35
biochemistry lecturers, two medically qualified, in the Medical
School to handle some fifty students for a 1-year pre-cliuical
course. The Medical School laboratories were destroyed by
fire a few years ago but have now been replaced with reason-
ably equipped, if cramped, accommodation. The University
Teaching Hospital, the only hospital in Lusaka, is large and
modern. The Chemical Pathology department processes over a
quarter of a million investigations annually employing ageing
auto analysers. In sharp contrast, a hormone assay laboratory
in the Department of Medicine is funded by the WHO and,
with a direct line, so to speak, to Geneva, lacked nothing. This
highlighted the general impression that there was very little
coordination between the many foreign agencies bent on pour-
Lug aid into an ailing Zambian economy. Essential basic re-
quirements were being ignored in preference for high profile
schemes such as the multimillion pound paediatric intensive
care unit being built by the Japanese. At UNZA, plans are
underway for the creation of a veterinary science department
while the existing science departments are in urgent need of
replacement capital equipment.
I came away with feelings of goodwill towards the Zambian
students, of sympathy for my erstwhile colleagues in their
struggle to maintain standards, and of profound disquiet for
the future of Biochemistry in UNZA.
A S h o r t C o u r s e in B i o c h e m i s t r y f o r N u r s e s in the
Tropics: An Approach with a Cultural Perspective
T J NGULUBE
Department of Physiological Sciences (Biochemistry)
University of Zambia
School of Medicine
P 0 Box 50110
Lusaka, Zambia
Purpose and objectives of the new approach
Most doctors, radiologists and pharmacists recognize the close
relationship that exists between their practical disciplines and
the basic sciences. This, in Zambia, does not seem to be so in
the health professions of nursing and the medical assistants. I
reached this conclusion after my association with nurses and
medical assistants (staff or students on training) during my
time as a medical student and later as a Medical Officer at the
University Teaching Hospital (U.T.H.) in Lusaka. And yet
these people form the core of health services in the rural areas,
where they practice with little or no supervision. They form an
important pillar of the Primary Health Care Programme in
Zambia.
When I joined the Biochemistry teaching staff of the School
of Medicine, I was asked to design and teach a Biochemistry
course for the Post-Basic Nursing (PBN) students doing their
diploma or Bachelor of Science in Nursing. The aim of my new
approach was to make the students recognize the relationship
between the basic sciences and the health profession in
general, and to the nursing profession in particular. My ex-
periences while working with them in the hospital were quite
useful.
B I O C H E M I C A L E D U C A T I O N 12(1) 1 9 8 4
Problems and short-comings
As in many other developing countries, the effectiveness
of teaching is usually hampered by lack of audiovisual aids,
proper textbooks and co-ordination between the various
disciplines. Due to problems of time and staffing I had to
teach the course alone. This was, however, not a big problem
as my knowledge of the other disciplines was still good.
I was given one lecture hour per week and the course was
to last 11 weeks. Two of the weeks were wasted with the
problems of bureaucracy at the time of registration and enrol-
ment of the students. So I was left with only nine lecture
hours in which to teach the course. This, I was told, was due
to the shortage of time. After discussion with the course co-
ordinator I was allowed to have one more lecture hour per
week.
The other shortcomings I had to face was the gaps and
deficiencies in the science background knowledge of the
students. Some of them had done their formal secondary
school education as long as 20 years ago. Some had done no
chemistry, physics or biology during their time in secondary
school. According to the regulations governing the entry into
the Post-Basic Nursing School, the minimum duration between
formal secondary school education and enrolment into the
University is 5 - 6 years.
Course description
The undergraduate programme in Nursing offers the follow-
ing awards: Certificate in Public Health Nursing (CPHN -
a 2-year course); Diploma in Nursing Education (DNE - 3-
year course); and the Bachelor of Science in Nursing (BScN -
a 4-year course). The students for the BSc (Nursing) may come
from those doing the CPHN or DNE after completing the re-
maining number of years and doing the courses not previously
done. The programme is designed to accept students that have
successfully completed a 3-year Basic Nursing course as a
registered nurse from the various nursing schools in the country.
They should also have practiced for at least 2 years and should
be in possession of at least a pass in three to five subjects at
ordinary level or 5 subjects at Cambridge School Certificate
level. A Certificate of registration as a midwife is required for
those doing the CPHN programme. Most of these academic
requirements will have been full'flied at the time of their
enrolment for the Registered Nurse training course, namely
a full Cambridge Certificate (or equivalent) with passes in (i)
English Language (ii) Biology (iii) Mathematics (iv) General
Science. Two credit points are given after successfully com-
pleting the course as a registered nurse. This is also counted
as year one in the Department of Post-Basic Nursing of the
School of Medicine.
Biochemistry is taught as part of a course in applied physi-
ology and anatomy. Biochemistry is taught in the first term
only and there are no provisions for practicals. There was no
single suitable textbook for the course. Students had to
depend on lecture notes and references to standard textbooks
of biochemistry such as Biochemistry by Lehninger, Outlines
of Biochemistry by White, Handler and Smith and Biochem-
istry by Stryer. The course was divided into several sections at
the end of which a common disease condition in this part of
36
the world was discussed during one lecture hour in a seminar
format.
The following topics were covered, with the seminar topic
in brackets. A Introduction; basic chemistry - atoms, mol-
ecules, compounds; acids, bases, pH and buffers (Fluid
Therapy). B Amino acids, polypeptides, proteins and their
basic metabolism, enzymes - importance, nature and control
of activity; carbohydrates - types, function and metabolism
(Diabetes Mellitus). C Immunologlobulins - basic structure
and function; haemoglobin, myoglobin - basic structure and
metabolism (Jaundice). D Purines, pyrimidines and nucleo-
tides; nucleic acids, genetic code and mutations (Sickle Cell
Disease). E Role of proteins, carbohydrates, lipids, vitamins
and minerals in nutrition (Kwashiorkor and Marasmus). There
was no emphasis on individual structures. General structures
were given to indicate important groups involved in their
functions and metabolism.
Method of implementing the objectives
With the assumption that none of the students will have
heard of, or done, the course previously, I started off with
an Introduction to the course and then the hrst section of
the course was taught. I conducted and discussed fluid and
electrolyte balance as a seminar discussion, with special
reference to the prevailing clinical conditions in children
with gastroenteritis (all too familiar to the students and
myself). At this point I asked the students to write an essay
in which they should discuss the following aspects: Whether
they think the course will be relevant to them, whether they
feel that it would make a big difference in their understanding
and practice of their past careers and how they hope to use
it in their future careers, and finally what they would have
liked included in the course.
After this the course was implemented as planned.
A series of lectures was followed by a lecture hour of class
discussion on a common disease condition, along the lines
suggested by Ahmed. 1 Prior to these sessions some students
were selected to talk on certain aspects of the disease which I
wanted illustrated by the knowledge gained from the previous
series of lectures. Whenever possible they involved some
nursing aspect of the disease condition. These seminar dis-
cussions were followed by a take-home assignment focusing
on the preceding lectures and the seminar discussion. At the
end of the course they sat a multiple-choice question test.
They were, again, given another essay to write regarding the
course, with the following guidelines: 'From your own under-
stan iding of the course to date, write a brief essay on how you
feel regarding the relevance of the course to your future
career, whether you think this course has made any difference
to what you already knew before, whether the course has been
able to meet most of your expectations before you started the
course. What were the major difficulties with the course?'
They were also asked to write on their academic background,
and fmally to make any other comments or suggestions they
thought appropriate about the course.
Seminar discussions and take-home assignments
The seminar discussions were held in a free and open atmos-
phere. After each student had discussed a particular aspect of
B I O C H E M I C A L E D U C A T I O N 12(1) 1984
the topic, pertinent points were noted and there were then
open questions from the audience. Finally, after discussing all
possible aspects, there was a general question and answer
session. This turned out to be a time when most of the
students sought explanations for some observed phenomenon
during their time of practice in the hospitals. The seminar
discussions were finally closed with a take-home assignment
aimed at integrating and consolidating the knowledge gained
so far. A typical assignment question is given below:
One weekend you had decided to visit one o f your
cousins in a peri-urban compound. On arrival, your
cousin was only too happy to see you after such a long
time. He feels that you will provide the solution to his
problem, now that he has concluded that modern
hospital medicines have failed to cure his daughter's
illness. The daughter is a known 'sickler' who has been in
and out o f hospital on numerous occasions. 'Cousin" he
asks, 'CouM you help me with K250.00. There is this
herbalist from a neighbouring country who is reputed to
cure all types o f diseases. He has asked for K250. O0 to
end once and for all my daughter's sufferings.'
(a) Do you think it is possible for the herbalist to cure
sickle cell disease? Explain the reasoning behind ),our
answer.
(b) What are the main biochemical differences between
the haemoglobin in d normal adult red blood cell and
that in the red blood cell o f a patient with sickle cell
disease.
(c) What wouM be the main type o f jaundice in a patient
after a sickling crisis. Briefly explain your answer.
This assignment question followed the lectures on nucleo-
tides, nucleic acids, the Genetic Code and mutation and f'mally
the seminar discussion on sickle cell disease. The questions for
the assignments were put in such a way as to reflect the typical
thinking of the average patient, person or nurse in this
country. The person is ignorant about some aspects of a
disease or a particular clinical procedure. The student was
required to use the knowledge acquired to explain the answers
or use it as a basis for explanation to the patient or guardian.
The results from the assignments were summed up to folTn
the results equivalent to one continuous assessment test. The
second test was a formal multiple-choice type, taken at the
end of the course.
Discussion
Biochemistry, though undoubtedly useful to the health
sciences, is probably the one course that most medical
students and other health science students do not take to too
enthusiastically. Hence, in the design of this part of the
course to the nursing students with no recent science back-
ground, I decided to use their nursing, cultural and some-
times social experiences to make them appreciate and develop
interest in the course. This was reflected in the take-home
assignments and seminar discussions. It was therefore gratify-
ing to note that the students looked forward to the course
each week and also the take-home assignments. This was better
reflected in the essays where a student remarked: 'The weekly
 37

assignments were helpful and stimulating. They encouraged me T r a d i t i o n a l Medicine i n T h e S u d a n

to read up and keep abreast with my biochemistry (lectures).
BAKRI O SAEED*
They made me remember what I learned.' Another one wrote
'Biochemistry is rousing my interest (in the nursing profession)
Introduction
because it is making clear why so many treatments are given
Sudan was originally inhabited by Hamitic-speaking people
and the underlying causes for the many diseases'. However,
in the north and Negroid tribes in the south. Later the muslim
some interesting remarks made by the students supported my
Arabs infdtrated the country and were able to add an Arabic
earlier views about our nurses, that is in most cases their
flavour to most of it.
errors of commission or omission were due to lack of under-
The southern part of the country remained isolated from
standing of the patients' condition or disease. The following
the rest of the world until the turn of the eighteenth century.
are notable quotes: (a) 'The nursing profession has ceased to
The ancient Sudan was the seat of the ancient Nubian
be the nursing of olden days where the nurse just carried out
civilization which co-existed and mixed with the ancient
the Doctor's orders. Instead she should be able to provide
Egyptian civilization. Between the 7th and 15th centuries, the
intelligent care based on scientific theories and facts. Thus I
northern Sudan witnessed the rise and fall of three Christian
feel knowledge of Biochemistry is essential to the nurse as
Kingdoms. Arabization and Islamization of Bilad-al-Sudan
well'. (b) 'When one knows the reason why one thing is done,
occured over a long period of time by Arab infdtration
she will do it properly, not mechanically'. (c) 'This is a worth-
through different routes. The rise of the Islamic Funj Kingdom
while course and we need the knowledge in order to improve
in the 16th century accelerated the pace of Islamization of
our nursing standards'. (d) 'It was an eye-opener'. These com-
Bilad-al-Sudan. It encouraged Arab immigration which made
ments further reinforced the view that in order to improve
the country a unique centre of cultural interaction which gave
medical care in this country, with the ever diminishing and
Islam the ascendency over Christianity and pagan beliefs.
over-stretched resources, it is necessary to improve the teach-
Fusion of the Pharonic, Christian and Islamic cultures with the
ing standards in our health institutions. Appropriate teaching
indigenous cultures gave the Sudan a unique and huge cultural
of some subjects, like Biochemistry, which are considered too
heritage of which traditional medicine is an integral part.
complicated can thus make quite a difference in the way one
uses his/her skills. This was better reflected by one of the Definitions
students who wrote: 'I hope to use this knowledge to provide Traditional medicine A group of experts from the African
better care to patients and for planning appropriate nursing region, convened by the WHO regional office for Africa, met
intervention'. Of course most of the things discussed in the in Brazavllle and arrived at the following definitiont of tra-
course were known to them, but they had no idea as to what ditional medicine:
they meant. Thus, they could not intervene appropriately if
" . . . the sum total of all the knowledge and prac-
the change in the patient's condition so demanded of them.
tices, whether explicable or not, used in diagnosis,
Thus another student wrote: ' . . . the patient will also bene-
prevention and elimination of physical, mental or
fit because if all the nurses know why they are doing certain
social imbalance and relying exclusively on prac-
things then the patient is at an advantage'. It was clear from
tical experience and observation handed down
most of their essays that they felt the course is useful and that
from generation to generation, whether verbally or
it would enable them practice their professions more
in writing".
knowledgeably than was the case previously.
Among the suggestions made was that the course be The present discussion will encompass three important
expanded to include other topics such as renal, cardiovascular facets. The African indigenous culture, the ancient Egyptian
and gastrointestinal problems. It was also felt that the time heritage and the Arab influence. In addition certain other
was too limited, and that this needed to be increased so as to selected topics will be described in more detail.
cover various additional topics and in more depth, the more so
African traditional medicine
because the course was new to them and had introduced new
In the Southern Sudan, the development of traditional medi-
words and concepts.
cine has not been significantly affected by external influences.
It is now hoped that the course will include a few more
It is dominated by superstition and communication with
topics and more time will be allocated. This should go some
spirits. The African traditional healer claims a sort of com-
way towards fulf'diing the institutional objectives for setting
munication with spirits which reveal to him the aetiology and
up the Department of Post-Basic Nursing in the School of
nature of disease and methods of treatment. A similar type of
Medicine. The ultimate objective of the institution is to
medicine predominates among the Nuba tribes in Western
prepare nursing leaders capable of assuming positions in
Sudan.
nursing administration, in nursing education, in public health
There are many forms of treatment, including massaging or
nursing, in clinical nursing practice with emphasis on Primary
sucking the diseased part or taking preparations made o f herbs
Health Care, and to provide them with adequate resources,
and animal parts.
facilities and opportunities for their professional growth.
Reference * Dr Saeed is an MD from the Sudan who is at present doing re-
search in the Department of Biochemistryof the Universityof Leeds.
IAhmed M (1981) A new approach to teaching Biochemistry to Nurs- ~"WHO technical report series 622 (1978). The promotion and
ing StudentsBiochem Educ 9 19-20 developmentof traditional medicine.

B I O C H E M I C A L E D U C A T I O N 12(1) 1984