Saturday, March 28, 2015

"That's it"

       "That's it". We have never experienced these two words in all four years of our practical nursing experience in a Canadian setting. We have been fortunate enough to be surrounded with diverse resources and treatments that are easily accessible in the healthcare setting.  When a particular treatment has failed, there has always been an alternative protocol to follow. 

In Canada, birth is considered a celebration of life. Families experience overwhelming feelings of joy and love upon the arrival of a newborn child. Child mortality in Canada is not as prevalent as it is in some African countries. According to the UNICEF organization infant mortality is 6 times more likely to occur in Zambia than in Canada, which was a culture shock in itself to us. Families tend to dissociate themselves from children as some are not expected to live past the age of 5 (119 deaths per 1000 live births). A large majority of people, in one way or another, have experienced the loss of a child to the extent that it has become a part of life here in Mongu, Zambia. Here, on the postnatal ward, the families are not as involved with the birthing and postnatal period as they are in Canada.  This leaves the mother to become her own support system. The lack of unconditional love and support for what we know to be a "creation of life and happiness" is a hard concept to grasp.

So precious.... so small... so weak... a little human being trying to hold onto its place in this world, is what we saw through the walls of a neonatal incubator one morning. The babe was severely dehydrated due to poor feeding that unfortunately led to hypovolemic shock (hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body).The babe appeared to have poor muscle tone, had a mottled appearance, and her chest was retracting with efforts to breathe. In order to receive proper hydration the babe needed intervenuous access, which had gone interstitial earlier that day. In efforts to save this babe we decided to call the physician. It was in that moment, after the physician had tried the veins in the hands, arms, feet, clavicle, and  shaved a portion of the head with attempts to start an IV, that we lost hope. The physician then explained "that's it". 

The strong front that people here in Zambia put forward with regards to pain, loss and suffering is unbelievable to us. Woman are taught to be "tough as nails" and mask their emotions. The mother was devostated when explaining the prognosis of her baby girl. Although there was an existing language barrier I comforted her, held her hand and let her know it was okay to cry. Rubbing the father's back and hugging the grandmother were moments that I take away from this emotional but remarkable experience. Palliative care is not part of common healthcare practice in Zambia. We, as a team, were able to advocate for this family who needed palliative support more than anything in this difficult time. This advocacy allowed the mother to feel supported and hold her babe during this emotional situation. 

Due to a lack of resources something as simple as dehydration, which is preventable in Canada, is a common reality in Mongu. Perinatal and early child mortality rates in Zambia are among the highest in the world (Hyder et al. 2003; Madise et al. 2003; Stanton et al. 2006). It is difficult to accept this reality as we are used to seeing and practicing health care in such a different way back home. Upon reflection, we came to the realization that the physician was well aware of the pending prognosis, but went out of his way to attempt to start an IV on this babe to emotionally support us as students.    

At the end of this experience, we recognized a great need for a balance between being empathetic and accepting the current reality here in Zambia with relation to postnatal and maternity care. We never would have expected that the words "that's it" could lead us to a new perspective of life, and open our eyes to cultural differences.

Prayers and love to the family we cared for this week. 


          Trisha and Amanda 

This is the grandmother and mother during our last day on postnatal

This is the twin sister of the neonate that passed away


  1. Dear Amanda & Trisha,

    Your heart wrenching story brings me back to an earlier post from Danielle about education versus knowledge versus wisdom. It makes me reflect on the differences between education (what you have learned is best practice), knowledge (what you came to realize was possible even in this difficult situation - which was palliative care and comfort for this mother and baby), and wisdom (how our Zambian colleagues make and live with these difficult circumstances and treatment choices every day). Good on you for recognizing what you could do and doing it - and for recognizing what your Zambian colleagues have to face every day.

    "That's it", so hard to say and to live. Two words you will carry in your being for a long time, I am sure. Take care of each other and cherish the wisdom,

    Tricia Marck

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