of healthcare services all over the world and beyond are tired and feeling under constant assault. We are undervalued, underpaid,overworked and no one seems to want to hear our voices or opinions on how our livelihoods and those of our patients can be improved. Nursing is under assault and it is worldwide. Systems everywhere are out to get us and no one feels that pinch more acutely than us Black Nurses and i am tired and frankly do not feel like celebrating anything nursing at the moment. I know that for those of you have been brought up to believe that Nursing is give-all-no-complaint-noble-godly-self sacrificing vocation, this might seem as a ungrateful thing to say but unfortunately it is the reality.
Racism still has its foot on our necks despite report after report highlighting the far reaching consequences of the effects of racism on Black Nurses and although everyone acts surprised and expresses their displeasure the status quo is truly and firmly maintained or worse. It's like perpetrators and their over lords get more oxygen to double down and dream of more ways to heap misery. Cut pay, overwork them,remove any form of family support or any support for that matter, while making them jump all manner of hoops that they would be forgiven for thinking they were working in a circus. So no, there is nothing to celebrate here. Nursing is under attack and Black Nurses are bearing a huge chunk of this full on assault! I for one do not have the energy nor the required bandwith to celebrate. So until things change and the over lords start valuing nursing and the important part Black Nurses play in propping up healthcare systems worldwide and paying us our worth, there will be no celebrations.
TAKING CHARGE: When racism threatens to derail your career!
This week while scrolling on twitter(it will forever be twitter! Sorry X) instead of doing the work I was meant to be doing ( procrastination will be the death of me! I am a work in progress) , I came across a tweet about a young Black nurse who was concerned that he was experiencing racism at work and had reached out to his mentor for some advice as to what to do. The advice given was opposite of what many have often followed ( put in a complaint/grievance) and instead was about choosing you battles and planning your exit. I must confess it threw me for a moment, because i would have said report it, raise the grievance so that there is a record, even if the system is broken and onesided, because somebody somewhere will one day thank you for having had your grievance recorded because it helped them hold that party/organisation to account even if at that particular time it didn't serve you. But then on reflection, I found that it was very sound and practical advice for that particular situation, a young Black Nurse just starting out in their career. Because on many an occasion we have seen and witnessed the disturbing fact that the complainant is normally the one who gets their life and livelihood disrupted while the one who was at wrong gets to keep their job and all the perks that come with it, sometimes they even get a promotion! And if you are just at the start of your career the knock on effect and consequences can be more devastating.
I was then reminded of the brilliant author Toni Morrison’s saying/observation about racism about it being a ‘distraction’ and how it keeps you from doing your work because you are forever caught up in a loop of trying to prove them wrong! And I was like, Aha, that indeed has been their strategy all along. Think of how many Black nurses have quit their work or been let go because of experiencing racism and/or after raising grievances to that effect. How many have left to protect their peace and gone on to work as agency/bank nurses full time with no prospect of career progression, pay increases, backing of an organisation and access to a pension scheme? While the instigators and perpetrators are free to continue working, progressing in their careers with the backing of the organisation and access to a generous pension scheme and full employment benefits. We are constantly playing catch-up with careers, wealth generation, health equity, a decent life and home and a comfortable retirement. How do we change the narrative especially for our young Black nurses who are just starting out?
Don’t get me wrong, this is not to say that you must endure horrendous racism to gain the above, because nothing can ever compete or replace your health and mental health that constant weathering due racism does to our bodies and soul, that’s not it. It is a way to look at other alternatives to quitting or being pushed out after raising a grievance, a kind of nipping the problem in the bud before it causes you further harm. It involves using the same tactics you would use to ensure career progression when you feel stuck at your current post, you move. So instead of being stuck and bogged down with the farce of an investigation into grievances you have raised, you change tactic by not raising that grievance.
Under that tweet, was a brilliant reply that mentioned strategy, importance of picking your battles and conserving your energy and channelling it to find ways to move to your next opportunity in a department, ward or organisation that values you for who you are and doesn’t put obstacles in your way because of your skin colour. Like i say in my book ‘The Extreme Sport of Nursing while Black’ :- Check out your employer. By doing research, you get an idea of the work culture of that organisation, ward or unit and if they would be a good fit for you. If it all checks out, you move and take yourself somewhere where you are celebrated and allowed to thrive. Strategise to soar, the tweet said and it has now become one of my favourite phrases.
“Strategise to soar, higher and higher out of reach of petty fingers” - Andrew Nwosu
Maybe this way, we get to somehow even the playing field, even for a bit instead of playing catch-up. So here’s to STRATEGISING TO SOAR and leaving petty fingers behind!
The Wandering Nurse. x
ARE YOU DELEGATED?
As a healthcare worker, you probably know your way around the equipment used in your chosen path, be it a blood pressure machine, an X-ray machine or even a centrifuge. So when you start that new job, or change departments, you often would get stuck right in, helping out perform tasks on the ward or department, helping out colleagues and contributing to the patients smooth and safe journey whilst they are in hospital or clinic.
While offers of help are often met with gratitude and appreciation especially in a busy clinical setting and one is left to carry out tasks, within their scope of practice, i should add! The same cannot be said in a Clinical Research setting. That is not to say that your offers of help are not appreciated within a research setting, it just means that, even if your help was needed, your colleagues would not be able to call upon you unless you have been trained and delegated to whatever research study they would be working on.
Clinical research is heavily regulated as you would understand, since new medicines and Equipment are being tested and researched as to their usefulness and effectiveness before being licensed for use on the general population. So one would expect that a series of rigorous sets of rules and regulations are in place to ensure that the end product(s) are indeed suitable for human consumption and use. Amongst the long, essential list of regulations is one known as the ‘Delegation Log’.
The Delegation Log is a vital piece of documentation that is used to keep track of those that have been trained and then delegated tasks on a particular research study. It is an important part of a long list of checks and bounds that are put in place to protect the integrity of a research study. That is the reason why you cannot work on or perform any study related tasks unless you have been trained and delegated to those tasks by the Principal Investigator(PI) in charge of the study.
So when your kind offer of help is turned down next time, it is not because it is not needed and that your colleagues are not grateful, but it is because you are not on the delegation log and thus can not perform any study related tasks!
Clocking Off: How I learnt not to take work home!
Black Woman working on a Laptop
As a Black Woman, I am well aware of the double edged sword( Black & Woman) of having to work twice as hard as everyone else on top of having to constantly assess and reassess your work because if anything would go wrong, you would most likely be the first to be blamed. I am also acutely aware of the racial trauma we endure and the need to be constantly hyper-vigilante in all spaces we occupy, which just adds to our racial injury.
The COVID-19 global pandemic has forever changed how we work and the workplace culture that accompanies our jobs, so to speak. In the midst of a forced shutdown, companies and employers were forced to bring in changes that many have been asking for years that most employers have mostly paid lip service to! Working from home became “THE THING” and the era of employer led as opposed to employee led flexible working came into place. Gone was the so-called rat race and all over the world employees were reflecting on what life meant to them and what changes they wanted to make. I for one was here for all of it.
Woman on Laptop and Smartphone
The world of clinical research is a fast paced one with specific timelines on collecting clinical data and reporting them. For example, more often than not, sponsors require data on SAEs to be reported to them within 24 hours of one being reported. As a clinical research nurse/study coordinator, participants had my work number and preferred to call me as opposed to the emergency number they were provided with at the start of the trials. It was great that i had such a close working relationship with our trial participants and that contributed to the smooth running of our trials but it also meant that i was almost always the first to learn about issues arising like an SAE!
That was how i found myself dealing with an SAE and the paperwork that followed, not to mention the numerous phone-calls to the sponsor on a Friday evening way after work, on my own unpaid time. Having a work phone and carrying it home with me, seemed like a great thing to do as a way of getting on top and planning my work but it also meant that it ate into my private home time and i could not really switch off. I literally carried work home with me everyday! No wonder i was constantly tired, feeling like i was being pulled from all sides, but, hey, wasn’t burnout a great marker that you were doing something right?
Black Woman reading a book.
Fast forward to a new job and I am going through all the IT set-up and but this time I have no work phone, so I would not have to carry work home with me and I could maintain that work like balance that I so craved and had etched out but I am also a work in progress, because in the middle of setting up emails and teams, I found myself synchronising my phone to my work emails and teams! Luckily I caught myself just in time to remind myself that I was already doing enough, giving my 100% at work and that work stayed at work!
But we all know that it takes years to unlearn traits that have been part of ones identity formed from societal pressures and perceptions. So I have to fight the daily urge to be on top of everything and synchronise my phone to work emails and teams and remind myself that when I leave work, I make sure I leave ‘work’ behind!
How do you maintain your work life balance? Drop us a comment.
The Wandering Nurse!
x
WHAT'S IN A NAME? When being Kenyan saved my Nursing job!
I would be lying if i said i have never really given much thought to my name(s), after all they are me, my identity even during the times i have rebelled against said names! My whole life has been defined by my names so it came as no surprise when my career was about to be defined by them, even i did not see in what way.
I have ( and I know, many other Black people/ Nurses) lived and worked in a world where my name determined whether I got a job interview, whether I got a job, whether I got promoted or paid equally as my peers! You get it! My name seemed to be a barrier, so when the opposite happened and it became my saving grace, I was very surprised to say the least.
Working for an agency or the nurse bank gives you the flexibility to choose your working hours as well as where it is you would like to work. You also get to work with different teams on different wards and develop working relationships (or not), and this knowledge is often filtered through the various agency/trust bank grapevines. Which wards/units and teams were okay and which to avoid. This meant that there were wards/units that always struggled to get their vacancies filled and the ward and duty managers got clever. They devised ways to get these vacancies filled, unbeknown to us by creating false vacancies within the popular wards/units thus taking away choice, safety nets and in some cases putting patient safety at risk.
I got caught up in these ‘work houdiniships’ on a couple of occasions and apart of causing a of angst and disorientation, they also caused pay disputes with regards to who was meant to sign the timesheets and whose budget the pay would come from! you ended up chasing payments weeks after you had completed your shift. So, i tried to avoid them as much as possible, but oneday i got caught up in one houdiniship from hell.
I had booked a shift on a ward that i knew very well as i had worked on this particular ward as a permanent staff member before and knew the staff and the layout well. I turned up for my shift, bright and early only to be told that they were fully staffed and did not need me and had not booked me! I called the trust bank to let them know what was happening and was told that yes i was indeed booked in for that ward but was meant to work elsewhere to go help with washes and be the healthcare assistant for the day. The ward i was to be sent to was one everyone avoided due to how rude the staff there were making it a very unpleasant ward to work on, hence why they struggled to fill any vacancies. I declined and stated that i would rather go back home as the whole essence of agency/bank work was the freedom and ability to be able to choose when and where you worked, a point that neither the trust bank call handler nor the duty manager took kindly to and i was threatened with referral to the Nursing and Midwifery Council (NMC) for breaking the patient safety code of conduct by leaving the hospital short staffed.
I left the ward after explaining the situation to the manager and matron and went home. On my way home, i received a call from the trust bank informing me that i had been suspended and all pending shifts cancelled pending an internal investigation, and that my return to working for the trust bank would be dependent on the outcome of the investigation. I was annoyed that they would do that and i was confident that nothing would come of the investigation as i had done nothing wrong! So i told her that while i felt it was unfair, their action, given that i was a full time bank worker, i would await the outcome of the investigation. I was then told to write a statement of events, which i did and emailed it to the head of the trust bank as requested.
Two weeks later i received an email from the head of the trust bank asking me to report to her office. Being summoned is never a pleasant experience but i was surprised this time. It was a friendly setting and a very relaxed chat. She said she wanted to meet me and talk to me face to face before she decided how the investigation was to proceed. She proceeded to ask me where i was from as my name reminded her of a brilliant Kenyan Doctor she had worked with years ago at a previous trust. We talked about all things Kenya and how while my name was similar to the Doctors, we were not related in anyway and that i had never met him, let alone met anyone with the same surname as mine professionally during my working career in the NHS.
She then asked me to narrate what happened on the day, which i did and i also told her how common these houdiniships were becoming especially when the duty manager was the same one who had been on shift on that day and how on many occasions, she had moved me to wards where i was way out of my depth, like surgical trauma and when i voiced concerns she had replied that i was a qualified nurse with a PIN. This is when, i was informed of the complaint the duty manager had written, claiming that she had requested me to go to a different ward to help cover due to a crash call and i had refused. It was the first time i was hearing of this false account of events. I told her that she could confirm with the ward manager who had taken the call and spoken to the duty manager and then relayed the message to me, that there was no crash call and that i would not have refused to go to that ward nor left if that was the case! I also got to hear of the letter of support from the ward manager and matron decrying the drastic measure that had been taken to suspend me.
She then told me she had wanted to look me in the eye when talking to me, as she could not believe that a Kenyan would behave in the way that the duty manager had described, because she had worked with Doctor Onyango and other Kenyans and they were all very good at their jobs, reliable,honest, hardworking and put patient safety above all else, so she could not believe that i had been negligent. She had also looked at my file and in the five plus years i worked for them and there had been no complaints made against me nor any caution on my file. She lifted my suspension but said she would keep a note on my file for two weeks and if no issues arose during the investigation, then my file would be wiped clean.
I later found out that the duty manager was sacked after complaints from other nurses about her attitude and false statements amongst other things. I would like to say that houdiniships are a thing of the past but that’s not the case, unfortunately and because the largest agency/bank workforce are from the Global Majority, they bear the brunt of vexatious complaints. I picked up a great assertive tip from (yes), a brilliant Kenyan Nurse for those times you find yourself in a houdiniship:
“State that your skills set do not apply on that ward that you are being moved to, however, if they are happy to guarantee a waiver in writing that they will take full responsibility for any clinical and safety shortcomings that could potentially or accidentally occur, then you are more than happy to work on the new ward!”
I still haven’t met this Doctor Onyango but if he ever reads this, i would like to say a big thank you/erokamano and also a very big thank you to all my fellow Kenyan Healthcare Workers out there.
x
Shamim aka The Wandering Nurse.
Are you Hustling backwards?!
Onwards to new adventures!
One of my favourite programmes on the BBC used to be ‘Wanted Down Under’. It followed families who wanted to relocate to Australia or New Zealand, from helping them find homes, jobs while also giving them a reality check via a comparison cost of living between the UK and their dream new life in a bid to find out if the dream was affordable. For some the better salary and cost of living afforded by moving made the dream a reality and for others it meant hustling backwards, with their dreams deferred or abandoned.
Making the decision to leave home and start a new and hopefully better life in a new place or country is something humans have been doing since time immemorial and it’s a decision that is never taken lightly. For some it is the lure of a better work life balance, affording them more family time or more time to indulge in life long hobbies or passions. For others it is the promise of a regular paycheck and the job security that comes with it, a way to support themselves and their families free from worry and stress of not knowing if they would be able to do so day after day. It is this latter reason that i would like to focus on, because more often than not, the lure of a regular paycheck and job security blinds us and we do not take into account the full picture of what the cost will be and if it is at all worth it.
How can i make sure that my take home pay will be sufficient?
In my book ‘ The Extreme Sport of Nursing While Black : A Survival Guide’ , I talk about the importance of negotiating your salary so that you get paid your worth as well as really scrutinising your contract for any issues before signing on the dotted line. While this is still sound advice, i would like to add another tip, especially for Nurses being recruited from abroad, and that is to carry out a cost of living calculation to find out if would be able to live comfortably with the money you would be paid, your take home pay.
The first step would be to find out what your take home pay would be after all deductions, do not be fooled by the salary figure quoted, as that is normally your gross and not net which is likely to be significantly lower! Remember to ask during the recruitment process and not after you have signed your employment contract! The Salary Calculator is a handy site that helps you calculate how much your take home pay would be approximately. You can customise to see your take home pay yearly, monthly, weekly or even daily. This would give you a rough idea of what you are actually being paid and from that you can then do your cost of living calculations.
Armed with this information and your calculations, you can then make an informed decision whether it is worth it to take that job and uproot yourself from all that you know, or if you can negotiate for a better pay or hold out for one or better still, if staying and diversifying your income portfolio would be best. Whatever decision you make, make it work for you and having the full picture salary wise is one step in that direction and towards a financially secure future.
Here’s to Hustling forwards, always!
The Wandering Nurse x
A Bundle of Joy and a Great Sadness
It was the last week of Block 2 exams and we were busy revising, while waiting to find out where our next placements would be. I was also waiting for news about my friend who was due to give birth any day soon. I did not have to wait long, because, the afternoon of 30th August, she sent word that she was in labour and being a Nurse/Midwife and a Primigravida, she was waiting until her contractions were frequent before coming into hospital. So i waited anxiously .
Around 7pm, i was informed that she was at the maternity ward and was asking for me. The ward was full as it was baby boom season and we quickly settled her in but my friend had other ideas. in the absence of any pain relief, she decided to go crouch by the water tank. This water tank was the bane of all Nurses/Midwives as it was outside in a dark area with no light source, not to mention filthy, but labour pains made my friend forget all this. So we sat, cursed( she doing the cursing) while i cajoled her to please consider coming inside.
After hours and lengthy negotiations and her insistence that i not leave her side at all, i managed to get her into the delivery room for one last V.E to check her dilation progress, in between reassuring her husband that all was fine. At 8 cms it was almost time. Room prepared and delivery pack at the ready, it was time. Although tired and sleep deprived, given it was around 2 am next morning, i was excited that i was finally going to meet this bundle of joy. At 10cms, we ask her to push with the next contractions.
It soon becomes clear that an episiotomy is neccesary, she just wants it over with. Crowning, screaming, swearing with lots of encouragement, out pops the head with a great deal of lovely black hair. i remark at how lovely the mop of hair is, my friend goes into full meltdown. Turns out she wanted a bald child and refuses to push any further! we are stuck, she is determined to close her legs and go to sleep. We enter panic mode, appealing to maternal instincts not to harm the child. To please push so we can deliver the child safely.
She is having none of it! but at least she stays on her back. It's now all hands on deck or we lose the child. Hand on belly with next contraction two apply fundal pressure while the rest try to get the child safely out. Finally the child is safely delivered. All is well, she is tired but thrilled and both parents are happy to meet their Son. I am tired to say the least, sleep deprived and have exams in a couple of hours. I finally excuse myself with a promise to come back later to visit before they go home.
I walk back to the nursing school, its almost sunrise. Exams start at 8am and i have not slept a wink. As i pass by the dining hall, breakfast is being prepared. i relay the good news to the cooks. The telly is on and the News about Princess Diana’s death is being announced. As i climb the stairs to my room, shocked and numb. I am reminded of the reality of life: one life begining, whilst another one was ending!
The Importance of Grieving!
I came across a post ( link at end of post) on my timeline on X ( formerly twitter), by a Kenyan Nurse in the U.K talking about her nursing experience in Kenya especially with the managers, which was mostly negative in terms of their support for anything progress related as compared to her experience at an NHS hospital on a ICU unit, where the leadership encouraged progress and supported it. According to her, this latter experience cured her fear and insecurities around sharing her nursing career goals and dreams. From the replies to her post, it seems that she is not alone in having this fear of nurse managers in Kenya. While i can understand where she is coming from and i am happy that she found healing and a positive leadership style at this NHS ICU, unfortunately this is not the case all over, especially from the point of view and experiences of alot of Black Nurses working across NHS hospitals and even beyond.
What Nurse Cate had done was significant and in those series of tweets ( or Xers), she had demonstrated that she had grieved her past job experiences and resulting traums, healed from the traumas and celebrated her victory in her journey towards her nursing career. In her podcast episode( link at end of post) titled ‘How long can you grieve a job’, Dr Monica Cox talks about how much we can lose from our jobs, in terms of how we enter our workspaces full of high hopes and great expectations to grow and thrive, only for the opposite to happen, and we end up leaving, full of disappointment and disenfranchisement. She talks about how these loses are profound for People of Colour (POC) and those from maginalised communities, and how grieving for those loses ( job satisfaction, promotions, safe working places etc) is important to both mental and physical wellbeing, and is something that should be encouraged and acknowledged.
I was reminded how as Black Nurses, we come into nursing full of hopes and expectations to grow and thrive in our workplaces. We enter the workplace in all innocence, giving our all and, more often than not twice as everyone else, shrinking ourselves to fit into places, institutions and structures that are hell bent on drowning our voices and keep us out. We are forced out of jobs and with it out of our careers, growth, seeing through our work and projects we started. We do not get to bear the fruits of our labour, for the workplace is structured to reward hardwork with progress in relation to climbing ladders, one we do not get to do. It is not by accident that we make up the largest agency workforce, because leaving our jobs and working on our own terms is the only way we can survive, provide and protect our peace. We carry with us all of this trauma of loss, loss of identity, loss of self and loss of security. We carry on best we can and rarely do we stop, take stalk and grieve, to heal.
According to Dr. Cox, we need to grieve our work losses and also celebrate the victories no matter how small. When we allow ourselves to grieve, we start on the healing path. Just remember the saying ‘ grief is not linear’ , there is no timeline. Grieve the loss of a stable workplace but also celebrate the reclamation of your peace, working on your terms and protecting your peace.
Tell me what you think. Is grieving for your job important?
The Wandering Nurse X
Harnessing the POWER of the Beauty and Grooming Industry for Community Health.
Salon image from Unsplash
“The beauty industry in Kenya is a booming sector with plenty of growth opportunities. It has been estimated that the market for beauty products and services in the country is valued at over KES 20 billion, making it one of the most attractive markets for investors. The Kenyan beauty industry has grown exponentially over the past few years, mainly due to increased consumer demand for quality cosmetics and skin care products and services.”- The Star Newspaper Kenya.
The beauty industry in Kenya is said to be worth billions, with the Star newspaper putting the value at Kes 20 billion and still growing. One would ask how this is the case in the midst of a global cost of living crisis and other economic challenges? This is actually a worldwide phenomena, In the U.K, analysts found that the sale of red lipstick increased whenever there was an economic downtown, the explanation being that, looking and feeling good, boosted morale, giving folks a reason to carry on. Something behavioural economists call “The Lipstick Effect”.
What Is the Lipstick Effect?
The lipstick effect is when consumers still spend money on small indulgences during recessions, economic downturns, or when they personally have little cash. They do not have enough to spend on big-ticket luxury items; however, many still find the cash for purchases of small luxury items, such as premium lipstick. For this reason, companies that benefit from the lipstick effect tend to be resilient even during economic downturns. - Adam Hayes, Investopedia.com
Why am i talking about this and why do i care about why people are spending their money within the beauty industry? I care because this industry has the power to transform healthcare, community healthcare to be precise. It is a public health gem just waiting to be discovered and tapped into. It will literally put back the “Community” into Community Healthcare!
How can the beauty industry help? I hear you ask? Hear me out!
Man at Barber shop by @chrisknight on Unsplash
Grooming and beauty routines have been a part of human nature since time immemorial, whether is was done in the privacy of one’s home, within an informal community gathering or in formal settings like hair salons, barber shops or highend spa centers. They also act as social gathering places, where people talk and focus on the daily goings on of life in general, private problems and politics, while also having some downtime to themselves away from their daily hectic life routines. Hair salons and barber shops can be found almost everywhere in any setting, be it the city, informal settlements or rural communities. They exist in some shape or form, more often than not, providing not only beauty and grooming services , but also group and individual therapy of sorts, comradery, sense of belonging and most importantly TRUST. The bond between a hairdresser, barber or beautician and their client is sacred and built on trust. That is why people stick to their hairdresser or barber (shop) for a long time, sometimes even travelling for miles to where they are and feel bad, almost like committing adultery, when they go get services elsewhere.
For quite a while now medicine and the pharmaceutical industry have focused more on curative medicine than preventative medicine, especially for non-communicable diseases, like Type 2 Diabetes, High Blood Pressure, Cardiovascular diseases and cancer. This lack of focus has caused an increase of people being sick and diagnosed with preventable diseases, putting a burden all over the world on healthcare systems, resources and economies. While preventative medicine is slowly making a comeback as the world realises that “prevention is really better than cure”, screening services are still not up to par and people are falling through the cracks and Black people are more disproportionately affected than any other community.
According to The World Health Organisation ( WHO ) Africa, 25% of hospital admissions and 13% of deaths in Kenya are due to Cardiovascular disease, with hypertension being the most significant risk factor ( WHO Africa, 2018). This led to the launch of the national cardiovascular diseases guidelines by the Kenyan Ministry of Health. A survey conducted in 2015 by The World Organisation (WHO) Africa, found that due to demographic and social changes which included an aging population, urbanisation and the adoption of unhealthy lifestyles, led to a rise in Diabetes in Kenya, with 88% of people not knowing their diabetes status, which was a cause for great concern given the costly public health implications for the country. The third leading cause of death in Kenya after infectious and cardiovascular diseases, is Cancer , with Cervical Cancer being the 4th most frequently diagnosed cancer and the 4th leading cause of cancer in death in Kenyan Women(National Cancer Institute of Kenya, 2023). Other cancer statistics are available on the National Cancer Institute of Kenya’s website. A third of Cancers are preventable. Early screening and detection improves the possibilities of successful treatment.
Early Screening and Detection: the gaps and possible solution.
If there is one thing i have learnt, it is that time is money and it is scarce, but with proper planning and time management, one can make good use the time they have. The other thing i have learnt, is that going to a hospital or clinic is a big deal, both in terms of time and money and most Kenyans are weary of hospitals. Both things would explain the low uptake of screening services provided. People are time starved and mostly use hospitals as a last resort for treatment, less so for screening services which tend to be provided during working hours and are focused around international themed days or months that are centred around those particular diseases. For example, the various Kenyan agencies, like the Ministry of Health, use social media to highlight their various screening campaigns, but you would be hard pressed to find any leaflets around those campaigns and where they are situated when you walk into any government office building, supermarket, malls or generally anywhere frequented by the targeted population!
The whole public health strategy to screening and raising awareness needs a rethink with the introduction and utilisation of different stakeholders, because clearly, the current strategy is not working. Meet the people where they are at, where they are more comfortable and where they prioritise their time with the person(people) they trust. You need to look no further than the barber shop, the hairdressers and salon and the spa centres.
One research study published in The New England Journal of Medicine in 2018, showed that when 52 barbershops offered blood pressure monitoring services, their participants blood pressures dropped. Joseph Ravenell, in his Ted talk, explores how barbershops can keep men healthy( links located at the end of post). So the precedent is there. It can be done and with successful results.
Imagine if you went to your local Kinyozi and while you were having you weekly shave or treatment, you could have your blood pressure checked? You could have a conversation about the importance of Prostate Cancer screening and where you can get one? You could have a blood test to check your blood sugar levels and your risk of type 2 diabetes? You could talk to your fellow men about their experiences? Have that support?
Imagine if your local hairdressers or salon had leaflets about the importance of early screening? Information about the five gynaecological cancers that affect women and what to look out for? If your smear test and vulva health check could be done at the same time as you were getting that brazillian wax? If your appointment included a wellness check? A blood draw to check for your hormonal levels? Your Vitamin D levels? If you could have an all round wellness check while having your selfcare session at your local salon, spa centre or barber shop? Imagine how many lives that could be saved due to early screening and just good old conversation within well managed time constraints? The list is endless.
Now ask yourself: WHY ARE WE NOT HARNESSING THE POWER OF THE BEAUTY AND GROOMING INDUSTRY FOR COMMUNITY HEALTH? We have done it before during the AIDS/HIV Pandemic, why can it not translate to other Non-Communicable Diseases?
For my fellow Healthcare Workers in Kenya reading this, there is an opportunity here to step in and offer these much needed services. Find a salon, a barbershop, a spa centre, a lab, a Pharmacist, a Registered Nurse to partner with.
The Wandering Nurse. @thewanderingnurse.rn
Sources and Further Reading:
Kenya launches national cardiovascular disease management guidlines: https://www.afro.who.int/news/kenya-launches-national-cardiovascular-disease-management-guidelines-0
No-cost diabetes care saving young lives in Kenya: https://www.afro.who.int/photo-story/no-cost-diabetes-care-saving-young-lives-kenya#:~:text=Diabetes%20has%20been%20on%20the,not%20know%20their%20diabetes%20status.
National Cancer Institute of Kenya: https://www.ncikenya.or.ke/index
An overview of the Kenyan beauty industry: trends and opportunities- https://www.the-star.co.ke/news/2023-01-12-an-overview-of-the-kenyan-beauty-industry-trends-and-opportunities/
Lipstick Effect: Definition, Theory, Value as Economic Indicator: https://www.investopedia.com/terms/l/lipstick-effect.asp#:~:text=The%20lipstick%20effect%20describes%20the,them%20forget%20their%20financial%20problems.
How Barber Shops can keep Men healthy: https://www.ted.com/talks/joseph_ravenell_how_barbershops_can_keep_men_healthy?language=en
What happens when you put a Pharmacist at the Barber: https://www.menshealth.com/health/a19430360/barber-shops-blood-pressure-study/
Why Barber shops may be the key to improving Black Men’s Health: https://time.com/5480371/barbershop-blood-pressure-program/
A Case for Clinical Nurse Specialists in Kenya?
Whilst the long awaited rainy season is upon us in Kenya, it also heralds the season of joint aches and pains for my dad, especially his knees. A trip to the doctors saw him sorted out with some pain killers, with a recommendation to come back and see a specialist should he not see any improvement in his symptoms. The said specialist could only be seen on a Wednesday, as that was the only time he held a clinic.
A couple of weeks later, with no significant improvement in his symptoms, he decided to go see the specialist. He called me once he was there and quickly handed over the phone to the doctor, who introduced himself and then to my surprise revealed that he was an orthopaedic surgeon. You see, i was at a loss as to why my Dad was seeing an orthopaedic surgeon and not a Rheumatologist? I was also questioning as to if seeing folks with joint pains was actually the best use of the surgeons time and what, if any was the waiting list like to see him? Anyway, he managed to convince my Dad that it was indeed time to start using a walking stick to help take the pressure off his knees abit.
All this got me thinking about the state of specialist care in Kenya and the under utilisation of nurses and their skills within this sector. Why are there no Clinical Nurse Specialists in Kenya? And is it time ( long overdue) to introduce this branch of Nursing?
Healthcare worker with a patient.
Nurse training in Kenya, be it via government training institutions like the Kenya Medical Training Colleges ( KMTC) or via private colleges and universities, in my opinion, is one of the most rigorous and thorough all round training programme and produces very knowledgable, highly skilled and competent Nurses, who can work in various sectors and departments. These Nurses qualify with a wide range of skills from history taking, clerking, pharmacology, management just to name a few, making them well equipped to work as part of a team within a hospital setting to autonomously within a rural health centre setting.
So it makes no sense as to why Nurses are not being used to their full potential. Why patients have to wait to see a specialist. Why there is no proper follow-up or aftercare of specialist patients who are on long-term care, because there is a shortage of specialists.
Why are Clinical Nurse Specialists Important?
The concept of a Clinical Nurse Specialist is not something that is new within the Kenyan healthcare system. We do have Nurses who are specialists in areas like Immunisations and Family Planning, Infectious Diseases just to name a few areas. The problem is that, it has not extended to other speciality areas like Rheumatology, Diabetes, Cancer, just to name a few, where long-term care and close follow-up is needed to optimise treatment and improve patients quality of life. This would also create a new career path for Nurses, which would in turn help solve the employment crisis that is plaguing the Nursing sector and seems to mainly affect degree holder Nurses but also improve continuity and consistency in patient care.
So who is a Clinical Nurse Specialist and why are they important?
“Clinical Specialist Nurses/ Clinical Nurse Specialists ( CNS) work in a variety of acute and community settings, specialising in particular areas of practice, as part of a multidisciplinary team to provide high quality, patient-centred, timely and cost-effective care. They provide tailored care depending on the patient’s level of need. They also provide education and support for patients to manage their symptoms, particularly patients with long term conditions and multiple morbidities”- Royal College of Nursing(RCN).
Like every other country in the world, Kenya has a shortage of healthcare workers, and that includes Specialist consultant Doctors. This shortage means that there is a high demand often with long waiting times for one to be seen and diagnosed, as they divide their time between their hospital(s) and private practice, and often incurs a hefty price in terms of consultation and various fees. Access to specialist care also involves travelling to the big city hospitals or Doctor’s plaza, where they have their private practices. All these are barriers towards patient care and safety, as more often than not, continuity of care is lost, with the patient sometimes ending up being worse off, as their condition deteriorates, where follow-up care involves them going through the whole process above. Having a Clinical Nurse Specialist can help bridge or even close those gaps.
A Clinical Nurse Specialist can take over the supervision and follow-up care of already diagnosed patients, freeing up the Consultant Specialist to diagnose new patients and more complex patients who require a their input. This then ensures that the patients are followed-up and continuity of care is maintained which in turn helps to keep the patients out of hospital admission. From a revenue point of view, patients save money on consultation fees, transport and hospital admission costs and the specialists increase their revenue by being able to see more new patients.
On the whole, Clinical Nurse Specialists help improve patient outcomes, decrease specialist consultants workload and deliver high quality care. So isn’t it high time the Kenyan healthcare system utilised the valuable resource that is the Clinical Nurse Specialist?
Useful Links:
The Busyness of DYING!
Hi, welcome to another episode on the wandering nurse podcast.
This episode is about me rambling on about Men's boxer shorts and my personal issues around death and my own mortality.
Psst... Let me tell you a secret.
Please allow me to interrupt your scrolling as I bring you News about boxershorts and not those fancy boy shorts but plain old Jersey mens boxer shorts! Lend me your ears, for you will not want to miss this piece of life changing news!
I have reached that age where i value comfort above all else. I don’t have time for fancy underwear that make me wonder what my femoral artery did to them, as they try to cut off my blood supply! and do not get me started on thongs! Why someone would want to walk around with a constant wedgie and sore bum crack is beyond me, but if that is your thing, much respect to you.
It is not much to ask for some level of comfort out of the many contraptions we are required to wear and it looks like i am not alone in this thinking because the history of women’s underwear has somewhat come full circle from drawers in the 18th century to 21st century boy shorts gaining popularity. So when my sister called me a couple of months ago to inform me that she was now wearing her husbands underwear, courtesy of her having forgotten to do her laundry, hence running out of clean panties and that from then henceforth she would be wearing his underwear! I laughed as it was soo her ( she does the most random things, like calling me yesterday as an emergency, just to let me know that Aquaman had been returned to sender- her words), any way i digress.
So i found myself one lazy morning adopting her sharing is caring ways and that is when i realised we had truly been conned as women! The levels of ease and comfort i got from the boxer shorts was on another level. My femoral artery could now do it’s God given work unhindered plus everything was all held in one place, comfortably . So i quickly used my Amazon prime addiction( it is a thing) to find women’s boy shorts and 48hours and quick wash and dry later , i was the proud owner of a couple of packs.
They unfortunately turned out as another con , like everything else marketed to women( like how are women’s shaving razors so expensive, while the same make of Men’s are cheaper and do the same job?). They were not as comfortable and by now i should have learnt that most of these concepts only work on industry size/ shaped women’s bodies ! So off i marched to Primark ( i was not about to spend premium money! i was not aiming to look like David Gandy or Beckham, see underwear adverts for reference) and bought me a pack of cheap as chips, men’s jersey boxer shorts underwear and lets us just say, i have not looked back since( well except for the odd days, mother nature pays her monthly visits and reenforcement trounce comfort)
Don’t take our word for it( we may just be a pair of mad sisters ). Go and get yourself a pair and you can thank me later! For those who already knew this secret and did not share, may your bum cracks be forever sore .Thank you for listening/reading and normal service shall resume next week .
P/S- they are a hundred percent cotton ( all round goodness for your ladybits!)
The Busyness of DYING.
January 29 2023
Today i was completely paralysed in bed, i could not get up, i felt like i could not breathe, like i had to train my body onto how to draw breath. This has been happening a lot lately, not the paralysed in bed part but the feeling like i can not breathe, like i am having a panic attack. I keep on telling myself that I'm probably too stressed for my own good.
My dad had called, very early in the morning, which is unlike him, so that spooked me and when i called back i expected the worst and yes it was bad news, a friend of a friends had died and while i did not know her that well, i had known her enough to feel saddened by her death and the family she leaves behind. This reminded me of life and how short it is and i was reminded of something that i have become aware of lately, in the past couple of years: I have been soo busy dying that i have forgotten to live!
To understand my busyness with dying, we have to go back a couple of decades to when i think the trauma of death and dying started, but i wasn’t aware of it till later( self reflection and introspection and all!). A friends wife shared a video post about childhood trauma of her talking about how she can not nurse any of her family members and gets annoyed when her husband falls sick as all she can think of is that he is going to die. It was a post i could totally relate to because i was the same, having looked after loved ones from a young age and watched most of them die, i had not realised how those experiences had affected me. Despite being a nurse by profession, i totally freeze when any of my family members are sick, i go into withdrawal mode and sometimes even anger, angry about why they are weak and have fallen sick. I literally struggle to look after them in any capacity and i had not realised that it was a trauma reaction caused by my childhood experiences of being a carer for several relatives and for my own mother as well.
But while witnessing those that i loved and cared about die around me definetly instilled the fear of nursing those close to me, my busyness with dying was majorly sparked by the death of my Mother. My mother died at the tender age of 46. When you are a child, you always see your parents as old and rarely think of their lives as individual people outside their role of being your parent. The significance of her age at death( which i only found out years later as i never knew her year or day of birth till later after her death) only hit me when i became a parent( although it took time for me to realise it).
Becoming a parent really changes your perspective of the world at large, suddenly everything is frightening and dangerous and all you want to do is to protect this/these little beings that are now dependent on you who do not come with an instruction manual. It is literally on a wing and a prayer and sometimes on lots of unsolicited, unhelpful advice! And also it is from your childhood experiences of how you were parented or how you witnessed others being parented. You suddenly start to see your parents through and from a different lens. You start to wonder and be interested in their lives as individuals, as parents, what their hopes and dreams were and you also start to measure yourself via their milestones ( or maybe that's just me).
I found myself calculating my mothers age at different stages and milestones of her life: how old she was when she had her first child, my half-brother? How old was she when she got married and had me? How old she was she had my other half siblings, you get the picture, and i would then compare her milestones to my own. It helped me know and try to understand her better, helped me try to understand the decisions she made ( good, bad and ugly). It also shaped my parenting skills and what experiences and skills i wanted my children to have and each time something went wrong or they didn’t meet my expectations at that moment, i would find myself telling them that i was doing/teaching them (whatever it was at that time) so that they would be able to stand on their own two feet and look after themselves when i was not around! It was all so automatic that it never occurred to me that from the day they were born, i had been preparing my children for my death.
I had built my whole life structure, work, experiences, memories, everything around my death. I was so busy dying that i was not living, not living my dreams and aspirations, not giving my self any grace or leeway to get anything wrong. I was constantly on a schedule to get everything done and done right so that when i was dead, my children would not struggle.
Talk about unresolved childhood trauma! In my head, i could not possibly outlive my mother ( why i thought that is something i still have not figured out, given that i could go with my dad and live well into my nineties! But that is a story for another day).
So you must be wondering what all this has got to do with my being paralysed in bed, suffering from what seems like a panic attack, willing myself to breathe? Well it has everything to do with it, because this year i turn 45, which means i only have one more year to live ( if my fears are anything to go by!). My children, ( who might need therapy later), thank God ,are
on their way to becoming individual, wholesome adults and i was in a great place spiritually. In all sense and purposes i had accomplished what i had set out to do and i was ready, but was I? Why was i lying in bed paralysed with fear, unable to breathe? Why was i having frequent panic like attacks? The truth is, i don’t know! All i know is that somewhere along the line, i had completely forgotten to live, i had been so focused and wound up in being busy trying to prepare my family for my death that when i finally thought i had achieved that, i realised that i did not know what to do. If i was not busying dying what was i meant to do, how was i meant to live? And how was i meant to live in this one year that i had left? ( i know! Im a work in progress)
Surely if my fear was of dying, then my chosen profession of Nursing, would have cured me of that ( if we go b y Immersion therapy! ) as i had wholly and totally immersed myself in the art and science of life and death, so it stands to reason that my fear is of living! The irony is that i am a firm believer in fate and pre ordained destiny, th at when one’s pre-ordained time is up then it is up and that no one knows how or when they will die.
So in theory i could drop dead any minute, or right at the age of 46 ( not tempting fate) or go on to live a long and healthy life like my dad! I would never know, but in the meantime i am paralysed by the year i supposedly have left and learning the art of living. ( i did say i am a work in progress),
So while i figure out how to eat, pray, love my way to my supposed death, i am trusting and charging you all to keep me in check. Should i actually die at 46 or live past it, i hope you will all teach me how to live ( once i am done with the busyness of dying).
How do we build wealth and financial security as Black Female Nurses?
Tweet by David Ring RN
I have stopped reading any reports that come out about racism at work and society because as a Black Woman, I live it everyday and no report or survey is going to tell me what i and other Black people do not already know. Reports and surveys without actual change and actions do nothing but perpetuate the racial trauma we already experience. So when i saw the above tweet highlighting an NMC report about Black African Nurses, i was not surprised, because again, it is something i have talked about and written about. I chucked it up to another casualty of racism and how it frames our careers and lives as Black Nurses.
As days went by, this tweet stuck with me and i reflected on the ways racism and the status quo goes on to affect every aspect of our lives as Black Nurses. Nursing is a predominantly female profession and so it stands to reason that those most affected by the statistics reported by the NMC report would be Black female nurses. Nursing is a career and a career implies progression, climbing the ladder or whatever it is you want to call it! But is it just a job and not a career when your gender and race are barriers to your progression?
Countless studies and reports have shown that women earn far much less than their male counterparts in all parts of society( google can be your friend if you want to read all about it), not to mention the time off and part time working that women have to take on, if they want to start and raise a family. This gap in payment also translates to pensions thus affecting women’s retirement. As Black female nurses we get to fight on two fronts, the gender pay gap and the ethnicity pay gap, add the lack of career progression into the mix then you start to get the stark and bleak picture that this all paints for our futures!
I have not worked in the care home sector, so really can not speak to work and career progressions within that sector but i’m sure it holds the same prospects for Black Nurses as in any other sector: cheap labour and barriers to progression. As for the agency sector, it holds no progression whatsoever but provides that work flexibility that doesn’t exist with a substantive post, without the job security( but then again is job security a luxury afforded to us Black Nurses?)! More often than not, we sacrifice our dreams and hopes for that fulfilling career as a nurse( and i’m not talking about job satisfactionhere), and buckle down and work the hand that we have been dealt, as we have our immediate and extended families depending on us both here and abroad( back home), as well as the ever present bills and everyday living costs.
How do we ensure that we secure ourselves financially in the present and for the future? That we have something to show for all our hard work and that we can retire and live comfortably with our health both physical and mental, intact? That we can build or start to build that generational wealth? That we can leave our children better off? While the nursing path career now has more choices than just bedside nursing, we as Black Nurses, especially female nurses, have to find a way to diversify like some of our white colleagues who have taken to providing beauty treatments like botox or like Doctors and other Allied health professionals who can open a private practice We can not just rely on that one income stream from working for a care home or agency. How do we make our nursing NMC PIN work for us?
I can not pretend to have the answers as to how we can secure ourselves financially, i will leave that to the experts, but i hope this post starts a conversation, starts something, a spark, a desire to learn about wealth management, to have wealth, blessed wealth, to live comfortably , to not shy away from the notion that we are worthy, worthy to live a comfortable and financially secure life.
If you are looking for some direction or inspiration, then i would recommend reading ‘The Professional Troublemaker: The fear fighters manual’ https://amzn.to/3uHMLbYby Luvvie Ajayi Jones and also listening to the podcast as well. Another great book to read would be ‘The Power of Expertise’ https://amzn.to/3HJaQXVby Elle Pierson RN and ‘We should all be Millionaires’ https://amzn.to/3BqbFAWby Rachel Rodgers another one would be ‘Get Good with Money’ https://amzn.to/3W5XSHtby Tiffany Aliche. You can also follow their accounts on social media for hints and tips if reading is not your thing( you can get them in audio format as well!).
Here is to taking charge of our financial security and to a better future as Black (African) Nurses!
"CALLING IN BLACK": Affirming my humanity as a Black Woman at work.
“If you are silent about your pain, they will kill you and say you enjoyed it” - Zora Neale Hurston.
“10”! A high or low number, depending on how you look at it or the circumstances. It was a number i was proud of, a badge of honour of sorts, a vision and reality of how “strong”, “resilient”, “efficient” and “dependable” i was. I mean i was a put -your -head -and -work- kind of person, just get on with it. What i didn’t realise was that, perfect number 10 was killing me, taking it’s toll on me and was in some ways, rooted in racism! You see, for 15 years working as a qualified nurse, i had only taken 10 sick off days! i had a near perfect sickness record, but my mind and body were falling apart!( I write about this in a previous blog post: https://www.ayiechoodembiconsultancy.com/about-healthcare/racism-in-health-a-patient-safety-issue-navigating-healthcare-while-black-part-2
“Calling - in - Black” to work was journalist and social media satirist,Evelyn Ngugi’s way of affirming her humanity to herself by staying home from work to deal with the feelings of grief and it’s emotional toll after being overwhelmed by traumatic events around violence and trauma fueled by racism faced by Black/ African American persons in the U.S.A, according to Byers et al who wrote about her work in their paper: -Giving while grieving: Racism-related stress and psychological resilience in Black/African American registered nurses. Their paper looked at race related stress in the healthcare system and how Racism-related stress can affect nurses’ engagement, performance and practice. It is a great read and worthwhile read
Byers et al are not alone in looking at how racism affects the mental health of Black Nurses, according to a study conducted by Nursing Outlook, cited by Portia Wofford in her post : - Black Nurses’ Mental Health Matters, Black nurses perceived that they had low psychological resilience in stressful situations and were affected by both lived and vicarious racism. Portia also includes this quote below in her post which resonated deeply with me about my previous and current experiences within my workplace and how i now choose to respond to them.
According to psychotherapist Megan Watson, "Microaggressions and macroaggressions in the workplace, that stem from patients, colleges, supervisors, management, and the institution itself might be rooted in racist ideology and can put a heavy burden on the work that you do and ultimately impacts your burnout."
How does all this relate to me and my sickness record? Well after years of enduring pain and illness, showing up to work regardless of how i was feeling, because taking time off sick was (and is still) frowned upon, more so for us Black Nurses in the NHS, COVID19 happened and finally there were conversations happening around workload, racism, mental health and burnout especially around and about Black healthcare workers. For the first time, it was laid bare the unfair and uneven system and bias with regards to all four and more that had been placed on Black healthcare workers and the toll it had taken. Conversations around and about change were happening. Organisations promised to do better, be better, but words without actions are just that, words!
Fast forward to 2022, and i am working at a new organisation, a global one at that, with branches worldwide and nothing has changed. The racist ‘Strong Black Woman’ myth is still firmly in place. The myth that as a Black Woman/Nurse, you can do it all, you can manage the heavy workload without help at all and you will be more than fine, since you are a Black Woman and a strong one at that! It is coated in fake accolades, that tell you how efficient you are, how capable you are, how you just ‘get on’ with it, while more work is piled on and you dig in, carry on, because, as a Black Woman, you know you have to do the work or else you and your work will be called into question. You carry the load even as it breaks your back and mind. Do not be fooled by the accolades, the false praises that are slowly sending you to your grave, eating at your soul. Do not be fooled, no one is coming to save you!
So while, nothing seems to have changed, I have. It’s business as usual on the ‘trample on Black folks/Women’ street. So i am glad that i learned from my past mistakes, my betrayal of self and body. I learnt not to be taken in by the accolades. To see the situation for what it was, exploitation, rooted in racist ideologies. I learnt to listen to my soul and body. So next time the myth of the ‘Strong Black Woman’ came calling, and tried to break my body and soul, I listened to my soul and body and I Called in Black! I mean what is a perfect score worth, if you are not around to enjoy it because your body is totally broken or you are 6 feet under? Like Zora Neale Hurston said: “ If you are silent about your pain, they will kill you and say you enjoyed it!”
Do not suffer in silence, there are steps you can take to safeguard yourself:
Talk to your manager about your work conditions and if your manger is the problem, find out who your HR person and what your workplace policy is around raising grievances and complaints and escalate the issue. Write a letter/email highlighting the issues you face and who you have raised it with and when and what was the outcome. That way there is a record and not just a word of mouth scenario. See also https://www.gov.uk/raise-grievance-at-work of how it should work and what to expect.
Ask about your organisations Occupational Health Policy. Occupational health can help establish a safe working environment for you by providing a range of services which could include recommendations around safe work loads and safe working spaces with correct equipment. You can read more at: https://www.acas.org.uk/using-occupational-health-at-work
Further reading/resources:
Harder, better, faster, stronger? Work intensity and ‘good work’ in the United Kingdom https://onlinelibrary.wiley.com/doi/full/10.1111/irj.12364
RCN Nursing Whilst Black Podcast Series: https://www.rcn.org.uk/About-us/Diversity-and-inclusion/Nursing-whilst-black
Celebrating Black Nurses’ Impact on UK Healthcare: https://www.florence.co.uk/posts/black-nurses
New anti-racism resource for NHS nursing and midwifery professionals: https://www.nmc.org.uk/news/news-and-updates/new-anti-racism-resource-for-nhs-nursing-and-midwifery-professionals/
Combatting racial discrimination against minority ethnic nurses, midwives and nursing associates: https://www.england.nhs.uk/long-read/combatting-racial-discrimination-against-minority-ethnic-nurses-midwives-and-nursing-associates/
A Point of View: Calling in Black: https://www.theinclusionsolution.me/a-point-of-view-calling-in-black/
Black Fatigue by Mary-Frances Winters: https://www.amazon.com/Black-Fatigue-Racism-Erodes-Spirit/dp/1523091304/ref=sr_1_1?dchild=1&keywords=black+fatigue&qid=1592415015&sr=8-1 https://www.wintersgroup.com/black-fatigue-is-available-now/?__hstc=201086513.b0b4ad3e2d6f8cb2ac5c1fbd0bfcdd30.1667634858234.1667634858234.1667634858234.1&__hssc=201086513.2.1667634858236&__hsfp=638492305
Calling in Black by Nicholle Ramsey: https://www.amazon.co.uk/calling-black-Nicholle-Ramsey/dp/173607461X
DO INTERVIEWS MAKE YOU NERVOUS?
I hate interviews. The whole process is nerve wracking and i am never prepared, not matter how prepared i think i am. I suspect it may be the reason i have stayed on in jobs that were no longer meeting my needs, because getting a new job or moving to a new department more often than not meant going through the whole interview process! A process i would rather avoid at all costs, sometimes literally costs to both my soul, finances and general well-being!
Don’t get me wrong, I love being a Nurse and if i can say so myself, i am pretty good at my job/role. So my hate or should i say fear of interviews in not borne out the fact that i am bad at my job, it is due to the fact that i would have to sit in a room and for an hour or less, and try edit myself and my skills to fit whatever role being interviewed for and this often leaves little space to be yourself, let alone showcase the multi levels of self and skill that make you ‘YOU’, and are indeed unique to yourself.
So when i recently found myself in line for not one, but two interviews, i went into panic mode. Thankfully they were both to be held online and i was not required to do any presentations, both which were a plus, as i would at least be in my own environment and i had no added stress of trying to come up with a power point presentation. I also made the conscious decision that i was going to bring my whole authentic self to the interview and not try to shrink myself and personality. They might as well see and get the real deal!
So i wove my personality and skills into my answers, it was scary at first and on more than one occasion i caught myself overthinking and trying to give a more sanitised answer, like when one interviewer asked me where i saw myself in years to come and i answered back, ‘in a field with Goats’ ! While they laughed for a full one minute, i mentally tried to think of something else but then remembered that i was being my authentic self and yes i envisioned a future that involved goat farming, so when they stopped laughing and waited for my answer, i said that was it! When another asked what unique thing/skill i would bring to the team, i quickly blurted out ‘Myself’ and went on to expand as to why ‘Myself’ was unique and how that would enhance the team. I recounted how a piece of machinery had me flummoxed, how chocolate cake makes me happy and how i am grumpy if i haven’t had my morning cup of tea, all within the narrative of my skills and experience.
So weeks later, it was refreshing to read Jilliane Yawney’s post about using story telling at job interviews. Click on her post below to read her brilliant tips and maybe next time you won’t find job interviews so nerve wracking.
Also check out this link to a briliant thread by Sahil Bloom on navigating your career/work life ⬇️
https://twitter.com/SahilBloom/status/1551197313510641667?t=BGbdXMp0cyIytMGRQmGVwQ&s=19
P/S- i got job offers after both interviews. So tell your story, show up as yourself and own that Job Interview! What’s the worst that can happen?
A QUICK and HANDY GUIDE TO SETTLING IN THE U.K: FOR KENYAN NURSES!
Part 1: LOOKING AFTER YOURSELF - Physically & Mentally.
After months and weeks of frantic preparation, you have finally made it to the U.K to begin the next chapter in your Nursing journey. Congratulations on making it this and best wishes in all your endeavours.
The Covid-19 Pandemic has shown us now more than ever that ‘health is wealth’ and by health i mean overall health( physical and mental). Moving to the U.K might not seem like a big change in terms of things like jet lag etc because there isn’t such a huge time difference like with other countries e.g USA and also being that Kenya was former British Colony, some things are familiar, but it is a big change weather wise, culturally, food wise, socially and even accommodation. Once the excitement of moving to a new place dies down and everyone gets back to the daily grind, it can all seem overwhelming causing anxiety and loneliness in some cases.
That is why looking after yourself and knowing what to look out for and where to get help/ resources when needed is so important. When i first came to the UK, the only serious illness that i had ever experienced was Malaria. So months later i was in bed not able to get up, whole body aches and pains, sore throat and running nose. I genuinely felt like i was dying and having no family or friends around to lean or look after me only made it worse. I was staying at a hostel at the time, where meals were served at set times downstairs in the canteen. I managed to drag myself on day 2 of being ill downstairs and the security guy at the desk took one look at me and said ‘ i see you have finally got the welcome FLU’! He asked if i had any supplies, i had no clue what he was talking about? it was summer, how did i have the flu? He helped me get some food, got me some Lemsip, tins of soup and multivitamins. He then went on to explain to me what he meant by the ‘welcome FLU’! He was from South Africa and over the years he had noticed that those who migrated to the UK, got this one bout of very strong flu within weeks or months of them migrating. I know it is not scientifically backed but then i started noticing the trend amongst friends and colleagues who had migrated as well. So i pass on this tale to you as a forewarning to be prepared and have some supplies, just in case you get hit with this ‘Welcome FLU’. Thanks to him and his rescue pack i was on the mend and back to work.
You can buy your much needed rescue supplies from any pharmacy over the counter or from most supermarkets, but i would recommend BOOTS: https://www.boots.com/ over all the others like Superdrug, Lloyds or Supermarket pharmacies. My tried and tested reasons being:
Their points/ rewards system is the best out of all of them like Superdrug, Holland&Barrett and signing up for their points card is a great way to save money, earn points which you can use to pay for products.
Their own brand products are just a good sometimes if not better than branded ones.
They have a wide variety of products and lines from baby stuff, cosmetics, skincare and alot more especially at their bigger stores, so you can do all your toiletry shopping as well as pick up essential medicines all in one go and have i mentioned while earning rewards. it a win - win for me.
They also offer a wide range of other services depending on store.
So if you have not already done so, get yourself a boots card and thank me later!
You may have come with your friends as a group or have family here in the UK which is great as having loved ones nearby can be a blessing when adjusting to new settings and scenarios. Technology has also made it easy for us to stay connected to those who are far away. Sometimes due to work commitments or time differences it may not be possible to stay in touch with friends and family that you have left behind as much as you would like to or even at all.
You are not alone and there are support networks you can plug into. Most NHS Trusts provide some sort of counselling/ therapy services for staff that you can self refer to or call if you feel overwhelmed and need help, be it work or home related. I am not sure about provisions in other settings like Care Homes or Private Hospitals.
Others that might be interest and are worth noting down/joining are:
KENYA NURSES/MIDWIVES- UK( KENMA UK) : http://knmuk.org/ They aim to bring together all UK Kenyan nurses and midwives for common good and to help collaborate with like-minded organisations across the world.
Equality 4 Balck Nurses: A great organisation that can support you when you are experiencing racism or discrimination at work. They also have a weekly zoom session that you can join as and when for support. https://www.equality4blacknurses.com/
Part 2: LOOKING AFTER YOURSELF - Money Saving/Work/Food/Shopping Tips
You would have to be on another planet, if you are not feeling the pinch or have been affected in someway or another with the global cost of living crisis! Lets just say that even before the Covid-19 pandemic and the war in Ukraine, nursing pay has not been that great and that we have been feeling the economic downturn shift for a while now.
I remember going shopping for food or anything and converting the cost into Kenya Shillings and almost fainting. I still do it even now, 20 something years later! I refuse to buy an avocado for £1! You’ve got to draw the line somewhere. As a Nurse working within the NHS or Social Care sector, you can get discounts across many high-street stores by just showing your Work ID badge, or via your local NHS Staff discount pages that your has managed to negotiate on your behalf as part of their staff benefits, or you can sign up for Discount Cards, that you can use to get money off your shopping, phone deals, home gadgets and much more. Some come with an initial fee to join, but are worth it in the long run. Two that i can think of are:
Blue Light Card: For just £4.99, members of the Blue Light community can register for 2-years access to more than 15,000 discounts from large national retailers to local businesses across categories such as holidays, cars, days out, fashion, gifts, insurance, phones, and many more. https://www.bluelightcard.co.uk/index.php
COSTCO: Great for if you prefer to shop in bulk. https://www.costco.co.uk/
FOOD
If you like eating out and are craving that Kenyan feel to going out, then you are in luck if you are in London, mainly East London, as most Kenyan Restaurants/ Eateries are based there.
If you happen to be based in Swindon then Masai Choma House on 131 Ferndale Road is your place. Other places can be found via Google or word of mouth but remember not all those that use our Kenyan Heritage actually cater for them.
When it comes to food shopping, it is worth shopping around but time to do that is rarely available so my go to supermarkets are: Lidl and Aldi. They are pocket friendly and most of their stuff are own brand and actually taste way better than the branded stuff! In fact buying Supermarket own branded stuff not only saves you money most times, they actually taste better most times ( Think Panadol/Paracetamol).
For Spices and stuff like Maize meal and Chapati flour or even greens and fruits, then its cheaper and better to buy them from your local South Asian store which are mostly branded as Halal stores as opposed to the World foods section that have now popped up in most major supermarkets. I tend to get my Meat/chicken and fish from there as well.
PHONE/SIM CARD PROVIDERS
Calling home( Kenya) used to be a problem, one had to buy a calling card or use access codes to call home. Calling home has never been easier especially with apps like Whatsapp, Facebook Messenger etc, the only problem is that they require the party that you are calling to be online and we all know how expensive bundles in Kenya can be. While you can roam with your Kenyan numbers and use them to call home, you will need a local UK number for day to day use. If roaming, i find that Safaricom is cheaper that the rest.
Most service providers conduct a credit check before you sign up for a monthly/ post paid deal. If a pay monthly deal is not your thing then there are great pay as you go Sim only deals out there. remember to check coverage in your area, you do not want to get a deal where you can only use in certain spots! If you want a UK line that you can also use to call Kenya on then my go to one is LYCA: https://www.lycamobile.co.uk/en/rates/#/international , it has great low rates when calling Kenya and also free Lyca-Lyca calls.
Whatever provider you are looking for, do not forget to check what savings you can make using your Blue Light Card. Usually you can save more on top of discounts already provided by your selected provider.
CLOTHES & OTHER STUFF.
I am not much of a clothes shopping person as most of my time is spent either in my work uniform or in my pyjamas once i am home, so i would be utterly useless at telling you where you can get the latest fashions etc. I also hate shopping so i tend to go to one store and that is it and for 20 or so years Primark has served me well, especially when it comes to essentials needed for work and new items and for other stuff like coats and jackets or seasonal wear, Charity or thrift shops are my go to places. But those are just my preferences.
The UK is a place where you can have four seasons in one day! I have also discovered that an Umbrella is much of a hindrance than help when it is raining as it rarely rains without wind or in a straight fashion! rather, as one friend put it ‘ it rains in a diagonal way’ and half the time you spend trying to stop the umbrella from flying away! Investing in a couple of waterproof good coats is essential. A thick one for winter, a slightly lighter one for Autumn and Spring and a general light rain coat for summer. I would also add a fleece sweater for work, if your work place does not provide one. They are much more comfortable and less bulky to wear when at work.
It would also be a good idea to buy some leggings or thermals that you can wear under your uniform, especially during the cold months as you have to bear below elbow when in a clinical setting, so wearing a sweater on the ward is a no-no. I tend to buy the long sleeved basic tshirts and leggings at Primark, not forgetting a couple of long thick socks.
You will quickly find out how expensive anything Black hairdressing is with varying quality at every turn, so if you have that friend who knows how to braid, plait or style hair then keep them close or else you better learn fast how to look after your own hair and how to make a hairstyle last that bit longer. All things Black hair are a tad expensive and hard to find unless you are in a town that has a Black Hair Store. If you happen to find one in your town, ask them if they have an in house hairdressing place. Most of them do. You can also find a limited amount of Black Hair Products in Boots, Superdrug, Amazon, online stores and some select supermarkets.
These are just some tips that i hope will help. I know it is not at all exhaustive but i hope it can be start into getting you settled. If there is anything else you would like me to touch or expound on, please let me know. Please share with friends or anyone who you think would benefit.
Wishing you all the best in all your current and future endeavours.
The Making of a Nurse: Pre-Training School(PTS)..#TheAccidentalNurse Pt 3
Hey, welcome back to The Wandering Nurse and to the 6th part in ‘The Accidental Nurse’ series, my nursing memoir.
This is the last part of Pre-Training School(PTS) and is also when i learn about the death of my Mother which in a way leaves me homeless. There are changes other interesting changes in my personal life and we finally find out if we make the cut, marks wise and can finally graduate from Pre-Training School to Nursing School proper.
A lot has happened from In the three or so months of Pre-Training School(PTS), from my reporting day on September 2nd 1996 to end of PTS in December 1996.
I was also getting to know more of the early year groups ( Sept. 1994 and 1995 intake) better, expanding my friendship/ tribe circle. They were all on various placement shifts and areas with some of the september 1994 intake on their health centre management in Isebania, which was located near the Kenya - Tanzania border. It was great to get study tips from them and also to borrow some of their notes which we used to help during our revision sessions.
We also found out that the septum, which was the nickname given to the partition between the female ad male sides of residence, functioned in two ways and only on the first floor. It had a hole at the top that was used to pass on information about whereabouts amongst other things. It also had another opening at the bottom which was concealed for obvious reasons because it was large enough for an average adult to pass through. It was used as a bridge of sorts when needed and involved a lot of planning and lookouts. It also seemed to be used by the less brazen of the male students. That was because, the staircase to the female quarters was in a more exposed place with direct view from the deputy principals house or the senior tutors house, while the staircase to the male quarters was a bit more hidden, obscured by the dinning hall and somehow not that well lit!
Exam day came upon us and it was mainly anatomy and physiology with one paper heavy on bones. I loved exams but i was nervous, understandably about how i would do. We had our last paper on Saturday morning, by which time I was excited at the prospect of my mother coming over like she had said. I alerted the guard at the gate and the kitchen staff to call me if there was anyone looking for me who identified as my mother. I waited, lunch time came and went and soon it was evening and she did not show up. I was disappointed but I also realised that she may be too weak and frail to travel, especially given that the journey could be a long and arduous one. I decided that I would go see how she was doing the next weekend, after getting our first exam results, hoping that I had made the grade to remain in the programme. We would then have something to celebrate.
On Sunday, I decided to take my cousin up on her offer to go visit her and meet her family. She lived in a place called makongeni and it was a long walk from the MTC to get there, but i did not mind as i was a great fan of long walks. The walk to Makongeni took me past the prison and pleasant scenery which made walking fun. The visit was pleasant and I got sent off with enough supplies from their shop and a promise to visit often.
Monday after class, I was summoned to our class tutors office. Being summoned to the office almost always meant one thing - you were in trouble and trouble came with consequences! I tried to run through my mind what it was that i could have done to warrant a summons ( sneaking to Kisumu was up there in the major league) and if I could handle let alone talk myself out of whatever consequence was coming my way! I walked into the office determined not to show how shit scared I was( apparently I have a great poker face, as he later said, but unrelated to this incident! He complained of never being able to read me! and here i thought, my eyes always betrayed me!).
I sat down on the chair opposite and waited for my fate. He asked how I was doing and settling in and then when was the last time I saw my mother? I thought about lying but then I decided that since he was asking he probably knew the answer, so I might as well just tell the truth. So I said Sunday past and I waited, hoping that it would just be a stern telling off and not a suspension or worse, expulsion. The strangest thing happened, it was like he had read my whole life file, either that, or my family drama was not at all unique to me but instead common and therefore he could accurately guess what our family dynamics were. He started talking about how my parents had subjected me to a traumatic upbringing and even went as far as listing them. He then went on to berate them for not caring about me, not even bothering to check up on me, being that I was in a new and unfamiliar environment, far from home. At this point I started feeling pretty angry myself, coupled with the disappointment I felt about my mother not coming over as she had said she would.
Once he was satisfied that he had riled me enough, he dropped the biggest bombshell of them all, forever changing my life in more ways than one. He said my sister had called on Thursday and had wanted to talk to me but as I was in class, they asked she could leave a message instead. She did, it was to say that my mother had died that Thursday morning and could I be released to go home. He went on to say that it was decided that I was not to be told until exams were done as they saw no need to disrupt my exams with the news. Then he went on to say that it was a good thing that I had at least seen on the sunday the sneaked out and given the circumstances he was not going to punish me but I should never repeat it again.
I sat there in total shock and numbness. I mean, what was I meant to say to all that? In an instance, my life had changed, taken a major detour. I tried to make it make sense, but I could not. I excused myself from the office, walked to the field adjacent to the dinning hall, where tall, dark and handsome( let us call him ‘M’ ) and the other boys were playing basketball and told him what had happened and then proceeded to walk to my cousin's house. I guess I needed to hear it from someone who was family or I just needed the comfort of family. I was not sure but I knew that at that moment, I needed to walk and maybe, just maybe, I would discover that it was all a dream and I would wake up. Sadly, it was real. M stepped up and became the rock that I needed to lean on and made the weeks and months after her funeral bearable.
Life moves on and nothing stops for you, not even for a minute. I came back to college, to find that not only had I aced my exams, my paper was used as the marking scheme - a hundred percent all round! The bar had been set and I now had a huge target painted on my back, not to mention buckling under the weight of expectations from the whole administration, who had somehow adopted me and decided that I was to be kept away from all sorts of corruption, moral or otherwise. Classes and college life resumed as normal. We learnt about medicines, how to make hospital corners, patient vital sign observations, midwifery, how to make an orthopaedic bed, how to change a bed with a patient in it from top to bottom and from side to side, history taking, amongst many other new and alien things. It was a lot but fascinating to say the least.
For reasons I could not explain, the female 94 class liked me and I got to hang around with them in their rooms and occasionally accompany them on their nights out. Apparently the security guard was convinced I could never be up to no good so I was their way past curfew. It also turned out that on the occasion the deputy principal was doing an impromptu walk around, checking rooms and floors for contraband and stray men, my presence, past curfew in any of their rooms was deemed as a good sign that nothing untoward was going on. This endorsement shielded me from any more shenanigans with the males and I even became firm friends with the emergency landing trio. You can say that my social standing within the MTC community and beyond was much improved and I was enjoying every minute of it.
There were loud bangs on almost all doors, people were shouting downstairs. It was dead in the night and I wasn't sure if I was dreaming or someone was about to be expelled! It turned out, there was a huge emergency at the hospital and it was all hands on deck even us PTS folks. The driver of a bus full of passengers was speeding, causing the bus to overturn and fall down a bridge into a river. It was carnage with horrific injuries and death and since Homabay district hospital was the nearest hospital, all casualties and bodies were being brought in and as in every hospital, Homabay not an exception, night time staffing was at bare minimum hence why the whole MTC students were needed.
I had never seen so many people with such horrific injuries in my life. There was blood everywhere, screaming and it was overwhelming, not knowing what to do or where to start. We got assigned jobs with the whole operation being coordinated by the then brilliant medical superintendent( or Med-Sup as he was known), who happened to be a dental surgeon. I got to see my first and last jaw wiring. It was a long night and by the time morning came, I was exhausted but we still had to prepare for and attend class. It turned out to be the first and last all hands on deck emergency I ever witnessed and participated in during my whole time at the MTC.
The whole PTS routine of classes, exams and lectures with evening and weekend exploring was all nailed to a T. Thankfully we all kept passing our exams and when the final exams and practical assessments rolled through, we all passed and could finally graduate from Pre-training school to Nursing school proper. That also meant that we had earned time off, a couple weeks of annual leave and we could leave the campus and go home which was all very exciting for everyone except me. I had no home to go to. Yes I had family all over but I was somehow estranged from them and had only lived with my Mother, who was now dead leaving me homeless. M and I boarded a bus to Kisumu, he was going home, looking forward to catching up on movies he had missed. I, on the other hand, was going to stay a couple of days with friends while I figured out what my next move would be. I kept this news to myself. I was not ready for what December 1996 had in store for me.
What are some of the best career advice you have heard?
🩺Was busy minding my own business, curled up on the sofa, catching up on my favourite show #sweetmagnolias when I heard this 👇🏾 and I had an Aha moment! One of the boys working in the kitchen wanted to know how to become a chef and how much school would cost? So Erick, the chef tells him, he has to be sure it is what he wants as it can be a lonely profession with long hours, leaving no time for a social life let alone family life!
🩺It has to be up there with some of the best career advice out there. Basically what he was saying was that if you are not passionate about something, then choosing it as a career will be a slog! You will tired down doing a job you hate just to pay off the debt you took to study it 🙆🏾♀️😶😭.
🩺I immediately thought of #Nursing (as that's my profession ) and how thankless the work can sometimes feel, especially now with everyone just about hanging in there, with nothing more left to give. Don't get me started on the pay! As much as it has been labelled as a calling by some, even the most charitable, passionate and vocational Nurse is struggling at the moment 😕, questioning how much longer they can hold on for?
🩺But it is not all bleak( believe me). Records show that alot of people have been inspired to take up Nursing, having witnessed how brilliant nurses have been during the pandemic( we have always been brilliant, but we will take our flowers 💐 even if late). All that is great given the huge financial burden one now has to take on to train as a nurse! That makes this 👇🏾 quote even more poignant - 🗨make sure you love it, before going into debt for it 🗨 and if that is the case, then a Huge welcome to you all #studentnurses and aspiring futures nurses into the wonderful, rollercoaster life that is Nursing.
💊🩺💊🩺💊🩺💊🩺💊🩺💊
#NHS #nursingschool #Nursing #careeradvice #mentoring #nurseconsultant
