Wholeheartedly: 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.