This week has past in a blur of chaos. The first year nursing students arrived on the wards on Tuesday. Although this is there second hospital placement, they are still only allowed to do day rotations on Men's and Women's ward, instead of spreading throughout the wards including Peds, Outpatients and Maternity. Although this makes sense, considering they have not covered the speciality areas in theory, it causes quite the congestion on the wards. We have 30-35 patients, 3 staff + 2 missionary RNs and 6 students. This ratio may not be strange in the hospitals back home, but considering the size of the nursing office and the limited resources, we're having trouble not tripping over ourselves.
Amid the staff chaos, we have had to deal with some difficult medical conditions. On Wednesday, the transfer vehicle from the outpost clinic dropped off a lady. She was unresponsive on the trolley as they ran past my office to Women's ward. I chased them into the room and grabbed the transfer letter. The words "diabetic with no insulin" jump off the page. The patient is a young mother, whose previous admissions have been complicated by seriously unstable diabetes. I tell the staff member in the office to get the doctor and the RN who are in the ward...the patient had died prior to arriving at the hospital. Our blood sugar machine was "HI", which means a recording higher than 33!
The news was given to the young husband and the patient's mother. The reaction was not what I expected. The mother started to wail and scream. She began to flail and colapsed to the ground. Thankfully, I was able to grab the 3 month old baby off her back just before she landed on him.
I stood in the middle of the large crowd that gathered, holding a baby whose mother just died, whose father was running away screaming and whose grandmother was sprawled out on the ground screaming.
In utter shock, I realized that we'd have a baby to take care off again. So for the next 48h baby Stanley was shuffled around the maternity unit until I took pity on the only nurse there and took him home for the afternoon.
Its hard to wrap your head around a death of this nature. At home, her high blood sugar levels would have been better controled through accurate monitoring with home glucoscans and sliding scales of insulin. But here, in resource poor Africa, the clinics don't even have glucoscans let alone the individual patient as the sticks required for blood sampling are so expensive. There is also a shortage of insulin and no one has fridges in the village to store it, anyway. The only reason Kalene Hospital has supplies is that the people from the home countries of the missionaries donate it.
It was a rough one to absorb, but thankfully, baby Stanley is doing okay, aside from having a slight cold which he's now passed on to me!
The week was not all bad, however. There are quite a few Brits here at the moment and we were able to organize a "Tea and Scones" party (complete with clotted cream). Gathered around the only satelite TV in the area, we watched the Royal Wedding!
Only 15 days until Amy and Julianne arrive...I'm looking forward to a short time away from the mission to catch up on sleep and news from home!
Saturday, April 30, 2011
Sunday, April 17, 2011
Orthopedics, the carpentry of medicine!
It has been a busy couple of weeks at Kalene as an orthopedic surgeon, Dr. Gill, arrived (we now have 7 doctors!) and with him came an onslought of patients with various fractures and osteomyelitis. At the same time, we had a 48 hour blitz from an ortho team in Lusaka that flew in to deal with the obscure ortho cases. This team, headed up by Prof. Jellis, visits Kalene several times a year. Each visit last less than 48 hours and involves a clinic on the first day, weeding through all of the referals of ortho patients that we've saved for him over the past few months, seeing who is appropriate for surgery. The second day was spent in the OR, going though an intense list of patients with operations from setting fractures, grafting old compound fractures and even correcting a fused ankle from septic arthritis! Needless to say, the wards are busy too, as these patients need to be prep-ed for the OR, then monitored as they return to ward, semi-conscious on Ketamine anasthetic.
Along side the ortho patients are 5 babies with measles....in 4 beds. We have very few semi-private rooms (6 in total, only 2 on Men's ward). This has created a problem, as the first case of the the recent outbreak of measles was on the pediatric mal-nutrition ward. As you can imagine, these babies and toddlers have very little reserve and are therefore quite sick with measles. We've been isolating them as fast as we can once the symptoms appear, but seeing as the incubation period for the virus is 2 weeks...we're looking ahead to an outbreak every 2 weeks for a while. Thankfully, I have been vaccinated against measles, because one day last week, I walked into the isolation room to see a 1 year old baby, completely naked sitting by himself on the bed bawling his little eyes out. I turned to the man in the room, and he indicated that it wasn't his child and was he absolutely unprepared to care for him as he was watching the other child in the room. The baby's name is Gift. I sat down beside Gift and when he didn't cry any harder, I picked him up in my arms. The poor baby was freezing! All he needed was a blanket and a cuddle! He went right to sleep. It's amazing how easy some nursing is and how much suffering can be cured by a simple hug!
While all of this is going on on Men's Ward...chaos ensues elsewhere in the hospital. Last Monday, I was walking by Women's ward an noticed a commotion. Commotions tend to happen during visiting hours, so I didn't think much of it as I went to investigate. In the bed, lay a 14 year old girl in a full-blown seizure. This was the first seizure I'd ever seen. Emma was already there, so I ran to get the doctors and the diazepam. At this point, we believe that the diagnosis is neurosyphilis. The girl seized for nearly half an hour, even with diazepam and phenylbarital infusion. She de-saturated and basically stoped breathing on her own. As we are fairly ill-equiped when it comes to ventilatiors and ICU...we manually ventilated her for 6 hours. My shift went from 1800h-1900h....it was uneventful, until she seized again, 45 minutes into my shift, at the same time as an unconscious, hemorraging admission arrived an needed to be taken directly to the OR. It made for a crazy evening with doctors, nurses and monitoring equipment flying in all directions, but there's nothing like an emergency to pull everyone together.
I'm looking forward to a busy month ahead. Becs comes back to run Men's ward at the end of April and I am leaving then for Lunda lessons for a week or two, after which I head to Lusaka for the Safari and then the dreaded Zambian RN exam...
Well, it's a short note, but I'll try to write more later!
Along side the ortho patients are 5 babies with measles....in 4 beds. We have very few semi-private rooms (6 in total, only 2 on Men's ward). This has created a problem, as the first case of the the recent outbreak of measles was on the pediatric mal-nutrition ward. As you can imagine, these babies and toddlers have very little reserve and are therefore quite sick with measles. We've been isolating them as fast as we can once the symptoms appear, but seeing as the incubation period for the virus is 2 weeks...we're looking ahead to an outbreak every 2 weeks for a while. Thankfully, I have been vaccinated against measles, because one day last week, I walked into the isolation room to see a 1 year old baby, completely naked sitting by himself on the bed bawling his little eyes out. I turned to the man in the room, and he indicated that it wasn't his child and was he absolutely unprepared to care for him as he was watching the other child in the room. The baby's name is Gift. I sat down beside Gift and when he didn't cry any harder, I picked him up in my arms. The poor baby was freezing! All he needed was a blanket and a cuddle! He went right to sleep. It's amazing how easy some nursing is and how much suffering can be cured by a simple hug!
While all of this is going on on Men's Ward...chaos ensues elsewhere in the hospital. Last Monday, I was walking by Women's ward an noticed a commotion. Commotions tend to happen during visiting hours, so I didn't think much of it as I went to investigate. In the bed, lay a 14 year old girl in a full-blown seizure. This was the first seizure I'd ever seen. Emma was already there, so I ran to get the doctors and the diazepam. At this point, we believe that the diagnosis is neurosyphilis. The girl seized for nearly half an hour, even with diazepam and phenylbarital infusion. She de-saturated and basically stoped breathing on her own. As we are fairly ill-equiped when it comes to ventilatiors and ICU...we manually ventilated her for 6 hours. My shift went from 1800h-1900h....it was uneventful, until she seized again, 45 minutes into my shift, at the same time as an unconscious, hemorraging admission arrived an needed to be taken directly to the OR. It made for a crazy evening with doctors, nurses and monitoring equipment flying in all directions, but there's nothing like an emergency to pull everyone together.
I'm looking forward to a busy month ahead. Becs comes back to run Men's ward at the end of April and I am leaving then for Lunda lessons for a week or two, after which I head to Lusaka for the Safari and then the dreaded Zambian RN exam...
Well, it's a short note, but I'll try to write more later!
Sunday, April 3, 2011
A little bit of Lunda and whole bunch of French!
I see that it has been way to long since I updated my blog. It has been a very busy time since the last post! I'm currently the only RN working on Men's Ward and so have been working hard, attempting to make clinical judgement calls that remain within my scope of practice while acknowledging that doctors are tied up in surgery and will not be into assess new admissions for several hours.
This week we have had a few very acute admissions including a motorcycle accident with suspected head injuries (he turned out to be alright). On Thursday, a young boy walked into the office with a large cloth drapped over his head. His brother handed me his ticket (chart) and before I could read much of the notes the boy, Paul, removed the material and an odour overpowered the office. Paul has third degree burns covering his half face, scalp and left shoulder. I could tell that the wounds had started to heal and that a significant infection had already set it. I motioned to the boy to sit up on the examination table and looked round for someone to translate for me....of course no one was around. I saw that their address was a village in Congo (DRC), so taking a huge chance, I greeted the brother in French...amazingly he is fluent!
As it turns out, Paul is a non-verbal epileptic who fell into a cooking fire 7 days ago during a seizure. He and his family then walked 2 days to Kalene Hospital as there are basically no hospitals in DRC.
Although, Paul has a huge road ahead involving 5 or 6 debridement operations followed by multiple skin grafts, its nice to know that I can communicate with the family fairly freely as they will probably be here for 4-6 months.
For the last few months there have been a few young boys in traction on our ward because of femur fractures. They have been so fun to have around, especially as they begin to walk. Grivan, 9, took longer than expected to walk after the traction was stopped because of numbness in the instep on his foot. He gingerly took step after step toward me, until one day he decided to do my morning round at my side! He is such a trooper and over a game of checkers, he gave me Lunda lessons! He would giggle the entire time at my accent, but at least he wasn't too critical! He went home on Saturday...so I'll have to look for another patient to teach me.
Two of our head nurses on away on holiday and sick leave, so there hasn't been enough RNs around to do night on-call rotation, but God is good! For possibly the first time in Kalene history, we have 6 doctors! This has allowed for a doctor on-call system to be implemented as well as a specific doctor responsible for each ward. I'm so grateful that I've had brains to pick over the last few weeks as I familiarize myself with treatment protocols for tropical medicine...as long as I figure this out in time for the RN exam!
I found out this week that I will be writing the exam on June 2 in Lusaka. This is such an answer to prayer! Both I and Emma need to write this in order to practice for 6 months on more in Zambia. The timing looked like it was going to be an issue as Emma needs to go to the UK in mid June and I am going on a safari at the end of May. The timing could not be more perfect, allowing for the least amount of flights and expense as I can just stay in Lusaka for a week.
I'm really looking forward to a visit from 2 great friends from Canada to go on the Safari ...the next couple of weeks will be filled with planning...and maybe some studying!
Well, that's about it,
Rachel
This week we have had a few very acute admissions including a motorcycle accident with suspected head injuries (he turned out to be alright). On Thursday, a young boy walked into the office with a large cloth drapped over his head. His brother handed me his ticket (chart) and before I could read much of the notes the boy, Paul, removed the material and an odour overpowered the office. Paul has third degree burns covering his half face, scalp and left shoulder. I could tell that the wounds had started to heal and that a significant infection had already set it. I motioned to the boy to sit up on the examination table and looked round for someone to translate for me....of course no one was around. I saw that their address was a village in Congo (DRC), so taking a huge chance, I greeted the brother in French...amazingly he is fluent!
As it turns out, Paul is a non-verbal epileptic who fell into a cooking fire 7 days ago during a seizure. He and his family then walked 2 days to Kalene Hospital as there are basically no hospitals in DRC.
Although, Paul has a huge road ahead involving 5 or 6 debridement operations followed by multiple skin grafts, its nice to know that I can communicate with the family fairly freely as they will probably be here for 4-6 months.
For the last few months there have been a few young boys in traction on our ward because of femur fractures. They have been so fun to have around, especially as they begin to walk. Grivan, 9, took longer than expected to walk after the traction was stopped because of numbness in the instep on his foot. He gingerly took step after step toward me, until one day he decided to do my morning round at my side! He is such a trooper and over a game of checkers, he gave me Lunda lessons! He would giggle the entire time at my accent, but at least he wasn't too critical! He went home on Saturday...so I'll have to look for another patient to teach me.
Two of our head nurses on away on holiday and sick leave, so there hasn't been enough RNs around to do night on-call rotation, but God is good! For possibly the first time in Kalene history, we have 6 doctors! This has allowed for a doctor on-call system to be implemented as well as a specific doctor responsible for each ward. I'm so grateful that I've had brains to pick over the last few weeks as I familiarize myself with treatment protocols for tropical medicine...as long as I figure this out in time for the RN exam!
I found out this week that I will be writing the exam on June 2 in Lusaka. This is such an answer to prayer! Both I and Emma need to write this in order to practice for 6 months on more in Zambia. The timing looked like it was going to be an issue as Emma needs to go to the UK in mid June and I am going on a safari at the end of May. The timing could not be more perfect, allowing for the least amount of flights and expense as I can just stay in Lusaka for a week.
I'm really looking forward to a visit from 2 great friends from Canada to go on the Safari ...the next couple of weeks will be filled with planning...and maybe some studying!
Well, that's about it,
Rachel
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