This will be my last post from Africa and boy I'm all churned up. I'm just nowhere near processing this experience so I don't think I have anything coherent to say. And I suppose the wine I've been drinking doesn't help in that arena. I did notice that I'd been doing an awful lot of complaining about the nursing here and I'd really like to correct that picture a bit. First of all, I see a hell of a lot of nursing that pisses me off right in my own backyard in New York. The problem here is that they haven't yet figured out how to transition the nurses from didactic to practice. To be perfectly honest, this is exactly the problem I see with the nurses in my own agency, so it's a hard nut to crack. They absolutely need a lot of help here. More than we do. Much. But there are some nurses that I have met here who are almost heroic in their ability to work with nothing and yet make a positive difference in the lives of the people they care for. I want to tell you who they are.
Khawulile Magagula - In-Service Coordinator for the hospital. My counterpart here and one of my favorite people. I plan to keep in contact with her.
Sandile Malaza - I met him in the Men's surgical ward. He is now the Infection Control Coordinator and it's scary how much they need him. (You wouldn't believe what I've seen)
Lukhele Bongani - Staff Nurse in the ART clinic. It took a while for me to get him to trust me, but once that happened, we had some wonderful talks.
Sanboy Mamba - A clinical instructor in Community Health. I went out on home visits with him and some students. He is a wonderful teacher with a truly open mind.
Hlengiwe Mohale and Love Kumi - You're not going to believe this but both these women are Maternity/labor & delivery nurses, unfortunately not there much when I was. Betty worked with them a lot and they have the potential to turn that ward around.
Simon Banda - RN lecturer. He had just the right amount of outrage over the situation along with the ability to communicate productively. I hope he comes to the States.
I'm going to miss them. I'm going to miss how open and welcoming they were to me. I'm really going to miss the work now that I know better how to do it. And I'm going to miss Africa. So much. Oh hell. I'm tipsy and I may start crying. Kevin and Sheldon, who I've grown to love in one week, are off to Mtubatuba for the weekend so I've got my final night here all by my lonesome. This leaves me way too much time for reflection. Alright. Enough. I fly out tomorrow. I'm surprised at how much I've enjoyed keeping this blog. Thanks for coming along. See you next week. Carter - you owe me dinner.
Friday, March 6, 2009
Thursday, March 5, 2009
My Last Full Day at Work
I can't believe this is coming to a close. I will say, however, that this last real day at work truly was a culmination of all that I have learned.
I decided to face my most disturbing placement and see how I would function now that I've gained some experience. I went back to Labor and Delivery. Once again, I witnessed no nurturing of these women, or assistance given to them with their labors. Since the room was open with no curtains drawn, and my actions have to count as "mentoring", not just nursing, I was able to do the work and mentor at the same time. I applied massaging pressure to the lower backs of 2 women who demonstrated reduced muscle tension and more even breathing. One woman, during the pushing phase of her labor, was laying with her head and back flat on the mattress. She was being yelled at to push but was unable to gain much traction to make her pushes effective. I suggested that perhaps if her back and shoulders were elevated it might help her. There was a slight nod in response but no move made to elevate her. I slid my arm under her shoulders and told her to look at me when a contraction came and that we would push together. She looked at me and nodded. Then she looked up at me, tensed up, I lifted her shoulders and encouraged her to push. I praised her. The baby came. The mother looked at me and smiled. She squeezed my hand and laughed. The preceptor looked at me and said “Thank you. You really helped her”. I know this seems like something that goes on all the time in delivery rooms but, I'm telling you, it doesn't ever happen here. My goal was to show that, by working with the mother rather than intimidating her, labor actually proceeds more effectively. It is a moment I will never forget. Ever. Just peak. I think it may be the most important mentoring I’ve done yet here. Of course, 10 minutes later I saw another nurse yelling at a laboring mother and actually slapping her legs to get her to open them wider. It was sadistic. I hope that at least the preceptor I worked with will encourage the student nurses to assist the women who are laboring and not continue to treat them like misbehaving children or worse. I have seen and met some truly wonderful nurses here, working in unimaginable circumstances, but this wa
rd is scary.
The second half of the day I spent visiting 2 groups of AIDS orphans in rural areas about 45 minutes outside of Manzini. I wanted to post a video I made, but I seem to be unable to complete that process without error. I will try even after I get home. They are beautiful and their situation is heartbreaking and that's all I have to say about that right now.
Tomorrow there is a ceremony for the first year students. Then I pack. On Saturday I fly home. I'm ready to go home. I miss Stephen and Liam and Stella too. But I want so much to come back some day.
I decided to face my most disturbing placement and see how I would function now that I've gained some experience. I went back to Labor and Delivery. Once again, I witnessed no nurturing of these women, or assistance given to them with their labors. Since the room was open with no curtains drawn, and my actions have to count as "mentoring", not just nursing, I was able to do the work and mentor at the same time. I applied massaging pressure to the lower backs of 2 women who demonstrated reduced muscle tension and more even breathing. One woman, during the pushing phase of her labor, was laying with her head and back flat on the mattress. She was being yelled at to push but was unable to gain much traction to make her pushes effective. I suggested that perhaps if her back and shoulders were elevated it might help her. There was a slight nod in response but no move made to elevate her. I slid my arm under her shoulders and told her to look at me when a contraction came and that we would push together. She looked at me and nodded. Then she looked up at me, tensed up, I lifted her shoulders and encouraged her to push. I praised her. The baby came. The mother looked at me and smiled. She squeezed my hand and laughed. The preceptor looked at me and said “Thank you. You really helped her”. I know this seems like something that goes on all the time in delivery rooms but, I'm telling you, it doesn't ever happen here. My goal was to show that, by working with the mother rather than intimidating her, labor actually proceeds more effectively. It is a moment I will never forget. Ever. Just peak. I think it may be the most important mentoring I’ve done yet here. Of course, 10 minutes later I saw another nurse yelling at a laboring mother and actually slapping her legs to get her to open them wider. It was sadistic. I hope that at least the preceptor I worked with will encourage the student nurses to assist the women who are laboring and not continue to treat them like misbehaving children or worse. I have seen and met some truly wonderful nurses here, working in unimaginable circumstances, but this wa
rd is scary.The second half of the day I spent visiting 2 groups of AIDS orphans in rural areas about 45 minutes outside of Manzini. I wanted to post a video I made, but I seem to be unable to complete that process without error. I will try even after I get home. They are beautiful and their situation is heartbreaking and that's all I have to say about that right now.
Tomorrow there is a ceremony for the first year students. Then I pack. On Saturday I fly home. I'm ready to go home. I miss Stephen and Liam and Stella too. But I want so much to come back some day.
Tuesday, March 3, 2009
My Final Week
I just cannot believe that this is my last week here. I've spent so long looking towards this trip. I'm concerned how I'll feel once I get home and no longer have this in my future. I guess this is just to say, I'd really like to return.
I'm here now with Sheldon, a nurse who is also a Professor at the University of Rochester, among many many other things, and Kevin, also a nurse, who is a Professor at Georgetown and is one of those running this program. I like them very much and we've actually been having a lot of laughs. Kevin got in on Saturday night and on Sunday he and I went to Phophonyane Falls and hiked around in the off and on rain. It was so beautiful and I'm frustrated that I neglected to bring my camera. Sheldon got in Sunday afternoon. Yesterday was spent orienting him to where we're working and formulating a plan for the week. Betty would have been so happy and I really missed her. They seem to have turned a corner and, now, all the work
we wanted to sink our teeth into for the past 3 weeks is available for us to do just that. This makes it doubly frustrating that I'm leaving soon. I want one more month. Ah well. Maybe next year?
Today, Sheldon and I went with the HIV Task Force to a support group for HIV+ people. It was a wonderful group which was actually being interviewed by a related agency. I was able to ask questions of the group members about the difficulties they encounter adhering to medications. The main obstacles they face begin with a severe lack of food, followed by lack of access. They have to go so far, most often on foot, in order to get to a clinic. These long distances make keeping up with medications almost impossible. Lastly, superstition was reported as a problem for some people, although not members of
this group. The belief that the medicines don't work or are poison is very common. It was a great group to be a part of. After that, we all piled into cars and vans and we were shown "The Garden Project", a community garden created with outside funds. It was beautiful, although right now its main crop is potatoes.
And finally, we went on a home visit to a mother with newborn twins. This was when I wanted to scream about leaving in a few days. There is so much more work I could be doing. She had done such a wonderful job staying adherent to her meds, increasing the likelihood that her children will have been born uninfected. I praised her for what a wonderful mother she is and when we left her hut the woman running this program said "She shouldn't be having babies". She didn't seem to have any idea how not helpful a statement like that is. Exclusive (meaning no water or food at all) breast feeding for the first 6 months is the best thing for an HIV+ mother to do when there is no clean water available for mixing with formula (never mind the risk of watering down formula when there isn't enough money). I asked if this mother is breastfeeding and the woman running the program (let's call her Mary) said that she had told the mom to exclusively breast feed one child and to formula feed the other!@#$@! I, calmly, asked why. Mary said, "because I don't think she can handle breast feeding both of them". And I'm thinking, "so which child is she going to choose?" Which one will have a higher risk of death by diarrhea? I talked about how helping the mom get food for herself, rather than formula, would make her better able to exclusively breast feed both kids, decreasing the risk of HIV infection for both and for intestinal disease for one. If she's unable, then you could start formula, which you would then have to stick with so as not to risk HIV infection with reintroduction of breast milk. I don't think she really thought much about what I said. I hope to be going out with the HIV Task Force again on Thursday. Perhaps I'll have an opportunity to readdress this topic. Although it will be too late for this mother and at least one of her children. I hope so much that they stay well. I will have to provide "Mary" with lots of information to give them about how to disinfect water. I wish so much I could visit that family again. I know I won't forget them.
I'm here now with Sheldon, a nurse who is also a Professor at the University of Rochester, among many many other things, and Kevin, also a nurse, who is a Professor at Georgetown and is one of those running this program. I like them very much and we've actually been having a lot of laughs. Kevin got in on Saturday night and on Sunday he and I went to Phophonyane Falls and hiked around in the off and on rain. It was so beautiful and I'm frustrated that I neglected to bring my camera. Sheldon got in Sunday afternoon. Yesterday was spent orienting him to where we're working and formulating a plan for the week. Betty would have been so happy and I really missed her. They seem to have turned a corner and, now, all the work
we wanted to sink our teeth into for the past 3 weeks is available for us to do just that. This makes it doubly frustrating that I'm leaving soon. I want one more month. Ah well. Maybe next year?Today, Sheldon and I went with the HIV Task Force to a support group for HIV+ people. It was a wonderful group which was actually being interviewed by a related agency. I was able to ask questions of the group members about the difficulties they encounter adhering to medications. The main obstacles they face begin with a severe lack of food, followed by lack of access. They have to go so far, most often on foot, in order to get to a clinic. These long distances make keeping up with medications almost impossible. Lastly, superstition was reported as a problem for some people, although not members of
this group. The belief that the medicines don't work or are poison is very common. It was a great group to be a part of. After that, we all piled into cars and vans and we were shown "The Garden Project", a community garden created with outside funds. It was beautiful, although right now its main crop is potatoes.And finally, we went on a home visit to a mother with newborn twins. This was when I wanted to scream about leaving in a few days. There is so much more work I could be doing. She had done such a wonderful job staying adherent to her meds, increasing the likelihood that her children will have been born uninfected. I praised her for what a wonderful mother she is and when we left her hut the woman running this program said "She shouldn't be having babies". She didn't seem to have any idea how not helpful a statement like that is. Exclusive (meaning no water or food at all) breast feeding for the first 6 months is the best thing for an HIV+ mother to do when there is no clean water available for mixing with formula (never mind the risk of watering down formula when there isn't enough money). I asked if this mother is breastfeeding and the woman running the program (let's call her Mary) said that she had told the mom to exclusively breast feed one child and to formula feed the other!@#$@! I, calmly, asked why. Mary said, "because I don't think she can handle breast feeding both of them". And I'm thinking, "so which child is she going to choose?" Which one will have a higher risk of death by diarrhea? I talked about how helping the mom get food for herself, rather than formula, would make her better able to exclusively breast feed both kids, decreasing the risk of HIV infection for both and for intestinal disease for one. If she's unable, then you could start formula, which you would then have to stick with so as not to risk HIV infection with reintroduction of breast milk. I don't think she really thought much about what I said. I hope to be going out with the HIV Task Force again on Thursday. Perhaps I'll have an opportunity to readdress this topic. Although it will be too late for this mother and at least one of her children. I hope so much that they stay well. I will have to provide "Mary" with lots of information to give them about how to disinfect water. I wish so much I could visit that family again. I know I won't forget them.
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