Into Twenty Two

 

The last Friday of the year has fallen on the last day of the year. Happy New Year’s Eve from Richie Online. While all the circumstances are pushing towards no article, I had to squeeze the time from the day for the Friday tradition. It has surely not been a great year for this blog with so many Fridays on which we did not honor the obligation of providing the readership with pieces but it surely went better I expected for reasons I whose discussion I would rather postpone.

At the start of the year I wrote two articles in which I declared that 2021 was going to be our year. One was on why the year was going to be a wonderful one and the other about how to make it a wonderful year. Just like me, you probably do not remember much from the articles, but I hope 2021 was a good year. Nonetheless, if you are reading this you have something to be thankful for and that is the gift of life itself. That is enough capital for turning things around in 2022.

Generally, the year 2021 did not start on a high note as we witnessed the second wave of the Covid-19 pandemic to which we lost our loved ones and notable figures in society. As the year progressed, we witnessed a progressive toughening of conditions as there was a resounding cry that pa ground sipali bwino. Looking at social media posts, one can notice that many are talking about how they did not manage to accomplish the preset goals for 2021 to different degrees. While this may be the case for most of us, I would like to offer a new perspective.

For those that believe in setting goals, it becomes frustrating when the nicely set goals are not realized by the set time. This leads to a sense of frustration and may prompt one to give up. In most cases, it is difficult to see the good out of the failure but I would like to implore you to see beyond the result because sometimes going through a process is a win in itself. Whenever you do not get a desired outcome, you still get something in the name of experience which you can use on the next attempt at it.

Another way of escaping the trap of dwelling on failures is by celebrating achievements. Most people who set goals have multiple goals for a particular time period. While some of those may not work out, there will be a proportion, however minute, that will be realized. While reflecting on what could have been better for the failed goals, it is good to celebrate the ones achieved.

2021 gave us a lot of catch phrases. The social media gurus on Twitter Malawi created a poll on what the most popular catch phrase was for the year and “tigona panja” came followed by “aliyense azipanga zomwe zamusangalatsa and “kalikonse mukaona”. I will dissect these in a bit.

Tigona panja literally translates to “we will sleep outside or outdoors”, and was used by people to imply that they will be pulling all-nighters having fun. This came from Martse’s Mkatimo song which features Hyphen and Barry one and is arguably one of the best songs from Malawi for the year 2021. Malawians are fun loving people and we generally kept the partying and clubbing spirit through pretty much all the waves of the Covid-19 pandemic. Many will tell you stories of how they had so much fun to the extent of getting home at 6 am from clubbing sprees. While that may not have any issues in itself, it becomes a bit of an issue when it is habitual. With our economy, very few have the money to sustain their week-in week-out partying habit. Trying to keep up with such has seen many fail to develop their personal lives in the areas of career and finances. Here is a tip for 2022. While kugona panja may be a good experience, it is good to live within our means to avoid unnecessary expenditures and debt.

Kalikonse mukaona. While this catch phrase went viral in 2021, it is actually a 2019 thing. If you have seen the video and are wondering what happened for Mr Damiano Ganiza to tell Brian Banda that “he will see something”, here is the back story. The clip was taken at COMESA Hall where the country’s electoral body was receiving nomination forms from presidential candidates who were contesting in the 2019 elections. With the nomination process requiring a lot of paperwork, Brian Banda was surprised that Mr Ganiza had come in with little if any papers, prompting him to say “komatu mwabwera opanda kalikonse”, meaning the presidential hopeful had come with nothing. The response? Kalikonse mukaona. You will see something when the time comes. Eventually, Brian and the rest of us did not see kalikonse and his bid was rejected for not having brought the requirements, but what if he actually did? Perhaps we should learn not to judge people by the outlook or to at least keep our judgements to ourselves. For those of us who are planning to do something, we need to keep our cards close to our chests and tell the Brian Banda’s of this world that aona kalikonse when the time comes. Not everyone deserves to know our plans. Wa liwamba sapanga mtswatswa.

Aliyense azipanga zomwe zamusangalatsa was another common catch phrase this year. Everybody should be doing as they please. With people having strong opinions about how others should live their lives, spend their money, run their businesses and handle their social media, this phrase came about to remind people that everybody has a preference and that you need to let people live their life the way they want. What we have seen now, however is that people have used this saying to defend stupidity, throw away the concept of standards and to abuse others. Cheating on your partner? Failing exams? Drunk driving? Aliyense azipanga zomwe zamusangalatsa does not apply there. I will tell you where it applies. Simbi Phiri inviting Koffi Olomide to perform at the birthday celebration of his wife and Namadingo posting about the Range Rover he is going to buy. Their money and social media platforms, right? It is what it is. Don’t blame Simbi for not hiring a local artist to perform. Iye wakonda Koffi ndi Makhadzi.

Looking at the ending year, it is important to recognize the progress we have made as a people and to think about what we should do in the new year. For the first time this year we saw a decline in those stupid chain messages that told us to forward something to two groups for us to get the latest Range Rover. Kudos, everyone. We have however seen that with our phones increasingly getting smarter than the owners others are still getting trigger happy with sharing irrelevant graphic images in the name of wanting to be the first to share some “news”. Some don’t even bother to check if someone has already shared the same video of a bwanyanga mask from the gulewamkulu cult doing sexually suggestive dances while completely naked. These habits should remain in 2021.

Plans and resolutions. I would encourage you to put some together within reasonable means. The importance of having a roadmap for the year cannot be overemphasized. While it may be possible to go through the year without any sort of plan and pull many things off, it is good to have plan that governs your habits, movements, company and choices overall. Osamangokhala ngati chinyama chopanda mzimu. Plan.

Like many who read these articles, I am getting to a critical age where settling down is important. I am actually considering that. I should agree with Reverends Alexander Kambiri, Zacc Kawalala and Essau Banda that you all need to be getting married if you remember the name Patrick Mphaka. Even Sheikh Dinala Chabulika cosigned. Tikukula, guys. Tikwatire. No two ways about it.

When it comes to money, let us make more to be able to afford to save and invest some. In 2022 we should go beyond talking about what other people have and think of what we can learn from them to make financial progress. Chaka chamawa tibweze ngongole. Let's pay back all the people we owe, in the name of everything holy. 

A Happy and Prosperous 2022 to you all! Tiyeni tigone panja but we should remember that COVID-19 is real and HIV is still around. Let’s enjoy but we should remember to get back to grinding.

 

 

 

Medical Training: a Comment on Comments

 Today is one of those lucky Fridays on which we have a piece to enjoy. The unusual bit about this article is that by writing about this topic I have deliberately broken the first rule of this blog. Know what it says? No author shall write about topical or trending issues. Just like shadow members of parliament claim to have been asked by their prospective constituents to contest for elections, I will also claim that some readers have asked me for my opinion on the issue of the withdrawals of final year students at the Kamuzu University of Health Sciences. 

On a normal day, I would not have taken up the challenge of drafting this article owing to the Richie Online philosophy of prioritizing fact-based opinions over trending issues. I was however sucked into the issue when I saw the quality of the debate on social media. A lot of people have strong opinions with no knowledge of what things are like at the medical school in question. The few who have an idea about what happens there are either not speaking out for one reason or the other or adding emotions to the debate and that is why I will just give some insights of what people need to understand before adding their voice to the debate.  

The practice of medicine is a perfect blend of science and art. To have a full understanding the body’s function, disease processes and how drugs work requires excellent understanding of science. However, to figure out the exact problem the patient in front of you has is a bit of an art. You must think about the hidden clues in what the person in front of you is saying to figure out what condition your patient has and why they are presenting with such at that time. With that in mind, the training of medical doctors and other professionals must be rigorous and foolproof. In motor vehicle mechanics terms, dealing with sick people can be likened to fixing a car while it is still running. As you can imagine, that would be particularly challenging.  

Medical training at KUHeS is aimed at equipping students with both theoretical and practical knowledge that enables the student to handle and treat a patient at the end of their training. The six-year course starts with the Foundation Year also popularly known as premed (premedical sciences). In this year, students study Language and Communication Skills, Biology, Mathematics, Physics, Chemistry and Computer Skills. Students who marginally fail to get the passing mark are allowed to sit for supplementary examinations but those who fail a certain number of subjects are withdrawn outright without the possibility of repeating the year. The logic behind this, as we were told, was that people who could not handle premedical sciences cannot handle basic medical sciences which are essential in medical training. I would agree with that reasoning.  

Then there are the basic medical sciences. These include anatomy, physiology, biochemistry, pathology, microbiology, and pharmacology. The study of these subjects happens in the two years following premedical and is divided into body systems. At KUHeS, the assessment of knowledge in these subjects is done through the integrated exam paper which combines questions from all the subjects.  

Year 3 to year 5 of MBBS comprises the combination of classroom and bedside learning. In this period, students are supposed to do ward work and demonstrate clinical skills as part of their training and this is reflected in their assessment which is divided into three parts: continuous assessment, written exam, and the clinical exam. Students must pass each of these components to pass a particular rotation or department. This means that if a student passed the continuous assessment and written examinations but failed the clinical exam, the result of the rotation is a failure. After passing all the end of rotation examinations, students are also subjected to an integrated examination at the end of the academic year. In the end of the year integrated assessment, students are examined on the material from all the departments they have been through in that particular year, and this comprises of a written and practical examination. If you are to think of it in football terms, the end of rotation examinations are qualifiers for the big tournament of end of year exams. A special type of the end of year exam is the infamous “FINALS” in which final year MBBS exams are examined on the content from year 3 to year 5. You may want to know the reasoning behind this. Patients are whole humans and general practitioners are expected to see a wide range of cases from convulsing children, adults with heart failure to women in labor. A chronically diabetic patient who has an accident and breaks a bone will need the doctor to consider all their needs and so will a psychiatric patient who gets pregnant and needs obstetric care.  

There is one interesting thing about the continuous assessment for the end of rotation: its content. In the first place, students are given logbooks to keep track of the procedures they have performed and observed and all the important cases they have seen in the department. There is also a list of graded bedside and classroom presentations that a student must do but what I found the most interesting was the subjective assessment. As part of the assessment comes in the form of subjective opinions from the senior lecturers and doctors in the department. The reasoning behind it? There are some things that written papers, logbooks and practical examinations cannot assess. Punctuality. Presentability. Attitude. Work ethic. Empathy towards patients. Teamwork. These attributes are observed by the seniors who are directly mentoring the student and if one is found lacking at this end they risk failing and repeating a department regardless of their performance in the other areas.  

There are specific rules that apply in the cases where one fails an exam. As I mentioned, the end of department examinations are like the qualification matches for the end of year exam and students who fail any block are not allowed to sit for the end of year exam. Once they have repeated and passed that department, they are allowed to sit for the end of year exam and then proceed to the next class (or graduate if in final year). Those who fail their final year exams are either allowed to re-sit for the exam or repeat the entire year. This repeating means that they must do all the rotations or departments all over again before having another go at the end of year exam, failure of which attracts a withdrawal.  

The trigger to this article is the social media debate about what is going on at our medical school as rumor has it that there are increased incidences of withdrawals of students in their final year. While some have jumped to the defense of the school and pointed out that medical degrees do not need to be handed out like doughnuts, others have bemoaned the strict and prohibitive nature of the assessments in medical school. From the other narratives that are circulating, some students feel targeted for withdrawal by lecturers in some departments and others have argued that it is wrong to assume that someone can be withdrawn on academic grounds just because of a lecturer’s sheer emotion. I will not comment on the specifics because these things work on a case-by-case basis. I will, however, point out some of the issues that I have with the arguments people are putting out when debating the issue in question. 

Firstly, I would like to address the issue of withdrawing a student in their final year. To be fair, by the time a medical student reaches their final year, they have absorbed a lot of material and been rigorously tested through all sorts of examinations. In the case where somebody has finally managed to pass all the rotations of the final year and qualify for the infamous “finals,” chances are that they will manage to get the passing mark. There are a few cases in which people have failed to do so for one reason or the other, but students make it on the second attempt. There are some peculiar cases, however in which students failed the repeat final exams and ended up being withdrawn, raising eyebrows from other students, and interested parties and leading into suspicions of foul play on the systems and lecturer’s part. On the one hand, one would wonder how one would fail the exam having passed through all the rotations of final year twice and on the other hand you would wonder if the assessment system can be manipulated to target a student. I would say that both situations are technically possible so we should not rule them out when looking at the matter. 

Then there is the issue of lecturers failing students who would have otherwise passed. I have a problem with the way that people have jumped to the defense of the lecturers because we know that our tertiary institutions have lecturers who make a name out of boasting about the number of students that fail their course. It may not be all lecturers, but there are some bad apples that may deliberately fail students for the fun of it. For some, it may be that the lecturers themselves have challenges with teaching and providing formative and summative assessments to students. This may be because the lecturers themselves are doctors whose training is in providing clinical care with little or no training in education. While most have done an excellent job of training other doctors, there may be others who have challenges with calibrating their expectations on what a student should be able to achieve at a particular level of their training. To answer the question of whether a lecturer or set of lecturers can fail a student who deserves to pass, I would give a yes. It is technically possible and cases of such have happened. You may even have examples from your own institution and medical schools are not immune to this owing to the complexity of the nature of assessments.  

The other problem I have had with the arguments surrounding this issue is that people have taken this issue as an opportunity to vent about all the problems that we have with medical education in Malawi. I must confess that it took me a bit of time to separate the issue of the withdrawal of senior medical students owing to my own traumatic experiences as a medical student. The debate about the withdrawal of medical students has led to the resurfacing of issues to do with the hostile teaching methods and intimidation employed by other lecturers, favoritism and sex for grades and other issues. While some of these may be linked with assessment, it might be worthwhile to address them independent of the issue at hand.  

There is a transcript of a student that was allegedly withdrawn circulating on social media, and it has some people wondering why the student was withdrawn after consistently performing well. The question one must ask is whether rules were followed in the making of the decision to withdraw the student because there are clear rules surrounding that. Some have argued that the student in question should head to the courts instead of the social media. While I know some people who have won court cases and returned to college after being withdrawn, such cases take a lot of time, resources, and patience which a lot of people do not have. At the end of the day, you are not guaranteed that your outcomes will be good if you seek the intervention of the courts although I will say that it is one avenue that one can explore. 

There is one question of what alternatives we have for students who fail their examinations in senior years of medical school after amassing huge volumes of medical knowledge. Others have suggested an alternative degree that such students can graduate with to allow them to have a starting point and to participate in other areas of medicine outside of clinical practice like medical education. Alternatively, some have suggested the option of transferring the prior grades and completing medical training in other schools outside the country. Plausible, but not manageable by all.  

At the end of the day, we all agree that there is a problem of some sort in our midst. There will be all sorts of opinions and suggestions as to what can be done and some of the solutions will be radical. All I can suggest is that we debate this critical issue with objectivity. Then are others that are suggesting a change in the “system.” As we think of the best system for ensuring fairness in the assessment of medical students, we should not forget about the importance of ensuring that standards are maintained and the quality of medical doctors coming out of our medical school is not compromised.  We should also realize that this is the best system we have had for years and that even the best systems can be manipulated for personal interests. The challenge here is that of balancing fairness and quality and I think it is fair to say people will always have something to say about whatever system we put in place for this.

To medical students who may happen to be reading this, your training is not easy and will require that you give it your best in every way. You need to demonstrate that you can handle the scientific, artistic, and the ethical demands of being a doctor. There may be issues along the way, but you need to soldier on because your training has never been easy and will never be.  

Let me end it right there.