Some bless you and others slap you

 “You step into people’s lives and make a difference. Some bless you and others curse you. You see people at their worst and best. You see life begin and end. You see people’s capacity for love, courage and endurance.”

I have only been in Kenya about two months. The above quote is from a sign that hangs in the nurse’s station. Every day I read it and think about its truth. Work has had many ups and many downs. When I came to Kenya I started working as a maternity nurse. Finally, after starting to get the hang of things, I was transferred to the female surgical ward because of a ”nursing shortage”. I laugh at the term nursing shortage because it implies that the other wards are adequately staffed.  Now, I am working on the female surgical ward.

Everyone is probably wondering how I am adjusting to being a nurse, since this is technically my first nursing job. It’s still so weird calling myself a nurse but slowly I’m getting used to it.  The adjustment is going surprisingly smooth. Of course there is a lot I don’t know, but, I try to ask a questions and look up things I don’t understand. The biggest set back to my learning is the language barrier. Rounds are usually in Kiswahili, broken English, one of the 42 tribal languages or all of the above. Most of my patients don’t speak any English and some don’t even speak Kiswahili. However, it’s amazing what a smile and a handshake can do to build a rapport with patients.

There is so much to say about work, I couldn’t possible blog it all. Below is a collection of times I loved, hated, and times I will surly never forget. If I have learned one thing working in Kenya, it’s to keep a sense of humor. Without one I wouldn’t last a day.

·         One of the first days working on the surgical ward I completed morning rounds with the doctor. I am aware of ever patient’s condition, including bed 113. Chronic septic ulcer of the left lower limb that is now malignant. Patient is scheduled for an above the knee amputation this week. Plan for today blood transfusion, clean, soak in precept and dress in the ward.

Day continues, I begin to give IV mediations. I then hear “sister sister (something in kiswhali) tembea”. I can only understand the word tembea, meaning to walk. I assume a patient that should not be up is walking by the urgency in their voice. They drag me over to the other side of the ward and point to the ground. There are maggots crawling on the ground. Tembea… maggots are walking. I look at bed 113 and the patient is pulling maggots out of her septic wound. My poker face completely failed me, all I could say was “oh no…. Let’s not do that”. 

I cleaned her wound which included pulling maggots out of a very septic leg. Since then her leg has been amputated. I asked the mama if she was sad her leg was gone. She responded hapana (no), she said she was happy because now the bugs are gone. That makes two of us.

·         Another old mama, bed 115. Age 70 (her granddaughter thinks) and very very confused. Admitted for a wound on the abdomen, and possible bowl proliferation. Plan for the day, clean and dress wound. Place colostomy bag, measure output and type of output, continue antibiotic treatment. First day working with her I introduced myself. She forgets me within seconds. I go to dress her wound and she screams. Squirming she screams “the mzungu is trying to kill me, the mzungu is trying to kill me.”  The ward is full of patients so everyone can clearly hear the only white person on the ward is trying to kill people.

Second day, greet her, this time her eyes squint and lips pucker. The colostomy bag I placed yesterday is ripped off and thrown across the ward. Ok mama, I get the point, you don’t want to be friends. Start to clean her wound and she slaps me. Thanks mama. I then proceed to try to hold her hand down and do a dressing at the same time. Replace the colostomy bag and tape the edges against her stomach.

Day three, I think I am smart. I find a caretaker to hold her down. I get the same look as day two. However, this time she looks at me and tells me she would slap me if she could. Colostomy bag nowhere to be found.

Although this patient hates me there is something about her I love. I hope I’m half as feisty when I’m old.

·         My first month here I worked in maternity. Many days were spent in nursery. Charles is admitted to Tabaka as a result of the health care strike. Charles is born 28week and is tiny! I have never seen something so small. 2 pounds, not feeding and difficulty breathing, odds are not in his favor. NG tube inserted, feedings started, and oxygen given. Sadly that’s about all I can do with limited resources. Amazingly, he makes it a week. One week becomes two and two becomes a month, he’s a little miracle. I become close to both Charles and his mother, when you spend a month caring for something so precious it’s hard not to.

Today Charles is still alive. He’s not out of the woods yet, weighing in at about 4 pounds, but he is making considerable improvement. I’m watching a miracle happen before my eyes, Although I’m not in maternity anymore I go every day during my lunch break to monitor his progress. His mother calls him her miracle baby.

·         New Patient admitted on Saturday, the day I’m off. Bed 101, female admitted for snake bike to the right foot. I work with her throughout the week. She is in no need of surgery and fortunately did not suffer any systemic affects… very lucky. Tuesday, I finally get the full story about what happened. She was in her house barefoot and a snake bit her. She tourniqueted the foot twice, once at the ankle, another a little further up. Smart thinking. We continue to talk and suddenly this smells comes over me. Being in a surgical ward I have become very in tune to the smell of necrotic tissue. I then ask what is that smell? She then replies the snake. Once again my poker face fails. All I can say is where is it? She points under the bed. Literally I jump half way across the ward in my Tinkerbelle scrubs… very impressive, I’m sure I lost all creditability! A few translations later I find out she killed the snake and brought it to the hospital in the event she needed to be treated for systemic affects. Also smart thinking. But, four days post bite she still has the snake... rotting under her bed. Tabakas female surgical ward is not the place to be if you are sensitive to smells.

Like the quote said, you walk in to people’s lives, some patients bless you while others slap you. Maternity brings life and unfortunately death. Finally, we have  a mother whose capacity for love, courage and endurance for her baby is a miracle in its self.

 Welcome to Tabaka

Conducting official nursing business. Just kidding.

 

One of my little preemies.

 

Baby Charles, this pic speaks for itself.

 

One of my favorite mamas on the surgical ward.

She has been through so much but continues to smile.

 

In other news, if you have been following my others posts you might be interested to know contact information has been exchanged between CMMB and Maisha. Also, Lawrence’s brother Sunior has been sponsored to go to school.