Mary Ntata is a nurse from Malawi who trained in the UK and is currently living and working in Coventry. She travelled to Malawi to see what the conditions are like for the nurses who work there.

Thursday, 30 March
I've just completed my last shift before leaving for Malawi.
It was a quiet shift - I settled the five patients in their private rooms and, with another nurse, kept an eye on them overnight.

Looking round the patients’ rooms at their TVs, kettles and telephones, it makes me wonder how different the conditions will be when I visit the hospital in Malawi.

I am excited about coming back, seeing my family and friends, eating Malawian food and seeing what has changed in the two years since I left.

But I'm nervous about visiting the hospital.
Poor wages have led to massive shortages of nurses and I'm wondering how bad things have actually become.

Sunday, 2 April
We went to the main hospital in Lilongwe today and followed a nurse called Khetase past a long line of women and children to the children's ward.
I was so shocked by what I saw. The ward was dirty and although there was a cleaner mopping the floor, it made no difference because the ward was so crowded with patients and their guardians.

Many of the children were sharing a bed with another patient and this is on a ward where the children are seriously ill - the equivalent of a high dependency unit in the UK. One boy, Godfrey, lay very still on the floor with his head on his grandmother's knee. He had acute diarrhoea.

In the UK he would probably be on a drip but here there was not even a bed for him. Philip, a small baby was malnourished and also seriously ill with acute diarrhoea. Khetase told me he is an orphan and his parents died from HIV/Aids.

Khetase told me how frustrating it is to work without the equipment she needs. Often she doesn't have the prescribed form of antibiotics for the children so she has to improvise, for instance, oral tablets instead of intravenous.

This affects the survival rate of the children. Usually they have to split intravenous fluid bags between the children as there aren't enough for everyone who needs one.
In the UK each bed would have oxygen available but here it is only available in three beds so the children have to swap around. None of the beds have sheets, just bare plastic mattresses. The children were all crying or lying very still and it was so horrible to see. I wished I could do something to help.

Rainy season
Another nurse, Christine Chimbaza, took us to the women's medical ward. All the beds were full and so was the corridor outside, which is open to the elements and the rain in the rainy season.

One patient, Sarah Kamodzi, who needed a blood transfusion, was told it would not happen unless she could find a donor herself.
There is no blood in the hospital blood bank.
Christine was administering injections without protective gloves and this is on a ward where at least 30% of the patients are HIV positive.
She uses gloves only with patients who have been diagnosed with highly infectious diseases and did not even have a proper bin for used needles.
She understands the risks to her own health, but tries not to think about it as she feels compelled to ease the suffering of the patients. (…)

Like all the nurses in the hospital Christine works very long hours - sometimes three shifts without a break - for very little pay.
She takes home the equivalent of £40 a month and has four children to support. It is no wonder that the hospital only has a quarter of the nurses it needs.

I found today really upsetting, especially seeing the conditions on the children's ward. I wished I could use my nursing skills to help. (…)

Coming back to Malawi has made me realise how much my skills are needed here, and made me even more determined to come back to help my people.

Source: Mary Ntata, “Diary of a journey back”
(695 words)

Assignments:

Work on a total of three tasks.
Tasks 1 and 2 are compulsory. Choose one task from 3.

1 Summarize the narrator’s experience. Do not use more than 150 words. (30%)

2 Briefly describe Mary’s feelings and analyse the devices employed to present them and to reduce the distance to the reader. (30%)

3 A An English-speaking developing country tries to convince its skilled workers living in industrialized Western countries to return home. For this purpose a leaflet is planned. Describe its design (i.e. layout, illustrations) and write the text for such a leaflet, giving reasons for your choices and referring to your knowledge of the issue and the facts given in “Diary of a journey back”. (40%)

OR

3 B “It is no wonder that the hospital only has a quarter of the nurses it needs.” (ll. 50/51) Write an article for your school magazine in which you discuss to what extent this situation is a consequence of globalization. Refer to the example of Malawian nurses as well as to similar cases that you are familiar with. (40%)

OR

3 C Every year, hundreds of trained nurses leave Malawi to live and work in developed countries. However, Mary writes that her experience made her “even more determined to come back to help” her people (l. 55).
Discuss her decision about where to live and to work and compare it to that of a character in a fictional or non-fictional text or a film who also had to make an important decision in her / his life. (40%)

You are expected to write at least 500 words in no more than 240 minutes.

Source: Berlin: Senatsverwaltung f. Bildung, Wissenschaft und Forschung