Riding the bus

Blood pressure screening clinic in Sefula Village

What’s in a name?

           I was basking in my glory this week on the postnatal ward at Lewanika General Hospital.  Labour and delivery and postnatal are two areas of nursing I am very passionate about.  On Monday I met a little guy I fell in love with.  He had a difficult birth and wasn’t breathing when he came into the world.  He needed to be resuscitated and was oxygen deprived for an unknown amount of time.  He was put into an incubator in the “special care” area of the postnatal ward for close observation, routine medication administration and IV fluid.  When I was first introduced to him, he was struggling to breathe and was very pale (a sign that he wasn’t getting enough oxygen), even with oxygen on in the incubator.  He was unable to regulate his temperature, had poor tone and no sucking reflex. I was very concerned for his well being.  The baby’s fourteen-year-old mother and grandmother were reluctant to get close with the baby.  If there is any reason to believe that a baby may not survive, the mother will try not to develop too much of a personal attachment.  Once I realized how sick the baby was I decided that he shouldn’t be alone while I had the time to sit with him, so I planted myself in the “special care” area and held the little guy, rocking him and doing my best to keep him comfortable.  Eventually I was able to encourage the mother and grandmother to come spend some time with the baby.  I tried to explain the severity of the issue.  I asked the baby’s mother if she had any questions for me and she asked me if her son would be okay.  I told her that I wasn’t sure, but that he was very sick.  It was hard to tell them something like that.  I wanted to give her any hope I could, but I didn’t feel hopeful.  As the day progressed, the four of us spent more and more time together, taking turns rocking the young baby.  I asked her what she was thinking of calling the baby.  She then asked me what my name was and then said she liked my name.  I didn’t understand what she was saying, but she explained that she wanted to name her sweet baby boy after me.  I was overjoyed and completely flattered.  What an honor it was. 

           When I left that day it was bittersweet.  I was excited that a baby would have my name, but I was also worried for the baby’s health.  I thought about him and his family a lot that night.  Then next morning when I went in I was pleased to see that he looked much better.  His colour was better, he had better tone and was more active.  Each day since the first, little Megan seems to be improving.  I believe that it will be a long recovery from his traumatic birth, but I think he’s got some good fight in him. 

Megan H

            

"TIA"

     The past few weeks have been nothing short of amazing, among other things. When we first decided to go to Africa we knew it would be a life changing trip, but little did we really know of what to expect. Of course we have all heard stories or seen pictures of what Africa is, but nothing compares to being here completely immersed in a new and unique way of life.

     At first it was intimidating being here, and it was difficult to get used to being the minority in a new country. Things here are so very different is so many ways that we have a saying for when things go astray: “TIA” (meaning ‘this is Africa’). One good example of a ‘TIA’ moment was our bus trip out to Mukambi safari this weekend. We had just left our place and no more than 5 minutes later the bus was pulled over getting gas and changing a tire! About an hour later we were back on the road again. These little bumps along the way are just something we have come to expect here, and when they happen we look at each other and say “TIA”!

     However, day by day life here is becoming more natural. Everything here is at a much slower pace, we call this African time! Although different than what we are used to there is something so peaceful and relaxing about living life in the moment. Life at home is full of rushing around and getting all your tasks done on time it seems. Here we enjoy the smaller things, like watching the sunset with a glass of wine or sitting around the barbeque with a group of friends, with no place to go and all the time in the world.

     This is not to say that everything here is wonderful, in fact it is quite the opposite at times. There have been many times where we have wished we were back in Canada; whether it was for personal reasons or simply wishing we had the clinical resources of back home. Nursing here is challenging in a whole new way. The few resources they do have are often not exactly what you need or are difficult to use. Something as simple as taking vital signs can take an extremely long time to do because the equipment is so old and worn. Critical thinking comes in very handy here, and we are thankful we had such a great education that was able to teach us the skills we needed for this.

     This past week we were on the post natal ward (sorry this blog is posted so late!). We helped care for new moms and their babies. We got to look after two tiny 6 week old twins who had come in for weekly weights. We ended up admitting them to the ward because they had high temperatures, and they were diagnosed with sepsis. The mother is HIV positive and so we got the blood work ordered to see if these tiny babies are also infected with this devastating disease. We can’t help but feel sadness for these new lives that may be burdened with HIV from the innocent age of 6 weeks.

     Lastly, we really enjoyed our safari weekend! We did three game drives and saw many animals including elephants, hippos, zebra, and lions. The food was amazing and the shower were even hot!

Finding Strength...

       As we entered the Maternity Ward this morning, we were filled with excitement at the thought of
bringing new babies into the world. If either of us had known that today could possibly be the most
difficult day we've had in our nursing careers, I doubt either of us would have gotten out of bed this morning. It happened in the afternoon, at the very end of our shift. Alicia had never seen a c-section or a Caesar,   as the Zambians call it, and even though I 've seen a few now, the sight of a new baby being brought into world warms my heart and I willingly take any and every opportunity to be a part of it.
       The patient was 16 years old and this was her first baby. The midwives informed us that she had been fully dilated since 1700 hrs last night, but the baby had not yet entered the birth canal. As you may or may not know, there is an increased risk of infection once the cervix is completely dilated. The doctor did his best to induce her this afternoon, but it was unsuccessful and they made the decision to take her to the operating theatre. We tagged along, stethoscopes and ambu-bag in hand, ready to help deliver the baby. As the doctor cut into her abdomen and opened her womb, we began to notice a strange odour. The baby's head had already begun it s descent into the birth canal and he had become stuck. We watched in horror as the doctor and midwife pushed and pulled every which way, desperately trying to free the head and get the baby out. After what felt like an eternity, the doctor pulled him from the womb. He was pale in color and the cord was wrapped around his neck. As the doctor handed him to the awaiting nurse, we listened for the telltale cry, but the baby made no sound. The nurse placed him on the warmer and we rushed over to help. We suctioned him, inserted an airway, bagged him, and did compressions on his tiny chest, but he would not breathe on his own. We continued to try to resuscitate him for quite some time, but soon we realized that he wasn 't going to wake up. I put my stethoscope to his chest for the very last time and heard nothing. We looked over at the mother, lying on the table, watching us as we tried and tried, but could not save her baby. When we left the OR and entered the changing room, we fell to pieces. We could not speak, we could only cry. Why hadn 't anyone intervened earlier? We had so many questions. Especially, could we have done more? No. We did everything that we could possibly do in that moment. We couldn 't save him.
       It will be hard to face going back to the Maternity Ward tomorrow as this is weighing heavy on
our hearts, but tomorrow is a new day and another opportunity to bring new life into this world. We
take comfort and find strength in that.

Meagan M and Alicia

Sefula Clinic

This week was a change of pace. We worked out at Sefula clinic which we knew was far away but as we got in the cab Monday morning and started driving we realized just how far it was. It took us about thirty minutes driving away from Mongu, if we continued in the same road we would end up in Livingstone (according to Nawa our cab driver). We then turn down a gravel road for another ten minutes. The gravel road was so rough that Nawa preferred to drive in the ditch as it was a smoother ride. 

We got out of the cab and explored the clinic. We were surprised to find a male and female ward, a maternity and pediatrics ward with a labour room and incubator as well as an OPD and ART clinic. The clinic even had a small pharmacy and labratory. This clinic of course was on a much smaller scale than Lewinika General Hospital which we had just been at with only two admitted patients but nonetheless treated many outpatients and held clinics everyday for health promotion. 

We started in the ART clinic doing blood draws to count CD4 and then moved on to the OPD (out patient department or comparable to Emergency room) here the patients had to bring a notebook for the nurse to write in (no doctors at this clinic) and they sit down and explain their symptoms. Depending in the symptoms the nurse will either ask for a Malaria test, take some vital signs or prescribe medication. There was not a wide selection of medication and many patients left with Panadol (equivalent to tylenol) and antibiotics.  It was challenging to get used to letting go of needing to know what is wring with every patient like we do in Canada. Due to less technology and diagnostic equipment the condition is treated by the nurses best guess based solely in signs and symptoms. 

It was interesting to attend the health promotion clinics. Moms and babies travel up to several hours from small villages surrounding to attend the clinics. Everyday of the week is a different topic. The clinics were taught in Lozi so we did not understand much of what was being said but were happy to help weigh babies or give immunizations and thrilled to play with them. 

During our week at the clinic we were very shocked when we received word that a mom had delivered her baby on the side of the road because she had not made it to the hospital in time. (The mother in law was angry with her for not complaining of labour pains enough which resulted in them starting their walk to the clinic to late). We assessed the new little girl who was sleeping, 3.2 Kilograms and looked healthy. We then assessed Mom who had walked the remainder of the way to the clinic after delivering and was already up and walking around, packing her things getting ready to walk back home. We both adored the little girl for about ten minutes passing her back and fourth when the mom asked if we would like the honor of naming the little girl. After several suggestions and a lot of pressure Amanda suggested the baby be named Jenni which was a hit! Grandma, known here as KuKu started dancing around the room and danced her way out of the hospital singing and thanking god for a healthy safe delivery. And away they went down the gravel road with brand new born baby Jenni. 

During our time at the clinic we were blessed to have met and built connections with so many. We were even lucky enough to be given Lozi names. Amanda is now Limpo which means gift and Jenni is Tabo which means joy. As much as some days were slow and some days brought challenges we are both going to miss the unique and holistic experience we would never find back at home. 

Blood pressure screening and data collection done for 110 patients this week!

To Code or not to Code?

This week we spent our time on the Female Ward at Lewanika General Hospital.  Here, we cared for a combination of all female medical, surgical, and gynaecology patients and collaborated with nurses, students, and physicians. The nursing students are knowledgeable and more than happy to educate us on the illnesses specific to Africa (malaria, HIV, TB) and the different treatments available. We assisted with procedures, listened to the doctors as they did their rounds, and completed assessments.  Right away, we noticed the acuity of the patients here is much different than what we would consider an “acute” patient back home.  In Canada, almost all of these women would belong in the ICU.  We saw insanely high temperatures, elevated heart rates, and many low and high blood pressures.  There does not seem to be a sense of urgency when dealing with a declining patient, code statuses rare non existent, and death is common and frequent. 
 

During rounds on our first day we had a death occur.  As we were listening to the doctor doing his rounds, we noticed some commotion by one of the beds.  We went over to investigate and found a young woman gasping for air.  Her mother was at her bedside and was wailing and chanting in Lozi.  We quickly took out our stethoscopes and began assessing the patient.  We couldn’t find any peripheral pulses and the carotid pulse was growing weaker and more bradycardic. We tried to call for help, but no one would assist us. The nurses seemed to turn  blind eye and told us that they were going to call the doctor, and with about 4 doctors on the unit at the time, one eventually came over. We had no idea how to console the mother, and watched helplessly as the woman took her last breaths.  By the time the doctor came over to us, she had already gone and he pronounced her dead.  When we questioned the students about CPR, at first they did not understand what we meant; as we mimicked compressions and they finally understood, they said that that is not something they do here.  There is no resuscitation.  We later found out that this young woman had extra pulmonary TB, which is indicative of fourth stage HIV. 

Today we inserted a catheter into an incontinent elderly woman,  followed by a nasogastric tube because she was unable to eat.  It kind of mkes you question their rationale for things.  Even though the death that occurred on our first day was a young woman with fourth stage HIV, they did not help us resuscitate her at all, and here we are inserting an NG tube into a woman almost in her 80’s.  The average life expectancy in Zambia, so we’ve been told, is about 50 years old, which is a tough thing to wrap our heads around.  Back home in Canada we are performing full codes on 90 year olds.  The traditional wailing after a person passes away is not something we will ever get used to either.  It is an eerie, haunting sound that gives us goose-bumps every time we hear it. It is not something that will easily be forgotten.

Meagan M & Nicole S

Living Within Means

As nurses, we not only provide care to patients, but use knowledge and intuition to teach people and their families how they can help themselves... this is called empowerment.

Rianne and I relocated this past week to an outreach clinic that help severely malnourished babies and children to gain weight. This clinic is apart of the Mongu chapter of 'Village of Hope' (VOH)- this is a non-profit organization that helps vulnerable children all over Africa from providing them with a sponsor, so that they can have a home, eat, go to school and have a chance at life. The clinic is ran and owned by one woman who was passionate and dedicated to helping children survive this unjustifiable burden. The sick children that we are familiar with have detrimental diseases, such as cancer. No child should die because of a lack of food was the underpinning of her work and beliefs.

Our first day went from teaching to being in the clinic and then going to different huts for home visits. We did a nutrition teaching session to a few of the mothers in the village and the 'house moms' who lived in the orphanage homes. We have never been to a Mongu hut or have seen the available resources on a personal level, so when we presented our teaching, we thought it was basic knowledge to keep food safe and clean. We went over covering the food, ensuring that you store your food in a cool place (fridge) after cooking, how to keep it away from insects (cockroaches, flies and spiders) and to cut meat into small portions so it cooks to the middle. Well... did we just do a teaching session that didn't even relate to what these women had. No one had a fridge, there was no time to cut meat into small portions for 6-12 children, there was no house that could keep insects out, because it was wood, mud and some metal sheets on a dirt ground. This was 'their' life, not ours, and we learned quick about how teaching a 'basic' nutrition session wasn't really that basic.

Our work at the VOH clinic ranged from diagnosing, treating and providing medication from our diagnosis. This was something the both of us were not familiar with, but with support and using our knowledge of the common diseases in the area, we pulled through. We saw mostly children as there was a VOH elementry school right behind us and a few of the workers in the field.

Then there were the home visits. We are always practicing 'efficiency' and how we should be fairly fast to assess and see all of our patients, so that we can get our work done, but we weren't on anyone's schedule but our own... which is a very different pace than what we are accustomed to. We walked on average 3-4 hours in the blistering heat and on the sand with our heavy shetangeys (dress wraps) and umbrellas. For all that traveling and walking, we only saw 2-4 huts a day... seems like so much work for little pay off.

The ah-ha moment didn't come to us until we went into the homes... now we understand what it is like,  living within means and these women did. We asked about their food situation, where babe and mom slept, how they were doing with their mico-business and what were the challenges that they were facing at the moment. Most were very happy and had no concerns as most of the kuku's (grandmothers), sisters, aunts and other family members supported one another. It is such a strong sense of family and community. The most unfortunate part was to see often that the fathers of the children were not around... but the women are so independent and strong. They smiled when we told them their baby was healthy, fat and that they were doing a wonderful job. Seeing these huts for the first time made us so grateful to always have a roof over our head at the end of the day, and a bed to go home to.

The women bowed and were so grateful, giving up their only stool so we could sit down during our visits. When we said our goodbyes, a mother who spoke clear English said,
"Thank you for coming to Mongu and visiting us, the work you are doing really is a blessing."

And isn't that why we do this? 
Because we really do feel blessed by empowering those to live within their means...

Alicia and Rianne

Our canoe ride from a hut visit (on top of the 3-4 hour walk!)

The domino effect

This week I was able to work in the HIV clinic. In all honesty I was nervous and not so sure about working there due to having a limited knowledge base regarding HIV. After working there for a couple of days I walked away feeling thankful for the experience because I have learned a lot on such a huge issue here in Zambia which is HIV. 

I wanted to share with you one experience I had in this clinic this week. A young man aged 22 came in to the clinic with his grandfather (most children and young adults came in with their grandparents because many of their parents have already passed away from HIV/AIDS). I took his vital signs and I could tell from the findings that he was very sick. After his vital signs were taken we went into a room for the clinical officer (similar to our GPs in Canada) to assess him. This young man wasn't able to communicate with us... We got all our information from the grandfather.

After sitting and talking with the grandfather for a while an unexpected and unfortunate story was revealed. Since two weeks ago this young man has become confused and has lost his vocabulary. He has been vomiting every day and has had non-stop hiccups. Right away I thought to myself " why on earth did you not bring him in 2 weeks ago when these symptoms started". Before I even had the time to ask why he was not brought in 2 weeks ago the grandfather said " we live far away and it costs 20 kwacha (equivalent to about $4 Canadian) to get to the hospital and I didn't have the money". When I heard this my stomach dropped and it made me realize how oblivious I am that situations like this exist because at home if someone is sick we can find ways to receive medical attention.

The story doesn't end there.

So this young man is now here at the clinic and able to receive some medical attention. Right away I thought I wanted to admit this patient and thought that we would,  due to how sick he was. But his grandfather did not like this idea and neither did the clinical officer. 

The grandfather did not like this idea because it was only him and his grandson living in his hut and apparently the grandson helped out around the hut. If the grandson was not home things would not get done. Another reason was that if the young man was admitted it is almost expected that family stays at the bedside to give care to their family member. The grandfather said he couldn't do this since his hut would be left alone and he didn't want things to be stolen. Again, my stomach just ached. At home we would not be faced with having to make a decision about staying at the hospital or staying home because we have no locks. Again, I was oblivious to situations like this. 

The reasoning why the clinical officer did not want to admit the patient was because the nurses have to care for too many patients already and without the grandfather being at the bedside at all times they couldn't provide care to him. I could automatically feel my body heat rise. I have realized that the nurse/patient ratio here in Africa is very high, but I believe that isn't a good excuse to not admit this sick young man. I believe that even if they couldn't provide full proper care to this patient, setting up an IV to hydrate this patient and give proper medications to him would be way more beneficial than sending him back home. Don't get me wrong, the nurses do have a huge workload here and I truly admire their hard work, but I just couldn't stand turning away a patient because they were "too busy". I just wondered how many patients have they done this to?

The young man ended up going home with his grandfather. I still have a weird feeling inside me about this situation. But it really opened my eyes up to the barriers that people are faced with in underdeveloped countries. 

One barrier after another causing a domino effect seems to be a common trend here in Africa. 

Tracy

The True "Land of Living Skies"

     I would like to take a little extra space and do a bit of a random entry in this blog to tell you about a few aspects of our environment here. For me one of the biggest things to get my head about is the never-ending sky stretched out around us; the sheer vastness of it gives me goose-bumps. I am so use to the contained sky of living within valley mountains that not seeing a discernible end to it kinda freaks me out. Another thing with the sky is the clouds in it. They aren’t like back home either. They are really lively, almost sprinting across the hemisphere at times, and they take on so many different shapes, climbing up and twisting around. The clouds of the Okanagan will forever look like white cardboard cut-outs to me now. Also, you would think that with that much sky to see, one could anticipate a storm a few hours before it arrived, but you can’t. Don’t even try, it can’t be done. When the air starts to feel heavy and you think you can see the dark wall of grey coming, you have at most 30 minutes to get inside. Side note: The name of the street we are living on translates into “the place where lightning strikes” (Limulimga). So yeah, we get inside. I feel like I need to mention the floodplains at this point, and try to explain to you how amazing they are, but I don’t think it is the sort of thing that can be put into words. It is one of those ‘you really need to see it to get it’ kind of things. The last thing I am going to say about our physical environment is this: SO MUCH SAND.

      Moving on. The social environment is pretty awesome. Eye contact and smiles are shared with all the people you see, and saying “good morning” to everyone you pass would not be considered weird or unusual. Have you ever tried to say hello to a stranger on the street in K-town? I have. People give you a wierd look and probably believe you to be on drugs. Here, getting a million “good morning, how are you” ‘s each day can almost be expected, and feels awesome. The downside to all this friendliness is that you get nowhere fast. Seriously. If you have somewhere to be good luck getting to it on time. Socializing is so important here that you might be offending people if you tried to walk away from a conversation, even with the excuse of needing to be somewhere.

     Finally, I would like to talk about a little bit of culture. The Lozi people are so many things. Open and friendly. Stoic and determined. Honest and resourceful. You can rely on them to never be on time. They wear simple white bracelets, with more bracelets meaning higher status. Older women are respected for their knowledge. A shetange has 101 uses. The streets are full of people working, socializing and playing. The list goes on and on, but I think I have written enough for now. My one final thought is of the Canucks. To them, I say this: Get it together. Now. Enough of this bad news from home please, I would like to come back to see some playoff hockey, not to hear about how you all have had fun out golfing.  

-----------------Stephanie Simpson