Monday, April 14, 2014

Week 3 at Lewanika in the OPD

I spent my 3rd week at Lewanika in the OPD and had a very challenging and very rewarding experience.  I struggled this week with the differences between how I have been trained at home and how the emergency department operates here in Zambia.  There are so many cultural differences here that affect the way nurses and doctors provide care, but the big one that I noticed this week in the OPD was what seemed to me to be a lack of urgency or emergency ... at first anyway.

There was one situation in particular that was very difficult, but really illustrates the theme of this blog.  After spending a somewhat quiet day in the OPD with the clinical officers a patient was carried into the treatment room in an obviously compromised state. He presented with symptoms such as foaming from the mouth, vomiting, seizures, and a decreased LOC.  Needless to say .. I panicked!  I ran around like a chicken with my head cut off collecting vital signs equipment, trying to do an assessment, trying to come up with ideas about what might be causing these symptoms, all the while having no idea what was gong on with the patient because I could not speak any Lozi to their families and the patients were obviously not responsive.  I remember feeling the whole time very embarrassed because all of the other nurses and clinical officers kept such cool heads!   I remember thinking.. This is an EMERGENCY! Why isn't anyone showing a sense of urgency? I realize now when thinking back that although no one may have been panicking or showing outwardly a sense of urgency, they were all still being very effective in their roles, maybe even more effective than I was being!  It reminds me of the saying don’t judge a book by its cover, because at this point I definitely was.  Just because outwardly no one was behaving like they were worried or panicked about the patient did not mean they were not. I ended up running to find a doctor at one point because  didn't know what else to do, and when I returned with the doctor the patient had an IV, was in the recovery position, and the patients' family had given a history which lead to his diagnosis, which was poisoning. Reflecting now on this experience I think it was good that I did react the way id did and get the doctor to call attention to this patient because it was necessary, a doctor needed to be there to order emergency interventions, and I think all of my panic and anxiety sped up the actions of others around me which was positive as well.  I also learned though that people all react to stress in different ways and the Zambian nurses react very different from the way I do.  I have a new found respect for the Zambian nurses and clinical officers who remained so composed during this situation, but I also believe I modeled behavior that is sometimes necessary in practice that they may take into consideration in the future when the time calls for it.  At the end of the day I feel proud that I reacted quickly to a situation I felt needed closer attention and  although I may have looked pretty crazy in the moment,  it resulted in the patent surviving, which is the best outcome I could have hoped for 

Another theme I wanted to mention in this blog was teamwork and the importance of feeling supported by the nurses you work with.  Once the doctor had come to see the patient he ordered an NG and activated charcoal before leaving.  Once he left though there were no NG tubes in the OPD (which we had to get from another ward) and I felt like no one agreed with me that this patient really needed the NG at all.  At this point I began to doubt myself and wondered if the tube was he best thing for the patient.  Some of the nurses brought up some valid points like that he was already vomiting, and that we don’t know what kind of poison was consumed so there is the danger of perforation from the NG if the poison had caused burns, and so I began to really question myself at this point.  I recognized I needed to confirm my ideas and feelings with someone who understood where I was coming from I guess so at this point I went to find some support from the group.  I found  Caitlin, Ali, and Lauren in the conference room who all agreed that the NG was necessary and that the possible consequences were outweighed by the benefits and I found the support or confirmation that I was looking for.  This situation reminded me of how important it is, especially for a brand new nurse to seek out help and support when needed.  

That sums up a bit of what I experienced this week in the OPD and I look forward to my next placement t save a life center, 

Until then, 

Sarah: ) 

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