Clinical Impressions (and Depressions)
Sep 1, 2010
|July 19, 2010
We have met a lot of interesting people the past few weeks here in Lundazi. Shaun and I continue to work mon-fri at the District Hospital, which at times is very easy/boring and other times very challenging. I'm working the HIV out-patient Clinic right now, and Shaun's on the Mens Ward (Med/Surg) but will soon be in the Surgical Theater and then Maternity!
Today we visited an elementary school. We ran into the Head Master last week, and he's asked us if we could come every week to talk to the kids and staff about Health and education etc. It was quite shocking to see a school with 650 students and they only had two out-houses for toilets! the staff housing had no "sanitation" as they call it either...
And the classrooms were the "normal size" classroom for back home (approx 16' x 30'), only their classrooms have over 100 students in class (and dilapitated desks that would seat maybe 25 students per classroom). I can't imagine how difficult it would be to be a teacher (or a student) here!!!!
Anyhoo, life is ticking away and we are overall have a very positive experience. I have had a little 'meltdown' - this morning, as a matter of fact - where I was mostly frustrated with how helpless I feel at times. I don't speak the language or know the "system" or culture, or there just aren't the supplies/ resources needed...and feel at times that I'm really not much help at all. But I realize that it is early in our volunteer stint, and that relationships and trust will be created...and I already feel that I am getting far more out of this experience than I am giving, that's for sure!
There is a lot of social injustice here, and I think that's the hardest part to watch and even harder NOT to judge or jump to conclusions.
That's about all the news for now. We're trying to learn Tambuka and Nyanja (the two most commonly-spoken languages here, of the 72 national languages in Zambia!!!!). The people LOVE it when you greet them in their language...
It was my first day working on the Children’s Ward, and it was shocking. The excellence of nursing care that I witnessed in the HIV Clinic was not at all matched by the nurses I worked with today. We saw some very sick little people today, and I could not understand the nurse’s priorities.
A 3-year-old boy was brought in by his father, limp, with a respiration rate of 58. His file indicated he has pneumonia, probable malaria (with Anemia) and a severe ear infection. He had a very high fever, tachycardia (180/min), and had been nonresponsive since the night before.
The nurse was concerned about the paperwork, and sent the man (with child) back to the administration table for the proper stamp. When they returned, she started writing out the doctor’s orders, but did not even assess or look at the patient. All I could think about at that moment is how back home that same child would have had a swarm of nurses and doctors around him, checking ABCs, putting lines in, oxygen mask, vitals checked, stat lab-work and chest x-ray, etc, and sent off to Pediatric ICU.
The nurse just filled in the paperwork, and a moment later was chatting away to a friend. I saw this time and time again.
Is life really valued less here? It sure seems that way – countless times I’ve thought that – with so many deaths that seem could have been prevented, had the health team had more knowledge or been more assertive, or had there been the appropriate supplies.
Perhaps their apathy is a means of self-preservation, a caccoon from the pain of continuous loss. Most people I’ve met here have had a child (or sibling or spouse) pass away. Death really is a part of life here, and seems to be accepted as such.
We are at the other end of the pendulum here in Zambia. Back home, death and suffering is greatly feared and avoided at all costs; as are law-suits, and legal repercussions and angry family members that know how to advocate for their sick loved-ones. I have never been in a work environment where you don’t document everything. I did not see any Vital Signs taken today, no Nursing notes written (or Progress Notes for that matter), and not a single ‘prn’ medication charted.
Here, the family is responsible for the care of the patient – the washing, feeding, and taking to the bathroom. They even have to provide the food and utensils. It’s a shame that these family members don’t know how to advocate; they don’t realize that they even need to. Two of my little patients today couldn’t get any Tylenol suspension today from the nurse, because the family didn’t have a spoon (to give the medicine)! Eventually I asked if I could give the Tylenol with a syringe to the febrile kids...the last thing we needed was a febrile seizure! (The nurse, thankfully, was open to this, and said she had never seen oral medicine given using a syringe).
There are many challenges in this work environment. There is a definite higherarchy within the health-team (even within the nurses). And as foreigners and guests in their hospital, we keep reminding ourselves that we are not here to change their system. Quite simply, we can’t...not as volunteers who are here for only three months.
I’ve heard of foreigners that come into villages and actually do more harm than good, by introducing new/ Western ways of doing things, and then they leave. Often the foreign way is not culturally appropriate, not sustainable long-term, and not in line with what the Community identifies as a need. Shaun and I have been very cautious to come in the context of ‘learners’ (not teachers) and that we are here to help as they would like us to.
I bite my tongue a lot. And instead of making suggestions, I try to ask questions. We’ve only been here a month, and still have a lot to learn about the culture and community.
July 28, 2010
I’ve been at home with a head-cold the past couple days, and kind of glad I’m not at work. Shaun saw them carrying a small body wrapped in a blanket out of the Children’s Ward. I’m not sure if it’s the little 3-year-old boy I mentioned, or the Anemic child with a haemoglobin count of 1.2, or one of the others...I don’t really want to know...
August 8, 2010
The Plumb Line
I learned about the importance of a plumb line while laying tile flooring in our kitchen. It’s ultimately the very carefully calculated (straight) line, or standard, that you follow in order for everything to line up. No lop-sided kitchen floor or corner if you measure everything against the plumb.
I see plumb lines in many areas of my life. There are certain standards of safety and fairness that I will not compromise while rock-climbing, for instance. And in school we were taught about Nursing Standards of Care, how to assess a patient and prioritize tasks. My family and colleagues have taught me about work ethics, codes of conduct, and being accountable for my actions.
What I find challenging working in the hospital in Zambia, is that the nurses have different standards and different priorities. As a guest in their workplace, I am there to help, as they need and see fit. There are basic safety standards that I don’t ever compromise (such as Universal Precautions). But there are some standards that cannot be met to the same extent, because of shortage of supplies, or the staff here don’t value something to the same extent as we do. For example, a ‘sterile field’ is rarely kept sterile here (or even clean!).
While I don’t want to ‘correct’ people, or try to change the existing system, I also don’t want to do a patient any harm! There are certain tasks I won’t do, as I don’t feel comfortable with their method of doing it. I’m discovering creative uses for the supplies the hospital DOES have...alternative methods of maintaining some standards...but I often find myself looking at that plumb line, wondering how far from it am I willing to stray. In the end, the decision is based on what will do the least amount of harm, and will the patient benefit...