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