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.