Tuesday, June 12, 2012

Night Shift- Carlie


June 5, 2012
I am at the hospital with Athens tonight on our 4th night in a row of working nights.  I am not a big fan of working nights, and hopefully after this month we can get on a different schedule.  We are sitting together right now in the maternity ward nursing room, if you can call it a room.  It has four walls and a door but the walls only go up about half way so you can still hear everything that is going on around you.  There is one chair in the room and a long rectangular table that all the nurses here use as a bed.  The “table is breaking in the middle, so Athens and I have to sit on each end so not to break it.  Joe the nurse that is working with Athens is over in Urgent hanging out with the nurses I work with. Night shift here is nothing like night shift at home.  They don’t care if you sleep here on the job as long as you give meds when they are do.  Most of my patients that are in Urgent sleep outside on the ground at night cause its cooler.  So  it makes finding them in the dark to give meds difficult.  I am still trying to learn French, and its still difficult at times trying to communicate with others.  The other nurses are nice, and at times we can communicate with a mixture of French, English and charades. I have gotten quite good at acting things out!  In stead of getting frustrated at not understanding each other, most of the time we end up laughing over the fact that we cant seem to communicate. 
When we get off at 7 am we usually start walking back towards home instead of waiting on someone to come pick us up.  And I have found that even though I am exhausted from working all night, I still enjoy the walk back home.  The children here seem to have a six sense of knowing when you are coming down the road.  They start yelling, “Nasara” which means foreigner.  They get so excited when they see us coming.  And then before you know it your surrounded by 20 kids wanting to shake your hand.  Athens and I are beginning to believe that the kids communicate here with some sort of drum system because all the way home kids come out to shake our hands as if they were warned we are coming.  I have even stopped minding the small sticky and or wet hands that reach out to shake my own on the way home.  There happy smiles makes me not to dwell on the different germs I have come in contact with.
Athens and I have been able to help with two different births so far this week.  And birthing in Africa is nothing like birthing in America.  I have been told that the Bere Adventist hospital is the best hospital in Chad, which to me is scary.   I have always associated hospitals with being clean, but I guess African hospitals didn’t get the memo.  I knew before I came out here that it wouldn’t be anything like hospitals back home, but it still was a shock.  The hospital is dirty, and crowded.  When people come to the hospital it becomes a family vacation.  At night family members will sleep at the bedside or out side on mats.  It can make it difficult at times trying to figure out who is the patient and who is family.  The patients don’t wear gown, or have any sort of identification on them.  I found out real fast that relying on the fact that they must be a patient because they are lying in a hospital bed dose not mean a thing.  Apparently any bed is up for grabs if its not being used by a patient.  I have gotten used to the bats flying above me at night at the hospital, but am having trouble ignoring the bugs.    Africa tends to make its bugs supersized.  No bug should get that big.  I don’t know if I will ever be comfortable with the bugs and spiders here.  The two births we helped with went well.  One of the babies came out with the cord wrapped around its neck, and wasn’t crying when it was born.  But after hanging the baby upside down by its feet and giving it a couple slaps on its back got it crying in not time.  None of the births I watched during my cliniclas prepared me for births in Africa.  The blood drips off the birthing beds onto the floor, which makes it a tricky trying not slip in it, let alone just step in it.  After the birth we throw bleach water onto the floors and sweep it out side.  The birthing room is small and hot.  But you can’t keep the door opened because people we trying  and peer in.  I try and not look to closely to the walls because if I do I can see splattered blood that was never washed off.  I would love to give this place a good cleaning but that would be hopeless.  So instead I am learning to ignore the dirt, and filth.  Soon it won’t bother me at all.
The church here in Bendale which is where we live is a small one day church.  There is a roof, dirt floors , an dirt walls that go up about half way.  The first time I saw it I thought it wasn’t yet completed but I latter learned that they considered it done.  Church starts at 8 o’clock on Sabbath and goes to about 11:30 or 12.  They start out with singing, then a nature story, singing, children story, singing  then a bible lesson story, singing and then finally the sermon with more singing after.  The children sit on mats on the floor at the back of the church while the rest of us sit on benches.  I have come to hate those benches with a passion.  I never knew that sitting could cause so much pain.  There is defiantly no sleeping in church with those hard benches.  It makes me think that we would have less people sleeping in church back home if they decided to replace our nice cushioned pew for some hard wooden benches with no back support.  But when we sit for 3 plus hour on the those benches, it comes to the point where you cant concentrate on the sermon but only on the pain that is radiating from your backside up your back.  I feel like a child  who is constantly fidgeting and shifting instead of sitting still. I try to focus on the sermon but after awhile trying to relieve the pain in my butt becomes my number one focus.
The market here is another experience altogether. The market is dirty with lots of trash laying on the ground. The market consist of people sitting on mats on the ground and trying to sell whatever they have on their mat.  It could be grains, beans, peanut oil, some sort of leaves, onions, garlic and bowels of different colored flour.  The few actual stores have a little more to offer but not much.  Nothing that they sell reminds me of home. When you buy something like flour here they just dip their hands in the flour bowl that is sitting on their map and scoop it into a plastic bag.  People are allowed to touch food even though they don’t buy it.  After I found that out I wasn’t so worried about the merchant’s hands touching my flour, I started to wonder about all the other people who had reached their hands into the bowl.  The one comfort from home is the peanut butter they make here.  I eat the Adams Natural peanut butter but Africa peanut butter is better.  There is nothing like fresh made peanut butter.  What they do here is roast the peanuts in the sand, then grind them up.  It is completely natural with no added sugar.  I don’t know how I will be able to eat any peanut butter from home, now that I have eaten fresh peanut butter.
Gary and Wendy got back home today after a week in the capital.  We are still living in there guest room but we hope to be able to move out to the nutrition center in about a week.  I will miss the running water, and toilet at their house.  The nutrition center has a well which will be or drinking and showering water.  Or toilet consists of mud brick walls, a hole in the ground no door.  That should be an interesting experience…..  I hope tomorrow that Gary will be able to teach us to ride the motorcycle or “moto” as they are called here.  Either you walk, ride a donkey/horse or ride a motorcycle in Chad.  You rarely see any cars.  I think I have seen three cars since I have been here, and one of them is owned by the hospital.  Bronwin who is from South Africa/England has been helping us out with getting us to and from the hospital.  But it will be nice to have our own set of wheels and not depend on everyone else.  But I will miss the three of us on a bike together!!  We have a lot of fun trying not to fall in the puddles which are more like small lakes in the road. 

Night Shift- Athens



June 2, 2012: Saturday
 It’s our first shift at the hospital and it’s on nights and I’m on the maternity and Surgical units. Oh may what have we got ourselves into. I’ve never liked maternity so I don’t know why I agreed to this unit. I guess I was trying to be helpful and expand my horizon, but right now I’m thinking that probably wasn’t the best idea. Right away there is a lady in the delivery room and it’s her first child so I know it’s going to be a long night. The Chadian nurse is so excited to see me and wants me to help assess the patients and motions for me to assess her progress and I cringe at the thought of what I’m about to do. I look around for sterile gloves and some lubrication and then I remember that I’m in Africa and I reach to a box of clean gloves and as I stuck my fist up this woman’s vagina all I can think is INFECTION!!! I try hard to remember everything that I’ve learned about dilation and effacement and I move my fingers around trying to measure what I can’t see but I’m struggling. When I remove my hand and smile at the nurse and we switch places I almost gag at the thought of what I just did.  Suck it up Athens! You’re a nurse and you’re in Africa! After my pep talk I exit the room hoping I never have to do that again.
                The local nurse still hasn’t showed up yet and the other day shift nurses are ready to leave but I know they can see the fear in my expression at the thought of being along all night with a women in labor and 25 patient to man all by myself. They graciously stay late to help me. Note: I have not had any orientation to the unit besides 3 days of shadowing on the day shift and It wasn’t in English. I’ve had to learn routines by watching and asking people that speak English whenever I see them. I don’t know where to find anything. I’m really stressing out and the only thing I can think of to do is pray, and oh man do I ever!
                The women laboring isn’t making much progress so someone called the doctor and I’m so grateful cause she an American and speaks English! (Fist pump) As I finish helping pass medication to the patients I get to the last one and I so excited then all of a sudden the short African nurse passing meds with me starts yelling at me so fast that it takes me a minute to realize what is going on and I kind of want to laugh cause she sounds like a crazy person and apparently I did something out of order. I just stare at her with my dumb face and I watch as she shows me what I did wrong and I laugh because it was a pointless mistake but I just make note to self not to do it again. Why am I in Africa? The other night shift nurse finally shows us 2 ½ hours late and I’m a little annoyed and the doctor is to and sends him away.
                I make it back to the delivery room just in time to see the doctor give the lady an episiotomy and I’m reminded why I don’t like Maternity. Carlie and I watch as the baby is born trying to soak up all the information that we can on how things are done. (Soon we will have to do this on our own.)  I am given the task of cleaning up the baby and cutting the cord. I spend the next 30 minutes with baby playing with it and making it cry- it’s the only way I know it’s still breathing.
                Because we work at the best hospital in Tchad, Africa they like there staff to be well rounded so we also double as the night janitors. After the baby and mother are stable we have the honor of cleaning up all the blood off the floor. Since the traditional foot attire here at Bere Adventist hospital is flip flops Carlie are not really excited about blood splashed all over my feet and the other nurse can tell by our expression because she hands us a pair of tall rubber rain boots and I grin in relief. We spend the next 20 minutes scrubbing, squeegeeing, rinsing and repeating the process of cleaning the floor. And where does the dirty, bloody, amniotic fluid go? Well out the front door of course and down the side walk till it hits the dirt. We had to ask a couple of people that were sleeping on the ground outside to move because they were right in the line of fire… too bad we its already soaked part of their sleeping mat…only in Africa. 
                We finish cleaning up just in time to pass 12 am meds and hour late, but I’m just glad that they are getting passed at all. A lot of the night staff here would rather sleep then to do their jobs. There is only a couple and after their finished we have till 5 am till we have to pass meds again and take vitals (Vitals are only done once a day in the morning or on admission. Assessments aren’t done at all L we hope to change this.) The nurse I’m working with decides to take a nap and sprawls out on the wood table that is located in the nurses’ station. This table also doubles as an exam table and a desk and is about to snap in half judging by the huge crack in the middle and the way it bows.
                The lights are flickering; there are bats flying above my head, babies crying and topless Chadian women walking around mean while a giant coca roach is playing chicken with me. But I’m just so thankful that I’ve made it this far. Seven a.m. couldn’t come soon enough.

 June 3 2012: Sunday
Mark 10:27 “With man this is impossible but not with God; all things are possible with God.”
                As soon as I walk into the maternity ward the stench of sweaty bodies and urine plagues my nose and as I slowly open the door to the delivery room I pray that it is empty….. and alas my prayers are answered.
                The first task of the evening is putting in a new IV on a 7 day old baby. I’ve never done an IV on a baby so I don’t feel to confident in my abilities to try so I pass at the try and just watch and learn so I can be prepared next time. It took 2 nurses and 7 trying with the SAME needle to get a good stick. All the supplies and medications that the patients need here at the hospital have to be paid for right away. This family only had enough for one IV so that’s what the nurses had to use. Though I was appalled when they dropped it on the floor twice, but when you have nothing you take anything you can get.
               
 June 4 2012: Monday
                Not much going on in the hospital no babies were born which made the night go by really slow. It had rain earlier today so it was cooler then it’s been in a while. Not really thinking about how cold it could actually get in Africa we both went to work without any warm clothes. Bad choice. We spent most of the night spooning on top of a small desk in the urgency ward trying to stay warm.
                A boy that had come in the morning with a viper bite died in the night. There is no cure for snake bites here and the bite itself was 5 days old. A lot of people here don’t seek help right away they wait till they can take it anymore then they come in when it’s too late.
I got electrocuted AGAIN!! I went to unplug my computer cord and right when I seen the little blue bolt I knew it was coming and there was nothing I could do about it. I felt the shock go up through my arm and into my jaw. I’m pretty sure that my eyes were twitching. I jerked back my hand as soon as I could but not before I felt the horrible pain of the arm and jaw being fried. But I’m Ok and everything is functioning as it should. :)
 June 5: Tuesday
                Bronwyn is a girl out here from the UK who we have become close friends with and who we spend most of our time with. While we were sitting around wait to go to work a voice can out of the dark and it was Bronwyn in the bathroom “Umm… Did one of you finish the toilet paper?” There was a moment of silence where both Carlie and I looked at each other and just burst out laughing. Like can’t breathe, crying/ chocking kind of laugh. The door to the bathroom doesn’t have a knob on the outside so there was no way for us to take the TP to her…she had to come to us. There are no light except for the head lamps that we have so out of the darkness of the bathroom came a hand. Just at the sight of it we started laughing even harder. Probably the best part of our night!!
                I thought delivering one baby was stressful oh no! We had two women at the same time in the delivery room. Thankfully another nurse came over to help and it took 10 minutes for one lady to deliver. She literally came in and laid there for about 8 minutes and in the time it look for me to walk over and check on the other womens IV she pushed her baby out. As soon as I turned around Carlie was yelling “Baby! There’s a baby!” We race to put gloves on as fast as we can and grabbed the baby from Jo and start suctioning out the nose and mouth and drying her. Another successful delivery. YAY! I think I might be starting to get the hang of this.
 June 6 2012: Wednesday
                Always check your patient!!! Always! Always! Even when your best friend who is a nurse as well is telling you that a patient 2 beds over is dead. Never take their word, always check.
Working in nothing but Darkness.


  I was doing a dressing change on a patient and Carlie leans over and wispers in my ear “the patient in bed 16 is dead.” I look over and the family has covered the patients face and wrapped then with cloth and appeared to be lifting them up out of bed. SO as soon as I finish my dressing change I race to find Jo (the local night nurse that does not speak English) and we try to tell him in as much body language as we can that a patient is dead. He finally gets it and he follows us out. When we get there and walk up to the bed the whole family is surrounding the bed and we walk up slowly and Jo leans over the foot of the bed and starts shaking his head. I follow and as I get closer I can hear the patient snoring and I feel so stupid. I turn around and look at Carlie who still has a scared look on her face and say “Their not dead, their snoring.” Jo starts to laugh and tells the family and they start to laugh and then other patients and family member all over the ward laugh. I am so embarrassed. Moral of the story don’t listen to Carlie!


Tooth Decay


Sunday May 27, 2012
Today was our first day of doing anything medical and it was dentistry. Not really in our scope of practice but down here if you’re an American you’re pretty much qualified to do anything. There is a dentist here from Romania that was kind enough to take us along on his little bush clinic to do consultations. It was really simple just looking inside people’s mouths and writing down which teeth needed to be pulled. Most of the teeth that that people in the village pointed out as being painful weren’t even teeth anymore they were just roots that were left. The first mouth I looked in I said “Pull Them All!” They were so black and I don’t think that there was a whole tooth in her mouth. But in Africa they need all the teeth they can use so we only pull the ones that are causing them pain. Even though we didn’t get to do much we were just so excited to get out and interact with the people.
We are also in the process of learning French and so far we have picked up a couple of words and are learning the alphabet and the basics but we hope to be pros when we come home for Christmas. So watch out America, we are making progress

We are in Africa!!!


Friday May 25, 2012

I am sweating like a sinner in church. And have been since I have arrived.  I had no idea how hot it could get in Africa.  You sweat all day and all night. You become a constantly clammy mess, and I have been told that this isn’t even as hot as it gets here!  Hopefully by the time the dry season comes around I will be acclimated to the weather.   Today is been the coolest day so far since we arrived on Wednesday morning, and last night was the best sleep I have gotten.  We are staying at the Roberts house in their spare room until our house can be finished.   Once we move into our own house we will not have any running water and our bathroom will consist of a hole in the ground with four walls around it.  So we are enjoying having a bathroom with running water even if we have to bucket flush our toilet. 
Athens and I are looking forward to working in the hospital here in Béré. Pronounced “Berry”.  The only problem is the language barrier.  We don’t speak French and they don’t speak English.  So we are on the fast track to learning French, or at least trying.  It’s hard to function as a nurse if you can’t speak to your patients.
So far the only animals we have come in contact with is monkeys and spiders.  They have a monkey on the compound they call Red.  He is a cute monkey with the face of a old man, but is very naughty.  We are slowly becoming friends, but he apparently is not a big fan of the color of my hair.  I try not to take offense.  Athens and I encountered a hugs spider our first night here.  It was climbing up our mosquito net.  Neither one of us wanted to get out of the safety of the net and kill it so there is a good possibility  it could still be in our room somewhere.
Athens’ and I have developed a motto while we are here.  We like to say, “When in Africa” when referring to situations when we have to do things that we wouldn’t do at home.  Including the food we eat, the clothes we wear, washing our clothes in a bucket with soap made out of olive oil, and any other situation it applies to.
So far all the people we have come in contact with have been very friendly.  It is considered rude here if you don’t shake people’s hands, so there is a lot of hand shaking going on.  Even if you are in a huge group you are to shake everyone’s hand.  I find that it’s good idea to always keep a bottle of hand sanitizer on me.