Saturday, March 21, 2015

Only One in OPD

This week, I had the blessing of being able to practice in the Emergency Room in Mongu's hospital. Going in to this week, I was a little hesitant as I was the only student not paired with a partner. But my nerves were quickly cancelled out by my excitement for this opportunity. Here, they call the Emergency Room the OPD - the Outpatient Department. I was looking forward to observing the differences between here and the Emergency Room I worked in as a student back in Canada. However,  what I underestimated was how much this place would come to effect me.

Assessment room in OPD

When I was first introduced to Emergency Medicine in second year, I knew I had found my home. And what I came to realize in my week in OPD was that even though so much is different here, the power of this type of nursing is universal. They may only have two beds in their department here, or they may have missing or broken equipment. But under it all, even in lacking conditions, they thrive. It is different, but they know what to do. They know how to help their people. And it was the feeling of working with intelligent people, doing everything in a single moment to help people that are in need that made me feel as though I was back home. And I knew in my next few shifts that instead of comparing the differences, I was going to have to start learning. And boy, did I have a lot to learn.

I spent most of my first day with a Clinical Officer (CO) in the assessment room. Watching  him assess patients, read X-rays, and prescribe medications, I initially mistook him for a doctor. However, I found his role here was much more like a Nurse Pracritioner in Canada. In fact, I discovered that the Emergency Department is entirely run by COs, and that doctors are only called in for severe cases, or cases the COs felt they needed help diagnosing. When I asked the CO about his schooling, he told me the program he had to take was three years, he asked me about my education, and I told him I was finishing my fourth year. Silence ensued, as we both knew that even though I may have been the more educated one, he was the more knowledgable. And as he was willing to teach, I was eager to learn.

I finished off my day observing a gynaecologist in an outpatient clinic. Here, we informed multiple young women that they were either infertile, or that we could not find a fetal heart rate on their ultrasound. The women received the news as though we had just told them the weather forecast - no tears, no emotional display of any kind. The doctor saw my puzzled look and said "the women here are strong. There are many cultural differences that you will come to encounter. But know that even though the women do not express their sadness on the outside, it is still inside, and we must acknowledge that." Again, even in the hardest of situations, the Lozi people emanated calmness. I have so much I can learn from them.

The next day, I was pared with a Medical Officer. This person is very comparable to a doctor (I again thought they were a doctor), but have 5 years of education instead of eight. However, the man I was paired with was easily the most knowledgable person and teacher I had ever met. He was so eager to teach me about medicine in Africa. And he again made me realize I had underestimated how much learning I would do here.

This man spent the entire day teaching me, quizzing me, and collaborating with me on patient cases. As the day progressed, and we both felt more comfortable in each other's skill level, the conversation really started flowing.

At one point, the Medical Officer asked me, "if a patient comes in with symptoms of menopause, are you worried?" Knowing that these symptoms were not life threatening, I said no. He looked at me and said, "But this is affecting your patient's life. Everyday, they are living with these symptoms. And if these symptoms are affecting your patient, as a clinician, you must be worried. You must help. That is the job we have chosen. Helping people. You must remember that. No matter how small the problem, if you can help, you must."

As if fate stepped in, later that afternoon, we were assessing an elderly male that presented with swollen knees. The patient informed us that he was very upset, as he enjoyed dancing so much, and all he wanted to do in the last part of his life was dance. However, his swollen knees made it too painful for him to do so.

We examined his knees, and found that the swelling was due to an excess build up of synovial fluid (almost like the grease that allows your bones to slide easily on each other when they move). Then, for the first time ever, I watched someone do a Knee Tap. To do this, a needle is inserted in to the space with the excess fluid, and a syringe is pulled back to suck out the fluid. The amount of fluid the Medical Officer sucked off of this mans first knee was incredible - around 1 cup. After watching the Medical Officer do the first knee, he passed me the needle. In awe, I realized I was going to tap the second knee myself.

It is hard to describe the feeling of excitement, fear, and anticipation a student gets when they get to try a new skill. And reading this, you may not think it is that exciting that I got to put a needle in to someone's knee and drain out 70 mLs of fluid. But once I had completed my half of the procedure, the patient stood up, smiled, and started dancing. Tears rolled down his face as he told us "the pain is gone." And it was this moment that reminded me that even if you don't always save a life in medicine, you can always try to change one for the better. Even if it is something small for you, it can be huge for your patients quality of life. The Medical Officers teaching was immediately followed with an example. And that night, I went to sleep knowing that old man could dance his heart out for all the days left in his life. And that was more than enough for me.

Danielle doing a Knee Tap

I am ashamed to say that I underestimated the amount of learning I would do here. During this placement, I met some of the smartest, and most passionate clinicians I have ever encountered. Specifically, the Medical Officer I worked with, Mr. Kwibisa, went above and beyond to mentor me. Shadowing him had easily become the best part of my clinical experience. I knew already that I was going to miss him, his knowledge, and his eagerness to teach when I left. I was going to miss all of them.

My day later ended perfectly - not at clinical (which did end great), but back at home. Finally, we got our first Zambian storm. As my friend played the guitar on the patio beside me, I looked out at the thunder, lighting, and rain, and realized something amazing - I was at peace here. Everyday, I was being pushed out of my comfort zone to do the thing I loved, with people I loved, in a place I was learning to love. I am so blessed.

And at the end of the week, even though I was sad my OPD experience had ended, I was excited at what was to come. Africa and its people had begun to open my eyes to a whole different reality - not only of medicine, but of life. And I knew I would only continue learning next week in the small outpatient clinic I was going to.

- Danielle


  1. Loved reading this! Have a wonderful learning experience there Danielle and loving those people who are so easy to love! Linda Drew

  2. Dear Danielle,

    As a fellow Emerg nurse who like you, knew that the ER was my home as soon as I entered my first clinical day there as a third year student nurse, your stories make so much sense to me. And your appreciation for the differences between education, practice knowledge, and wisdom make my heart dance. The first is a step we must take on the road to the second, and the third (wisdom) is no guarantee for anyone - but there for the taking whenever we open our hearts and minds and listen for it. You are clearly listening,

    Tricia Marck

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