Covid-19 in a Dementia Unit

Always remember, a dementia patient is not giving you a hard time; he is having a hard time
~Bob DeMarco

He always picked on me. Graeme M. Frank* always did. At 6″2 tall, he towered over me like a mighty Goliath. He didn’t do it on purpose though. Alzheimer’s had robbed him of the joys of human interaction. Infrequently however, divine light illuminates his mind and his best sides strikes through like a bolt of lightning.

But he still picked on me. We could be attending to him with one of the carers and he would choose me as the target of his clenched fists. “You will get it!” he’d threaten but forget about it as soon as he said it. A lion’s roar.

I work in an advanced dementia unit hence Alzheimer’s disease is one of the challenging illnesses I’ve had to deal with. As intimated before, mental health nursing is not one of my strengths. I time and again rely on those I work with to hold me together.

I am the team leader of a very capable team. At any given time, I have N* and J* as my health care assistants. I focus on the nursing aspect as they focus on the intimate caring bit. That is what the papers say. However, we essentially team up every second of every 12-hour shift to offer the highest attainable quality nursing care for all our residents.

They know I identify too much with my residents. N is the chief whip of the unit. She demands thick skin from me. I try. God, how I try. Occasionally I feel so helpless as a nurse I have to go to J for cuddles. J stabilises the team. I couldn’t ask for better carers!

Take for example this fluffy Friday afternoon. Fresh as a sunny day in winter, time dragged on and Graeme did what Graeme did best; wander with purpose.

It is a phrase we use to describe patients who move from place to place. At face value, it looks aimless but the truth is, their thought process indicates that they have a purpose to the movements. It gives them something to do. You can safely encourage this in a nursing home. Quite the opposite if you’re nursing this patient at home. They may get lost.

I heard a scuffle and rushed out of the treatment room to the corridor. Greame was very agitated and pushing Hillary* away. Graeme jealously protects his territory. Hillary loves being with other people. We had not noticed Hillary walk towards Greame and hold his hand. Graeme wasn’t very pleased. Neither was Hillary. It broke my heart.

As Hillary tightly clasped my hand and walked in tandem with me to the dining room, I unsuccessfully hid the tears welling up in my eyes. N, being the hawk-eyed of the two carers wasn’t fooled.

“Catherine why are you crying?” She enquired.

I’m not sure what I said but it bordered on my feeling sorry that Graeme didn’t know why Hillary wanted to hold hands and Hillary not understanding why Graeme didn’t want to go for a walk together! I may as have well spoken in tongues.

N and J both held me in a five stars embrace. Just what the doctor prescribed. A therapeutic hug. A hug that went to a private school and had access to private tutors growing up. Hugs, friends, hugs should taste like this. I wanted to freeze this moment right here and put it in a mirrored column pedestal or in gilt-edged frames. Priceless.

Hugs are the words we utter when our mouths can’t speak.

See, both carers have considerable experience working in dementia units. You could say they have seen it all. Well, yours truly hasn’t and I’m not sure she ever will.

Graeme, apart from being ferociously territorial, picks on strangers. Especially strangers of the female gender. I was a stranger and a female; a typical low hanging fruit. It took a few months for him to get acquainted to both my face and voice. I am no longer threatening to him. In fact, he drawls a “hiya!” in a heavy Scottish accent whenever I pass him by.

Brian*, his son, nostalgically remembers his father as a family man. A true Scot. Before being admitted at this care home, he had taken care of his agarophobic wife and autistic daughter. He always looked out for them. He defended them and shielded them from the world.

With the straps of his boots, trudging from the Scotrail company to his home every other day, he looked out for them.  It came as a shock to the family when the tentacles of Alzheimer’s disease started eating at their beloved dad’s mind.

Alzheimer’s is a debilitating illness. It threatens to steal the person from themselves and from those around them. The decline in mental capacity is not only slow but sure. Medications oftentimes only slow the progress of the disease but not reverse it.

It starts differently for everyone. Forgetfulness being a classic symptom. Then a total inability to make independent day to day choices. It is a traumatic experience to watch someone you hold dear and near become a shadow of their former selves mentally speaking.

I have been here for a while now and every day I walk a mile in the shoes of my residents, it hurts my toes in several different spots.

When Graeme left for the nursing home, a void in the shape of his heart was left in that palatial home in Falkirk, Edinburgh. A void that shows in the frequency of visits from Graeme’s immediate and extended family. A void that is filled with silent understanding of what’s best at this point. A silence I could cut into and serve a chunk for breakfast.

The light in his eyes shine every time a family member visits. Everything changed with the dawn of the Covid-19 pandemic. Families had to stay away. Staffs wore Personal Protective Equipment (PPEs) and the familiar faces were buried in masks and visors. I was worried sick that his anxiety would be heightened.

To worsen a bad situation, Graeme contracted Covid-19. For a resident who moves unhindered from place to place, this was a major challenge for us. He was asymptomatic. Not even a cough. He had been diagnosed on a routine examination of all residents after one contracted it.

How they managed to get a throat and nasal swab from the able and mighty Graeme is a mystery I’m yet to unravel.

With a right-sided stoop due to scoliosis, Graeme shuffled along the unit without a care in the world. Nothing changed for him. Not even the novel Coronavirus was enough to dampen his spirits. Still he purposely rearranged furniture from one end of the corridor to the other. Still he transferred the cherry blossom-colored throw pillows from the Day Lounge to different bedrooms if they were open. Still he made a big fuss at personal care. That was our Graeme. Unbowed.

With Covid-19 restrictions, it has been a while since he last saw his family. Especially Brian, his son. Whenever he calls to find out about his Papa, we tell Graeme that Brian was on the phone for him. ” Oh aye!” He offers again in that exquisite Scottish drawl.

Last weekend however, Brian and his daughter brought toiletries and assorted chocolates for the staffs and residents in my unit. We encouraged Graeme to stand on the balcony so that they could see him.

He stood at the balcony, looked at the two and just when we thought he might actually register some recognition, he turned to a stuffed bunny that lay unattended on the couch. He picked it and went back to the Day Lounge. The perfect organiser. Always fixing everything to its place.

The memories and moments created with his family have fallen into the sofa cushions of time. So have the numberless conversations and the belly laughs together. There they all lie, in time, cataloguing the past and hopefully mapping out the future.

Time, I have learnt, does not offer any consolation to the declining mental capacity for dementia patients. Time for them is a vacuum filled with bits and pieces of a past that seems so long ago and a present that is held together in shaky ribbons and shoe strings.

I was afraid he would pick on me again. He didn’t. My soft voice, though wrapped up in a 3-ply face mask he still recognised. My eyes though hidden under a visor, still held his gaze and silently reassured him that we all were there for him.

The unforseen challenge was protecting other residents while still encouraging his ‘moving with purpose .’ How do you enforce isolation in an advanced dementia unit? What is the color of the sky in isolation and barrier nursing within Dementia Units?

N and J in my shift were integral in containing the spread of the virus. Every 30 minutes they’d walk up and down the corridor with bottles of disinfectant wiping down all surfaces. Every nook and cranny of the unit got cleaned a million and one times over. Happiness Unit*, though unhappy from semi-isolation from the other units in the care home,was not only spotless but germ-free.

It has been a while now since he tested negative. We are still working with the two metres physical distancing rule. Not for him though. Patients with declining mental capacity do not have the ability to comprehend the restrictions. The onus falls on the staffs to do it for them. For everyone’s sake.

Yesterday was special nonetheless. I was seated in a corner of the dining room nimbly working on my nursing notes. He stood at the door, gingerly holding the doorknob of the dining room where I sat (many metres away) and looked at me. He raised those bushy eyebrows as he held my gaze. I offered a smile. No reaction. I offered another. Then another one.

“Nice teeth,” he declared as he doubled up and shuffled back to the corridor. Pardon me if I’m smiling too much today. I just have to show you my nice set of teeth.

* Names of people and places have been changed to protect the identity of individuals and places. This is for confidentiality purposes.

Moving House

Home is where the heart is even if you can’t remember which box you packed it in ~Anon

The thing they never told me about abroad was that there were no bodabodas and no mtu wa mkokoteni. And people generally minded their own businesses.

My move from Huntly where nothing ever happened to legendary was filled with potholesthe size of an adults and hiccupsas loud as God’s thunder. It was a Wednesday. Wednesdays are supposed to be lively. This wasn’t. There was no life in my soul. Though I had passed the OSCE exam and I was now a UKRN, I still felt inadequate. I badly wanted to leave and go to a city. Any city.

I had experienced subtle micro aggression and hidden racism that I was just about done. Done with having to realize that I’m black. Done with feeling like an executive pariah. I have always preferred open rebuke to passive aggressive comments. Those made my red blood boil.

The transfer couldn’t come at a better time.

TIP : If you want to work in the UK, I propose you tell your recruitment agency that your like to be in a city or a major town. Small rural towns will suffocate you.

I packed my few belongings and hired a taxi to Aberdeen city. I had to do with the curious looks from my flatmates. Talking of whom, they had accused me of every evil under the sun. I had stayed with two couples. One Polish, the other a blend of Scottish and Litvia. The latter had their own en suite room, the Polish shared a bathroom with me.

This is where I came face to face with the glaring differences between housing options back home and in the United Kingdom. In Kenya, multiple occupancy houses are not a thing!

We had a duty rota to clean the common areas. The stairwell, the living room (which I never used), kitchen and in my case the bathroom I shared with the next door couple. This is where I had to learn to use a vacuum cleaner and a washing machine. A girl from my kind of background in Kenya had understandably never used either of the two.

As a matter of fact, they come in so many variations that I’m still learning how to operate them. I remember an impatient knock on my bedroom door one day after my night shift. It was Mrs.Mazur from next door.

She spoke in the most heavily Polish-accented English. From the tidbits I could gather, the bathroom needed to be scrubbed clean and I was being insensitive by sleeping during the day when the poor little bathroom was dirty. It was malicious to sleep when baby bathroom needed cuddles and a lullaby from mama. How could I!

I knew that it was not my turn to clean but either hers or her serial smoking husband. She gesticulated in angry frustration at me. Partly for achieving little communication because of the language barrier and partly because I looked unperturbed by her mannerisms.

Striding past her, I bounced down the stairs to the announcement board and brought her the tiny piece of paper that we called a duty rota. Calligraphically hand written there was today’s date and her name against it. She grabbed the rota from me and furiously returned to her room. I could hear her murmuring to her husband.

Poor man, I thought; that woman will kill him before the cigarettes do. She has a carcinogenic fiery tongue. Had I been my former self, mine would have clashed with hers and lit a fire. But this was a new me. Jesus had the wheel–and my tongue.

It takes an hour or so on the train from Huntly to Aberdeen city. It takes three decades and a prayer on the taxi. My cab driver was a chap who’d seen better days. He however knew a little about the world and over the staccato of the BBC Radio 2, we had a chat.

Cab Driver: Wherabouts yu’ from?

Me: Kenya

CD: Oh nice lassie yu’ run?

Me: (Giggling) Yes, for my life.

CD : (Laughing with me) That’s fine. We all run for our lives.

He noticed the luggage and the move and asked where I was headed to. At 70 years, he highly recommended the move. He said and I quote, ” this area has more sheep than people. A wee lassie need people.”

We can’t argue with our elders, can we?

The taxi rank is in the East side of Aberdeen bus station next to the busy train station. I needed to go to the West side where the bus station is. He could not help me any further without risking significant fines. I was therefore on my own. Just me, three boxes of baggage the size of a teenager and a backpack carefully strapped on my back.

This is where I missed watu wa mkokoteni. They make life easier. They help you carry everything and if you’re nice, they can carry you. Especially when it rains and Nairobi morphs into one big swimming pool. My father has been a porter for many years. He carries goods (not people Ha ha) in Wakulima market in Nairobi.

I missed him and his buddies. I wanted him to refer a good person to me to help me carry my burden from East to West. But this was Aberdeen. The glittering city in summer. I had to tough it up and solve my dilemma.

The Megabus I had booked was to leave for Edinburgh in an hour’s time. I had enough time. There was one problem though. The trolley I got from the train station had crooked, locked front wheels. It could also accommodate only two boxes at a time.

I had to leave one behind. However this is the UK. If a box or bag is left unattended for long, people will call the police and it may be taken away and treated as you’d treat a bomb. See something, say something is the slogan here.

I had horror images of being led away by mean looking Scotland Yard officers. Screaming at the top of my lungs that all I did was move house. Then I’d be sentenced to prison for causing public security concern. Then because I wasn’t built for a cage, I’d die, be buried and then my epitaph would read : She died for her baggage.

Thinking was not going to help me. I took a leap of faith and dragged the trolley. My blood alone propelled it forwards. Across a sea of people of all colours I pushed my evil trolley. I packed my boxes near the bus terminus. Luckily the people had “seen something and done something ” as the security messages blared from the different announcement boards.

The something they had seen was a struggling girl. And the something they did was leave her alone. I made a second trip and a third one to return the trolley. I was knackered. Why was I the only one moving house? Someone is always moving house in Nairobi. I missed seeing people move house!

The bus sauntered into Edinburgh bus station a few minutes shy of one O’clock. I was in contact with the owner of the Airbnb where I had booked a short stay.

I was only 15 minutes away going by the Google maps. I missed our Kenyan bodabodas. The rider would have lifted my luggage onto his boda, then somehow fitted me onto the same boda and off we would have left for the Airbnb. Ah the small joys of Kenya!

If it can’t fit onto a bodaboda, it can’t fit anywhere else.

I needed a taxi. Again. Edinburgh Cabs is the recommended taxi operator. I phoned and asked for a black taxi. A black taxi is not only black in color but also bigger. Can carry me and my sins.

Unfortunately for me, the taxis are not allowed to enter the bus station. One must access them from across the road where they have a cabstand. My driver called to let me know he had arrived. I had no trolleys. I was alone, again. My three boxes helplessly looked at me from the ground. Like a firstborn that knew his mum had hit below the rock bottom.

People walked around me into different directions and some gave me deserved look-at-this-poor-girl looks. Just what I needed. I approached a black bus station attendant and asked him for a trolley. He had been staring at me for a while now.

He smiled and in the most beautiful West African accent, he informed me they had no need for trolleys at the station. The baritone intonation of his voice sounded like the beats of Burna boy. Or Wizkid. Okay Pick any West African musician you know. My phone wouldn’t stop ringing. The taxi driver had the patience of a hungry infant.

He excused himself and helped me carry every last piece of luggage to the taxi. He is from Gambia he informed me. Getting a helping hand for the first time was golden. I half cried. He was the shining star in my dark skies. I tried giving him a token of appreciation. He politely declined. He just wanted to help me he said. I should have hugged him.

The cab driver was nasty. He shamelessly asked if I was carrying my life’s savings in those boxes. Retrospectively, that was hilarious! I didn’t however understand his whining. I had clearly informed the operator that I was moving luggage. There was no need for Mr.Cab to be salty with me.

He complained for the entire 15 minutes and I was too jubilant for that Gambian gentleman to be annoyed. The charge was seven pounds but I gave him a twenty and told him to keep the (insert a profanity) change.

My host was Russian. The tallest man I’ve ever seen. His girlfriend was petite. A lovely combination. I have blurry recollection of his name but I know it had a slav at the end. Somebodyslav from Moscow, Russia. In Edinburgh for 10 years and now virtually a Brit. He missed Mother Russia and hoped to take his girlfriend to see his parents soon.

I rated him a clean five stars on Airbnb. He was warm, his girlfriend a perfect host. She showed me how to use an oven to cook and warm meals. The closest I had been to an oven all my life was while watching Let’s Cook program on TV back home. Back in Huntly, my flatmates expected me to know. After all, the earth is flat and we all come from similar backgrounds, yes?Ha ha

I was not even aware cans of beans and fish could be opened using a can opener. First, we didn’t use canned foods back home and second, if we ever needed it opened, we could always use knives to piece the edges at the top of the can.

She showed me places to shop and even recommended an African shop around. Compared to the reception I’d had at Huntly, this was incomparable. It was life giving.

It would take me a week and a half to get new accommodation. There are no signs indicating houses as ‘VACANT’ like I was used to back home.

I had to use my phone to download different applications where tenants meet landlords . I missed waltzing into a building and asking ” huku kuna vacant?” Translation: is there a vacant here? A vacant is a loose word we use to denote an empty house for rent.

I reminisced how even if there was no vacant in that particular building, the tenants would guide me to available vacants within the area. Again, the joys of Kenya that I took for granted!

Recently I went to the African shop that was recommended. I needed plantains. I saw the Airbnb from across Gorgie road, Edinburgh. I felt like passing by and saying a massive hello to Somebodyslav and her girlfriend.

No Students in Class

I’m trying to be the person I was too lazy to be yesterday.

Shifted and subsequently broken. That was the state my heart was in when the airbus kissed the skies away from Kenyan airspace and dauntingly tilted towards Abu Dhabi.

I told myself that I wanted to go anywhere. Anywhere but home. I wanted to be away. To rethink, re-strategize and reboot. I was unsure of many things but one; I needed to go back to school. I needed my Bachelor’s Degree in Nursing. Now I have to tell you a story.

Little Red Riding Hood

Once upon a time, the Nursing Council of Kenya ( NCK) decided to have a conflicting educational system for nurses in the country. NCK, which is the Regulatory body for Nurses in Kenya, felt that it was the most beautiful thing to train nurses as Certificate holders, Diploma holders and then Degree holders.

To garnish the uninspiring system, NCK trained diploma Registered Nurses for an entire 3.5 years, taught them the same thing they taught degree holders for 4 years in University, and then refused to have a scope of practice.

The employers, government and otherwise, then went to the job market in search for nurses. They found degree holders but felt they couldn’t pay them for their high and mighty papers. So they shopped for diploma and certificate holders who could equally do what the degree nurses would do.

After all, the market was flooded with nurses. And any nurse is a nurse as long as they do what nurses should do. I do not know what that means leave me alone. NCK did not learn even after multiple attempts from professional bodies and unions to try cushion the future of the Nursing profession in Kenya.

“Let us train them all,” NCK reasoned. ” It has always been like that,” they chorused like well-fed baby yodas. “The employer can decide whether to employ the certificate holder or the degree holder,” they justified.

The brains behind degree nursing had had a dream. A dream where the value of the profession extended beyond Kenyan borders to global standards. A dream that students in high school would someday want to become nurses by enrolling for degree courses. That nursing would regain her lost glory and stop being viewed as a course of last resort.

A dream that nursing in Kenya wouldn’t be viewed as a subordinate branch of medicine but an equal player. That dream was in part transitioning the education system of the nurse. But NCK, just like the big bad wolf never changed.

Just like the big bad wolf, in the 20th Century, NCK won’t scrap off Certificate nursing training whose requirement is a D (or something similar) in KCSE and won’t create opportunities for employers to prefer nurses with advanced education. Baby Yoda belched with satisfaction at the confusion he created.

Then along strutted Little Red Riding Hood. She failed to understand the malignant injustice in the Nursing education system in Kenya. She especially felt that higher education should reflect in a wider scope of practice and a more defined scheme of service.

Higher education, she surmised, brought massive shifts in the world of possibilities. It was exhilarating. She saw a future whose direction she’d love to be part of. This borderline orgasmic determination scared some and inspired hope in others.

The science and art of caring for the sick was an empty clanging cymbal if it couldn’t work for the benefit of not only patients, but the nurses themselves. Laws that break the very backs of the taunted frontline workers are antithesis of what nursing embodies.

Little Red Riding Hood got an opportunity to test her theory. She enrolled for her BsN by God’s grace somewhere in the United Kingdom. This was in the year of our Lord 2020. Covid-19 was the king and social distancing the new gig. She was me. I was her. The End.

To the present…

I have been to numerous classes thanks to my interesting educational journey. What I have never considered is online learning. That is what Covid-19 has shoved down my throat. Perhaps it should be easy because I’m a qualified and registered nurse already but hand to Jesus and the choir of heaven, it is not.

It is even more convoluted when you’re as tech-ignorant as I am. I pride myself in having a fairly stable memory. I should remember my Computer classes not so many moons ago. However, the outlines are clear but they fade at the edges leaving blurs and smudges. Everything gets dark after that.


I need an IT boyfriend . It is urgent. Do you have a tech-savvy boyfriend? I need him. Sharing should be caring or something like that. This is where girl power comes in Mother Teresa. Loan me your geek boyfriend for the period I’m in school. Ha ha. I got you.

Two days ago I submitted my assignment and instead of posting it in the board where my lecturers can see it, I posted it in the Frequently Asked Questions’ section. It is only the patience of the lecturers holding me together. Like raggedy pieces of duct tape and a shoestring, they daintly keep me in place.

Blessings is my virtual learning classmate and she keeps asking where the assignment section is located. Ollie wants to formulate and answer his own questions. A certain Olayinka won’t fix his microphone during live class sessions.

The live sessions have become my favourite. They are gorgeous. See, we have two lead lecturers. M and Dr. P. For the entire semester of Summer 2020, if they say jump I must ask how high.

The time is 1200hrs BST ( 1400hrs EAT). M introduces the lesson and everyone has their mic on. She has a hard time getting the class to order. Everyone wants to say “hi everyone .” Daniel, who has joined us three minutes after the start of live recording also wants to chant ,”hi everyone.”

M and Dr.P briefly outline the learning objectives then M takes the lead. M is in Surrey and Dr.P is in London.I don’t know whether they know but their students are there just not there.

Solomon’s hand has been up for the last several minutes and M keeps asking him if he has a question but he won’t talk. He will not put his hand down either. We have to learn to live with him.

M is saying something about Harvard referencing style. She talks about sending us a link to learn how to cite them right. Charles has his microphone on. He is murmuring to some femeo that ,”aha, I can see them now.” Okay Charles we would like to see you too please turn the camera on.

M : Charles could you please turn your microphone off? I will allow time for Q and A at the end of the session.

Charles: ( To femeo) ahaa, now it looks good.

M: I’m sorry class let me mute all microphones.

I have forgotten what she was saying. Did she say the author’s name and the year of publication must be within brackets or was it just the year? I hope to catch up.

M goes on. She asks Dr.P if the screen she is sharing is legible. Dr.P rightly tells her that it is not and we would all benefit if the text was enlarged. Here comes graduated trouble.

M is as naive with technology as I am. Dr.P’s silence is too loud. Apart from Emmanuel who saves the day, we are technologically as tasty as plagiarism. Emmanuel reminds me of a classmate I had in my renal nursing program, Bundi.

Bundi was the genius of technology. He helped set up Power Point presentations, linked them to wondrous YouTube videos and still managed to screen in and screen out presentations. Emmanuel is my new Bundi.

Some child is crying in the background and I can’t tell whose baby it is. Neither can M. M just wants the microphone off. That happens. Almost immediately, the cursor on my screen moves and there is someone doodling on the screen. They are drawing tiny blue circles on the screen and M is ten milliseconds away from holding her forehead in exasperation. She doesn’t.

M : Please class note that we all can see things happening on the screen. Please do not touch your screen when on live session. Please try to not play with your mouse pads.

Ha ha M. I miss real classrooms. Where I would sit at the back and pass wiseass notes to my classmates as the lecturer talked. Whoever is drawing is officially my desk mate.

Eventually we get it and the lesson is halfway over. We pause for a quick Q and A. A girl is asking a question about some activities in Unit 7. People of God, Unit seven is not until three weeks from today. Pray tell me how did we get here?

Though she gets her answer, Dr.P is a quintessential Brit who tells her without telling her to calm her heels down. Oh you should have seen the smirk on P’s face. It froze the sun.

I have been dying to ask about word count. I am horrible at word counts. I always get it wrong. Dr.P is guiding me but all I hear is stuccato because someone’s cup is filling with water (or alcohol) somewhere. Children of Papa God, how hard is it to turn your microphone off though?

I have to ask Dr.P to say it again. This time, I am the one that interrupts it. There is a flying beetle that’s found it’s way into my living room. I left the window half open to let in some light. The early summer beetles have been dying to have a cuppa coffee with me.

A cuppa when in the middle of a lesson sounded like a beautiful idea so it buzzed its way into my living room. Wings tiny as a baby’s finger, he fluttered on in front of my face and I used my hand to swat him away.

That movement somehow touched my mouse-pad and the camera came on. P had to pause and watch me fight my monsters with the microphone off. What a spectacle!

Veronica wants to ask questions and “seek clarification ” on everything. She also wants to “clarify” what M and Dr.P have already said. My brain has taken a walk and I want to follow it. There is something about a teacher’s voice that just takes the pain and grind of life away.

A teacher’s voice is the blood running through the vessels of peace, love and harmony. The intonation of the teacher’s voice; as s/he explains a concept is a melodious tune to our hearts. A teacher’s voice cannot be ignored. It is also a cajoling lullaby. So I doze off somewhere along the lesson.

I’m startled when my earphones fall off and for some reason I am thinking about Samuel L. Jackson. I think he would be a badass teacher.This is why they record these lessons. Samuel L. Jackson would record them too.

We must access them if we are to pass the module. By the time we chant ” bye everyone,” Ollie still isn’t convinced that his answers are not related to the questions asked in the assignment.

Charles and his femeo left the session at the 47th minute and Solomon’s hand is still up. He says nothing. Seen. Not heard. Does his voice sound like Samuel L.Jackson’s? Is his voice the love song of the nightingale and the lark who we can’t hear anymore?

Why is his hand up? I wish he could type his thoughts in the chatroom. He doesn’t. Like a sleuth he wanders in our online presence. He sees us but we can’t see him. His virtual hand however, remains up. I must go back to that recording.

The Golden Girl From Swansea

The Germans say that a person has learned much who has learnt how to die. In my line of work as a nurse, death is one dull dreary experience and I have interacted with it several times. My colleagues and I are always fighting it on behalf of our patients. The statistics have so far been overwhelming in our favour. Sometimes however, the thin curtain between life and the other side gets lifted and it is bye bye.

Never before in my career had death become all too familiar as when I started working with residents. The beauty of a close knit care home is the homely atmosphere.  Everyone knows everyone.  Some residents know the team and they can tell who didn’t come to work when. It is also very hard not to have some degree of emotional attachments with them.

Good nursing practice says to empathize with clients. This calls for walking a mile in their moccasins for a nurse to offer quality care. I wore pair of Maddy’s* snub-nosed blue shoes and they fit snugly. I didn’t didn’ttake a mile in them. I completed the whole race track and loved it. This 98-year old golden girl from Swansea leapt off the page like a catchy headline.

She had been living in the advanced dementia unit I worked in for an year before I was transferred there. I do not understand my nursing journey oftimes and I gave up trying. I had hoped to work in the special nursing unit but by some twist of fate, I was posted in the advanced dementia unit.

Mental health nursing, psychology and indeed psychiatry never tickled my fancy in nursing school. The memories I have are of my team and I at Mathari Mental Hospital in ward 6B where I had a glimpse of what diminished mental faculties can do to someone. It weighed heavily on my spirit like a little baby elephant and I eliminated mental health nursing as a career.

Indulge me a little. On our first day at the aforementioned ward in Mathari mental and referral hospital in Nairobi, Kenya, we met Ndung’u*. Thin as a string with eyes that could light up a room, he tried to be invisible most of the times. Ndung’u had perfected the art of being inconspicuous. In a populace of all types of mental illnesses, it paid to not be visible for the others. Whether this was a mannerism from him or an adaptation, we will never know.

He however chewed his tongue whenever he was not eating or talkingto the voices in his clean shavenhead. You could hear him chew his tongue. The whole world could hear him chew the tongue. Ndung’u approached Mary*, one of my group mates and said ,”sister nipee.” We were greenhorn student nurses wondering who we had wronged for us to be thrust in to a such a ward.

Perhaps having seen the scene that was about to be created a few times too many, the nurses on duty smiled as Ndung’u asked for this mysterious object from Mary.

We didn’t even know how to communicate with mentally ill patients leave alone give them stuff. In Kenya, mental illness is frowned upon. Schizophrenia to be specific is not even a mental illness; it is the result of witchcraft. Either that or the good ol’ mama and papa pastors will attribute it to a few episodes where the patient forgot to tithe.

This is the culture we were coming from. Theory in class had dispelled a slither of that belief but this is a reality that even the most learned need to grow into.

Ndung’u was adamant that Mary needed to give him something. With open palms that revealed dark undergrowth under the fingernails, head hung expectantly on his side and those pleading big black eyes, he paused from chewing his tongue and took his voice a decibel higher.

“Sister nipee, Sister nipee, Sister nipee!”he impatiently exclaimed. Mary asked Ndung’u what it is that he wanted as the rest of us tried to be cowardly strong behind Mary. We had heard tales of students getting beaten by the patients and nobody wanted to provoke anyone. Silent lambs in a lion’s den.

Ndung’u quipped like a baby by its mum ,” nipee kanyonyo kamoja. Niwekee hapa (pointing to his palm) nifinye.” Fellow patients laughed. We laughed. The nurses laughed. Ndung’u didn’t.

That awkward moment made me abhor mental health as a future area of speciality. Finding myself therefore in an advanced dementia unit was not going to be fun. Maddy changed it. At 98 she still believed in exercises. She liked stretching in her bed though it was almost impossible for her to do so. Age and other short stories.

It was my role to encourage her and help her complete her morning ritual.This was followed with a ,”cuppa nice, cold water.” Which she hungrily downed as the folds of saggy, wrinkled skin on her Caucasian face danced to every gulp. Maddy , though weak, used her Zimmer frame to use the toilet. She knew when she wanted to go and she was the most helpful resident I’ve ever met.

On this particular day, after administering medications, her alert-mat buzzer went off and I knew she had woken up.Maddy woke up every day at 9.30am. She was a clockwork. The mixed type of dementia had not taken that away from her.

The carers, N* and J* were with another resident and Maddy couldn’t wait. She was a high falls’ risk and that explains the alert-mat buzzer system. This alerted everyone that she was up ready to rock then roll.

“Good morning Maddy,” I pleasantly greeted.

“I want to wee-wee” she replied. She always said that whenever she wanted to have a short call.

Pushing the alert mat under the low profile bed, I silenced the alarm and stabilized her onto the Zimmer frame as we trudged to her toilet. She had partial sensorineural hearing loss and it was hard sometimes for her to hear what anyone was saying. She was too sweet however, that she always filled in the gaps the way she wanted; to fit the context.

Either that or my accent betrayed me. Ha ha. “Are you from Swansea?” She asked when we were having a shower. “No Maddy I am from Nairobi, Kenya” I reassured.

Maddy: Oh Swansea near the church? I am from Swansea too.

Me: No Maddy. Nairobi. Kenya. Africa.

Maddy : You should take me for the mass today. They sing good music. What’s the name of your husband? I might have seen him at the church in Swansea.

Me: Maddy (increasing the cadence of my voice, somehow adopting a British accent) I am not married. Do you know of a good man around? (I teased)

Her sunken ash grey eyes lit up. She must have managed to hear what I said. She looked at me long and hard as I oiled her lanky legs and declared, ” you have a medium bum you should get a good man.”

I know I’m not supposed to laugh but that sent me rolling on the floor. She joined me in the laughter and started a sing song ” medium bum, medium bum, you have a medium bum”

Maddy : Margaret has a medium bum.

Me : My name is Catherine not Margaret.

Maddy : Margaret has a medium bum, medium bum…

Oh well, you can’t say I didn’t try, right?

Maddy spent days in the lounge or in the garden or simply lying on her bed. She enquired frequently about the days of the week and no matter what you said, it was always a Tuesday two seconds later.

Tuesdays were pension days and she loved going to the post office to collect her pension.

Even having lived with mixed dementia for a few years, she never lost her bourgeoisie. She wore well-pressed attire complete with matching shoes. Her daughter Sheila* always provided these. She would never leave her room without her white pearls dangling from her slender, furrowed neck. This would be accesorised with a hand bag which she called a carrier bag and a pocket of disposable tissues slipped under the sleeve of her sweater of the day. Our prim and proper Maddy from Swansea.

But I did…

Staffs new and old adored her. She had a kind or funny thing to say about anyone or anything. A carer could be tucking her in bed at night and she would enquire when the carer was going to bed themselves. She would offer us to sit and eat with her at meal times. She didn’t understand why we kept walking about and helping other people eat!

On the day she complained of rigors, I had spent a few hours of my day with her. Palms feathery and mild as the clouds, I lifted them to my masked cheeks and reassured her that we were doing everything in our power for her to be alright.

Earlier in the day we had had a loving conversation.

Maddy : I wish it was summer already

Me: Summer is here Maddy and I’d love to take you to the garden.

Maddy : (at the top of her lungs) There’s a tiger in the garden!

Since December last year her health had significantly deteriorated. The dementia robbing her of what magic of life was still within. Her ability to perform a few of her own duties totally impaired. She couldn’t stay in the day lounge with other residents without falling asleep ten seconds later. I believe as we age, so do we want to take naps.

She sometimes would manage to break through the fogginess of this abysmal cloud of mental decline and express herself. Our Maddy was still in there somewhere.

This was one such day and I’m glad I held her hands in my gloved palms and listened to her. I still feel the heat of her palms piercing through my face mask. She pushed away her teddy and clutched her baby pink soft blanket and told me just how cold it was. This was the only time I saw her in tears. It ate at my heart and I couldn’t wait to have the antibiotics Dr.Jill* had prescribed over the phone ( thanks to the fear and restrictions surrounding Covid-19 pandemic) ; and have Maddy start on them.

The paracetamol I had already given her was yet to kick in and she was having it very rough. Maddy was coming down with a chest infection and I had proved it through a set of vital signs and a phlegmy cough that I had not witnessed all day until now. Until now when the sun was hauntingly lingering in the British summer skies daring man and beast to move. It harshly bounced off the walls of the care home and flatteringly kissed the petals of the snowdrops that shyly looked to the ground.

Though on End of Life Pathway, Maddy’s demise broke my heart in a million little pieces. I never got to be there with her as she passed on. She transitioned to the other side on the very same day I got my Covid-19 positive results.

Yesterday I went back to our unit’s gallery. I saw her. She held her teddy and with cheeks as bright as her soul, she smiled. From her heart, she smiled. I fingered this photo of hers with immense nostalgia. I caught a tear that threatened to ruin the lapel of my uniform. I missed her once more.

It is a habit that photos of deceased residents get discarded after a while but I don’t see Maddy’s going anywhere. She was loved by staffs and relatives alike. She was loved for her nimble thoughts when they happened. She was loved for her witty sing songs.

She was loved even when the fangs of dementia clutched her brain and rained painful hallucinations on her. This golden girl from Swansea was loved even when this dying and jaded cold stare of Covid-19 robbed us of the little time we had left with Maddy.

* Names have been changed to protect identity of the mentioned people. This is for confidentiality purposes.

Through My Covid-19 Eyes

I think more than anything, I wanted some form of positive vibrations.

I didn’t plan to be a nurse. It is a fact I never shy away from. In fact, my mother had earlier in life written me off in any medical course. I had been an angry, impatient and particularly rebellious little girl.

Mother dear couldn’t wrap her head around my lack of manners. She kept moaning in tired resignation, ” you’ll never be a nurse or a doctor. Because if a patient presents with a headache you’ll inject medicine into their heads.”

Years later I’d discover that she wanted to be a nurse herself so I’m here living her best life. Parents!

This noble profession prepared me for several things in life. It especially taught me to be flexible and accommodating. It is gloriously refreshing when I can swap my shifts with a colleague and get an extra day off. I did exactly that on that fateful Wednesday the 13th of May 2020.

As I stepped from my apartment, the late spring freshness wafted into my nostrils like fresh roses. I closed my eyes and took a deep breath and held it in for a precious few seconds smiling to myself. Gingerly, I made my way across the road and onto a lean concrete pavement that wound itself across the sleeping Dalry Cemetery in Edinburgh city heading off to my workplace.

Instinctively, I stopped near a once white tombstone and gazed towards an imposing Scottish spire. Its gothic stained glassy top shone in a beautiful spectre of a million dazzling rainbow lights behind the burning golden ball of the morning sunrise. In childlike wonderment my eyes glistened as iridiscent rays stretched over this tombstone. Whoever lay here must be a happy soul. He attracts the morning sky.

I shook myself from this unending, stupefying reverie and reminded myself that at this rate, I was going to be late for work. Determinedly, I trudged forward and a sense of foreboding suddenly gripped my heart. Just as fast, it left me. Momentarily, this got me very puzzled. Perhaps it was because everyone else is fighting Covid-19 one way or the other. Perhaps because like many other frontline workers, I am very nervous.

I consoled myself knowing that we didn’t have any Covid-19 positive case at the care home I worked in.

I spent the day with two health care assistants who are wonderful at what they do. For the period I’ve worked in care homes, I have enjoyed the magic of team spirit. Being a team leader during a crisis needs you to believe in your team. To have an outsized sense of possibility whipped together with a diminished capability for pessimism. We had to pull through our 12 hour shift.

But even the best laid plans go haywire, don’t they?

I had a day off on Thursday and Friday, I was meant to go back to work on the weekend. I woke up feeling lethargic on Thursday morning. Through my Covid-19 eyes, this is my zero day.

Day Zero

After the shower, my neck itched. Either I’m suddenly allergic to my shower gel or something is wrong with my towel. I decide the towel is guilty without letting it have its side of the story. I popped it immediately into the dirty linen basket. I would get to it later. I do not know why my throat is so dry. My lips are cracking and the Vaseline lip moisturizer isn’t helping. I think I’m coming down with a sore throat. I can’t stop clearing my throat.

Day One

It is my hair wash day. Oh I love washing my kinky curls. I have a certain unhealthy obsession with washing my hair. I relish the scent of my deep conditioning cream. I savor with orgasmic delight the different fumes of the flowers and oils that make up the natural hair moisturizer. Just that today I can’t smell it. It surely isn’t expired? I check again. Expiry date is sometimes in 2022. That’s odd. I tell myself. I can’t stop clearing my throat either. And is it me or is this place getting hot by the minute?

My appetite is almost non existent. It is now 1307 hours BST (1507hrs EAT). I have not had anything to eat. I make a cheese omelette and it miraculously has no smell. I am at peace with that because I like eggs just not how they smell. However, they are tasteless! Whatever games my body is playing on me they have to stop. My neck continues to itch. I apply some antihistamine cream and make a mental note to pass by Lidl to buy some skin-friendly detergents.

By 1900hours the itch is gone. The constant clearing of my parched throat has been replaced by a deep hacking cough. I feel cold alternating with hotness of body. It is officially a ping pong. Hot cold. Hot. Cold. Cold. Hot. I have this aura of darkness around me.

Day Two

I wake up at 2.30 am covered in buckets of disturbingly drab sweat. I do not sweat easily. My Zumba instructor, before the Covid-19 pandemic, kept pushing me harder than everyone else because he thought I was not giving it my all. I did. I always do. My sweat glands are just too fussy and they play hard to get. You can’t easily excite them. Until tonight.

Perhaps it is because of the dream I’ve just had. In this dream I’m strapped onto a ventilator and I keep trying to ask the attending nurse to let me see my heart’s rhythm on the cardiac monitor. The nurse is busy splitting tubes to use on the next patient. Come on, I silently pray, I need to see that rhythm. I am not very good with cardiology so I want to ask my Critical Care Nurse instructor ( mentor) what in the world that rhythm is. But the nurse is very busy and I wake up.

There are smouldering embers in my throat and someone is intentionally fanning them to life. I suddenly cough again and this time it hurts like broken promises. I go to the kitchen and get some warm water from my mini flask. It soothes the throat albeit temporarily.

I had to change pillows because the one I laid my hot head on was drenched in sweat. I love pillows. My bed has six pillows at any given time. Yes I need to hold something (until someone shows up) as I sleep come beat me. Some girls have boyfriends and husbands or partners. I have pillows.

I am working today. I head to the carehome with heart in my hand. Even the sun seems to have left my skies. It is ominously sulky. I don’t care how much workload I have today. All I know is I’m tired and my legs feel like pins and needles. From the calf muscles to the soles of my feet it feels like some fire ants are having a post lockdown party. I try stretching and running as I go to work but I’m as uninspired as a politician after elections.

The News

Just after washing my hands, on my way to my locker to get changed, the manager summons me to the office. She stands two metres away and tells me one of the residents had turned Covid-19 positive. This is the resident I had been worried about (she had read my documentation and reports and everything a nurse should write in case of concerns) on Wednesday.

Residents refer to the people being cared for in a care home. I am saying this for the sake of Dr.Mary, my close friend who thinks a resident is a doctor undergoing his or her residency program in a hospital. It is a homonym Doc. Tembea dunia Mary, tembea ha ha.

I immediately tell Nurse manager R what I’ve been feeling. She makes the right call and tells me to go back home, self-isolate and phone NHS 24. Now, fellow Kenyans, NHS 24 is a phone service for the national health service of United Kingdom. You get to consult a doctor on phone and you may be advised to go to the hospital or something like that.

The Phonecall

It took about 5minutes for the doctor to get back to me. I explained my symptoms and she dropped the bombshell unapologetically. “All your symptoms are suggestive of Covid-19 infection especially now that you’ve been caring for someone who has turned positive.” She goes ahead to outline things I should do including a test to confirm but I’m not listening. Suddenly I can’t breathe through my nose because it feels congested. She keeps asking if I’m there . I am there. Just not there.

The Test

I didn’t handle it well. I didn’t handle it well at all. It feels like scratching your brain through the nose. It feels like being forced to gag on your tongue. When they trained me how to collect the swab for Covid-19, they didn’t mention it would make me squeamish too.

There is a beautiful aspect nonetheless. We have a Drive thru testing centre. It is for key workers and healthcare professionals exposed to Covid-19 in need of testing. You get swabbed while in the taxi. The Council (government) organises for your transport from your house and back. Therefore swabs are taken whilst in the car.

But Satan had other plans. The taxi never showed up in my case. They only offered half-hearted apologies an hour after I had already undergone the test! I booked my own Uber and was careful to stay masked and come straight to the house after the test.

I keep praying that I didn’t expose the two Uber drivers I used that day. I didn’t even know where the test centre was. I got lost and kept circling it until a kind missus directed me. Story for another day.

Day Three

Self isolation ongoing. I feel very tired. My joints ache including these tiny finger joints. The pins and needles feeling intensify on my legs. I was too tired to exercise. I slept for ages. I struggle to breathe through my nose. It is blocked. My brain automatically wants me to use my mouth. However I know if I do so I may never get better.

I keep saying to myself: the nose is for breathing and the mouth is for talking. This is the mantra that saves me. I repeated it the entire duration of my isolation. I wasn’t having this virus change things.

I know I have Covid-19 even if the results are not yet out. This is no normal flu or cold. I confide in Dr.Mary. She tells me I’m overthinking though I know she is playing safe. On one hand she is my friend and her unwritten job description is to make me feel sweet in this unforgiving world. On the other hand, she is a paediatrician and she knows better. Gotcha Mary make up your mind! Doctor or friend? Haha

I also confide in another friend who’s like a big brother. He prays for me and tells me to stop imagining things. I guess friends generally don’t want to help us in our journeys of overthinking. They just want us to be calm and see the best in everything.

However, these two friends were wrong and I think they knew it. They just didn’t want to confront their fears. After all, they hadn’t met anyone close to them who’s Covid-19 positive. They sure didn’t want pretty lil Cate to be the first one! But I have done them the honors.

Day Four

I still teach Hypertension on Facebook. I pretend all is well. I can’t allow this to stop me from writing. Honestly if there is one thing God gave me as a gift, not only to the world but to myself, is writing. Writing keeps me from going nuts. Writing helps me go nuts safely. Writing saves me from myself. Writing calms down the voices that would otherwise be too loud inside me. Informative writing aimed at sharing knowledge is borderline orgasmic to me.

The Results

That is when the birds sung but I couldn’t hear them.

Aftermath

I didn’t handle it well either. I posted on Facebook right when most of my Kenyan friends were rubbishing the Ministry of Health’s daily briefings. They said and I quote, “I’m yet to see or hear of anyone who’s Covid-19 positive. Kwani where is the government getting all these numbers from?”

I posted that to, one, make people know Covid-19 is not an imagination and two, help myself process it.

I had to pull it down. The curiosity was from outer space. The ignorance in how people handled it too much for me to bear. More than the toll the virus has on everyone, the fear and stigma and generalized doom will be the end of us.

I remember listening to Chris Cuomo (CNN Prime time News Anchor and brother to New York City Governor Andrew Cuomo) when he had the virus.

He had intimated that the virus wants you to sleep and lie down for it to thrive. So he had to move and work out no matter how he felt. He had to do deep breathing exercises no matter the resistance in the airways. I decided to be Chris Cuomo. Just the female version. Without the money and definitely without the experience.

I ChrisCuomod my body. I even managed to do push ups. Two and a half and now I want an Olympic medal. Or a Head of State Commendation or a Medal of Honor, come on folks, get me a medal will you? The fact that the second one is done while I’m half alive doesn’t count. The baseline is that it gets done and I manage the remaining half by collasping on this old grey carpet that needs vacuuming asap. I danced Zumba. I also tried jumping jacks. Youtube became my darling. Thank God for accessible and affordable internet in the UK.

You should have seen me arms raised high above my head, neck straight like an experienced swan; balancing on the balls of my feet as I deeply breathed in and out. In then out. Then cough like the world was coming to an end. Cough some more. Consistency is the key here, so I coughed my lungs out.

I’ve done more series of exercises in my period of isolation than I’d ever done before. This was purposeful. The possibility of deterioration and death were lingering at the back of my mind. More ChrisCuomo to me yay!

I had lengthy talks with the virus. I reminded it that my body is a temple of the Holy Spirit and that it can’t accommodate both light and darkness– my body, not the virus Karen. So I gave it an ultimatum. I told it to push me down for the period I am in isolation because that’s all it had. It responded by giving me more rigors. I shook like a twig in the wind. I was as hot as I was cold.

It sent me a memo in the form of blinding headaches, constipation with zero appetite. It fired off messages in the shape of deeper and more frequent bouts of continuous cough. It sent me to my knees with crushing joint pains. Everything that can hurt hurt.

The virus cackled maniacally and intensified pain in my throat. My nose suddenly had a river of life that never ran dry. My disposable tissues had nothing on it. I wrote ‘more tissues’ as what I needed most when manager R asked me for a shopping list. She brought boxes upon boxes of them. These babies should last me till eternity. Hehehe. The virus was deciding how I lived my life.

I had moments of extreme sadness. I wanted my mother. I also wanted to sleep and be told I’m going to be alright. I hated being alone in a foreign country. I wanted my neighbors. Why am I single? I wondered. I felt ugly. I hated my dry lips. I wanted people to talk to me but I also didn’t want to talk. The mental torment of this monster is beyond description.

I was grateful albeit begrudgingly to be single and live alone. I didn’t think I’d handle the thought of exposing other people. Glad I was to be away from my mum and dad who I’d expose to this virus. Happy my siblings were away from me.

I missed the sun. As if on cue, it dutifully rose every morning before half past five. It peeped through my bedroom window, mocking my sadness. I opened the curtains to allow it in. I badly needed to see the sun, my flaming ball of orange every spring morning. I wanted to gaze at the feathery blue skies. I wanted to see other people.

I used paracetamol 6-8hourly because of the fever and rigors as advised. I also bought a mouthwash which I used to gargle and this greatly eased the pain and discomfort in my throat.

I had to rehydrate too. I downed numberless gallons of lemon,ginger and honey concoction. Being a renal nurse only complicated matters for me. I started a fluid balance chart for myself. Stop laughing…I recorded my input and output. I watched the color of my pee and panicked one morning when it was deeply saturated. The only thing I lacked was a urine measuring jug. Okay, now I am laughing.

Today, I watched the rising sun again. I paused again at the same spot –that tombstone. There was no foreboding.¬† Just a deep gratitude that the sun has kept shining.

Never before had the morning sun’s kiss felt so life-giving.

Tantalisingly, it curled beneath the rustling birch trees casting shadows so replescendent and gratifying that my heart melted. I almost touched it. The magic after a mirthful winter, the sweet smelling flowers along this path that permeates the air with warmth like that of a hug from a dear friend.

The Call To Nurses

Let your Better dreams fly you to your destiny.

Despite the constant din that drowns it, the human voice is the only sound able to penetrate the layers of any solid to reach its audience. The firm call to a listener constantly pushing , encouraging and sometimes seducing him to open that next door. This video e, even if a whisper, is loudest when it is speaking the truth.

It is that voice that I have always listened to. Amidst the bedlam that characterises modern living, the small still voice has always called out to me. Like an evening breeze wafting the smell of pine trees and romance to my nostrils. Like the stray rest of dawn that pierces through my drab window curtains every Summer morning. Unfazed. Unintimidated.

The sheer audacity to not only dream but wake up and pursue the same with an athlete’s single minded focus. Taking pleasure in the small acts of daily living. Of daily nursing procedures. Winding paths of my career and personal life never once deterred me from the goal labelled BETTER. Elusive sometimes it has been. But it has always felt like BETTER has always waited for me but at the same time hiding from me.

Better nursing standards. Better nursing roles. Better me and a better shot at credible educational opportunities. If you are like me, then the bodacious hum of the human voice is calling unto you and you want better. What better means is very subjective. My better came in the form of Nursing in the United Kingdom.

This article seeks to inform you of my footsteps at every stage. Fall right in and wear my rather ill-fitting shoes. Who knows, maybe to move this mountain, these little stones will count for something someday.

Prepare

United Kingdom is one of the countries globally that has elevated the profile of a nurse. Unashamed of resting responsibilities on the nurse, UK has made virgin discoveries into what a nurse is when all limitations are withdrawn. Not only does she train her nurses, The Kingdom (Queendom maybe? Haha ) has gone ahead to let nurses practice within laid down schemes of service. If sexy was a profession, nursing in the UK is.

The possibilities are ad infinitum. From the clinical setup, to being a first assistant in theatre to aesthetic nursing, you’ll be limited by yourself and not the lack of empowerment. National Health Service (NHS) offers an aromatic buffet of options to sample from. Private hospitals and care homes challenge one to be more than they ever believed they could be.

The prerequisite is meticulous preparation. Deciding your basic motivation and diving deep into the process that becomes your new normal. Even now, I remind myself why I am in the UK. If money is the only motivation, then I should pack my bags and leave for a better economy. I am spoilt for choice anyway.

The pursuit for money is there though. Like haemoglobin, it is attached to every biconcave corpuscle of my red blood cells. How I decided to go about it led me to finally settle my heart in the land of her Majesty the Queen. But we are not talking about my escapades, are we?

Each choice you make carries with it a truckload of pros and cons. Every NO you say to a job offer allows you an opportunity to say a better YES when it happens. As a very loose translation if you’re interested in career progression, go for NHS hospitals. If you want some instant cash,maybe you want to go into the care home and private hospitals setup. Do your research. Ask people who are genuinely interested in informing you and not recruiting you.

For the nurses that hold specialised Higher National Diplomas, decline offers that do not place you in your area of speciality. Rejection is the very essence of acceptance. You must be able to reject. Be willing to be rejected too. Above everything else, what you’re bringing to the table is a wealth of skills and unmatched ocean of knowledge. You are complete and I want you to have the courage to realize it when negotiating for a job offer.

International English language testing system (IELTS)

This is undoubtedly the elephant in the room. It seeks to show that you have no idea what English as a language is. Yes I’m kidding. It tests you in Speaking, Reading, Writing and Listening.

Booking the correct exam is as critical as air is to a plant. Without it it wilts and dies. A sad, lonely plant. An unspoken plant. We will never know if it had babies. Oh poor plant…

Book the UKVI academic IELTS. The only difference between this and the other Academic IELTS is the presence of United Kingdom Visas and Immigration number (UKVI). For some weird reason, to have your visa processed at the Embassy you’ll need a UKVI reference number.

If you have had a previous satisfactory Academic IELTS, you will still need to sit for a general UKVI Ielts to facilitate your visa application and processing. To avoid this double whammy, why not just sit for the UKVI academic IELTS? More information is found on www.nmc.org.uk/registration

Talking of which, use this same website to create an account ( use your email) with which to communicate with the Nursing and Midwifery Council of the UK (NMC).

Competence Based Test Exam (CBT)

This is an online, computer generated exam. It is offered by Pearson Vue at 9 West Building in Westlands. Set at multiple choice questions of 120 in 2 hours, it covers the entire nursing process according to the NMC. The reason is because NMC UK does not have the ‘Diagnosis’ part of the Nursing Process. Think about Assessment, Planning, Implementation and Evaluation.

Please note however that the Nursing setup in United Kingdom differs in that you would need to do a different CBT exam for Midwifery if your target is to work in a Maternity set up.

Tip: Most recruitment agencies will not tell you about this. They will let you think you can work anywhere. As a midwife, ask about the Maternity department and how to get there. They even pay a higher starting salary!

You would need a different CBT if your goal is mental health Nursing. They managed to split the pie of nursing into small pieces which when whipped together, materialize into a giant pizza.

Get That Job

You really will need an agency to help you break down the contracts into small chewable bits. I will not recommend any agency at this point. I suggest you use your search engine to look for ‘Agencies that recruit nurses in UK.’ The choices are as many as the blinking stars in heaven.

Your agency should be able to advise you on where to live, the salary, the expectations and any other hidden clauses in your contract.

Decide where you want to live. England, Scotland, Wales and Northern Ireland are what makes up the United Kingdom. Perhaps the most famous destination is London. Mainly because when one hears of UK while in Kenya, we all tend to think of London and nothing else. How mistaken I equally was!

Again, do you want to be a city darling or a rural town specialist? Take your time. Nurses are in high demand in UK and you’ll not regret taking your sweet time to sign a potential contract.

Do not be intimidated into accepting a job offer. The agents are trained to make their offers sound like the dreams you’ve always had. Majority are fantasies, despise them.

Verification of Academic Documents

With the account you registered at NMC, you can now approach the Nursing Council of Kenya (NCK) and ask them to send your papers to NMC, UK. This is done at a fee payable via mobile money wallet at the NCK offices. Once received, verification should take about two weeks. NMC will write to you with what is called a Decision Letter.

Decision Letter

It refers to official communique from the Nursing and Midwifery Council of United Kingdom inviting you to the UK to sit the next part of the registration exam called the Objective structured clinical exam (OSCE). You are even bound to get more serious job offers if you already have a Decision Letter!

I think we have been chained by people who went ahead of us so much that we do not know we can do this by ourselves. We have been shackled to the chains of local agencies which charge us an arm, a leg and a slice of the left kidney to help us get here. So imbued we are in the politics of ‘godfather’ that we forget the power that we possess in our very hands.

It is those cages that have you and I detained and deeply pained that I seek to break. You can do this.

Work Permit

After a job offer, you will get what is termed as a Certificate of Sponsorship (CoS). The CoS is a work permit allowing you to live and work in the UK. For the purposes of this blogpost, your work permit is issued under the General Occupation Shortage List. That qualifies you for a Tier 2 Visa. With the CoS, you can apply for Visa.

I reiterate the need for a good agency. The agency should facilitate all your visa fees by your employer. Perhaps this is where I mention that a credible A-rated employer will pay your agency for your sake. Therefore you will not need to pay any fees to the agency. Watch out however for the fine print of your contract.

There must be a clause that binds you to your employer for a period of time. Also check out if you would need to pay some money to your employer if you left them before your contract expires.

Visa Application

You will have all paperwork in order because you’re an amazing nurse by nature. If you are married, please supply your marriage certificate. I insist on veracity. Tell the truth about you. Do not worry about your finances. Your CoS already has it covered. The application for a Visa is carried out by TLS Contact Centre in 9 West Building, Westlands. You will get the visa I have no doubts.

Welcome to The UK

Congratulations on your Visa. The ocean and the sea are calling out for you. Perhaps you want to do a farewell party before this? Maybe tell us hopeless things like Majuu here I come. Ha ha. However if you’re me, just pack your books, your treasured possessions and leave. You can tell I am too good at goodbyes, no? Come on, stop breaking my heart. Insert a smiling emoji here…

Have your itinerary clear to a fault. As I strode down the steps of the baggage bay Aberdeen International Airport; suitcase in hand and a backpack strapped on my tired shoulders, the last thing I wanted was a no show by my agency staffs. It happened.

The Finals

You will have a practical exam as I had intimated earlier in one of my articles. It will be booked by your employer. You will have to be trained for it and finally take it at a centre near you. If your employer is as adventurous as mine was, you might find yourself in Belfast, Northern Ireland taking the exam all the way from your chosen work station.

This is when you will receive your license. It is known as a Personal Identification Number (PIN). You now carry with you expert power to exercise and demonstrate the NMC Code of Conduct.

Having listened to that bold voice that dared me to dream, I haven’t once stopped. I have learnt I can as well be a student too. I can absorb as much nursing education as possible. I can learn the ways of my mentors from Kenya to the UK. I am still learning. I endeavour to raise the profile of the Kenyan nurse and I will not do it by sitting pretty and watching my painted nails dry. I must put in the work. You too.

Basic Levels of UK Healthcare

Real heroes and heroines stopped wearing capes. They wear uninspiring scrubs and dangle stethoscopes from their oversized pockets.

The time is 1430hours. I have been checking the world clock on my screen every minute. Partly because I can’t sleep and partly because I have no headphones. I left mine at home and the airline is not providing any.

The couple next to me are having a beautiful moment together watching whatever it is they are watching. The man is American and the lady is Spanish. I have become a connoisseur at telling accents. Before, all whites were ‘mzungu’ but nowadays I appreciate their different backgrounds.

They look so sweet together and I suddenly miss being in a situationship of some sort. It is a fleeting thought and I banish it as soon as it appears. Because it is liberating to not have to share my bed, yes? Yes I’m joking Karen.

I am aboard KQ Flight 0390 to Heathrow, London. We taxied off at Jomo Kenyatta International Airport (JKIA) at 0930hrs. I have no idea where we are but I see clouds outside my window seat. Fat clouds. Wispy, feathery clouds. Clouds that look like a hybrid of a cat and an eagle. Small clustered clouds. Undecided clouds.

This is the second time I’m leaving Kenya for UK. The difference is that this felt like an actual goodbye. This time, I could taste the colours of my light face powder in the tears that streamed down my flushed cheeks. I still could smell my elder sister’s love on my shoulder when she embraced me that morning inside Paul Caffe Coffee shop at JKIA.

My sister has always looked out for me. She is older by two years or thereabouts but we grew up together. Fraternal twins of some sort. She is the brains where I am the muscle. She strategizes, I execute. She thinks before leaping, I leap then think later. We are complete opposites of each other and maybe that is why we are so intertwined.

Shii (my sister) is not one to show emotions. She cries and laughs in silence. The ultimate prim and proper EnglishLady. I display my emotions. All barrels out. That is until I jeed a recharge where I withdraw into my cocoon of silence. Shii is witty as a housewife’s bucket and takes a backseat wherever I’m involved. Allowing me to rush ahead and knock my head off.

It came as a shocker then when I came from the lavatories at the said coffee shop and found her in tears. That is the first time I saw my elder sister unashamedly break down in my presence.

At first I thought it was her eyes. Her eyes have recently decided to be wee devils and they tear up. It wasn’t. I pushed away my suitcase, crossed over the hard, cold table and sat next to her. I am the queen of public display of affection. She loathes it. Ha ha.

Nestling her dreadlocked head on my left shoulder, she cooed up amidst sobs,” I will miss you.”

I may have heard many warm things in life but those words chewed me up raw. My insides trembled and the pieces came out as hot tears that soaked onto her white and red-striped cardigan. “Me too Toto, me too.”

Father calls all his children Toto. It is a contraction of Mtoto meaning Child in Swahili. We have adopted it as a family.

I would miss her. I do. I always will. But I had to leave Kenya and fast. My Endocrinology appointment awaited and I had a follow up interview with a Trust in the National Health Service(NHS).

This departure was emphatic because I had finally tied all the loose ends in Kenya and I was ready to settle down in Edinburgh, United Kingdom.

Even as I formed shapely images of the clouds that rose invitingly in the skies, I knew I had made a definite decision. That decision involved me missing my elder sister more than anything in this world.

The NHS is a government funded public medical and health service anyone living in the United Kingdom can access. This is without being asked to pay upfront. What they don’t tell you however is that as an immigrant worker, you pay an Initial Health Surcharge (IHS) of about 500 Sterling Pounds for every year you’ll be in the UK. This is at the Visa application stage. Last I checked the current government plans to increase that fee.

It baffled me the first time I came here. My appointment with the endocrinologist had been occasioned by a referral from my general practitioner.

Health systems in UK are tiered up into different levels. At the most primary one is the community. That is equivalent of community health nursing in Kenya. It however is very formal and organised unlike anything I’ve ever witnessed.

In hot pursuit are the health centres. Only that they are not called health centres. They are know as General Practitioner’s (GP) medical practice or GP surgery. Why someone in Britain thought it is cute to call a health centre a ‘surgery,’ I will never comprehend. Just like I’ll never understand people who don’t eat avocados. What is your problem guys?

The interesting thing about health centres, is that they have a GP (a medical doctor) in charge as opposed to the health centres I was used to back home. There are imaging services and specialist services like physiotherapy and podiatry. Some clinics are run entirely by Nurse Practitioners.

This is the first place I interacted with a Nurse Practitioner. I always heard of them but I never knew it was a real thing. Stella Donohor (name changed) was her name. She was a Reproductive health nurse practitioner. When I booked an appointment, the medical receptionist sweetly informed me that Nurse Donohor would be the one to see me.

Raised up in a culture where a nurse isn’t really appreciated or viewed as someone who knows her or his trade, I was mesmerized. Coming from a tribe that sees nurses get short changed at the table of opportunities, I was impressed.

She let me call her Stella and because I accused her speculum of being too tight in my lady parts as she did my Pap smear,I tricked her into answering some of my burning questions. Ha ha. Yes I know how to strike up conversations in the middle of uncomfortable procedures.

A nurse practitioner, she told me, had to have a Bachelor’s of Science degree in whatever field of nursing she chose. She also had to undergo a Prescribing Course. I will revisit this topic some day in the near future.

The doctor handles all other cases. Doctors are few (so are nurses) hence the nurse practitioners help the entire citizenry by handling some cases and referring the rest appropriately. The teamwork between the Nurse practitioners and the doctors is to die for.

My GP had handled my other cases and referred me to the endocrinologist. I remember chatting with a nurse friend back home who told me it cost her an arm, a leg and a slice of her liver to afford the services of this highly trained specialist of glands and hormones of the body.

Therefore when I waltzed to The Royal Infirmary of Edinburgh hospital to see my specialist, I was sceptical if I was to cough up some Queen’s pounds. I did not.

As you’ve noted, we have graduated to the hospital. Hospitals are grouped into private and public ones. Private hospitals are not popular in the UK. They are mushrooming like bushfires because the NHS is overwhelmed but still, they are playing catch up. Worthy to mention is a branch of NHS that is the social care. This is where Care homes and home based care fall. They are either privately or run by the government. Majority are privately owned but regulated by the differed Health Care Inspectors of the government.

The inspection and regulation is a serious business and I’m full of praises for the way the UK as a whole has decided to take care of her geriatric population. That and the terminally ill.

NHS hospitals are then clustered into groups depending on the locality they are in. These many hospitals form a TRUST. Why the name Trust you ask me? I’m asking the same thank you very much. Perhaps the most famous one being St. Guy’s and Thomas Trust in London. One of its hospitals, St.Thomas, is where the good Prime Minister Boris Johnson got admitted with and recovered from Covid-19.

My hospital, The Royal as it is colloquially known falls under NHS Lothian Trust. The different Trusts across the UK run under different managements but all subscribe to the guidelines of the UK government. We could classify all these further based on the four countries that make up the UK. I feel doing so would be belaboring the point and akin to a broken record.

After a chat with Dr. Graham the Endocrinologist, I left for home feeling much better. I wished my sister was here. To hear what the good doctor had to say about me and to also accompany me home. She wasn’t. It was just me and my hopes and dreams strapped in a light backpack.

I did follow up with my interview and got the job I desperately needed. It keeps opening my vistas of healthcare in this country. I get to fall in love with a government funded, public owned healthcare without a cheap private option. Ranked as one of the top ten healthcare system by World Health Organisation, the NHS offers so much for a greenhorn like myself.

Chronic diseases are managed at the health centres only being sent to the hospital if and when acute. Community health is the heartthrob of United Kingdom’s healthcare. Without it, all patients end up in the hospital and cripple it. I have had a beautiful opportunity to be part of a community dialysis team. Accompanying renal nurses to deliver services in patients’ houses. This couldn’t get better.

Any emergency warrants a visit to the hospital while a minor concern sees you at the health centre. I can’t bring myself to say ‘surgery,’ sorry Your Majesty. Emergency services work. They are not a suggestion. The ambulance, fire, police departments are not flimsy afterthoughts. They are stark naked realities and I am mesmerized as a nurse.

When I asked Google to show me hospitals in the UK, he didn’t tell me about the mystery of Trusts. Now that it makes sense, it is prudent to think about the area you want to settle in then look for Trusts near that locality. Afterwards you can apply for a job in any of the hospitals mentioned. I think this is where you raise a glass to that.

Nursed Differently

Nursing is not about pills and potions, charting and call bells. It is about being able to love people when they least expect it, when they most need it, at their lowest.

Pain is a great motivator. Towards making great decisions or dumb ones, or both. Therefore, when I willingly chose to leave the Renal Unit, it came as no surprise.

Huntly is a rural town in the middle of Aberdeenshire County in the City of Aberdeen, Scotland. There is United Kingdom weather and then there is Scotland. Scotland’s weather is so beautiful that it breaks my heart again and again. That is actually a joke.

It is wet in Summer and wet in Winter. Wet in Spring and it badly wants to be wet in Autumn. Even the sun here rains; too intimidated to shine.

I arrived in Huntly in late summer and I was fascinated by the long daylight hours. Sunset at 9pm was marvelously beautiful. My web of intrigues was to be woven further by the system I found myself in at work.

Having left a specialised unit, it was difficult to adjust to a carehome. This is a home for the elderly. United Kingdom gives a damn about her elderly citizens. The closest I had been to this was Bethany House in Sagana, Kenya. This was several decades ago when I was still young, fresh and juicy.

I was wowed. Several tens of residents all comfortable in what I’d call a retirement home. If this was explained to me at the interview stage, I conveniently forgot about it. All I remembered was someone saying nurses get paid more in a carehome as opposed to a hospital and money was a motivation. A jolly good one.

I settled gingerly. It is not easy being black in a sea of white. It is a tiny drop in an ocean which is constantly in motion. To many colleagues, I was the first black nurse they had ever seen. Worse, the first ever Overseas Nurse to ever be sent to their rustic carehome. To some of them (read most) , Africa is a tiny village and we all live in even tinier huts and we sing with monkeys and lions.

We also wear silky loin cloths and speak Zulu and Xhosa. Well, The gods Must Be Crazy is a famous film and it looks like that is all these my colleagues knew. Talk of excellent acting. However the ignorance tasted like fermented bitterness.

I marveled at the disproportion between technological advancements and the level of ignorance about the rest of the world. Fast and furiously came the questions. Did I train as a nurse in Africa? I kept correcting them to say Kenya, not Africa. It was futile. Did we have hospitals in Africa? Did we wear clothes in Africa? How did I speak such good English? How long have I spoken English?

Then came the nursing team. Am I really a registered Nurse? Do they have hospitals in Africa? ( Side note: Do we? Do we have hospitals when our leaders keep running them down and rush to London or India for treatment, do we?)

Would I know what I’m doing at the OSCE exam? And the cherry on the cake, am I REALLY a nurse? It was too hilarious as to be dumb.

I worked under the registered nurses but mostly as a health care assistant. That was before I passed my OSCE exam and joined the register of UKRNs. I shadowed nurses as they did hand over reports and shadowed carers as they helped residents with various activities of daily living.

It was a normal Tuesday morning when I listened to Tracy the night nurse complain about a resident’s urinary catheter that kept falling out. Tracy was as white as snow. True story. She spoke through her chiseled long nose. She gestured a lot too with her perfectly manicured hands. Her short cropped silky hair had a fringe which she kept pushing away from her face. A modern day Snow White–with a nursing uniform.

While she described the catheter problem, I counted the number of tattoos on her arms. There was a baby elephant that was blowing bubbles on her left wrist, those bubbles were being eaten by a tiny dragon that was three centimetres or so below her elbow. I was just getting to a match of an eagle and a lion tattoo when Juan, my mentor interrupted my fascination.

“Catherine I want you to observe as Amber inserts the catheter then you can join the carers in serving breakfast, ” she sweetly chimed.

Amber happened to be the most qualified nurse of the day. After gaining consent from Betty, the resident, Juan, another nurse whose name I can’t recall, Amber and I went into the resident’s bedroom.

Betty was a big girl. At 68 years she oozed folds of confidence and chunks of hope. She had divorced exercise many years before her car crash which injured the lower segment of her spinal cord. She was doubly incontinent. Betty adored her snacks and even as Amber explained the procedure, Betty munched on a delicious-looking piece of Maltese chocolate bar.

She gave me one look and winked. Oh sweet soul! Trying to make me feel at home. I immediately took a liking to her. Amber confidently aimed the tip of the catheter into Betty’s private parts. I looked on as Juan and the other nurse kept me company.

That is when it struck me that Amber was not inserting the urinary catheter into the urethra. Juan and her pal were dutifully observing and encouraging her as I stood there flabbergasted. My mouth took over my mind.

“Nurse Amber please remove that catheter and insert a new one. Here,” I said as I suddenly took a new silicone catheter from the lower shelf of her working trolley and opened it for her. ” I will use my phone’s flashlight to give you more lighting. That is not the urethra. “

Uh-oh. I forgot the rules of engagement. I was to watch not talk. I was to be seen and not heard. All I wanted was the catheter in the urinary bladder. We weren’t going to achieve that if we inserted the catheter into the vagina. No wonder the nursing team was complaining about the catheter falling out. It definitely would fall out if what we were targeting was an opening bigger than a female urethra.

Amber silently allowed me to use my light to help her maneuver through Betty’s folds to locate the urethra. The female urethra is one canal that confuses many a healthcare workers if not the public themselves.

Located just below the clitoral fold and atop the vaginal orifice, it is easy to miss. Many may be forgiven to think urine is expelled through the birth canal. It is not. It is expelled through the urethra. It is what leads up to the urinary bladder,where urine is stored.

A urinary catheter is a tube used to access the urinary bladder so as to remove urine. Many reasons make the use of a catheter vital. Betty had had an injury which had severed the nerves that tell the bladder to release urine. The nerves that tell the brain that it is time to pee.

After leaving that room and washing hands, the atmosphere was ripe with palpable tension. Like slimy okra the team was unsure what to do with me. To love or hate? They decided to make independent decisions to be indifferent. How exhausting.

Betty was so appreciative and she would later joke with me about me being the first black nurse she was seeing. She however was to ask me if I trained in Africa as a nurse. If Africa had catheters. Ah, here we go again…

Juan my mentor didn’t chide me for talking during the procedure and she did not acknowledge my helping save the day. It was like nothing had happened. However, the nursing team gave me a wide berth. The hours I would shadow a nurse were greatly reduced. I was also not allowed to attend the handing over reports until I qualified as a UKRN. Amber also stopped talking to me.

It would later therefore come as no shock when I was on shift with her when a resident called me a few racist terms and Amber was silent about it. It happened twice. And twice in her presence, she didn’t intervene.

That was the straw that broke the camel’s back and I was the camel. I wrote to the powers that be and gave an ultimatum that if I wasn’t transferred from that carehome, either of the following two things would happen. A) I would lose my mind or B) I would book my next flight to Nairobi. Where skyscrapers and cars do exist,to everyone’s surprise.

Nursing in a carehome is different because it demands autonomy. The hospital will always have a team of fellow nurses but more often than not, carehomes are run by a single nurse on each unit. Every decision is made by that nurse and therefore accountability starts and stops with the nurse.

That experience horned my leadership skills and increased my problem solving capabilities. Geriatric Nursing is a broad area and I was able to integrate my theory into practice.

I consider myself very lucky to have begun in a carehome and as a care assistant. It helped me learn different things I only saw in textbooks. For instance mobility assistive devices. Take a Zimmer Frame for example, I had never used one or seen a patient use one. I know they are there in Kenya but for the chosen few. Money talks, doesn’t it?

I learnt the basics of moving and handling residents and patients. I appreciated how utterly incapacitating old age, frailty and dementia are.

I remember calling my best friend and sharing how one day I’d run a carehome in Kenya. That our elderly parents and grandparents have been left to fend for themselves in the rural areas while we could do with a formal system of care for their needs.

There is a desperate need for such as well as home based nursing care services in Kenya. The gap between hospital admissions and rehabilitation in the community for the elderly and terminally ill is valley-wide. A dry expanse of nothingness. It smells of loneliness, memories and anxiety for our grandparents and the terminally ill.

Perhaps this pool of silence on how we take care of our elderly needs to be poked. Maybe then it will cough into life.

One Exam in Belfast

Bangor is a coastal town in the Southern side of Belfast City, Northern Ireland. My hotel room overlooked the sandy Marina Beach. If it wasn’t the silly seagulls calling out, it was the whispering breeze from the salty waters.

Belfast is the capital city of Northern Ireland, one of the Four countries that make up the United Kingdom. She houses the Titanic Museum and the now all too famous setting for the Game of Thrones.

Bangor is half an hour from the Capital and less that via train from the George Best Airport in Belfast.

Funny how one Country can be split and give birth to two. Sudan, you weren’t the first one. Ireland did it for us ages ago. We now have Ireland the Republic which is different from Northern Ireland. Welcome to Europe.

I was here for the sole purpose of training for Objective Structured Clinical Examination (OSCE). This is the final exam towards Registration as a Nurse in the United Kingdom. My employer, for some humorous reason, found it fulfilling to have me transverse the Irish and Northern seas in search of knowledge and skills at handling this exam.

There are numerous testing centres in the entire UK but my employer had booked our test at Ulster University in Londonderry. Londonderry is where you visit the Game of Thrones sites and moments. You are welcome.

I owe it to them for allowing me to tour a slice of beauty from the heavenly pie that is Belfast and particularly Bangor. Coupled with sights at the vintage museum, my mind was pacified and ready to handle my reality.

Visiting the beach was one thing but practising for the exam was another. I have always been horrible at practical Nursing exams. Not horrible in the sense that I don’t pass ; horrible in the sense that I can’t think when I have someone hovering over my shoulders.

I feel imbued with disparaging anxiety and my examiner can touch my disorganized thought bubbles; hold them in his defty hands and drop them like the hot mess they become. What made OSCE even less attractive to me is the fact that one is required to talk through their actions. There is audiovisual recording of every step and somehow time runs out before you can say OSCE.

In retrospect, this employer knew what lay ahead and decided to entice me with beautiful scenaries and free flights to and from Huntly in Aberdeen City, Scotland.

Talking of which, Huntly is the Turkana of Scotland. Why they sent me there is still a mystery to me. Why I accepted remains a parable of Biblical proportions.

I without a doubt believe that pain obscures one’s judgement. It also leads to sinister decisions. My settling for that tiny town in the middle of civilisation’s desert was a quintessential example. Let us go back to the exam.

Nursing process encompasses four or five steps depending on who you’re asking. If you ask the United Kingdom’s Nursing and Midwifery Council, they tell you four steps are enough. These include Assessment, Planning, Interventions and Evaluation. Do not ask me where Diagnosing went because I was as perplexed as you are.

OSCE therefore, seeks to determine your ability as a registered nurse to safely practice within these steps.

Each step is acted out either by real patients (patient actors) or by mannequins. Fair enough, right? Wrong!

You’re required to speak. Suppose you’re washing hands, naturally you just do it and dont bother explaining the steps. Even in my basic Nursing exams in Kenya, not once did I have to talk through the entire process of handwashing. I had only been required to say I’m washing my hands.

OSCE expects you to say something akin to the following:

“I have opened the tap now I’m checking to see if the water is at the right temperature for my hands as I wet my hands. Now I’m putting soap onto my hands to cover enough surface. I am now rubbing palm to palm,now back of each hand with fingers interlaced. Now washing in between the fingers with fingers interlaced, washing my thumb and web of each hand,knuckles of each hand. I am now rubbing my fingers onto the palms of each hand, washing my wrists. I am rinsing my hands then drying with disposable tissues. Now I’m closing the tap with my elbows. “

All these is said as you do it and also as the clock ticks and tocks down from either 15 or 8 minutes depending on the particular situation presented to you.

That is not all, there must be Skillset stations where the examiners and their camcorders watch you save life or quash it. To practice as a nurse we must ensure you’re a safe nurse. Safety is only measured in practice not on paper.

From Basic Life Support to Aseptic-Non- Touch-Techniques, one must demonstrate ability to deliver quality care and do so efficiently. That informs the timing of these actions. You must be nimble in thought and fingers.

Practice therefore, is paramount. Many nurses I’ve talked to cite the English exam as the hardest part of the entire process. For me, it was certainly the OSCE.

I excelled in it much to my own amazement. Perhaps the promise by my employer that they’d transfer me to the city if I passed on first attempt added to my zeal.

There are unfathomable pressures that come with training for an exam in a far flung place. They didn’t matter though because I met lovely souls from every corner of the world. I made friends from the Philippines, Botswana, Zimbabwe, Israel and my country of the day– Grenada.

I didn’t know Grenada was a country. Heck, vicarious travel makes one think they know squat about the world they live in while they don’t. We shared different values but our love for nursing was universal. That plus Filipinos are excellent cooks. Yes I had to write it here somewhere. Food and I are in a stable relationship. Ha ha.

Their scrumptious chicken curry and chicken SomethingSomethingElse is to die for. I ate unreservedly. It allowed me a great chance to learn about the difference between Nursing education in the Philippines and in Kenya.

Being a sucker for Education, it marveled me that the Philippines abolished any other level of Nursing education less than a Bachelor’s degree. That to me is classical of a people interested in career development.

It explains the seamless transition of Filipino nurses into Western and Eastern healthcare systems. They have the papers to prove their qualifications. I nostalgically wished Kenya would one day get there. Where students upon graduating high school confidently approach University for a Bachelor’s degree in nursing.

The presence of Diplomas and Certificates in Nursing waters down the very profession we keep trying to herald forward. We will get there someday.

As the train galloped to George Best Airport in Belfast, I soaked in the earth-red houses adorning the shoreline of the city.

What a contrast to the humourless grey houses of Aberdeen! Aberdeen is famous for oil and granite. Granite therefore is the very mineral that coats the building bricks. In summer it sparkles in the sun. However, if you’re not looking, and I wasn’t, it is all backwater. Nothing ever happens there and it happens all the time.

For the purposes of information, there was a total of three examinations before I could finally call myself a UKRN. It started with the English Exam, a Competence Based Exam and finally the OSCE.

The first two are done in Kenya. They are easily available and unnecessarily expensive by my metrics. Lately, the Nursing And Midwifery Council subsidized the cost of the Competence based exam. It is cheaper today than it was when I did it.

YouTube offers great tutorials on the International English Language Testing System (IELTS) Exam. I prefer that to lecturers who will more often than not take your money and not deliver. Have confidence in yourself.

The difference between the English exam and OSCE is that the former seeks to prove that you don’t know a thing while the latter seeks to demonstrate that you know more than you give yourself credit for.

As I pulled the covers over my tired body in that shared apartment in Huntly, I envisioned myself passing the OSCE. The feeling of listlessness warmed my duvet and allowed me to have a fitful sleep. I needed to get out of that living death.

In Search Of A god called Peace

Not all who wander are lost. ~Lord of the Rings

I spat out the second bite of my lunch. It was potatoes and rice. Again. I keep telling mother that I hate this mishmash of ineptitude and discouragement. She doesn’t care. We come from Central Kenya and a meal without potatoes is a crown-less princess; she is just any other girl. Mum had packed this for me as I headed out for work in the Ward as a registered nurse.

I gave up on this meal and attended to one dialysis machine which had decided to burst my eardrums. I disliked the blaring alarms. The water plant had run out of water — third time this week. Julieta,my colleague and a damn great nurse, hurried out to refill the water tanks.

The other nurse was helping me circulate the blood manually by turning the machine pump to prevent blood from clotting.

We should not have been going through that but this is Kenya and here we do with what we have. We got tired of complaining.

After this ordeal bland as my lunch, the Nursing manager sent me a text that my transfer request had been accepted. I was finally going to Garissa County!

I had pushed this request to the recesses of my mind just like I had many other alternative versions of my reality. This was a wake up call. I had wanted to transfer to Garissa county but now I had a choice not to. A choice beyond Garissa. Beyond Kenya.

See, I had always wanted to leave my country. For better terms and conditions of employment. For betterment of my career and to see what else a nurse can be apart from a clinical nurse.

I knew I am an old school wannabe writer trapped in the body of a modern day Renal nurse. I have been very curious as to what opportunities the world has to offer a nurse who holds a pen. Kenya, understandably, limited that into clinical work and teaching if not research and marketing. I have no idea how the seed of a mysterious MORE was planted in my head but I sure watered it.

Going to the famously loved Nurse destination–United States of America. was out of the question. The process would take at least an year to immigrate. I had many things with me but time was not one of them. I needed out. My world was collapsing and the walls that held it were belly up.

The kitchen of my personal life was melting and I needed some ice on my tongue. I just wanted to go. To. Go. Anywhere. The god of peace, I needed him. If he couldn’t come to me, then I would go to him.

United Kingdom was floated to me by a former colleague. The problem was that I didn’t know what to do about UK. How did nurses immigrate to the UK?

I had a week earlier received a Skype interview invitation with a potential employer in the UK. I knew I’d ace it. My former colleague had said it was easy peasy.

I therefore wrote to the County Secretary to suspend my transfer to Garissa County. I would stay. I would stay long enough to eat my lustre less lunches and refill the water tanks in the water treatment plant.

A few days after my 28th birthday, I bade farewell to Kenya. This was done in complete secrecy. Only a handful of people were made aware. It felt like I was leaving for some vacation. Like I would be back soon.

Being conspicuous on social media, I continued a charade of someone who was still in the country but having some time off work. It worked. I never made it to the Broadway so social media can as well be my God-given stage!

There is nothing as testing as being alone in a new country and a different continent. Now I know. Now, I surely know. I however had too much pain back home that a change of scenery was welcome.

Offered a choice between drinking my own blood and going home to the embers of a dying personal life, I’d gladly have slit my wrists open.

Starting out where nobody knew me or my story was a plus. Because time is the great equalizer, the reality of the mistakes I made in accepting the job offer I received started showing.

The half-hearted explanations and witty exploitations from coworkers started manifesting themselves. It did not help that I was yet to get my Personal Identification Number (PIN/LICENSE) as a UK nurse. It was exasperating.

The United Kingdom became icy for me. But if I went back to Kenya it would be icy inside for the rest of my life.

As the days bled into nights,I spent some on the floor of my shared apartment crying and rocking myself to sleep. I longed for mum and her craftly uninspired packed lunches. I needed someone to talk to and I was in terrible shape. Home sickness they called it. It was more.

It was the feeling of worthlessness. The fangs of hopelessness dug into my flesh and ate away at my very core. It took me a minimum of three months to fully settle my mind and get my bearing . It took an even longer period of time for me to know my space as a nurse and fully exercise the authority enshrined in the Nursing Code of Conduct.

I used what I’ll call backwards strategizing. I was so encapsulated in my own misery that I failed to research well about Nursing in UK while I was still in Kenya. Emotionally fraught with all the things happening in my life then.

There are gaps that I did not identify and fill. There are potholes as sharp as any double-edged sword in the scanty information regarding migrating to the United Kingdom as a Kenyan Nurse.

It has been long but I love this country of the Queen. I have hopelessly fallen in love with Nursing here. I love the autonomy. I love everything that a nurse symbolizes here. I have had to learn and unlearn a few things but all in a day’s work!

My lessons I’ll share and more. We will laugh and discuss different aspects of this journey going forward. Every Wednesday will see a snippet of this process surface on this blog.

About my god of peace, he had always been in a cage in my heart and I finally broke the lock and set him free. I’m bathed in his iridescent golden rays of serenity.