This is where I live

So I made it back to Ripple also known as Mwaya Beach.

I never knew when I decided to volunteer in Africa I would be living at the most beautiful place ever.

I live in this lovely little cabin.

Sorry for the poor Iphone quality.

Where I can sit on the porch and watch the monkeys act insane.

This baby monkey is so cute and curious.

Or I can go hang out on the beach.
It is kind of pretty there.

I am now in Lilongwe (which is the capitol if you remember) to get my paperwork turned it.

This is my last step!

I took the 8 hour bus ride today, it was not too bad.

I had a book and read the whole second half of it.

I need to look for another one.

I am planning on trying to get my paperwork done in the morning and heading right back to Mwaya.

This last week has been a pretty relaxing one.

I went up to the Chintheche Hospital on Monday and was able to see around.

Then Tuesday I went to Kachare clinic and did more malaria testing.

It is nice to see around and see what my options are for working.

I am getting anxious to figure out what I can do to really make a difference.

I am not a patient person when it comes to things like this.

I am trying to remind myself that I have a long time and it takes time to learn.

It is very important to learn the system of everything and build a rapport with the staff before diving in.

I am excited to have a full week next week and find some work to do! 

I am especially excited to get back to the beach already.

I think you can see why I prefer it to the city.

I will leave you with a picture of these school boys. Karate chopping for every picture seems to be necessary.
I was quite proud of one though, he remembered my name from when I visited his class over a month ago!

Done! (With Orientation Anyway)

I am officially done with my orientation.

I could not be happier!

I will be heading back to Ripple this afternoon.

Just one step left to make it official.

I have to go to Lilongwe on Monday and then back on Tuesday.

I am not excited about this, but I am excited to have a few days off and travel with only a small backpack.

Taking my huge duffel bag with me is a huge pain in the ass.

I am ready to drop that thing off and not use it again for a very long time.

Last weekend we went to the crisis nursery.

It is a place where babies go after their mother's die and their families cannot afford formula.

They are returned to their families after they no longer need formula, so generally about about 18 months.

The babies of course were cute, and a couple of the older ones were full of attitude.

This is Emmanuel. He kept trying to steal my camera. He wanted nothing else to do with me. 

Have you ever seen a baby so fat? Her face was squished in!

This is Lucy, she was my favorite. They suspect she has HIV, she is delayed and small. The sweetest, happiest baby ever.

Stella has a major attitude. She got over it rather quickly though.

 Then on Sunday I worked on planning a trip that I am going to take with Mike and his friend from home at the end of August.

We are planning on going to Zambia, Zimbabwe, and Mozambique, plus maybe more.

Which I am trying to talk them out of the two other countries.

Mike keeps saying it will be fine because I can just drive through the night.

No thank you.

 I am excited for the trip. 

I figured I better go while I have the chance and will not be traveling alone.

This week I finished up in Men's surgical ward.

Believe it or not I enjoyed my time here.

I took it upon myself to draw all of the blood samples one day.

This kept me busy and made the time go by fast.

Plus I love to draw blood and start IVs.

I was also pleased with the staff.

The nurses were so funny and always very lively.

The charge nurse yelled at some doctors, which made me very pleased, it is about time somebody stuck up for themselves and the staff.

The surgeon also kicked out his intern for not knowing information about a patient.

This also made me very pleased.

It was also nice to see people with problems that could be fixed.

So the week went by pretty fast. 

I also have discovered I love elderly men!

I think they are cuter than babies. 

Which you have now seen my pictures of the babies.

Yes, they are cuter.

One man was a retired school teacher so his English was very good, he would always tell me what people needed.

He was always sitting in his bed and just looked happy.

I have decided the men are much happier people because they have never stressed about anything like women do.

I am going to pack up my bags and catch a mini bus to go back to this beautiful place.

Another week done.

This week I spent my time at the under five clinic on Monday and Tuesday,

then at the female medical ward the rest of the week.

While at the under five clinic I did parachecking, which is the quick malaria test.

They check pretty much everyone for malaria here, it is very common.

So I poked a bunch of fingers.

I think about a total of 125 just myself.

The day before nursing students were also doing some.

So yeah, there were a lot of crying kids.

I feel so bad because of the lancets we use the stick the kids, it is pretty barbaric.

I would much rather have an IV started any day.

Yeah  I would be crying too.

There were a couple of kids that stood out during my days there.

One was a two year old little girl named Anne.

She was livid that I was about to poke her finger, it was quite the fight.

It is so hard to poke a finger with they squirming so much. 

They can wiggle their little joints in ways that should not be possible.

Then they always think the stick used to collect the blood  is another poke.

That is when all hell breaks loose.

It takes quite precision to get the drop of blood on that tiny hole.

This kid did not make it easy.

Well luckily I had done a bunch before her so I had become pretty good at it.

So we got done quickly.

Her mom took her in the hall and was putting her on her back.

Anne was pissed.

She started yelling the worst things she could think of her in two year old Timbuka vocabulary.

All of the women were laughing and her mother was too, while telling her to stop.

I do not know that I have had a two year old that angry at me.

And I am pretty good at making kids mad.

She was just quite the little pistol.

I said, "Now I don't know what you are saying to me but I know that it isn't nice."

This made all of the mothers just laugh even harder.

I did feel bad.

I hate that I cannot explain to them what is coming and then that it is just one poke.

At home I rely so much on talking to my patients and empowering them with any choice they can have.

Of course I still talk to the kids, they just do not know what I am saying.

Some of them can just tell by the tone.

One little boy who was four sat down in his little suit and just held out his finger.

I asked are you ready?

He just nodded and did not flinch.

I am so amazed by the toughness of these kids sometimes.

Other kids think that because I am talking nicely to them I will not do anything hurtful to them.

I feel like a traitor.

I make all of the kids smile and giggle and then just stab them.

The other kid that stood out was a three year old little boy.

He climbed on his mom's lap and showed absolutely no expression.

I could not get him to crack a smile.

So I just got to it.

He cried but held pretty still and I got it done very quickly.

Then while waiting for the results he was sitting by his mom.

I saw him point to me and his mother just nodded.

He came over and gave me his ten kwacha coin.

After I stabbed this kid he wanted to give me a gift?

It was the cutest thing in the world.

I could not deny the gift from a toddler, he would not understand.

So I thought I would just give him something in return.

I started digging through my purse.

I would have given the kid ten million dollars if I had it.

But instead I thought a quarter would do.

The mother was so pleased and just grabbed and hand and said "Thank you!"

I had not done anything, it was her small child who really was kind.

Another observation I made was the fact that the older children help out with the younger ones.

When I say older I would guess they are around eight.

If a mother has two little children the older siblings have the expectation of caring for one of them.

They soothe the babies, carry them in chintenges on their backs.

I am always amazed at their ability to care for their siblings.

I was also thinking how bratty our children are at home.

Any eight year old that would have to sit all day with other screaming kids would be so annoyed.

We also always bring things for any kid to do to keep busy.

I have never once seen a child with a toy and especially not an ipad to keep quiet.

These children are taught patience and responsibility at a young age.

Yes maybe a bit too much responsibility.

But I definitely think there needs to be some sort of medium ground for kids at home.

I cannot get over how many of the children are such brats at home.

Parents constantly make excuses for their parents and everyone of them has an ipad or a gameboy.

I think this just makes the children feel entitled to everything in life to be handed to them.

They never have to earn anything or have any sort of responsibility.

How will they ever know how to be adults?

Kids here are forced to grow up too fast, 

but I enjoy seeing children with a sense of responsibility and knowing what it means to be grateful.

Then I was on the female medical ward.

Within the first few minutes of being there I was sitting in the break room and a rat almost ran over my feet.

The nurse asked if I have ever seen a rat?

I said yes plenty.

What I did not say was well not in a hospital because that is gross!

So I got my orientation started, they showed me around the ward.

I will say that it was pretty clean and organized!

Well for Africa standards, I know the rat thing kind of throws the picture of clean off a bit.

That morning we went to a meeting.

A meeting on performance management, but yet I am pretty sure we left the unit with no staff to go to it.

I was pretty annoyed.

He kept saying how they need to stop letting everyone die.

Yes, that is a good point.

Also if you do not have something call another unit and ask, do not just let people die.

Seems reasonable.

This went on for two hours.

I was so bored and tired of hearing it, the lack of motivation from a lot of the medical staff is hard to deal with everyday.

When we went back to the ward I noticed one very sick patient.

I helped changed her bed and got blood on my arm, here that is slightly scary.

I went and asked for soap.

They looked at me like I was crazy, so I just grabbed the alcohol stuff they use to clean things with and scrubbed my arm.

I started reading through her chart.

When we did vital signs nothing looked good.

I have learned that people that look this way will not get better and I do not think putting a bunch of supplies into her is going to help.

So I figured I was not going to fight this time, it does not seem fair to.

Sometimes I think it is better to not constantly poke and prod at people who are not going to make it.

So I went home and expected her to not be alive in the morning.

But I walked in and could hear her moaning with every breath from the nursing station.

I was shocked.

So I went through her chart more, I noticed a lot of things could have been done to at least try.

The patient was actively bleeding out.

They tried to put a feeding tube in her the day before.

I told the nurse there was no way she could handle it.

I also recommended a repeat blood test, maybe another transfusion, and some drugs to help with clotting.

She seemed very attentive to my recommendations.

I asked how would we get them done, she said call a doctor.

Then she told me she was going on break and would be back.

We had been there approximately thirty minutes.

I have realized there is no rush in anything here and it will not change the outcome anyway.

So I just said whatever and she went for a forty five minute break.

So I sat alone and watched the unit.

Finally some doctors came in, I had noticed a doctor from the day before.

I asked her if I could talk with her about a patient. 

She was extremely receptive to it.

She asked me what I thought was wrong and what I thought should be done.

I was impressed that she even cared to listen to me.

She went to see the patient and wrote some orders.

I was glad that something was going to be done.

Especially since the lady had survived the night.

She did not survive the next night though.

I got to the hospital and noticed that I did not hear her constant moans but nurses were doing rounds and her family never left her side.

So I did not get up to check.

We went for a meeting and I came back the doctor asked how she was doing.

I told her I had not checked, just looked at her chart briefly.

When she went to go check on her, she was dead.

I do not know how somebody did not notice.

They prepared her for the morgue.

I did not choose to be involved in this process.

Cleaning her up when she was still alive was almost too much for me to handle.

I spent the rest of the day pretty much doing nothing.

The one doctor would have me assist her with things, which I liked but other people were not doing much.

I went for lunch and both days when I came back nobody was at the station, they were all in the break room.

How would they even know a new patient came?

I just sat there and read every magazine or medical book I could get my hands on.

I texted Mike to tell him everyone was at their forever long lunch, I asked who do you think is watching the unit?

He replied, the rats.

I said well yes, and me.

I usually try to not correct nurses, because I am in orientation and I am here to learn.

But some things are just too much to take.

Just simple things like putting in an IV and knowing that you have blown the vein.

I already have control issues watching other people do things, I just want to do it myself.

Well I told her that it blew.

She thought that putting the antibiotic in it to see if it worked was acceptable.

I actually told her no.

I said if you want to check it you need to use saline.

She tried and it would not flush so she just pushed harder, the patient was grimacing.

I finally said stop, if it hurts her and you cannot flush it is not good.

I find a vein and put the IV in myself.

Like I said I have control issues.

I think part of me has started to shut down from being in this hospital and seeing people die everyday.

There is just no way I can deal with all of it and come out sane.

I think this is what happens to nurses in units where sadness is all around you.

You become insensitive.

But yet I see how it affects my attitude and mood in general.

I just start to feel worn down.

Luckily this happened very close to the weekend.

So I have all weekend to just relax and hang out.

I also am going to go to a place called the crisis nursery this afternoon, and get my hands on some babies.

It is basically a large group home for babies.

I figure this will have to put me in a good mood.

I already feel better after not having to go back today and getting to sleep in til eight thirty!

I woke up at six and thought oh I really need to get up, then I remembered it was Saturday.

I could not have been more happy!

Only three days left.

I will be doing men's surgical ward next week.

I figured I would save it for last because taking care of pre-op and post-op patients is something I know.

I am so excited to head back to warmer weather and the beach!

Just one last annoying thing I need to do.

In order to process my paperwork I have to take it back to Lilongwe.

If you remember this is an eight hour bus ride, yes that lovely crowded bus.

I have decided I will buy myself something from the market in Lilongwe for rewarding myself for getting through this process and maybe one other thing for the bus ride.

They have a really awesome market place there.

More wood carvings then you could ever imagine.

It will be my goal to get something for a good price.

There is nothing I love more than bargaining!

1 Month in Malawi

As of yesterday I have officially been here for one month.

Crazy!

I do not feel like it has been that long at all.

I do miss some things about home.

The top two being Rosie and my bed.

But there is no way in hell I would even think about making that journey back.

I have bad dreams that I have to go all the way back home!

Sitting on the plane and in airports for 27 hours was more than I can handle again for awhile. 

To reward myself for making it a month I bought a chintenge. 

A chintenge is the piece of fabric African women use for just about everything.

A skirt, to hold things, and to tie their babies on their backs.

I will be using mine as a cover up.

I bought these awesome travel towels, they pack small, dry fast, and apparently I needed an XL.

I have to get dressed in the shower just so everyone does not see my vagina.

I figure this is not a great first impression to make.

So my chintenge will come in handy!

Maybe a towel or beach towel would be a great birthday or Christmas gift (ahem family). 

This weekend has been very uneventful. 

But I have not minded. 

It has been chilly and rainy here the past few days.

Turns out here when it is fifty degrees the locals think they are going to freeze to death.

I heard, "It is very cold here." no less than 25 times on Thursday and Friday.

My time in the eye ward was extremely boring.

I got left in a room three different times by the nurse in charge, she said, "Just wait."

I am not as patient as the locals and I do not appreciate just waiting.

I have never had time creep by so slowly!

So come Friday I went with the intentions of leaving at lunch so that I could get my visa extended.

Ella, the nurse in charge told me to just go in the morning and then come back.

It was true that I needed to get it done in case they decided to close before three that day, you just never know here.

So I went  back in the cab and headed back toward town.

When I got to the visa office there was a long line.

Of course the immigration officer came right up to me since I was the only Mzungu (white person) in the place.

He took me back to a room, where they just stamped my passport, then sent me to the cashier.

Of course I was shoved right in front of all the other Malawians and they were told to let me go first.

I felt pretty guilty, honestly I wanted to wait in line longer, I did not want to go back!

But I was grateful for the first time in a long time I was not being pushed.

The pushing makes me want to punch somebody in the throat.

I keep my hands to myself though.

So I paid my money and realized it was only eight thirty.

How did it only take thirty minutes to take a cab, walk, and get through the line?!

So I headed to the Coffee Den where I can pay to use Wifi.

Yeah I ran out of things to do on the internet in about thirty minutes.

Well I figured I needed to go to the store and get something for lunch.

Then I thought I should walk home (about a mile away) and make my lunch and drop my laptop off.

Then I walked back to the taxi stand and got a cab and headed back. 

I got back at 10:15 am, how the hell did all of that not last longer?!

So I decided to sit in registration, I think the guy wants a mzungu wife so he at least talks to me non-stop and gave me the very important job of writing what he has already written into a book.

Then we took an hour and a half lunch.

I ate my lunch in about fifteen minutes because I was the only one eating at first.

Then I just sat and waited for lunch to be over.

Finally it was time to go back to writing things in my book. 

We saw only about five patients and the clock was ticking very slowly.

I was smart and had already had Ella sign my paper saying I had completed my days before lunch was over.

So I informed the guy at three that I had to leave. 

He asked why? 

I said I needed to go to town, which I did but just for a bottle of wine (I left that part out).

I left and felt like a kid skipping school.

I avoided running into Ella and got to the cab as fast as I could!

I was free!!!!

I am hoping this week is better than last, I may not make it if it isn't!

Friday night I stayed in and cooked some pasta, drank some wine and watched TV.

Saturday I went to the market, took a nap, used the internet, drank some rum and coke and ate left over pasta, and also had a good talk about culture and life in Pakistan with one of the guys who lives in the house where I am staying.

This morning I washed my clothes, and then came to town.

I am glad for a sunny day!

It was so nice just washing my clothes outside in the sun.

There are several local men hired to help at the house where I am staying.

I used to feel guilty about this, but now I know that we are providing them a job.

90% of Malawians are unemployed.

And the ones that are employed make next to nothing.

I asked the other day what a nurse makes and it is 94,000 kwacha a month.

If you remember the exchange rate is about 350 kwacha per USD.

That makes the yearly salary of a nurse about 3,222 USD.

This is somebody who went to college and got a degree.

I do not know how they even live and support a family off of that.

Many of the people here do not only support their immediate family, they also send money to extended family members.

It is crazy to me.

I still do not like the men to do all of my work for me.

I feel bad because they are not being paid anymore while I am there.

And also I am quite bored and was so happy to just wash my own clothes.

Also by wash I mean with a bucket and some washing powder.

I do not think washing machines exist in this country. 

It got me thinking about all of the things in the US that we think of as being necessary.

Washing machines, dishwashers, and oven, electricity, a car, and many more things.

I am also guilty of thinking that way.

I would have never at home been ok with one uniform top (yeah the other one did not last long, it now only has one button left, I think he was trying to hurry and finish that one! So it stays in my bag.) and one pair of pants.

But it really is not a big deal.

Also I can count on my hands the amount of times I have even washed a single item by hand at home.

I only have one stove top ring to cook on, no microwave or oven.

I do not have a hair dryer or straightener.

I always rely on public transportation to get around, and I am cheap so cramming in with a bunch of locals is always the way I travel. 

But I am not really missing or lacking anything.

Granted I rarely even get the chance to do my own laundry, I have to be sneaky to get it done without it being taken from me!

But it is nice to live a life of simplicity.

I am sorry in advance if I come back a freak and refuse to wash my clothes if I have worn them less than five times.

Also in sad news Jimmy the pre school coordinator drowned in the lake on Friday while trying to help a girl that was struggling.

I have only met Jimmy a few times while being at Ripple.

He is the one who did my orientation.

I knew right away that Jimmy had a passion for life, his community, Ripple, and all of the children that he taught.

I am learning very quickly how very fragile life is.

At home I feel like nothing bad really ever happens.

We somehow always end up ok.

That is not the case here.

In the past two weeks I have already seen two dead bodies, and heard of three other people dying.

I also hear the cries of many families everyday at the hospital.

Even the dogs I pass on the way to town constantly look like they are dying.

I was sure the one had died, it really needs to.

But no of course it has to still be alive and walk next to the road just while I am walking by.

You know those ASPCA commercials that always come on and make you so depressed?

Yeah those are the same commercials I always liked to use as an example for Douglas and Rosie about the great life they had and how they should stop being such assholes and more appreciative. 

Well this dog will make you about ten times more depressed than that commercial.

It is mangy, looks like a skeleton, and I swear it was barely breathing the day I saw it in the ditch.

Mike always asked if I wanted him to put it out of his misery.

Of course I would scream no! 

I do not even know why I gave him the satisfaction of getting me worked up, he would never hurt a fly even if it was dying.

In good news I was able to skype with my dad for the first time yesterday!

We have been emailing and texting some, but it was nice to actually talk to him.

He of course filled me in on how Rosie is doing.

And it seems like she is adjusting just fine.

I guess my sister told my dad that she did not think she could give Rosie back when I do come home.

My dad told me that he knows the moment I came home Rosie would leave her and never look back!

I agree completely.

Before I left she would not even get in the bed with Merik while I showered, she would sit on the mat outside of the bathroom door.

And if Merik thinks I would ever in my life would I part with Rosie she is crazy!

Well that is my non exciting week.

Here is to hoping this week goes by fast!

I am in the five and under clinic tomorrow and Tuesday.

I guess it is not at the hospital.

So let's hope some taxi driver will know where it is!

I will leave you with a picture of the chintenge and the cat Simba who is quite the character!

Oh and a picture of the group I stole from the Ripple blog, I am ready to get back to Mwaya! 

Only four of the volunteers from this group are still at Ripple. I am going to be seeing a lot of different volunteers in my time here!

Yes, he was just staring at me. He is pretty crazy.

My pretty chintenge! I want a lot of them, I want a quilt made and a dress! I also think that I will carry my babies like they do. I'm sure somebody will call CPS when I pick the baby up by one arm and sling it on my back. But hey, it works!

Routine

I think there starts to be a point when things feel normal.

This week that has happened for me.

I have always thought that I adjust to things rather quickly because of my lack of caring about routines.

But I seem to be in one already!

My weekdays go something like this.

Wake up around six.

Shower.

Feed the cat (the little shit will not leave me alone until I do).

Make breakfast, always toast and eggs.

Kind of do my hair (with out a blow dryer or straighter not much to do).

Put on mascara.

Walk out the door.

I walk about half a mile to the taxi stand.

Immediately when I get there somebody yells to ask if I am going to the hospital.

Well I do everyday.

So he yells at another cab to wait for me.

I get the the hospital, and head to wherever I am going that day.

I leave around four.

Then head to either the market, grocery store, or coffee den to use the internet.

I make sure to get home before five thirty when it gets dark.

Then I pretty much just eat and watch some tv on my laptop and fall asleep well before nine.

I am glad that I feel comfortable here.

But routine is not my thing!

I am getting a little bored. 

I will say I have not felt tired in weeks though, it is amazing!

I have only two more weeks left then I will be headed back to Mwaya.

I have already made a list of things I want to do in my free time there.

Hike the mountain, go snorkeling, find a crocodile, swim, run, and go to a soccer game!

I am also ready to be back with the group.

This week I have spent my time in the ICU.

Turns out monitors and vents do exist.

When I got to the unit there were two patients.

One was a teen who had eclampsia and had last her baby during childbirth.

The other was a man with a severe head injury.

The man was intubated.

Apparently his tube was clogged and the doctor quickly came in to change it out.

What?!?

People do things with urgency here?

Then he yelled something at the nurse.

An angry doctor and people stressed.

It felt like home.

So much so that I was not even phased by any of it.

Just grossed out by the amount of secretions an adult can produce.

I am learning more and more everyday why I am a peds nurse.

The rest of my time there was pretty boring.

Because there was actually quality care.

It was nice to see this side of health care here.

I am now moving onto the eye ward tomorrow.

I am way less than thrilled about this.

I do hope that we do at least see a lot of patients and keep busy!

I would say I am ready for the weekend, but I am not sure of any plans.

Last weekend was a pretty packed one.

Mike did come and we celebrated Fourth of July basically by eating hot dogs and wearing American t-shirts I found in the market and then going to the hotel and dancing in a dark sweaty room with a bunch of locals.

It was pretty fun, but we are lame and were in bed by midnight watching How I Met Your Mother.

The next day I went to Kande Beach for Hassan's (the guy I am staying with) birthday celebration.

The ride there and back was scary as shit!

I do not like driving 75mph next to people swerving around on their bikes,

children playing, and dogs running (yes a puppy was hit and not killed, I said we could not stop because I could not handle it. Hopefully it died fast or was just scared and not seriously mangled).

The beach was fun though!

It is fun and exhausting constantly meeting new people!

I did meet a girl who I really liked.

Of course she leaves in three weeks so we decided we cannot really be friends.

But we had a lot of fun anyway!

Once again I went to bed early, and the next day I found out a lot of people got angry drunk after I did.

I am glad I just saw the fun dancing part and then had a full eight hours of sleep.

It is already four thirty here.

So I guess I better wrap things up and head home for a night of dinner and tv.

Oh routine.

I am feeling very American today.

Yesterday was my final day in peds. 

It was a tough one.

When I had first arrived to the hospital I had been informed that a patient died.

It was a four year old girl with what they thought was Guillian-Barre Syndrome.

Since they do not have venilators they could not support her respiratory status.

I did not think that she ever looked that bad.

She was saying the day before, "I am fine, I am better."

So at least she did not suffer.

The worst part was that there was a dead kid in her bed with all of the other children and parents around to witness the whole thing.

I cannot imagine what those children are thinking!

Unfortunately it is not uncommon here so many of them are probably not too phased.

In the morning I went to the high dependency unit to see the new patient.

It was a little boy who they thought had severe anemia.

He was pretty much unresponsive.

We did a blood glucose and it was in the 20s.

The pushed dextrose and he began to cry and turn away from us.

Crying kids are always good!

They were preparing to transfue so I went to assist with the burns.

I gave lots of recommendations.

We used warm soapy water to clean the burns instead of clorahexadine.

And gave some pain meds!

The other nurse and I gave the surgeon lots of recommendations and he said he was happy we were there and he would try to change things.

Then I went back to check on the sick boy.

I was told there was no improvement.

He was not responding again.

Nobody was around or seemed to care.

I then had to play doctor.

I figured nothing was going to put the kid in a worse condition than he already was.

I told the nurse we needed to recheck his sugar.

Once again it was low.

So we pushed the dextrose.

I checked pulses.

Yeah I could not find any.

I told him then to run a fluid bolus.

We did, there were finally some faint pulses.

I tried to get a blood pressure, of course there was not one.

The nurse said he had to leave to go to his meeting.

I asked if they bag or do CPR if kids stop breathing.

He said yeah and pulled a bag out of a drawer for me.

Well thanks, I am sure it will be successful.

The kid's breathing got more shallow and I saw blood start to come out of his gastric tube.

I did not like being in there alone,

I went and got a nurse.

She said do not bag, there is still respirations.

My reply was yes, barely and there will not be for long.

She did not seemed concerned.

I told her to call a doctor.

The doctor did come and agreed that the kid was in septic shock.

We tried about all we could.

I was drained and there was not much improvement.

I decided that nothing I was going to do was going to help.

I think we were only prolonging the poor kid's life.

Which is not fair.

It is also not fair to waste meds and fluids on a child that has no hope.

I want to change this.

There needs to be better assessments and early intervention.

I will be working on this.

Today I was in the HIV/AIDS unit.

It was very well organized and stocked.

But a lot of clerical work.

The nurse was being very pushy and not very patient with me.

I am just tired of living in another culture today.

I am American.

I want to walk fast.

I want my personal space.

And I do not want to be shoved.

I do not want to listen to horrible African Christian music all the time (do they really have no more than ten songs???)

I also do not want to be the center of attention and talked to all the time.

I also do not want to hear honking cars every few minutes.

I am just annoyed today.

Luckily Mike is coming tomorrow and we are celebrating the fourth.

I got Jack Daniels, hot dogs, and lay's chips.

I am ready for a night off!

I think after this week it is very needed.

Happy 4th of July everyone!

Also this post I wrote yesterday.

But in true Malawian fashion the internet was not working so I could not post it! 

Also a side note the child did die yesterday I was told.

There really was nothing that could be done.

It is just so sad that it is the norm here.

Well I think I am going to try to take the weekend off from thinking about things and just relax.

I got pushy.

So Thursday I finished up my last day in the ER.

It was another day like the rest, except this time a family brought in a dead person.

I guess this happens often.

It takes time and money to reach the hospital so many people die on the way.

Thursday night Mike and I drank, I needed to drink after those few days.

We attempted to go out, but there is not much to do in Mzuzu.

So we mostly stayed in, I introduced him to Tech N9ne, and we watched "How I Met Your Mother."

Friday we took a cab back to Mwaya.

It felt so good to go home.

It is crazy how quickly a place can feel like home, I definitely am starting to feel at home there.

We had a pretty relaxed weekend.

Mike and I watched "The Lion King" and more "How I Met Your Mother."

I went on a seven mile run, laid on the beach, had some Tonga lessons (I suck), ate food, and drank sangria.

Come Sunday I was headed back to Mzuzu.

The bus ride back was interesting.

It was filled with obnoxious drunk men.

One kept shouting about me I assume, because every time he would shout they whole bus would look at me and laugh.

I was starting to get pretty pissed at him.

Luckily he got off the bus long before I did.

Alcoholism is a major problem in this country. 

People are often drunk at all times of day.

So nobody paid the guy any attention at all.

Monday morning I headed to the Chief Nurse's office to get my next assignment.

She told me I could go where ever I wanted as long as I got them all done.

Well you can just guess what I choose next. 

Peds.

I got to the peds ward there was another woman being shown around.

She is from England and here with an organization to be a clinical instructor.

I then got my tour.

There are essentially six rooms.

The nurses station and treatment room are in the middle.

Next to the nurses station is the burn room.

It is about the size of the treatment room at CMH and contains five beds.

Two of the other rooms which are about the size of two patient rooms put together contain eight beds each.

Then another two rooms which are a bit bigger contain about 14 beds each.

Where there is not a bed there is a mattress on the floor.

The mothers and patients share these beds (calling them beds is generous, they are the size of cribs).

I went to listen to report.

There is a doctor volunteering from the Philippines, his main focus is nursery.

He learned that a baby died in the night and he was very angry.

The baby had central cyanosis and they thought pneumonia so they started antibiotics.

The baby died about thirty minutes later.

I later asked if they have ventilators for any patients in the country, the answer was no.

If they need to they can intubate and the mother can bag.

I think that this does not happen, the baby just dies.

After report I followed the doctor to the High Dependency Unit.

It is basically their PICU.

There were three patients.

One was a kid with meningitis, he had been brought in so late that he could no longer function.

The other was a baby with an abdominal mass.

The third was a baby with now a repaired hernia that had caused an obstruction.

What interested me was the baby with the abdominal mass.

His stomach was so distended.

I noticed the mother was breastfeeding and the patient was not on any fluids.

I later noticed no patients are on fluids, there are also no monitors, and vital signs and assessments are non-existent.

The patient was put on oxygen due to increased difficulty breathing.

Since there are no sat monitors they just go off of clinical signs.

They have oxygen but it only goes up to two liters. 

And they only have that set up at certain places.

I told the nurse to ask if the patient was pooping or passing gas.

The mother said no.

I told the doctor that the mass or something has caused a bowel obstruction.

He agreed and let me put in an NG tube.

But there is no suction, so we had to let it drain by gravity.

I am sure that it was so thick it would not come out.

I asked about IV fluids and he said no it was not necessary because the patient was eating.

I told the doctor the patient should not be eating because he will end up perforating his bowel.

He did not really agree, but I told the nurse to tell the mother to stop feeding.

We then moved onto other patients.

As I was coming around the corner I saw a patient with severe hydrocephalus, it was a four month old and I would guess her head was the size of a volleyball.

Even her face started to look smashed in.

Then the surgery team started to round.

I got right in on this!

They saw many kids with abscesses, hernias, the hydrocephalus baby (which they asked if she had been to surgery yet, I wanted to say, "Do you see an incision dumbass? Because I do not." I decided this would not be appropriate.)

Then we got to the burns.

Talk about terrible.

I have never seen anything like it.

Four of these kids I would guess were at least thirty percent.

I did not see their backs.

They leave their burns open to air, not dressed.

I started asking about nutrition.

Turns out nobody is eating.

Well I got to educating everyone, including the surgeons.

He agreed to put NG tubes down two of them.

Turns out we do not have formula for them.

Did the nurses tell the parents to get any?

Nope.

Then it was time to administer meds.

The nurse calls out the patient's name and the mothers bring their sick kid up to the cart and we slam IV antibiotics in all of them.

Some kids are lucky enough to get either half a tab or a quarter tab of Tylenol.

I am not even sure how they mother's give it to them.

Many of the IV's were bad, and who knows for how long. 

I informed the nurse that they needed new ones.

She agreed and said she would do it after she finished passing meds.

In the afternoon it was slow.

I noticed that kids just lie in their beds and do nothing.

So I took some paper and made a ball, we played catch.

I also gave some kids pen and paper to draw with.

They were having a blast, they were more lively than I had seen any of the kids all day.

At the end of the day the doctor came back and was going to refer the patient with an abdominal mass to another hospital.

He thought that the patient could continue to eat and go by public transport.

I disagreed.

I said that he was for sure a bowel obstruction and should not be eating.

He argued that the patient has not been puking therefor is not a bowl obstruction.

I of course argued back, the patient is also not pooping or passing gas and his abdomen is huge.

He does not need to puke to be an obstruction.

We went back into see the patient.

There was some green output from the NG.

He then agreed the patient was also obstructed.

Well no shit.

I also pushed that we needed at least maintenance fluids to get him through the night.

He was reluctant because of being unaware of kidney function.

 I said yes but giving a very sick kid who has had an obstruction needs fluids, just to get him through the night.

He said he was nervous because night nurses could not manage fluids.

He finally found a syringe pump and said he was ok with it as long as it was run on a pump.

The largest syringe we could find was 30mls, the patient needed a rate of 36 ml/hr.

I knew the pump would beep all night and new fluids would not be started.

But I figured it was the same as not getting any fluids, what else could I do?

I had at least won one battle.

After that I called it a night and headed back.

I was so tired and drained I went straight to bed after going to the grocery store and to the market.

I knew that today was going to be another tough day.

When I got back today many of the patients were still the same as the day before.

I attended some morning rounds, many patients were getting discharged.

I visited my little ortho kids and gave them each a colored pencil and piece of paper.

Then I went to the nursery for a tour.

The babies were so tiny in their bassinets and the mothers all gathered on the floor waiting to breastfeed.

One mother was expressing milk by hand into a medicine cup to feed to her neonate.

It was so impressive to me that these mothers who just gave birth hours before were sitting on the floor.

Then I headed back for some burn treatments.

These kids with terrible burns get no pain medication at all.

They are debrided in their beds while all of the other children anticipate their turn.

It was heartbreaking.

This toddler who is not staff anxious screamed bloody murder at the sight of the gauze being opened. 

Since there was not much I could do, I did what I could.

I showed the mother how to hold the boy straddling her lap and put his face into her chest so he could not see.

I patted and talked to him (not that he could understand me), and held him the best that I could.

I was glad when it was over.

I only assisted with one treatment and then went to meet some of my fellow volunteers for lunch.

After lunch Kate a Ripple volunteer who is a retired doctor from Scotland came back to the hospital with me so she could see around.

The ortho kids proudly showed us their pictures, and we saw the other patients, and then I showed her the burns.

One dad asked me about his child.

He was wondering about debriding the outside layer of the skin off.

I had asked the surgeons the day earlier about surgical debridement.

They said it would bleed too much and they would have to wait until it sloughs off on its own.

I told the father this and then told him to talk to the surgeons.

He said ok, he just thought I was the one in charge of the burn unit.

This made me very sad.

I have only been in that room a couple of times.

I then asked him about the patient's nutrition. 

He said she was not eating much.

I told him she needs a lot of calories and protein, so things like eggs and peanut butter would be great.

I did see another parent later bring back a bag full of food.

I think that my education did some good.

It is amazing how little the medical staff talks with the parents here, it makes me sad.

Later in the afternoon I saw a doctor assessing a patient.

I went to see what the issue was.

It was a baby with severe pneumonia and a pleural effusion. 

Her respirations were extremely fast, but he had just turned up the oxygen and she was crying, so I was not too worried.

I listened to her, she did not sound too bad.

So I let her be.

I later went back to check on her, while she was sleeping I counted her respirations: 114.

I took her temp hoping she was febrile because this would be an explanation and an easy fix.

She was not.

I went and informed a nurse.

He said it was fine the patient had been seen by the doctor.

I said yes but the condition had not improved.

I asked if she was dehydrated, he said no, she was eating.

I told him this was dangerous but also knew that there was no other option really.

I did see the patient breastfeed and she did seem to be able to latch without struggle.

I am just afraid that when kids work that hard to breath they eventually just stop breathing.

I unfortunately know this from experience, fortunately though I learned this in a place where resources and help is plentiful. 

I am afraid this is not the case for this child. 

I am hoping for improvement overnight and that I am wrong in this case.

Being in peds is extremely hard.

But I also know this is exactly where I need to be.

I am sad that I only have one day left.

I think that when I am done with orientation I will be visiting the local hospital.

Kate has told me this place desperately needs my help.

I'm hoping I can be pushy enough to make some changes in practices and care.

As hard as it is, I am so amazed by the kids and the parents.

They are grateful.

Parents do not complain that nurses and doctors do not come see their kids, they are just grateful when they do.

They do not demand pain medication for treatments, they know their child is getting what he needs and they help hold.

They do no demand another nurse come try for an IV, they hold their child still and tell them to stop moving.

The kids may scream but most of them hold completely still, because they know they need to.

Parents have to stay and care for the children.

I think that some parents go get supplies or do washing and other parents watch their children.

I have not seen a single nurse responsible for a child. 

They know they have a responsibility, and that is their child. 

This is something I rarely see at home.

I think the hardest part of my job there is dealing with difficult families and bratty kids.

Here it is heartbreak, lack of supplies, and fighting to get anything done.

I am very interested to see what can be done and how staff will be receptive to new ideas.

There is a lot of work to be done and I am hoping that I can make a much needed change!

I am exhausted and need to head back to get some much needed sleep! 

I will leave you with pictures of the burns.

Just know that they are very graphic and not for everyone!