Thursday, April 18, 2013

We will Carry On.

     No, I didn't post a blog last week, sorry Mom! So I am going to have to talk about my last two weeks here, and then since this will probably be my last entry, I should talk about some final thoughts on this experience.

Week 4: In the bush.
     Outreach week! Anna, Amanda and I spent 4 days out "in the bush" working in a small clinic and getting a glimpse into village life. The clinical side of the experience wasn't all that exciting, with people coming in with small aches and pains that we treated.
 The biggest part of the clinical aspect was the connections we made. Lihana is an amazing woman who runs a feeding center, medical clinic and orphanage within the district of Mongu. She is a huge advocate for the people of Western Province. She is one of the people we went on this outreach with, and because of this visit she was able to connect with yet another isolated clinic. The village life was definitely the highlight of this experience. We sang and danced and told stories around a big campfire in the middle of a sand field every night. The best story I think we heard was one told by a young 8 or 9ish year old girl. She told us a story of a little girl who went venturing into the deep bush one night. This little girl continued her journey down dark paths until she came upon a ghost blocking her path! The ghost demanded that she sing and dance for him, or he would eat her. The young girl telling the story then proceeded to get up and start singing and dancing by the fire. She sang something along the lines of "please Mr. Ghost I do not want to be eaten!". It was very cute, and the little girl in the story managed to get away from the ghost. I thought the story ended there, but it didn't. The grandmother to the little girl had gone looking for her grand-daughter and had run into the ghost as well. The grandmother could not sing and dance however, so she was eaten. Great ending to the story, don't you think?

Week 5: Bubbles make the world go round.
     My final clinical week was spent on childrens ward (also known as C Ward). I was able to really work with and teach many of the Zambian nursing students on this ward, as there were many first years who had little instruction from anyone but themselves (the nursing school in Mongu has almost no teachers right now). We also got to do a lot of "play therapy", AKA having fun playing with children's toys. It was a lovely way to end my clinical experience.

Some things I struggled with while here:
  • The situation in life here (especially in terms of health care and life prospects) is crazy unfair. Why was I born into a first world country? It all comes down to chance, and this fact makes me feel guilt every time I think about everything I have.
  • Getting lots of attention by being the stand out minority meant talking to a lot of people. I am not a particularly talkative person, so the constant conversations took a little getting use to. Being treated so differently also led me to think "will I ever be truly capable of knowing the culture here?". I think that because we are seen so differently and separated as such we could never completely be a part of the people of Mongu.
  • There is so much poverty here that it seems to be considered normal living conditions to be living in a small hut with a large family without water or electricity. It really would take a lot to even just get the majority of the population above the poverty line.
Some things I learned:
  • There aren't just 2 or 3 ways to do things, there are millions. 
  • The struggle of nursing without supplies is accomplished here everyday, and you can do a lot with a little. This makes creativity and critical thinking a huge asset to have, and those are skills I further developed during my time here.
  • Canada's culture sucks. People have the capacity to be so much more friendly and open (even under the poor circumstances many are in here).
  • Singing and dancing does more than just make people happy. It unites, heals, and gets you some good old fashioned exercise.
To quote Carry On by Fun.: On our darkest day, when we're miles away, sun will come, we will find our way home.
---------------Stephanie Simpson

Friday, April 12, 2013

Save a Life


            I spent my last week in Mongu at the Save a Life Centre within the Village of Hope.  The time I spent there was the best time I’ve had my entire stay in Africa.  I have learned so much this week.  I worked with amazing people, had many different experiences, and had the opportunity to be much more immersed in the Zambian culture. 
            The mission of the Save a Life Centre is to provide rehabilitation and care for malnourished children and babies.  Children who are severely malnourished are admitted to the center until they are well enough to return home.  Children who are not admitted, or who are discharged once they are well, are part of a feeding program that typically lasts up to six months.  Admitted babies and children reside at the center with a caregiver, who may be the mother, the grandmother, an aunt etc.  In some cases, these parents of these malnourished children have died from HIV/AIDS and have caregivers who cannot afford to supply them with the nutrition they need.  In other cases, the parents of the children do not have the means themselves.        
            This past week there was one young girl admitted at the center.  She is just a year old and weighs about twelve pounds.  Her mother has been staying at the center with her also.  This young girl really touched my heart.  She was very quiet and reserved when we first met her, and she’d just gaze at us with her big, brown eyes.  We were finally able to get her to smile the other day, and when she did she gave us the biggest grin.  She smiles with all she’s got.  She scrunches her nose and bares her teeth for us while letting out the cutest giggle.  You can actually see the happiness radiate from her.  Her mother says she’s happiest when she has a full belly, which makes sense and is true for most of us too.  Her diet is very regimented in order for her to put on weight.  In addition to snacks and meals that she would typically eat at home, she drinks a milk-based solution high in fat and calories, and eats eggs and groundnuts as sources of protein.  She seems to really like this other food too.  She takes everything she’s given without a fuss.  On Thursday she was well enough to be discharged from the center.  I went along to drop she and her mom off at their home.  It is important that the director of the center knows exactly where they stay for home visits in the future.  It was bittersweet saying goodbye to the young girl.  I was happy she was well enough to leave the center, but I was sad that she wouldn’t be around to visit with anymore.  I really enjoyed all the time I spent with this little angel. 
            It amazes me how much we take for granted in Canada – things like health, nutritious food, running water, plumbing, electricity, and transportation.  The people of Zambia have so little, yet they are so resourceful and grateful for what they do have.  They find ways to survive as best they can.  This center is an absolute blessing for those children whose families struggle to provide for them.  Since working with the Save a Life Centre and learning about of all the great work they do I have decided to sponsor a child on the feeding program for six months.  Fortunately, I have the advantage of knowing exactly where the money is going and whom I’m helping with my effort.  I strongly encourage anyone reading this blog to visit the Save a Life Centre website (http://zam.co.za/Save_a_Life.html) and consider sponsoring a child yourself.  If you do choose to sponsor a child you can email info@zam.co.za.  There are many kids here who could use your help.  

Megan H.


Friday, April 5, 2013

Babies, babies, babies!!!


Congratulations to all the beautiful Zambian mothers who have given birth to little bundles of joy this week! What a wonderful experience it has been working on the maternity ward at Lewanika General and with the fantastic midwifery staff. It is such a joy to welcome the new babes into the world and a great learning opportunity working alongside the midwives. The birthing process here is so amazing...no pain medication, no screaming and hollering, the mothers have to walk back to their beds immediately after birth and if no complications arise they can go home within a few hours!! Easy peasy right!? They make it look so simple, but I can only imagine what they have endured throughout the process. I am thrilled to be a part of it and to be able to help deliver the babes, clamp and cut the cords, weigh them and carry out baby assessments. One of my favourite things during a birth was when the midwives were encouraging the mother to keep pushing through by saying "happy, happy, happy" as the baby was on its way. I also have really enjoyed carrying the babes over to the post natal ward to be discharged and all the women outside in the corridors chuckle away as we carry them with big smiles on our faces :D It is such a different atmosphere on the maternity ward and a much happier environment compared to other areas of the hospital that are medical/surgical. I love the sense of community that the mothers here have not only on the maternity floor, but most places we go in Mongu. When one mom leaves her baby unattended it may look as though she has temporarily abandoned the child at the bedside, but the other mothers seem to always be there looking out for one another and their babes. It is a wonderful sight to see, and I had a very joyful week! 
 
-SB

Thursday, April 4, 2013

The Children's Ward

Last week I was on the children's ward by myself, and it had its ups and downs. During my shifts on c ward I spent a lot of time with a malnourished 5 year old little boy who had an anastomosis and an ileostomy done. When the week began, the sutures at the bottom of his stomach opened. The next day, the top opened. I was horrified that i could see this little boys intestines as he laid in his hospital bed, but i understood that the surgeon could not close him yet because the sutures would not hold in his fragile skin, and we needed to wait. Also, due to the lack of supplies on the ward, he did not have the the correct ostomy appliance on his stoma, and his skin is completely broken down from fecal matter. On Friday when I went to do his dressing change in the morning when I arrived on the ward, I found his sutures all completely broke open from his chest to his pelvic area, and all of his colon exposed. 

Immediately our team started moving, and just like at home when something serious happens, I could feel the panic in the air. We got our instructor, three doctors were called, two of whom came in to see the patient, and another instructor of ours came to the ward as well. I was so thankful for the support from my peers and instructors who also recognized this young boys condition as an emergency. No one was on Africa time this morning! 

When the doctor eventually made it in to see this patient, my emotions and frustrations took over. If we were in Canada, we would have so many more resources to save this child. TPN would be running, an IV would be running, he would be on a clear fluid diet, and he would have the correct ostomy appliance on his stoma so that his skin around the area wasn't so broken down in the first place. I hate that even though we are doing all that we can for this young boy, it does not feel like enough. Not near enough. At home, there is always a doctor to call, a Wound care nurse to consult, a colleague to ask their opinion... Their is always something more that can be done; a solution waiting to be found. At the end of your shift you can leave feeling like you did everything you possibly could, that you are leaving your patient in trusting hands, and that they will receive the care that they need while you are gone. That is often not the case here, and I did not feel this way. 

My instructors helped me to realize that in Africa, these are the frustrations that we face every day. These are the times that we need to look at what we ARE doing for this child. If I hadn't found him that morning, who knows how long he may have stayed like that for. 
 The doctor came to the conclusion that he could not close the boys stomach because his skin would still not hold, and that we are doing everything we should be for him. He did order more pain medication and F100 (a formula used for malnourished children and babies). 

This week on the pediatrics ward showed me that African children are the strongest, bravest souls on this planet. They face health challenges in their first few years of life greater than some Canadians will ever have to deal with. It breaks my heart that these challenges take away from them getting to be a child... Getting to laugh and play like they should be doing.  Us being on the children's ward give these kids something to smile about, though. This week I played with the children, brought them toys, made them smile, and brought as much laughter to the floor as possible. We give these children hope, and provide them with the best nursing care that we can. That, all on its own, has made my trip to Africa worth it. 

- Rianne Swanson

Monday, April 1, 2013

Boat cruise on the Zambezi River



We Sing, We Pray, We Dust

     I remember my reaction to the male ward, during the initial hospital tour, like it was yesterday. The patient beds so close together, the overwhelming pungent smell that overtook my nostrils, and the countless male patients, just skin and bone, that were laboured with every breath. I remember looking around at my fellow classmates and feeling reassured when their faces reflected my exact emotions. Later we spoke excitedly about starting work on every floor but unanimously the male ward was dreaded and secretly I prayed I would be placed anywhere but there. The minute the assignment sheet was posted and the words 'Nicole.M. - Male Ward' came into focus, my heart sank.
      I am a firm believer that everything happens for a reason so I decided I would remain silent about my disappointment and head into the experience with an open mind.
      I can proudly state that this past week Stephanie Simpson and I bravely tackled the ward. Miraculously, I can honestly say that I thoroughly enjoyed the experience and learned a lot about nursing in Africa and truthfully, about myself. Sometimes the best experiences can come from being pushed out of your comfort zone and this was definitely one of those times.
     So there I was on my very first day on Male Ward looking around, just as overwhelmed as ever. Trying to get myself pumped up and positive I walked over to the Zambian nursing students and asked with as much enthusiasm as I could muster "So guys where do we start?". They all looked at me strangely and one replied, "Well Sister, first we sing, then we pray, then we dust". Sing? Pray? Dust? That's when I really recognized just how different nursing in Africa really is. After hearing that response I came to the realization that I may be completely out of my comfort zone but that I still have so much to offer. I have the power to be a role model to these nurses and to demonstrate what I feel is most important - providing patient centered care.
      Zambians are very proud people and it is not always the easiest to tell if the nurses here are learning anything from us but deep down I know they notice the way we interact with the patients and take note.
     One case in particular that stuck out this week was when Steph and I arrived on the ward to find a patient that was a local prisoner laying on a mattress on the floor covered from head to toe in his own feces. We have no idea how long he had been in that horrid condition. Of course Steph and I were apalled and I am sure the looks on our faces gave away our distaste. We hurriedly gathered a basin with water and gauze to clean the patient up.That was a profound moment as patients on the male ward are often left laying in their own filth, waiting for their family members to clean them; that is if they are lucky enough to find clean linen and supplies. Us demonstrating that we will provide compassionate care and treat any patient with dignity regardless of their status, prisoner or not, was enough. The nurse noticed what we were doing and quickly joined to help us. The cherry on top of that experience was when the patient that was barely conscious prior to the cleaning, looked up at me and gave me the hugest grin.

     I now understand the impact our actions can have here but before we can take over with our Canadian nursing ways, we must learn to sing, pray, and dust.



- Nicole McComb




The Unseen Results - Mukambi

   This week we (Marlee and Jenni) stayed at Mukambi Safari Lodge, working daily with the surrounding communities of Mukambi Compound and Chunga Village.  Throughout the five days, we were faced with many barriers, mostly being outsiders in a small community.  It has been a week of smiles, laughs, frustration and realization.  We would like to share some of these memories of Mukambi and Chunga you all!
   Our week consisted of traveling to Chunga village to work at the Out Patient Department (emergency in Western terms), participating in the “Under 5” clinic, teaching grade 1, 8, and 9s at the Chunga boarding school, providing an information session at the Mukambi School for parents, and spending a day HIV testing. Each of these experiences showed us how different but more importantly how similar Canada and Africa truly are.
   Teaching the grade 8 and 9 students at Chunga is definitely one of our most memorable moments. For those of you who know us, neither one of us are overly outspoken and are not ones to speak up in a group, so this was a challenge! As our discussions around hygiene and sexual health progressed the students became more involved… asking fairly complex questions. These questions ranged from “what is masturbation?” to “is a sexual relationship between a 15 and 16 year old advisable?”  Masturbation in Zambia, especially in the smaller communities is frowned upon, and is not something that people here engage in.  In addition, sex in general is not common topic around the Zambian dinner table.   As we stood in front of 120 students and 4 teachers, we were at a loss for words and wanted to find the nearest exit.  After a few seconds, which felt like an eternity we realized the purpose of our visit.  The purpose being to spread valuable information about health, but more importantly, to have a clean slate, where they can ask any question they may not have been able to ask their parents, loved ones or teachers. 
   Our next adventure was teaching the parents of the Mukambi compound. We covered similar topics with the addition of Malaria, HIV, and basic first aid with the help of a translator because many people in the community only spoke Chitonga, the local language.  Impromptu teaching about safe sex and specifically how to put on a condom was a popular topic (a bottle of water was the only demo prop we had – limited resources at its finest!).  Even though we were able to pass on information about health, we ended this day feeling slightly disappointed as the response from the group was hard to read and we were unsure of their acceptance of us.  But throughout the rest of the week, we began to gain trust with the community by simply putting up health posters or playing a game of net ball with the school children, we realized that if we were able to reach one person throughout the health teachings, good things will come of it.    
   With the stigma regarding HIV being highly prevalent in this community we were uncertain of the turnout we would have with the HIV clinic. After the days end, we tested 28 people and felt like it was a very successful day.  This resulted in 28 people knowing their status, receiving information about preventing or living with HIV that we hope will be passed on to their families and loved ones.    
   Overall it was a great week at Mukambi.  Through our background and environment, we have learned to be “doers” and want to see results of our actions or a change for the better, immediately.  Whether it is with our looks, our careers, our education, we like to see the “fruits of our labour,” in a very timely fashion.  This week has allowed us to realize that even though we may not have seen a direct result of our teachings, it does not mean that change did not happen or will not come.  A simple demonstration of correct condom use, has the potential to protect one person from contracting an STI, having an unplanned pregnancy or receiving or passing on HIV.  We may never know the direct results of our time at Mukambi, but we have come to see that education is truly the best medicine. 

Mission Impossible: The Untouchable.



Mission: Survive one clinical week on the Male Ward.

Details: In the face of lacking supplies, extreme nursing workload, a language barrier, an unknown hospital political process, discouraged critical thinking and an evil doctor, you must care for patients in every way you can, and come out of it with your head still perched upon your sweat soaked neck.

…mission accepted.

     With so many things stacked against them, it is a wonder that patients, family and nurses alike make it out of there in one piece. The “supply room” is a spacious room, but only because there is next to nothing in it. It contains just a few boxes of IV fluid and some catheters on the floor along one wall. Even clean linen is scarce. The number of patients fluctuates, but you can be assured that there will be at least 40 patients (medical and surgical combined) on the ward with only 3 nurses to attend to them. There are often many students on the floor though, so they seem to manage in their own way. One of the most difficult things to work with is the fact that the nurses here are not taught critical thinking skills. These skills actually seem to be discouraged, and the only purposes the nurses have are to clean and to follow doctors’ orders. Following orders isn’t necessarily a bad thing, but there are often times when a patient becomes quite sick suddenly and the nurses do not act because they do not have a doctor there to give the orders they need. And no, they do not call the doctor for help regularly. It was during these times that Nicole M and I were really able to kick butt and get things done, using our critical thinking to do what we could with what we had.  
     My stand out moment this week was the care for a particular patient on the floor. We noticed that his mattress had been moved to the floor overnight, so we went to check on him. He was semi-conscious, naked and covered, from head to toe, in his own feces. After a quick assessment we went to work cleaning him up and trying to talk with him as he became more alert. The nurse we were with though didn’t seem to want to come and help us even to just translate what he was trying to say. After scrounging up some linen we were able to clean and cover him, and we sat him up by leaning his mattress against his bed post, as he was too weak to sit by himself. His mouth was also covered in sores and muck, so we cleaned out his mouth with some of our supplies. It was then that he smiled at us. That single moment has made my trip here so worth everything in so many ways. Later that day when his guards came in they went to talk with the nurse. We heard them talking, laughing and saying “makuwa” (white person) a few times. We asked the nurse what they were talking about once the guards had left and though she didn’t really answer that question she did tell us that he hadn’t eaten in 5 days. You see, it is up to the family members to feed the patients, and he didn’t have anyone in the hospital to see him. He also was unable to get food for himself. The hospital provides one meal a day however, so we made sure to feed him when they came around with the food. We also asked her to tell the nurses to feed him when food comes, but who knows what will happen with that. I was really disgusted at how much the stigma of being a prisoner affected the ability of the nurses to care for this patient, but I hope that our actions were watched closely by the nurses (as I believe they were) and that they may take even just a moment to think about us and why we acted the way we did. Hopefully, these small thoughts will eventually turn into something a little more that can help the patients of the future.  

Clinical week 3 of 5: Completed.

-------------------------------------------------------------Stephanie S

Living with HIV


This past week I had the opportunity to work in the ART Clinic-the Anti Retroviral Therapy clinic where people go for routine check ups and treatment for HIV. It was such an eye opening experience while I sat taking vital signs for 4 hours nonstop person after person filtering through the clinic. It is amazing that some days they can have up to 300 patients come through. What really caught my attention is that HIV has no stereotype here in Zambia, and I never would have thought that many of the people who came through the clinic were living with HIV. It made me realize that we have been in contact with many people during our stay here that are living with HIV without knowing it, and we have danced and laughed and shared some great times and made some wonderful memories with a lot of the people without ever thinking that they might have HIV. It is very easy to stereotype people anywhere in the world when it comes to diseases and that there are many people here as well as back home who are living with some kind of illness that we may not see on the outside. Here in Mongu HIV affects the young and the old, the rich and the poor and it reinforces the fact that as a nurse it is important that we are seeing the patients for who they are and not just their illness. It was a very interesting couple of days and I am thankful for the learning opportunity.

-SB

First Aid Teaching

This week we taught a first aid course at the "save a life" feeding centre. At first this week seemed like a lot of work and not a whole lot of fun. Now looking back at it it definatly was a lot of work but with that came a great amount of accomplishment and a tremendous amount of laughter and good times. We will forever have a new respect and appreciation for all of our teachers as it takes an amazing amount of prep time to teach lessons and a lot of energy while in the classroom.
Our class was filled with 12 Zambian students of various ages, backgrounds, and professions.  Each one of them had their own story and reason for being in the class. Some were there because they were asked to be others were there because they wanted to know and teach their children all about first aid. Over the four days we taught first aid we developed friendships and were able to learn more about the culture and traditional beleifs these people have especially surrounding first aid treatments. We had some extra challenges teaching here in Africa. These included the language barrier and limited resources (as always is the case here).  We tried our hardest to present the information in a fun and interactive way. Through hands on activities, posters, games, and scenario playing we were able to engage our students and develop a first aid program that fit with their needs. 
On our last day we had a review and a practical quiz where we role played different scenarios and students had to demonstrate how they would respond. It was a lot of fun and giving out the certificates was a great ending ! 
Looking back at this experience we feel privileged to have been given the opportunity to teach.  Not only was it a great review for our upcoming outreach trip it was also a challenge that was well worth the rewards!
---Anna & Amanda---