An Overdue Update

It has a been a while since I have updated all you lovely people.  I have honestly been having a hard time finding inspiration.  A lot has happened (or so it feels) in the last three weeks or so, and as a result this post will be in the classic bullet format.  I see no way around it.

Since my last post I have:

-left Tanzania.  It was bitter sweet.  I was ready to go, but I will miss that country.  It is a beautiful place, with beautiful people, and holds a special place in my heart.  I would love to say more, but somehow the  words don’t seem to be coming.  If you want a place to visit sometime…. Go to Tanzania.

-I visited Mombassa with my Tanzanian wife J (this is an inside joke)/colleague/ and I would consider now good friend.  He is a wonderful travel companion, and I think has kept me from blowing my lid out of frustration on numerous occasions.  Sir, I thank you.  You know who you are.  If you want another cool place to visit Mombasa also gets the Daniel Barnhoorn seal of approval.  Cool infusion of culture, great beaches, and great climate.  If you do go, visit Diani Beach, and Ali Barbou’s Cave restaurant.  Both are well worth it. 

-I arrived Safely in Nigeria!  It was a terrible trip, but I made it.  It has been great to catch up with family, see the nephews and niece, bro out with my brother, and get some delicious home cooking.  Janice, it’s no wonder Jono slipped a bit after he married you J.

-Climbed a mountain.  Dave you probably wouldn’t agree, but I’m gonna count it. 

-Volunteered a couple days at Bingham University Teaching Hospital.  It has been a great experience.  I’ve also seen some pretty gross things, and learned a lot.  Burns are gross, don’t get third degree burns.  Don’t drive a motorcycle in Nigeria either, it’s a bad life choice.

-I was also lucky enough to be able to scrub in and assist with a surgery while I was here.  Cool Stuff.

- I know I am forgetting at least three things that I thought were important, maybe I will think of them later.  This post hasn’t been as long or as deep as I wanted it to be but I’ve been told by a few of my admiring fans that I need to lighten up my posts a bit.  So there you have it. 

Night Shift

I worked my first night shift the other night.  It took all my persuasive power to allow the Hospital administrator to let me do it.  She was concerned letting me stay out all night might cause me to get malaria.  I think I was spared from that plague by my prophylaxis.  It was an interesting experience.  For all of you that complain about grumpy nurses, try working a night shift.  It sucks and by the end you are… well, grumpy.  However, as the sun rose and I transferred accountability to the day nurse I had a distinct feeling that I may one day be a proficient nurse.  As my graduation day approaches there has been an increasing fear in me that I will not be ready to be a true full-fledged nurse.  Given that there was only one other nurse on  night shift  was given a certain degree of autonomy, a rarity in Tanzanian hospitals where all medical administrations must include at least a crowd of three other nurses for emotional support.  Since there was only one other nurse and she wasn’t all that keen to leave her chair, I was allowed to manage much of the patient care.  It was amazing to find that I was able to not only decipher the crazy Tanzanian documentation system but I was able to administer medications unaided, on time and safely.  No one died and a few people even seemed a little healthier at the end of my shift.  As I sank into an exhausted midday snooze I had a deep feeling of satisfaction, and proficiency.  For what it was worth, it didn’t last that long.  I still have feelings of inadequacy and probably one of the greatest fears of mine is that I will not be ready for the world of nursing by the time I graduate.  Still it’s nice to know that I might have the potential. 

Where Medications Flow like Wine and Doctors Instinctively Flock like the Salmon of Capstroma

I know there seems to be a lot about death the last little while on this venue but, if I am honest with myself, writing here really helps me to decompress and unload.  A patient died today.  There was nothing I or anyone could do.  She was brought into medical care far too late.  But maybe if she was brought into a proper hospital, where defibrillators exist, highly trained personnel, are within a couple minutes journey and medications flow like wine she would still be alive, she might be sitting in a hospital bed with her grandchildren bringing her hand made get well cards. Maybe if she wasn’t born in Tanzania. Maybe if her country had a higher ratio of nurses than 0.37 per 100,000 people.  To me she seemed young, about 60, but then in a country where a woman’s life expectancy is 49, according to the best WHO estimate, She must have lived a long full life.  It was still difficult to watch her pass from this life to the next.  I think it hurts my pride as a health care worker to see someone die. Everything you have been trained to do is to keep the grim reaper at bay, when he finally shows his hooded head and sickle you don’t know what to do.    I guess what it boils down to is, in a system, such as health care, where there is a limited amount of resources you can’t save everybody.   Yes, that woman given the right set of circumstances, could still be alive today, but she wasn’t given the right set of circumstances.  I have to rest in the knowledge that I tried, and given what I had, it was a damn good attempt.  I can also look forward to returning to a system where, medications do flow like wine, defibrillators do exist, and highly trained personnel can be conjured seemingly from the walls if the need arises. However even then, it is a good lesson to learn; that even in our system, resources are limited, people who need it can’t always receive the care they need, imbalances exist, and despite your best efforts you can’t always save everybody.  In the words of a man I highly respect: that doesn’t mean you can’t give it all you’ve got and try anyway. 

Stickin' it to the Man

 Recently I took part in the national immunization campaign here in Tanzania.  A four day event covering the entire country.  Close to 1000 children came through the health centre where i was working, to receive polio and measles vaccines as well as anti-worms medication and vitamin A (which I  was happy to note was donated by CIDA, or your tax dollars).  I was quite an interesting experience.  On the first day i played more of an observatory role.  I couldn't help but notice, however, that none of the sites where injections were occurring were being cleansed before injections were given.  A little perturbed, I asked why, thinking it was a resource constraint.  I was shocked to learn that the Government when issuing the vaccines had said not to cleanse the site first as the cleansing agent would kill the vaccine on entry.  I couldn't believe it.  (For all of you non-medical people, that is really bad, and totally unfounded.)  I suspect that the government didn't want to have to pay for all those swabs as well as the vaccines.  I have no evidence, however.  I would, though love to see the research done to prove that little fallacy.  After discussing with the nurse in charge how the reasons cited for not performing this essential task were completely unfounded, she agreed with me.  WIN!  It felt good.  She abruptly left and returned carrying alcohol swabs.  She even said, "The government may be wrong, but we can at least do it right here."  WIN.  I don't know if any of you have noticed but I have been really frustrated with the lack of change or willingness to change that I have encountered, it was nice to see a little difference being made.  And then after about half an hour, every alcohol swab in the hospital had been used up.  Less of a win, but at this point I'll take what i can get.

A Matter of Life and Death

She was twenty-seven, and had a son, he must have been about eight or nine.  It’s always hard to tell in rural Tanzania, life is hard on even the young here.  She had four diagnoses.  Of her four diagnoses, if she had had just one, she would still be a very sick individual.  Malaria, Typhoid fever, Syphilis, and AIDS, in Tanzania all of these are killers. Yet here she was fighting for life.  As I watched her struggle for breath all I could feel was angry.  This was not helped when one of the nurses came with a respirator.  As there was no oxygen in the entire hospital this was the only thing that they could use when a patient was experiencing respiratory distress.  I was even less encouraged when I noted the part used to seal in air was broken.  And I was even more angry when I watched the nurse begin to ferociously start pumping air at a rate that would kill someone if indeed the machine was operable.  I guess that in itself was a blessing.  The nurse grew tired and to feel like I was doing something I took over.  As I sat there pumping, watching her struggle for life, I felt overwhelmingly sad and frustrated by the inability to do anything at all and most particularly by the unfairness of it all.  What made this woman’s life less valuable than mine, or any of my patients in Canada.  If anything it was more valuable as she had lived far fewer years than the general populace of the patients I have had the privilege of serving in Canada.  And yet if one of those patients were experiencing the respiratory distress that this young Tanzanian was, they would be surrounded by doctors within seconds, have any known medication that could possibly be effective shoved into their system, and had an oxygen bar hooked up within seconds.  Here I sat, pumping a useless piece of shit, and watching a sick patient slip into the afterlife.  There were no medicines that would kick start her breathing again, the one doctor had left on a much needed errand, and even if any of the nurses knew CPR, it wouldn’t do any good as none of them would perform it, not on an HIV positive individual. 

After about an hour or so, I was relieved of my duty and the last rights were performed.  My anger was little assuaged as another patient’s call phone rang, and was answered.    I was then forced to go take dinner. Guests in Tanzania are not allowed to work too hard.  In fact no one is.  I obliged, knowing I didn’t really have a choice if I wanted to maintain any sort of cultural respect.  I went to bed that night angry, frustrated and sad. 

I was awoken the next morning to the sound of my phone ringing.  As my primary goal for being at this centre was to learn about maternity care in Tanzania, I had left instructions with the nun in charge to call me if any mamas-to-be came in.  Greeted, and told, from what I could piece together using my limited Swahili, that there was a mama, four cm dilated and I had better come quickly.  I obliged here and was at the hospital in minutes.  Everything went smoothly and within a half hour a healthy baby boy entered the world.    Despite the events of the last twelve hours I couldn’t help but feel proud, and happy that I could help bring this little miracle into the world. 

Within twelve hours I was part of seeing someone leave this cruel, hard and unfair world, and part of bringing someone into that same world.  I think there are coincidences.  I also believe that there is a God, who also incidentally cares deeply for His creation.   I think this was one of God’s ways of showing me that despite all the inequities, all the unfairness, and the harshness, there is also beauty, joy, and purpose.  I hope that I can make the choices that allow the young boy to live in a better world than, not twelve hours before, the other sick mother passed from. 

It's a girl!

Today I delivered a baby by myself (supervised of course).  Pretty cool stuff.  It really is amazing/disturbing/beautiful.   To all you women out there, better you than me.  And to all you mothers out there: wow.  If that was all you had to endure to be a mom, that sacrifice alone would be enough.  To my mom:  thanks for doing that for me.  And lastly to the mama who allowed a rookie male nursing student to deliver her baby: Thank you.  I will never forget that, even if you did think I was a gynecologist.