Being a nurse, village style.

 I used to say with sarcasm that I was going to work to save lives. If you were to hear me say that now before going to the clinic the sarcasm from that statement is gone. Since most of my community work seems useless due to lack of attendance, I was becoming exhausted and discouraged. Lately I have asked myself many times, "What the hell am I supposed to do?" I have literally been taken to a village, dumped into a house, and left there. Yes, I have Mary, who has helped me a lot. But she is not a medical person, and she does not even have connections in the clinic or nearby hospital. So as I said in my last post, I have been going to Bilia clinic now most days. Well I have felt more than useful every single day I go to the clinic. Malaria season is at it's peak right now, and many cases that come in seem to be very severe. I have been working in the clinic for the for a few days, so I am getting the routine down. Due to translation issues, I work with the clinical officer. He sees patients and asks history, if I see something abnormal or a question I want to make sure he asks, I speak up and we will go through the case together. I have also been taught how to prescribe the malaria treatment, so when a person comes back positive from their blood test, I prescribe their medication and send them to the pharmacy. It is simple, but I believe it makes things go much faster for the clinical officer who sees about 200-300 patients everyday.

Yes, this sounds simple enough. But it is never simple. Apparently the cool thing to do is hand the white woman (did I just call myself a woman? I am not sure I feel mature enough to be a woman. Laughing at the statement "a huge package" the other day made me laugh. That should be proof enough I am not a woman, right?) your seizing child when nobody else is in the room. This would be fine, if I knew where drugs were, dosages off of the top of my head, and had keys to locked equipment. I am more than confident that I know what to do in this situation and can handle it alone, but it is much easier if I can dictate to people what I need. Yes, I have been there a few days, yet I am usually yelling at people in these situations. I never knew I was a control freak until I became a nurse. Even in America, where equipment and help is available with all people around who are competent and skilled I still get defensive if somebody gets in my way, especially when that somebody is a new resident, "Get the hell back from my patient, I have shit to do!" Usually here in the clinic this situation is pretty well done and not too stressful, probably because they practice everyday.  But the other day I thought I was going to lose it. A seizing toddler was handed to me when the clinical officer had stepped out. I got the kid's weight (for drug dosage purposes) asked the woman standing in the room for rectal dizapam, tried to find IV fluids; door was locked, gloves; who the hell knows where they were, malaria rapid test; once again who the hell knows. Apparently the clinical officer had done some cleaning that morning. He walked in and said, "That child is having seizures." I thought, "Do you think I am the stupidest nurse in the world? No shit! He is having seizures." Instead I said, "That is why I need gloves, a malaria test kit, quinine and rectal dizapam; his weight is 10kg, IV fluids, and an IV catheter. He finally found some gloves and tried to give me a 24 gage (tiny) IV, no way was I putting that in a two year old. I said the lowest I will do is a 22, please just give me whatever is there and bigger. Instead he left the room to go find a different size. I mumbled some profanities about how this cannot happen and we do not have time for this shit. So I grabbed an 18 gage (really big for a toddler) and got the thing in. I do think I will be the best IV starter ever when I get home, situations like this are making for great practice. Also dark skin in rooms with no light are a challenge. Finally we got some antiseizure meds in the kid. I have no idea how long he was seizing for before he came, but with me it was over 3 minutes. After the kid stopped seizing finally, I could immediately tell that he had a stroke. He is very lucky to have lived, but I am afraid that he will now have to deal with the neurological issues that come with having a stroke. We sent him off to the district hospital.

Like I said, situations like this happen everyday, so much that they are running together in my mind and I can no longer keep the patients straight. Last week when I went to take a patient to the holding area, which has two beds, there were about 8 patients and guardians in there, being monitored and possibly being transferred. It is not all malaria cases that come though, I think my least favorite are the drunks that have been in fights and come because they have filed reports with the police. Because no translation is really needed, I can do this on my own. I just assess the patient, usually basically put a bandaid on a tiny cut and send them back to the police station. This one woman would not stop showing me what happened to her, I watched the first time and then was done watching, I would go to look at a laceration to describe it and she would be going through all of the motions, which caused me to not be able to look at the laceration. I had not even had my lunch yet, and there were sick kids to see. I was not impressed with her. I kept yelling, "Basi!!" which means enough. She would stop for a second and then go right back to doing it. There was more mumbling from me about I am a peds nurse for a reason. It is true, I do not do adults well at all. No he does not need tylenol because he was punched in the face, what do you really think tylenol is going to do for his pain? His hangover will be worse and I am sure he will be drunk tomorrow, let's not give that liver more of a jump start for the failure that is bound to come one day.

Well of course like most things in life (especially here) for me, when something is going well I should know it will not go well for long. On Tuesday I was at the clinic, the District Health Officer and the District Commissioner walked in. I have met with the DHO twice since being here, both times about the clinic at Khomera that needs to be open, and the last time I also asked about the possibility of working in the district hospital occasionally. She has known since November when I first met with her that I am a nurse, and working in the community, I also told her I was registered after spending a month at Mzuzu Central Hospital. She never asked any questions about anything. When I asked to work in the hospital here she said, send me your qualifications and then we will go from there. Less than a week later I emailed her the documents. I did not hear back, so I emailed her again. She is also supposed to be coming to see the clinic at Khomera to decide what to do with it. Well when she walked in the clinic that day she said, "Where is Khomera (which she butchered the name, showing me she does not give a shit) clinic?" I said, "Khomera clinic is about 8km from here, I walk here from home everyday." She just nodded and did not say anything else. I then went back to work. When I was called back in she said, "Why have you not sent me your qualifications?" I said, "I did, a week ago. Then I sent another email asking you to confirm that you received the previous email." She claimed she did not get either, I confirmed her email address and resent the documentation while she was standing right there. After she left the clinical officer said she was mad that I was there, and I was not allowed to work until she reviewed my documentation. Let's just say I was livid. It felt like such a slap in the face. One; she never informed me to send her any documentation for working in the clinics, she just said it before the hospital, so I did that, A WEEK AGO! Two; I even have completed my orientation in Mzuzu, can she not get a hold of that information and know that I am valid to work? Three; I cannot tell you how infrequently they have volunteers with experience and here for long periods of time, it is pretty much never. I am not a brand new nurse, I do not do things I am not comfortable with, and I know what I am doing and I believe I alone have saved a few lives. Do I get a thank you for all of the work? Nope! I get told to leave and when she reviews my documents I can come back to learn some more. Excuse me? Learn? Yes I do have things such as drug dosages to learn, but as far as taking care of patients, I think I am pretty good to go here. The clinical officer was not happy about the situation either. A few days later he texted me to see if I had heard anything from the DHO, I said no, nothing. He said he had called her the day before and did not get any feedback, then texted her, and she did not respond. So I spent Thursday and Friday at home with nothing to do.

Well nothing to do, is not completely accurate. I feel as soon as I get comfortable and into a book or going to nap, my door is knocked on. Wednesday night it was 9 when my door was knocked on. Now let me tell you, 9 is way past my bedtime! I was told that there was an HIV positive patient that had moved in with her family very close to my house. Her husband had left her, she was weak and vomiting, she had also tried to kill herself that day. When Mary told me the last part I said we should go and speak with her. We went in the dark with my head torch. Inside the house there were approximately six people sleeping in a line on the floor. I suggested we go outside so we did not wake anyone, and so she could speak in private. After some prying she told me that yes she did think it was much better to end her life because she is weak and also feels hopeless without her husband. I am no counselor but I did my best, I told her it is ok to feel this way and that yes right now it feels like her world is ended, but with time, she will gradually be able to be ok again. I also told her that she has a family who loves and cares for her very much, she is a person therefor she has worth. I also told her that killing herself would cause her family even more pain than she is feeling from the separation from her husband and she needs to try to not just think about herself right now, but think about her family. I told her that we care and she needs to talk to someone when she has these feelings. She agreed to retake the medication that she vomited, just sleep through the night, not hurt herself, and go to the clinic in the morning. I was back in bed by 10:30. I woke up as usual around five (thanks, Goose and neighbors), called the clinical officer about the patient and got his advice. He said to send her to the clinic. She was too weak to walk so I paid for a bicycle to take her. I went to check on her the next day, when she saw me she smiled a very big and bright smile, it made me tear up a bit (what doesn't?). She said she was no longer vomiting and feeling a little better slowly, she is to go back to the clinic in a week to see how she is doing and if her ARV formula should be switched. My translator with me said, "She said she was so impressed that you came to see her." She seems like such a sweet woman, and her son is one of my favorite kids in the village already, even though I have known him less than a week. He is so kind, gentle, and polite. I dropped a bucket of water on my leg and made a huge mess, of course I cursed. The kids all laughed, while he went to grab a mop and help. He also curtsies and says zikomo (thank you) every time I hand him anything. I love kids with manners! I made sure to tell his mom how much I enjoy him and she has done a great job with him.

On Friday I also had a teenage boy brought to my house by Willix. He said, "I have somebody who is sick and went to the clinic but it is a holiday so he did not receive treatment." I said, "What is wrong?" He said, "What do you call it when a person has an injury from another person by a knife?" I said, "Stabbed, he was stabbed." I expected this to be a fresh stab wound, it was not. As soon as he swung his leg over the bike I could see it was twice the size of the other leg, he could barely walk. I took down his dressing, he had stitches in place, there was some good pus oozing from them. His leg was hot and hard. I asked if he had a fever or felt sick, he said no, I am not sure how. I decided he should go to the district hospital, he said he did not have transport money, so I paid for both him and Willix to get there together. Willix came back that night saying they gave him oral medications, I was pissed. They always do this when it would be so much better to just do some IV antibiotics for a couple of days, or doses at least! Especially here when people are not going to come back if it does not work, they cannot afford it! Yet they give every person with a cough oral antibiotics. Let's just put it nicely and say they are not at the top of their game in medical care and treatment. I plan to go to the boy's house tonight and assess how he is doing. If it gets worse and not better I will go with him to the hospital myself and demand some IV antibiotics.

After this I went on a walk down to khomera, I was craving a coke, so walking 3 miles round trip to get one seemed more than worth it, plus it was a nice day out. On the way back a woman came running over to me and said, "mwana!" which means baby. I took the baby and thought as usual she was just showing me her cute baby. Luckily I was with a person who could translate. He said, "Mom says the baby is 8 months and cannot sit up." I asked where her house was and we went so I could do an assessment. Mom reported the baby had malaria when she was younger and had trouble breathing during it. I realized the baby had an anoxic event during seizures more than likely. I explained to mom about brain damage and that she was lucky to be alive, but unfortunately she would live with issues her whole life, there are no cures, and there is nothing we can do besides support her. I talked to her about moving the baby's legs and feet (she seemed to be posturing rather often), and doing tummy time to help her strengthen her neck. She thanked me very much for coming. She said she had been talking to her friends about it and they told her to ask me when she sees me. I guess word is out I am a nurse, and I absolutely love it! I am more than happy to see patients at my house, walking down the dirt track, or anywhere else they can find me, and at anytime!

On that note, I am happy here and absolutely not ready to go home. I have a huge issue though; money. I hate money, as I am sure you do too. I have grown to hate it even more now that I cannot work to support myself at the moment. Locals have suggested that I do small businesses, I think this more than defeats the purpose of me being here. I want to be supporting the local businesses and helping, not receiving anything that should be going to a local person, and not me. I have enough money until June, which is not nearly long enough! I hope to stay until December, to live comfortably I need about $500 per month (half goes to student loans and a credit card from home, like I said, I hate money!). I do not want anybody to give the money to me, I have been given more than I could possibly handle. The generosity of everyone is too much. What I want is a loan, I will work extra when I get home and pay it off. I am willing to go on a payment plan and also pay interest as I would on an actual loan. I hate that I am even talking about this, but at this point, I may be out of options. I have two more ideas, which I am not counting on. So if anybody has an idea or knows somebody that is interested in loaning me some money, please message me and let me know! I am willing to do just about whatever it takes to make it until December, going home (while some days such as the day the DHO told me to go home (back to my hut), sounds great, I was ready to book my ticket!) makes me want to cry in a corner and vomit all at the same time. Nobody wants this do they? I will be more than happy to work my ass off when I get home, I will need something to distract myself from my PAD (post Africa depression). Thanks in advance for even thinking of an idea or person! I would not be here without the support of everyone already, and I am more than grateful for this experience you have given me everyday!

Hope everyone has a good Easter! I will be dying eggs with the kids tomorrow, they have been really on my nerves lately. Let's hope I do not teach them a new four letter word!

Love these girls!

One of the kids with malaria that came in with seizures.

He was not too impressed with me, this kiddo was in with pneumonia.

Kate, always helping.

Richard is obsessed with Goose. Sometimes I feel bad for Goose, then remember that she more than deserves the abuse from the kids. Plus she attacks them in return.

I gave them the job of water my plants, it kept them busy for about 15 glorious minutes.

Little burn girl that came to my house for a treatment. Next time she came she no longer needed the bandage, it looked great!

We made hats.

Richard of course thought Goose needed a hat. She was not impressed.

Kid that had the long seizure.

Cutest thing I have ever seen; Martha pounding maize! I was impressed that she could even lift the huge stick to pound. 

The perfect day.

Before coming to Malawi I used to daydream about what I hoped life would be like. So far it has been pretty much nothing like that, until the other day. 

My friend Emily (from Ripple, well I guess she is really from Australia, I met her at Ripple) is in the middle of being a traveling hippie and I met up with her in Lilongwe. She decided she did not really have plans for the next couple of days so she would come to the village with me. I was excited to show her my house and the village. In true fashion, everything took too much time so we ended up arriving home at dark. Because it is about a 4 mile walk from that road and I do not know the short cut, we took bicycle taxis. This was a rather interesting experience in the dark, they at least had our head torches to help them see the way. 

The next morning I told Emily we should go to the clinic and spend the morning there. I had told her how great they have been there and they really let me do work, last week I assessed the newborn babies all on my own! I know this seems like nothing, but in my previous experiences they do not let you really do anything. So I was happy to work independently and make the nurse's day much easier. At six that morning Mary came over to say that Linda had been shivering all night and was really not feeling well. She had been diagnosed with malaria the day before. I went to check on Linda and took her temp, it was 104 and she had begun urinating blood. Recently at her school a boy older than her died from malaria, this was even after his treatment. So I told Mary that we were going to not take any chances and I wanted Linda to go to the clinic and get a dose of Quinine, this is the medicine used in more serious cases of malaria. She agreed and we went. Upon arriving to the clinic, I was a bit disappointed to find a new medical assistant. I had developed a pretty good relationship with the other one and knew he would listen and help with Linda. I was pleased that this medical assistant was also more than willing to help her. He let her skip the line of about 100 people, she came in to get her shot of quinine. Now Linda and Clara are like my kids and I have become very motherly to them. I have always thought that moms at work are so dramatic when their kids get shots. But seeing Linda freak out (she is always such a composed and strong girl) and start crying, really upset me. I may have even had tears in my eyes. She also kept saying she wanted me to do it and not the medical assistant. I thought it was so sweet how she trusted me to stab her more. She finally accepted that she had to get the shot and dropped her underwear and I held her while he did it. I then decided I would take the second dose home with me when I went home, since she needed one four hours later. Mary and Linda headed home.

I then asked the medial assistant what he wanted me to do to help him. He said yes you should stay and see patients with me. I would like to assess how competent you are. I said that is fine I will stay with you. After seeing a few patients a young man was practically carried in by his friend, he was sweating profusely. I was not sure if he was being dramatic or seriously sick. The medical assistant was about to send the boy to the lab for a malaria test, he had malaria about a month before. I said wait a second, and grabbed the kid's wrist, his pulse was 43. I then took his blood pressure: 80/50. I told the assistant, this kid is in shock, we need an IV, some fluids, and drugs right now. His friends carried him over to the ward where they keep the sick patients. I grabbed equipment to start an IV and fluids. By the time I was starting the IV the boy was losing consciousnesses. I got a line and started running a bolus. The medical assistant slammed dextrose (this is what they do in any event where a person is dying, they also have no glucometer. I hate this situation every time.), the kid then had the worst seizure I have ever seen, it lasted about a minute or so. Then he was gurgling and having extremely shallow and gasping respirations. I felt that he did not have a pulse anymore, yes I am sure his heart was beating since he was kind of breathing, but it was not good enough for me. I said to Emily, well I have never actually done chest compressions but I guess it is time to try. I started and she said that she has done CPR several times, I was more than happy to let her take over, as I was tearing up and on the verge of a breakdown while doing them. The medical assistant had run to get suction, he came back and did the foot pumping while I was attempting to suction. Emily stopped after a couple of rounds of chest compressions and the kid actually had a pulse. He looked at me and smiled, yes it was a neurological reaction, but hell at least it was a reaction! I laughed out of relief at that smile. We then got him into a recovery position and gave him quinine as well as more fluids. Emily and I stayed to do some more close monitoring. 

I had a short talk with the medial assistant about looking at a patient and making the choice is this patient sick or not sick? I said if they look very sick you need to go back to the basics, take vital signs, and then go from there. Early intervention is the best and even doing the basics can buy you time. I believe he listened to this and took it to heart. He is new and learning, I do not envy the position he is in. The clinic is very busy, resources are more than limited, and people are sick. He did a great job of being open to suggestions and giving it his all, I could tell he is a man that cares and is willing to learn. So the next patient he sent us was not nearly as sick, I got an IV in him, while attempting this the patient next to me projectile vomited right in my direction. I somehow managed to keep my exposed foot (yes I was wearing flip flops) from being hit with the vomit and still get the IV. All I could think was; yes, I still have my nursing skills. By noon Emily and I were drained, and I needed to head home to give Linda her shot so we told the medical assistant we were going. I jokingly said, "Do you think you were able to see if I was competent today?" He said, "Yes! You are the best! You did a terrific job and I would not have made it through the day without you! Please come back all of the time!" 

I love situations like that at my job at home. I love using my skills, working fast, and the adrenaline that comes with it. Here is a whole different story. At home I know help is coming and I am never alone. Here, there is nobody coming, there is barely anything you can do. All I have seen is things go badly. I have seen many people dying here, but something about this kid really got to me. Maybe how fast and dramatic it all was, I am not sure. But at the point that I started compressions I have never felt so helpless in my whole life. I thought if he dies I was for sure going to just start sobbing. I still have a hard time believing that we actually saved him. Since when does CPR actually work? But by the time we left for home he was responding normally to his family members and he said that he was feeling better. I will be very interested to see his outcome! 

When I got home there was a patient with a wound on her face waiting for me. It was a big tunneling wound. I cleaned it the best I could and told her to go to the clinic for antibiotics. I then headed over to Linda's house to prepare her injection. I was pleased to see her sitting up and peeling potatoes, it was a big change from the shivering girl I found on the floor that morning. I got there and she immediately took her underwear off. I was glad that she was that eager to get it over with but I had to mix the med first! She took it much better this time, I gave her three jolly ranchers and a princess bandaid on her butt. After this Agogo started calling me Kendall Namaziya, I was later told it was a respected name for a woman, I guess she felt that I had earned it. 

I went back home to sit and relax for a bit. In no time at all my house was full of kids, I gave them the laundry line we have turned into a jump rope, I just sat and enjoyed them jumping rope. Then Willix came, as he usually does after school. We watered my garden and assessed the status of all of the vegetables. I have about 60 tomatoes, carrots, and green pepper. The rain has already stopped so I am going to have to start hand watering them. The kids helped by filling my pitcher and bringing it to me, they also did some weeding. Emily started to cook dinner with the help of Linda and Clara. They have been staying at my house every night until their mother yells from her house that they need to come home. It is usually around 730. They always help me start my fire, chop vegetables, and do dishes. I love having them around. During this time another sick kid came to my house, he was complaining of fever, and body aches. I could not find anyone to translate, so I called my friend from Lilongwe; Edward. He did some phone translation for me. I told them he probably has malaria and there have been very serious cases and he needed to go to the clinic first thing in the morning. Mary informed me they came to her house around 3 in the morning, right before they went to the clinic. I think they realized the seriousness and wanted to be first in line, I was pleased to hear this. Then it was time for dinner, the girls stayed and ate about 75% of my dinner, we all three shared the plate. I was surprised they even liked it, it was all stir fry vegetables, but they gobbled it down. Mary called them home and Emily and I watched a movie before bed. 

I went to bed very pleased that night. I love that I was able to work and feel like a nurse that day, both in the clinic and at home. I love that people come to my house to see me when they are sick, and I love that the kids come to play. I have always wanted a busy house with lots of traffic and kids, I definitely have it! Kids now help themselves to water, dishes, salt, or whatever else they need. They know where to put their dirty dishes, and their trash. They have even learned how it is acceptable to handle my cat. Oh yes, I have a cat now. I love that I have to constantly step over kids just to get into my house or yard. I am really feeling part of the community and am starting to feel very close to these kids! It is exactly what I have always wanted. 

The rest of my week has also been good. On Wednesday I met with the district health officer about the need for Khomera clinic to be opened and about the possibility of me coming to work in the hospital on the peds unit occasionally. She is going to visit the clinic and see the state of it, then make a plan from there. She also said once I show her that I am in fact a registered nurse she is happy to let me come work on the unit. I will be very pleased to do some actual nursing work again! 

Yesterday I came to Blantyre I needed to go to immigration and get my visa done, I also wanted to escort two patients to the hospital. One is Alice who is three and has severe developmental delays, the other is Fredson, he is 73 with a massive neck tumor. I told Stella (Alice's mom) to meet me at my house at seven and we would walk to the road from there. I told Fredson's son that we would meet them at the road at eight. I figured, they are Malawian, they will be late. Nope. I was the late one to both places. We finally caught a bus and arrived at the hospital (Blantyre is about 150km away). I went with Alice first, I was afraid her problems would be ignored. The woman at the check in told me to go grab the white doctor and just plead my case to her, she said they normally do not scan kids or do anything for disabilities. So I went and met with Jo, she is here doing research and is a peds doctor from England. She was so kind to assess Alice, and then she said we should go see some other doctors because she was not sure of a diagnosis. When we did this a man overheard the situation and said, actually there is an American geneticist coming in the morning. Maybe he will have a look at her. I could not believe our luck! I then told Stella I was going to check on Fredson (I had left him hours ago) and I would meet her in the morning. 

Fredson basically had not been seen at all. I parked next to him on the bench with my book and we waited. After about two hours we were finally seen. I was glad to hear that they planned to do a work up for surgery. I am really hoping that will be the outcome! It is sad to sit next to him and hear him have a hard time breathing and talking. He was then sent to ultrasound and xray. I was starving so I left him and said I would be back to check on him tomorrow. 

This morning of course I was the late one again, I think by three minutes. But Stella was there waiting for me with Alice. We went to wait for the geneticist. After about an hour we saw him and the doctor from Ireland that we had seen the day before. They discussed her clinical features and decided to at least to an ultrasound to rule out hydrocephalus. That was initially why I wanted to come to Blantyre. I wanted to be sure that she did not have hydrocephalus, she does have a large head compared to her body. But after I had been assessing her more the past few days I was convinced she does not have hydrocephalus. But it was good we were going to check anyway. During the ultrasound he noticed she does not have a corpus collasum and her ventricles are enlarged, but no hydrocephalus. I felt bad for Stella because I do not know if she feels like she wasted her time, they view medicine and diagnosis very different here. They do not really seek information (probably because they are never given it) they only want the fix. Well that will never happen for Alice unfortunately.

I then went to see Fredson. He is waiting to see if they are going to operate, they have not reached a conclusion yet. I will have to go back tomorrow and see what conclusion has been made. 

I feel like I have been constantly traveling lately. All I want is to stay in my village house, with my cat, kids, get laundry done, and go to work. I am hoping this will happen soon! I have been enjoying the constant company I have, but am craving some alone time soon. Give me two weeks of that and I will want out again I am sure.   

Clara jumping rope.

Goose has learned how to climb trees.

Coming back from Bilia, the mom said she was tired so we switched. I took the kid and she took my bags.

If you are ever wondering what a cat looks like after eating spaghetti, this is it.

I was so excited to see a tortoise!

Emily and I out in Lilongwe.

Sunset out of the bus window on the way home.

Linda and Clara helping Emily cook.

Night time bike ride.

Goose has also learned how to climb the mosquito net.

  

Alice was pissed about the exam, even the pen from Edward did not seem to help.