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.

The Sticks

I have just arrived at an outpost setting in Tanzania.  I was told I was going to a dispensary (what the Tanzanians call a very small clinic), in Lushoto. As Lushoto is a small fairly isolated town in the Usambara Mountains of Tanzania, I was somewhat mentally prepared to be isolated. However, as we drove up the mountains, Lushoto came and went.  And so did the next small village, and the next, until an hour and half later, I arrived.  Talk about rural, Aaron, who has been Volunteering at the hospital with me in the lab, eating meals with me and just generally being a good person to vent frustrations with came on the trip with me but was unable to stay for the ten days I am to be posted here.  So I am by myself.  The children here are malnourished, the lack of education, an issue I thought was bad in Tanga, is multiple times worse, general hygiene in the population is poor, and the pharmacy that I thought was worryingly limited in Tanga compared with this one seems like a Shoppers Drugmart TM superstore.  I saw a plethora of frustrating experiences ahead. And while I haven’t ruled that out completely, that feeling was abated greatly when I saw how well organized the clinic is, when I met Sister D, and Sister C and Dr. N and his wife.  The Two sisters run a tight ship, and ensure that most of the essentials are present.  Dr. N, when he first met me, was warm and jovial and has taken every opportunity possible to educate me on the cultural practices here, the procedures performed, the illnesses present, and the frustrations of working in a setting as rural as this one.  His Wife, a nurse-midwife has been equally warm and welcoming and plays a variety of roles here at the clinic.  The two of them have been working in rural Tanzania for almost 10 years now.  To say they are inspiring would be an understatement.  Over the last two and half months I have been extremely frustrated with the sub quality care provided by even fully qualified nurses.  The two of them are working extremely hard to not only provide care but also pass their knowledge on to the next generation of health workers.  They, along with the Sisters here provide classes and training for almost twenty nursing students and volunteers.  As I said, I had been very frustrated with the lack of teaching that I had observed.  It seemed to me an almost hopeless system, that poor nurses would breed more poor nurses in the next generation, my experience thus far.  However, after seeing this exceptional group of Tanzanians, I have seen that this is not the only truth.  While I am not wrong, presently poor nursing  is breeding poor nursing, this group has proved to me that it is not a hopeless cause.  There are people making a difference, working tirelessly to provide care, and improve the medical system here.  And it is amazing what can be done with a little elbow grease, and a few resources.