At Ntcheu District Hospital they have the ability to test CD4 count (amount of immunity the person has) if that is low, they will then test viral load (amount of HIV virus in the person's body), if this is high they will consider changing the formula. When they came back from Ntcheu I was told that did not do any testing, the medical personnel said, "All of your friends (Meaning others with HIV, it annoys me that when in a certain demographic you are considered "friends." Every white person they have known is my "friend," I always have to say, I have no idea who that person is.) are fine, you need to eat more and go to church." Yes, I also thought she has had problems with isolation and depression, but I was not convinced that is her main issue. They have phased out a formula of ARVs last year, this was the one Rabekah was on. Since September 2013 she has been on a different formula, that is when she reported to begin having weakness and other symptoms of treatment failure.
About a week after going to Ntcheu, she became very ill. She had gotten Malaria. She was transferred from Bilia to Ntcheu. When I saw her at Bilia she was still alert and orientated, my presence even made her smile. I then went to Blantyre for a few days and had not been in touch with the family. I saw her father on the road, I asked about her, he said he had a bit of improvement at first but now is worse. I said ok, let me go home, put my stuff away and I will be over. I was not expecting to find her in the state that she was in. She was lying on the floor under a massive blanket, after greeting the approximately 10 people in the room gathered around her. I went to greet Rabekah. Her eyes were glazed over and she did not even look at me. During the time I was there she was restless, rolling back and forth and moaning. I told her father this is serious and we have to go as soon as possible. Because she is unable to sit on the back of a bike we had to arrange a car to come. I said I was going to run home, shower, and eat in case we needed to go that night. After seeing her health passport (book they write medical info in) from the last visit where they did nothing, I was not letting her go alone. The car was unable to come that night so we decided first thing in the morning would be fine, there were really no other options.
The next morning I woke up at six (late!!). I knew the truck had to be there already, I think it driving past the house is what woke me up (moving back to KC might be a little rough at first). I threw on clothes, packed a bag, and was out the door in ten minutes. I threw my bag in the back of the truck while all of my little friends stood on the porch cheering. Seeing me and a car first thing in the morning is just too much to handle. We got Rabekah from the house into the car (It has been about five years since I have had to transfer an adult, thank you nursing home for giving me enough transfers in my few years to last a lifetime!) Maxford (her dad) said I should sit in the front, I said oh no, I am fine and jut happy to have a ride. After falling off the side into a grandmother sitting in the truck bed (I apologized profusely and everyone just laughed and laughed. I am glad I did not hurt her!) I realized it is bumpy and the floor is best. I called the medical assistant at the clinic and told him to prepare for our arrival. When we got to the clinic, we got her out of the truck and got to work. I checked malaria-negative, put in an IV and started fluids, and the medical assistant started pushing glucose (I will always hate that they do this without a machine to test blood sugar!). Then I tried to get a blood pressure, she has bery weak pulses and I was not surprised that I could not get a blood pressure. The medical assistant gave antibiotics for a possible infection and I just waited, there was nothing else I could do. He said the ambulance would come to take us that morning. He was recording the data in her health passport when he asked, "What was her blood pressure." Me, "I could not get one." Him, 'Oh well I am sure it was fine." I can only imagine the look I gave him, I have been told more than once recently that I come off as a bitch (Of course by guys that think I am not approachable. No I really don't wish to talk to you, but you are more than welcome to send me drinks from across the bar.). Sorry I am not good at hiding my true feelings. I tried very nicely to explain to him about signs and symptoms of a patient in shock, I am no expert, but come on some of this is just basic knowledge for a medical person. I retook the BP and got 70/30. He said, "70/30?!" I said, "It is an improvement from no blood pressure, which is what she just had." He went home to get ready for his day's work. I sat and waited for the ambulance to arrive. When it came I did not expect everyone and their mother to be getting in, I was told only one other patient was being referred. Where the hell did all of the people even come from?! I went out and kicked everyone out so we could take Rabekah and lie her in the back. Once she was in the vehicle, I stood back and I swear people had to have been stacked on top of her. This time I requested to ride in the front.
When arriving to the hospital we went to see the clinical officers, I have recently been informed there are only two doctors in the hospital and they are both in administrative roles (yes, that makes sense). I knew we did not have long with them, so I just laid out the situation and what I wanted. I have learned in the country they hate confrontation, it is not really in their culture (unless you are a drunk man). Usually when I get confrontational they just five me what I want to shut me up. They agreed to admit her, run fluids, check blood for infection and CD4 count. They told me if the CD4 count is low they will then send a viral load sample off. All of these things sounded good to me. We got to the ward, which is familiar to me, it is where I stayed back in November when I became ill. They assigned her a bed, drew labs, took vitals (Bp now 90/60, improvement!). Then the team of clinical officers came around. The main guy kept speaking in Chichewa and was not involving me even when I said, "Sorry my Chichewa is not good, when you are finished can you please tell me in English?" Finally I got fed up and went through my spiel with him. Oh sorry for asking question and demanding to know the plan. I would love to send these medical people back to 2 Henson for a day, when we do our job we get threatened and screamed at. I have not even raised my voice! So the plan had not really changed, we were waiting on blood results, I was told the CD4 count could take a couple of days. I stayed until two in the afternoon, made sure her fluids were changed when the bag was low, brushed her teeth (I tend to be a freak about oral care on patients, I always think when I am unable to care for myself, you should shoot me. If you won't do that as least brush my damn teeth.), changed her bed and clothes. I have been getting quite the looks in the ward as I sit next to a very sick Malawian HIV patient's bed and perform the care of a guardian. Nurses do not even do these things here. A guardian must be with every patient at all times. Guardians must also bring the following to the hospital, bedding, towels, soap, dishes, and anything else needed. Needless to say, it is all very different from home.
Yesterday when I came back to the hospital I wanted to see CD4 count and make sure she was being cared for and in a stable condition. I walked with her sister who was bringing firewood. We stopped to pick up a friend. Two and a half hours later we were at the road to catch a bus. It normally takes me one and a half hours to walk to that road, and I do not know the short cuts! Nothing with Malawians goes quickly. When arriving to the hospital I immediately saw her IV fluid bag was dry. I went to tell somebody, I also told them I was angry because this patient came to the hospital in shock and critical, she needs fluids. He said yes, he would find out. I waited 15 minutes, they rolled the drug cart by and did not stop. Yeah, my blood was boiling. I went to the cart where three nurses stood. I said, "Did you get IV fluids? It is completely unacceptable that a patient who came in, in shock does not have fluids going since yesterday! This is just poor nursing care!" Like I said confrontation is their least favorite. I was brought fluids pretty quickly. The poor guy said, "I'm sorry." My response, "Don't be sorry, just don't let it happen again." Immediately after I said it, I thought where did that come from? I sound like somebody's bitchy mom. I do not wish to be rude and demanding, but it is necessary if I want her to get better and be cared for.
Today when I came, of course I was told that her fluids had not been running since last night and her IV had fallen out. I was pleased to hear that she was eating a bit of liquid food when spooned into her mouth and she did a great job swallowing her meds. I knew the clinical officers would be rounding again today, that is one of the main reasons I came. When I walked in, I was told visiting hours were over. I just said, oh sorry and kept walking. I have no idea why people think I am bitch. Also when the clinical officers were rounding I believe they said, everyone who is not sick go outside. Well I pretended to not know any Chichewa and stayed put. I had already told the nurses about her IV and fluids, of course nothing had been done. I was glad the clinical officer from Wednesday was not doing rounds on my side. He shot the other guy a look as to say, good luck with that one. Once again, so sorry for wanting decent care. This clinical officer was actually pretty great. I let him review her case before saying a word. I then told him I was upset about the fluid situation and I wanted to know her CD4 count results. He immediately started an IV and ran a 1 liter bolus, then sent a nurse to get the blood results from the lab. Her CD4 count was 280, this is extremely low, when a patient is first diagnosed with HIV if their CD4 count is below 500 they put them on ARVs. He suggested we switch her formula of ARVs (yes please!!), he did not really think a viral load was necessary since her CD4 is so low. He also wanted to do a spinal tap to rule out meningitis. He even took her blood pressure right then, it was 120/80, so she is very stable now. I was very pleased with him and thanked him a lot for taking the time and seeing her (see I can play nice). This afternoon I slowed the bolus way down because I did not want the bag to run dry and then run the tubing dry, when it was nearly gone I just clamped it. I figured a whole liter that fast with a stable blood pressure it was not a huge deal to get a new bag right away, I had also pushed enough for one day. One of the male nurses came by within an hour of me clamping the bag and said he would bring a new one. This is major progress!
During this experience I have learned such a sad truth. Patients do not get the care they need here. Yes supplies are limited, I almost freaked out when I learned they do not even have feeding tubes at this hospital, how much more basic of a piece of equipment can you get?? Maybe I will just have to make one. But even the simple things they do have, are not used to help people. I believe that most clinical officers and nurses look down on sick, poor, people and their families. I am sorry but just because you got an education and have a job it does not make you better than anybody, not start being a decent human and giving a shit about other humans. Nobody advocates for these sick people, they families are afraid to do so. They literally lie and die while nurses are washing windows. Yesterday morning a body was rolled out of the unit, I thought, was this a necessary death or poor management? It breaks my heart. Nobody in this world should be afraid to fight for proper medial care, or should they have to. I believe it is the job of everyone on the medical team. I especially take this role seriously as a nurse. If it is not in my patient's best interest, then no doctor, we are not doing it. Also do not tell me you can not order pain medication right now, I know you are not in an emergency, so you will do it right now. After telling off the nurses here, I hope the peds nurses are ready for when I start working with them. I think they will hate me within the first five minutes, I may have to buy their love with things. But maybe they will practice some better nursing care!
Goose news; thank you all for your concern! It means a lot to me. I was told that Goose was seen drinking water at the borehole near my house last week on Thursday. This made me feel a billion times better. At least nobody had her or had hurt her. When they tried to catch her to bring her home she ran away. I am hoping they are right and it was Goose, I am sure it was, nobody has ever brought me the wrong cat home before. I believe that she was in heat and went out to breed. I hope that she will come home soon, but something could have happened to her in the last week, who knows. I was woken up two nights ago by hyenas "barking" nearby. I hope she is smart and stays in trees at night and away from people. I have not offered a reward for her return, I can only picture a whole bunch of people hunting her down and breaking her legs just so they can catch her, I figure it is much easier to only tell the women at the boreholes that she is missing and to ask again if they have seen her. They all decided, oh she is just getting pregnant and will come home later. I hope they are right!
Also, I need more sponsors!! I only have three and I need 12. I do not want to be annoying and ask all of the time. But that time will come very soon. I need to make an adjustment to the payment amount. I have decided that the girls should only receive an allowance while in school, not during holidays, it will make it slightly cheaper for the first term. If you are interested in any way please, please contact me!
I better get back to the hospital and check that things are running smoothly. Maybe I will be nice and bring the nurses some oranges or something. They will probably think I have poisoned them. Then I should head home before too long, I have been getting home right at dark every night. It seems nearly impossible to get things done. Yesterday on my walk I accidentally peed in front of a group of boys, I checked the road for people, but did not think to look in front of me. I heard laughter and looked up, a couple hundred yards away there were two boys looking at me. I almost waved, but I just laughed and went on. Then I told some kids (half jokingly) when they asked me for money, "I will beat you." They started chanting "I will beat you! I will beat you!" There seriously is never a dull moment.
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| Blantyre |
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| Too many kids in my bed. |
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