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!