Canadian-Zambian Nursing students

Little Catching up to do! - Caitlan S.

Well, it has been two weeks since my last blog post! So I (Caitlan S.) have a little catching up to do! 

This past week I was fortunate enough to be at Save a Life Centre in Village of Hope with Lauren (which we will post about soon) and the week before I was on the pediatrics ward at Lewanika with Aileen. So I will inform all who are reading about my week on peds and then you can keep an eye out for myself and Laurens post later ;)

We were told before we embarked on this journey to Africa that it would be filled with some very high highs and extremely low lows. I had not understood this meaning until my week on pediatrics. It was THE hardest and most physically, emotionally, and mentally challenging week I have had throughout this practicum. However, it was also a week where I had some of the most inspiring and happiest moments of this trip. 

The very first day was the day that I felt like I couldn’t go on with this practicum anymore. Within the first hour of the first day on the ward, myself and Aileen witnessed a situation with a young boy that I don’t think either of us could ever have imagined would happen, especially to a child. The boy had a severely infected thigh with osteomylitis (a very painful infection of the bone) and a small incision used for drainage of the leg of pus and fluids that build up. The very first day I was with him, without analgesic or local anaesthetic, the doctor attempted to drain the boys leg by squeezing the leg on either side of the incsion and was unsuccessful. The doctor then proceeded to stick his entire pinky finger into the boy’s incision in attempt to drain the fluid from it, which was also unsuccessful. Meanwhile, I am holding this boy, listening to his piercing scream of pain, and watching him in otherworldly pain.  Eventually the doctor gave the boy local anaesthetic but then immediately (without letting the anaesthetic kick in) put his finger in again and then ended up creating a second incision to allow the leg to drain. This final incision was thankfully successful, the boy’s leg was drained, and then bandaged. Thank goodness Aileen was with me during this experience because she had a certain strength that I didn’t at that moment. I needed a shoulder and she was there. 

This situation was just entirely shocking to me to the point that I felt like I could not comprehend what was going on. There were just so many things about it that just seemed completely wrong to me in every way especially with the involvement of a child. I do understand and recognize that there are many inequities in underdeveloped countries and with a lack of resources, staff, and supplies, certain situations we just have to let be what is. However, what I learned through this experience is that there is ALWAYS room for patient advocacy and comfort. The rest of the days I spent on the ward, I made it my mission to be with and comfort that boy through every dressing and drainage and to advocate strongly to the doctor for analgesia for him. I feel as though our voice was heard during our time on the unit but the hardest thing for me to accept is that boy will likely experience that pain many times over without analgesia or comfort. This is that feeling of extreme lows. 

On the upside... :) By the end of the week, it was fantastic! Aileen and I made it our business to ensure that everyone on that ward, including parents, had some fun! So, we did some colouring, story times, and bubble blowing! It was so beautiful seeing smiles, hearing laughs, and seeing a community bonding together in less than happy times! One of the high highs during my pediatric experience was the day when Lauren, Aileen, Darien, and I taught two groups of 5yr olds at Limalunga school how to wash their hands and brush their teeth! It was a amazing day, especially when we did the hand washing activity and the kids saw glitter for first time :) The day was just filled with giggles, smiles, games, reading, and generally awesome times! I almost think we had more fun playing with the kids than they did with us, but we all had lots of fun! :P 

The week I experienced on pediatrics was one of incredible personal and professional growth. I feel as though I learned more than can be put into words and so much of which can be brought back to Canada with me into my personal life and nursing practice. It truly shaped my entire Africa experience and even though it was quite the week of roller coaster emotions, I’m so happy it happened especially with the group of ladies I am surrounded by. Special shout out to Mama Aileen :) 

- Caitlan S. 

Short and Sweet in Sefula

     Working at the Sefula Health Center was a great way to end our clinical experience. Unfortunately we only had three short days at the clinic due to a house illness (we will spare you the details), but our impression was that this clinic was clean, well run, and progressive. We had the opportunity to sit in on antinatal assessments, assist in the outpatient department as well as inpatient wards. Although this rural clinic was lacking in tangible resources such as running water, functioning blood pressure machines, and other things we take for granted, they did have educational and decision making tools posted on every available wall. We also found the staff to be the greatest asset to this facility with their diligent work ethic and effective communication. In particular, they were caring, and attentive to their patients, and focused on health promotion as well as acute care. One of the clinics largest services is its Maternal Child Health Department (MCH), each day a different public health topic was covered by an MCH educated staff member. We thought this was an important area of focus as maternal- child illness is so prevalent in this area of the world. By educating the mothers, Sefula is helping to build a stronger, healthier community. We really appreciated this experience as our final rotation and we are hopeful that this clinic can be a role model to others.

-Darien and Caitlin

A Matter of Life, Death, and Sparkles

     I apologize for posting so late!  Our internet has been shotty at best and I’ve been sick for most of the week.  This post is in regards to my fourth clinical week, where I was placed in the Out Patient Department (OPD).  I must warn you it was not an easy start to the week.

     Monday morning… 8:30am…  I had just finished my initial tour of the unit when the first dead body came in.  Carried in by the arms and legs by four men who may or may not have worked for the hospital or even known the victim.  In the emergency part of OPD, there are no doctors on staff.  Long story short, I participated in declaring the patient dead – not something I was ready to process at 8:30 Monday morning.  I can still hear the heart-wrenching, wailing songs of his mourning relatives.  Then the second patient came in.  She was alive, but just barely.  A case of end stage HIV/AIDS; she was so skinny, the blood pressure cuff couldn’t get a reading.  The sound of each breath made me wince, and she was going downhill fast.  I ran to get an IV bag of saline from another department while someone else started an IV.  By the time I came back with the saline, they were doing CPR.  A clinical officer and I kept up the CPR and ventilations for a while, but to no avail.  She was gone.  As we put the resuscitation equipment away, I got to thinking: why had we been thumping on her fragile chest and inflating her sick lungs in the first place?  If we had managed to restart her heart or her lungs – would she was been “saved”?  No.  A beating heart or inflating lungs alone would not rid her of the virus which had overtaken her body.  In her case, even ARVs were useless. By the time she was brought through the OPD doors, her body was shutting down.   So why did I feel so obligated to do CPR on this dying woman?  Simple: I am trained to keep people alive.  In medical culture, prolonging life is often the ultimate goal.  However, experiences like this remind me that death is also a part of health care.   

     Anticipating and planning for death seems like a morbid concept at first, but it also seems unfair to take control away from patients in their last moments of life. By assuming that this woman would have wanted air pumped into her failing lungs, I was putting my needs above hers. In my defense, I had no way of knowing her wishes, and airing on the side of caution seemed to be the obvious choice.  Even in Canada, end-of-life care conversations are often overlooked or avoided altogether. I suppose palliative care might be perceived as a low priority in a low resource country, but this woman suffered for the last few moments of her life because we didn’t know what else to do but try and bring her back.  It’s obviously not a comfortable conversation, but as I finally took the bag-valve mask off of the woman’s face, I really wished I knew that I had done the right thing for her.

     On a MUCH lighter note, Caitlan, Lauren, Aileen and I spent Thursday of last week at a school teaching 5 year olds about health!  After such a tough start to my week, teaching little kids to wash their hands and brush their teeth was like a breath of fresh air!  Health promotion is something I am very passionate about, and kids are especially fun because you can make it a game!  Check out the picture of Aileen and I with our group of kids; we’re all showing off our sparkly, “germy” hands! 

     

Can you imagine?

Can you imagine.....

Worrying that you may have been exposed to the HIV virus, and then...

Getting enough courage to go to the clinic to get tested, and then....

Arriving at the clinic after traveling from afar only to wait in a long line up, and then...

Feeling anxious, scared and alone while waiting to enter the testing room and then....

Entering the hot and cramped 50 square foot counseling office, where you would meet 2 counselors and 3 counseling students waiting to possibly give you life changing news...

Your session begins with a quick assessment of how much you know about HIV,

You’re asked “What will you do if you’re positive?”....“ Who will you tell if you are positive?”... “How will this change your life?”...

All the while with a bounding heart and sweaty hands.

Counseling concludes and now it’s now time for the test.

Your blood is drawn from a finger prick and dropped onto the rapid test.

You now have to wait for 2-5 minutes to know your status....

Flashes of every poor decision you’ve ever made cross your mind

Every time that you could have been exposed comes back in full force

You begin to imagine your sore throat is the beginning of the virus taking over your system...

Is the scab on your knee taking longer to heal than it normally would?

Has your husband been acting different than usual? Has he been coming home later?...

The test is now being read...someone at the desk is filling out a form with results that determine how you will live the rest of your life...

Will it ever be safe for me to conceive a child?

Will my partner be positive too? Will my partner leave me?

Will this affect my job?

How long do I have left?

The counselor turns to you and asks if you’re ready to hear your results

They show you a blank sheet of paper and explain how to read them

R means reactive, you are now HIV positive

NR means non-reactive, you are not HIV positive

The counselor turns to their colleague and collects your sheet of paper...your results.

They hand you the folded up paper and await your reaction.

You open it up......

This is the reality for many Zambian people every day. Can you imagine it? 

We know how this feels, because we did it. 

- Sarah & Robyn 

Back to Basics

Last week the three of us (Lauren, Ali, and Robyn) were on the Maternity Ward.  On Monday morning a woman was in labour and we had the opportunity to see the birth of her beautiful baby girl before the end of our shift.  From our experience on the maternity ward we have gained a new appreciation for the obstetric practices back home. One thing that we seemed to value the most was the way we involve family members back home.  We encourage family to be with the patient and comfort them, whereas here family members are not allowed on the Maternity Ward at all. This leaves the patient all alone during such a vulnerable time.  We recognized this while our first laboring mom was in the delivery room and took it upon ourselves to comfort her as best we could. There was a strong language barrier between us, but from her body language we could tell that she appreciated when we rubbed her back and aching legs, and provided her with a cool cloth.  We knew we made a connection when she started to ask us for assistance by addressing us as “madam.”  

It is clear that there is a cultural difference in how we view the birthing process.  At home it is important for a nurse to be with a laboring mom at all times and we felt that it was important to stay with this mom.  Some of the nurses on the ward thought it was strange that we were with this mom for such a long period of time, but we realized this was something that we valued and felt was important.  

Although our first day on the Maternity Ward wasn’t what we were expecting, we feel that we learned the most about ourselves and our values.  At home we can often be too task oriented and we can easily forget how important bedside nursing is and being present with a patient.  This was a good reminder on the difference we can make in a person’s experience; the littlest things can have the biggest impact. 

- Lauren, Ali & Robyn