God's work in action

I am going to upload pictures of people in the group doing God's work throughout the trip. It takes a long time to upload photos so it will probably be one at a time. Keep checking this entry. :)

 

Erin playing with kids from the primary school.

 Allison out in a village, Mbaloni, performing health care to those in a remote area. They weighed children, gave immunizations, and taught about health care.

 Anna bringing a smile to the face of a pediatric patient.

Through my eyes

I’m behind on my documentation for the past events. First of all, Sunday was very enjoyable and relaxing. We got to spend a good amount of time with the kidos over at the primary and secondary school, as well as return for devotional the the school on Sunday night. On Monday, I was back in the male ward, which I blogged about already. Oh and I also had kitchen duty on Monday. Tuesday brought about a chain of new events. The entire team packed into the bus and made the drive to Mbeya to view the Baylor Hospital. This specific hospital is part of BIPAI—Baylor International Pediatrics Aids Initiative. When we arrived we were introduced to a sweet lady named IJ who gave us a powerpoint presentation on AIDS. Lots of the information was very interesting and we were able to see the progression of many different medical conditions throughout the healing process via pictures on the presentation. The overall goal of BIPAI in Tanzania is to contribute reduction of HIV and AIDS related to morbidity and mortality among infants, children, and adolescents in Tanzania. They achieve this goal by a vision—to model pediatric clinical excellence empowering health professionals and communities to ensure sustainable, superior HIV care, treatment, enabling healthy and fulfilling lives for the children of Tanzania and their families. The objectives include

·      Support provision of family centered comprehensive pediatric HIV care and treatment

·      Enhance pediatric HIV case finding through a pediatric focused HIV counseling and testing model

·      Strengthen the local human resources and health systems capacity to provide comprehensive family centered HIV care and treatment services

·      Sensitize and mobilize people living with HIV (PLWHA) and the general community to support pediatric HIV prevention, care and treatment services

There is a lot of stigma here in regard to HIV which can cause further problems in the community. We were informed about a story of a young boy who had HIV and his family would not give him food or share clothes with him, and upon seeking medical attention he was beaten to death by people in the streets. This is a serious condition.

About 2.3 million children are currently living with HIV globally, representing 7.5% of the total number of people with HIV.

Mortality in untreated children is VERY HIGH. Left untreated, 50% infected children die before reaching age two. 200,000 deaths in children with HIV annually.

In Tanzania, 12% of pregnant women have HIV

160, 000 of children ages 0-14 have HIV, which accounts for 11.4% of all infections (UICEF 2009)

Those <15 years of age represent >30% of the population needing HIV care and treatment in Tanzania

Lack of knowledge regarding pediatric HIV in community and health care workers results in passive/late case findings and low pediatric enrollment in HIV care.

Sadly, here at the Chimala Missions Hospital, we do not have the reagent to do CD4+ testing. The resources are not available, so we no longer can give a test to determine if one has HIV or not.

We finished touring the hospital at Mbeya, which made me feel as if I were back in America. I’m not so sure how I feel about that, knowing that all of this money is put into one facility. I also question whether or not it is culturally appropriate, or if the people feel welcome here because it is so different than any other building in Tanzania.

After the tour, we went to eat lunch and then headed back to Chimala. It was Ashli’s birthday and we celebrated it after dinner back at the guest house. And around 9pm Ashli’s birthday wish came true. She wanted to deliver a baby on her birthday, and the phone rang with a message to go to OB. I joined Ashli down to the hospital and a cesarean section was about to be in progess. We scrubbed in and went into the OR. There were lots of complications during the procedure and the baby came out flaccid and not breathing. Ashli caught the baby and brought it over to the counter where we immediately started to perform CPR. She would count off, “1,2,3” and then I would pump. Apgar score for one minute was 4, and at five minutes was 7. The newborn’s heartrate had sped up and the oxygen, compressions, and pumping seemed to be helping so we continued working. We would get a grimace and a slight little cough every here and there but the minutes ticked onward. I kept saying, “Come on little boy, just tell me about it, tell me all about it.” Ashli kept stimulating the baby and checking the heart rate and observing for lung expansion. I had the pump in my hands. Although it seemed like an hour had passed, only about 10-15 minutes had actually gone by when the baby’s lungs started working without assistance. Momma was still open on the table and the doctors were working on her. We wrapped baby up and put him in the basinet to cart him down to the “uzazi” ward where momma and baby can be together. Ashli picked him up and put him on the scale to see how much he weighed, and as soon as he hit the cold scale we got the first big scream! He weighed 3.6 kg. We wrapped baby back up and then we all got close together and said a prayer for this new life.  Next we took him to “bibi” (grandmother), who was just gleaming with joy. She smiled so big, and she had one tooth in the front. I will never forget the moment we handed that child over and saw a happy happy happy grandmother. Then we cleaned up and headed back to see if we could help in the OR. Everything was under control, mama was doing well, and our job was finished.

On the walk back to our guest house Ashli and I were bouncing with happiness. It’s such a wonderful feeling after you experience a birth. The joy was screaming from our smiles. We stopped on the pathway home and turned off our lights to look at the beautiful sky. The sky was filled with twinkling stars. As we stared up at the sky we spun in circles and thanked God for such a beautiful creation. And then something made a screaming noise in the nearby distance and brought us back to earth. It must’ve been a baboon or something. We continued our walk back to the house and got ready for bed.

Today I woke up exhausted, yet excited to spend the day on OB. When I got down to the hospital there were two women in labor. I was on the ward alone, but Amy came and spent the morning with me, as the ladies slowly progressed. I found a chart for a young male burn patient in our ward and decided to return it back to male ward. I was further directed that he was in minor theatre, and when I got there, he was terrified and crying his little eyes out. He has second degree burns on about 40% of his body from falling into a fire. Now is the season where burns are very common because it gets cold at night. I got down on his level, held his hand and started rubbing his little head. There were only two other African nurses in the room who were about to start and IV so I decided to stay. I wanted to try and comfort this young lad because needle pokes are no  fun and due to his burns, he must be in an unbearable amount of pain. The nurses could not get an IV access point and stuck him three or four times. Everytime they would try a new site he would squeeze my hand really hard and cry out louder and louder. I kept saying dawa maumivu which means medicine and pain, hoping he would understand that this would ease his pain. Unfortunately no IV access site was attained, and eventually the doctor said no more sticks. This boy has very few places to get venous access due to his wounds and we do not want to damage them. The boy got an injection of ketamine via IM in order to go under short acting general anesthesia for debridement and dressing of his burns. Although IM takes longer to have the desired effect, within ten minutes his eyes were closed and we were ready to begin the procedure. Ashli, Anna and I scrubbed his burns with normal saline and pulled off all the skin that was peeling. Then we took betadine and covered all of his wound surfaces. Next we covered the burns with silver silvadene. We continued to put petroleum gauze over the burns and then dressed it with regular gauze and secured it with tape. We transferred young man back to the stretcher and brought him back to male ward. I can’t imagine the pain that he is experiencing. I feel for him, and want to help him, but there is nothing more I can do. He is in God’s hands. Please continue to keep this young boy in all of your prayers.

I decided that I needed to head back to OB because I had been gone for awhile, and the two laboring women were getting closer to delivery. The primigravida was at 9 centimeters and before I knew it she was pushing. The doctors had already gone for lunch but I had not left yet. Then Ashli popped her head in, and what a blessing she was. Amy and I were the only other two people there besides the two nurses. As the primigravida began pushing, and we were all working with her, the multigravida makes a yelp and the nurses nudge us over there. The head was coming and Ashli and I changed our gloves very quickly and delivered a baby unattended. The baby came out screaming and with an Apgar of 9 at one minute and 10 at five minutes. We clamped the cord, cut it, Ashli took the baby to the baby counter and I remained with mama to deliver the placenta. Mama and baby did wonderful and I am still in shock that we delivered a baby. I am so grateful for the education that I have received. All of my wonderful teachers have prepared us for moments like these. Baby number two was born with help from the African nurses while we were still caring for the other family. Thank goodness dear Ashli stopped by to check on me! I was so thankful for her help and we worked very well together as a team throughout the procedure. And just think, all of this happened before lunchtime.

A new passion

A new passion has surged within my veins. I have a desire to be the one performing surgeries. My shift continued on the male ward, and we had many new admissions this morning. Rounds took from 830 to a little after noon. After lunch we went back to perform minor surgeries. The first one required a debridement of a burn wound. A young boy had a seizure and fell into a fire that resulted in third and fourth degree burn on his left upper extremity. Dr. Stephen talked me through the debridement of this wound, and he worked on the more distal area as I worked on the proximal area. When you are in the moment, focused on a task, the gruesomeness of a wound is not as one would think. My job was to help get this poor boys arm cleaned up to the best of my ability. He was under ketamine, a short acting general anesthetic. After this surgery, I was able to assist an African doctor with a man who had been beaten. There was a gaping wound on his skull that needed cleaned out and stitched up. I observed the surgeon as he worked on the wound, and then bravely asked if I could try to suture some. He said of course, you are here for learning. He handed me the tools and then walked me through the process. I never realized how tough the skin is, and how much force is needed to make a stitch. It was a very interesting experience. The knot tying is also harder than it looks. I understood the technique behind the knot, but it was a matter of getting the knot as tight as it could be. With more assistance from the doctor we closed up the deep wound and got him back to the male ward. What a wonderful knowledge learning experience. Back in the male ward things had calmed down, and we made sure that everything was taken care of before we headed home for dinner.

As life leaves an earthly soul and joins Jesus in heaven

Pink… the color that represents little girls. I write in a state of mourning. Earlier this morning a young 7 year old girl was admitted o the female ward. The history taking was slightly askew… and we got controversial stories. I do know that the child is malnourished, has a chronic condition, is anemic, has acute gastroenteritis with dehydration and shock, and is critically ill. Her breathing is a hard site to watch. She uses muscles from her mouth, jaw, and all the way down her neck and through her shoulders as she gasps for each breath. You could hear her inspiration and labored breathing before you even entered the ward. She was critically ill and in need of immediate medical attention. She also needed blood. Her type and crossmatch was A+, which is my blood type. One of my dreams about coming to Africa was to give someone my blood and today that dream came true. I followed sister Janice to the lab where Miss Barbara collected my blood. I was able to then walk down the corridor and into the female ward where I would hang my own warm blood on this precious child. This was my third bag of blood to hang within the last five days. Her IV site was patent and flowing with NS, so I stopped that and started up my blood. I watched it flow into that small body. Life is not in our hands. As the night progressed, this precious soul’s earthly body was declining. Her lungs were overflooding with liquid and you could hear it in her breathing. So, we decided to give Lasix and put in a foley. All that was in the ward was an 18 french, so I headed back to the house to find a smaller foley for such a small child. While I was attempting to perform the procedure as sterile as possible with the resources I was equipped with, the Lasix had already begun to have its desired effect. Urine began sprayed and I knew I needed to pick up the pace. She tolerated the procedure well and urine flowed down the catheter. I knew I was in the urethra and up to the bladder so I pushed it a little further and then blew up the bubble with 5 ml of sterile water to maintain its position. I attached the foley tube to her leg and taped the bag on the part of the bed that does not move. I cleaned up all of the supplies I had used, straightened her bedding with the help of sister Janice, and continued to deliberate with all of the medical professionals. The doctors and Miss Bingham discussed different drugs and eventually hung Cipro (sp?) and Flagyl (sp?). For now that was all we could do, and we left the facility. Later in the night, around 530 pm, the doctors received a call on the cell. I felt a strong urge to go and check on my sweet girl. When we got there, she appeared worse than before. Her breathing was labored with continued use of many accessory muscles. She had bronchospasm and wheezing. As the doctors were performing and albuterol treatment, I watched the life drain from her body as she joined Jesus in heaven. I was sitting on the bed with her as she died. First her breathing stopped, and then her pulse ceased not too much later. I had never felt a pulseless wrist, and then tears slid gently down my eyes and dripped onto the bedding. I tried to be strong but I could not hold them back. Then I closed her eyes.

When I got back to the house I couldn’t face anyone and went directly to my room and sat on the first bed I came to. I put my hands in my face as the sobs and tears came. Next I knew Kellum and sister Janice were at my side. I am surrounded by such wonderful people. They comforted me and sat with me as I let the days events process. I don’t know how much time went by, but I appreciated every second that we were sitting there. Then all the girls came and we stood in a circle holding hands, and praying to the Lord.

I know that this sweet child is in heaven right now and I bet she is dancing with God, breathing out of healthy lungs with a smile on her face and joy written in her eyes.

The joy of a child's laughter

Hello again! We made it to Friday. Today I was on the male ward, and it wasn’t so busy in the morning. Of course once you say that things will pick up. After lunch we had many new admits and were able to carry out the doctor’s orders from the morning rounds. Not much had changed, and we just had to hang the usual meds for the patients. There are two young boys who have fractured the  head of their femurs and are in beds next to each other. They cannot have surgery because we do not have the resources available for a total hip replacement, and so we resort to traction. The young lads have to lay in bed for six weeks while the bones ossify and heal. Imagine laying in a bed, unable to get up and walk around FOR SIX WEEKS! And these boys are a joy to work with. They never complain—they sit there and endure the pain and boredom. One of my nursing friends came up with the idea of using balloons to do ROM exercises for these kiddos. So we used beach balls and have them pass or bop the ball back and forth between each other and ourselves. Their smiles light up with joy. Also today we brought paper and scissors and showed them how to make snowflakes. Then we made a contraption to string the snowflakes above their beds. The grandmother of one of the boys is always with him and she tells us thank you about every five minutes. They are just precious souls. 

The highlight of  my day was playing with a little tyke in the corridor. I stopped to say hello (jambo) and then he came and gave me a large hug with his little arms. I sat down to his level and he put his hands on my head and his bright white teeth came out with a huge smile. He was a joy to my eyes. And then I had this idea, maybe he would like to use my stethoscope and listen to my heart. I'm sure these children have no idea what this tool is used for, so I put the plugs in his ears and held the diaphragm to my chest. Almost immediately all I could hear were giggles. He kept putting the scope to my chest and bursting out with laughter from his working lungs, which many of the children at the hospital do not have. It’s a joy to hear laughter when you are surrounded with those in pain. He brought happiness to my heart and as I walked away to return to work he followed me. I scooped him up swung him around and his laughter resounded off of the walls. I set him back down, said goodbye (kwa heri) and continued my duties.

I lift my hands to the Lord

My shift was in the wodi na wanamume (female ward). Normally we start out with rounds by the doctors, but there was an emergency surgery this morning so all we could do was wait. The nurse’s cannot begin their duties until the doctors make rounds. Anna and I changed a few sheets and visited with the patients, many of which we were familiar with from the previous day. Every two days we switch wards. Something smelt askew in the ward this morning, and a patient asked for the nurse. This language barrier thing is very frustrating at times, and I wish I would have brought a Swahili-English dictionary and practiced more prior to the trip. We checked her tumbo (stomach) because she complained of maumivu (pain). She was admitted with a diagnosis of threatened abortion. We then removed the sheet and found her sitting in a pool of blood, with the cord of the placenta protruding from her vagina. I immediately went and briskly walked throughout the corridor to find the first doctor I could. Dr. Mahangay came with me and he immediately asked me and Anna to find a stretcher because she needed to go to minor theatre (minor surgery). I got to scrub in to surgery, and use my knowledge of aseptic technique. I assisted with the removal of the rest of the contents of the uterus. There was no way to save the baby because part of the contents had already been expelled prior to beginning surgery. My heart broke as I knew that this woman had lost her baby at the age of 17. The doctor’s words did make me feel better though, because he said that I saved her life by coming to find him. If she did not get immediate medical attention then she would have bled to death. Later in the day I got to hang blood for her and monitor her vitals throughout the transfusion, which went well until a few hours ago. She spiked a fever of 103 and so I sought out more medical attention. Sometimes when you get a transfusion, even if the type and crossmatch are the same you can still have a reaction. Many times in America people are premedicated with Benadryl and Tylenol to prevent adverse reactions. Unfortunately we do not have all of the resources here. There is no pyxis or room with dawa (medicine). The medicine sits in a cabinet and you have to get a prescription to go pick it up from the pharmacy nearby.

I believe that the highlight of my day was working with a woman who has stephens-johnson syndrome, which is a skin reaction in response to AIDS drugs. Her mouth is covered with sores and appears as a large bleeding scab that might fall off soon. Her entire body is covered with sores, and the sores are not limited to external surfaces. She has sores in her mouth, down her throat, and in her eyes. I got the privilege of being able to clean her up. We mixed half hydrogen peroxide with half water and gently padded her face, and let the liquid drip on her lips and cleanse the surface. Then we would take a tongue blade and wrap a small cloth around the top. This device would be dipped in the liquid and then gently put further into the womans mouth to cleanse deeper. She frequently would have to spit out bloody mucous into the basin, and the pain was written all over her face. I cannot imagine how it would feel to have sores on every inch of my body, intern and external. And as if this is not enough, part of stephens Johnson also causes swelling in the feet. Bilateral feet are filled with so much liquid they are translucent when shining a light on them. In better terms, her feet are large blisters covering the entire surface of the padding of her feet. She can hardly walk to use the bathroom, and stays in bed for the rest of the day. I have not seen any family come and visit her and she has been here since we arrived. Yesterday Anna and I got the opportunity to pray with her and we just held her hands and brought our requests to the Lord.

There were many blessings today, and I find myself very excited about the little things. The ability of the stevens Johnson syndrome had the ability to spit today, the precious little girl with malaria got to return home, I successfully started an IV, Anna successfully started an IV, Ashli successfully started an IV, Erin helped deliver four babies, a woman’s temperature of 103 dropped to 98 today, another woman stopped vomiting halfway through the day, we made an arm board to keep a vein open and readily able to infuse, the joy of poprocks, and way too many other things to mention in one small post. The Lord is alive and his work is very vivid in action. I love seeing my fellow nursing students interact with patients and watch faces of small children, men,and women light up with laughter as we say words wrong, show them fun new toys, paint nails, use balloons, poprocks, beach balls, wall crawlers and many other fun things. I can’t believe I only get to stay here for four weeks. Each day I wake up with new possibilities, and new opportunities to touch people’s lives. I want God to use my hands for his glory, and to paint new pictures with each action I perform whether it be taking a temperature, hanging meds, sponge bathing, IV starting, stretcher rolling, surgery assisting… and list goes on and on. God please paint people’s lives with our actions and give us the strength as we face fatigue and disappointment.

Thank you again for all of your prayers. Please pray for the woman with stephens Johnson, the woman with the blood transfusion reaction, and for all of those who have lost someone the last few days. 

Tomorrow I will be in male ward. 

I already have lost part of my heart in Africa

The trip was strenuous yet enjoyable. It took four full days for us to travel from various parts of America to Chimala, Tanzania. I thought it was very interesting that of the seven nursing students we are all from different states. It’s amazing how people can come from across the US and gather together to work toward the same mission. The hospital is in the shape of a square a full square. There are many different wards including pediatrics (watoto), male, female, minor theatre (minor surgery), major theatre (major surgery), and my mind is blanking on whether or not there are more wards. The days are long and I am exhausted by the time I get back to the house. In the middle of the hospital square is a hut, where many people stay throughout the day, both patients and families.

We arrive at the hospital every morning at 730. I have come to love the culture of the Africans. Time is not of the essence, unless it is in regards to worship. At 730 sharp, everyone from the hospital, who is able, joins at the hut and has a short devo. We begin with prayer (tu ombe) and then sing in Swahili, the language that the majority of the people in this community speak. There is a short devo, with a translator for us Americans. Then we sing some more, pray, and split up to various parts of the hospital to make rounds.

I have been in peds the last two days. It is very different from an American hospital. The role of the nurse is something I am still trying to understand. The family is responsible for changing the sheets, feeding the patient, bathing the patient, which I have learned to do as a nurse. Here, the nurse is more like a doctor. I love the environment and the trust that we are given. Our responsibility is more than I would have ever expected. From little things such as sitting and smiling at patients and making sick children laugh to injecting shot after shot after shot, mixing medications, assisting with a spinal tap, pulling up drugs that are used for anesthesia, to many other activities that a nurse in America would not be qualified to do. We have the training, and I feel comfortable in this position.

But, there is also the reality of life and death. Yesterday we had two deaths in the peds unit alone. People are very sick here. The lack of clean water, food, and the deadly effects of diarrhea and vomiting is something that Americans do not have to deal with. There are resources available to fix those problems. But here, in Africa, these are the things that cause death. And it happens so fast. The women were in the ward with the children and one lady motioned me over. The language barrier is extremely frustrating but we do all that we can and we are learning fast. I would point to one thing, she would shake her head, and this would continue for five, ten, fifteen things until we finally got the right thing. She was laughing at me, and finally I got everything done and checked her baby who was extremely tachypneic. I immediately sought more assistance, and sister Janice began working on the child. I went on to work with other sick kids and then I heard a scream from across the room. The mother got up and moved away from the bed. (The entire ward is one large room) I finished what I was doing and then went over and sat on the bench with the mother. She just clung to my arms and my head and was holding on so tight. We sat there and wept together for who knows how long. Our laps were both wet from tears, and when I had enough strength to talk I asked her if I could tu ombe (pray) she nodded and said (endio) which means yes. I prayed in English, which she did not understand, but when I said amen she said asante which means thank you. As much as I wanted to stay, I needed to continue working with other children.

Another difference with the culture and medical work is that in the one large room of pediatrics, and im sure other wards, when a person dies they cover them with blankets and leave them on the bed until the family takes them away. Then, the mother took the child, wrapped her on her back with a kitenge and went home. And this was the first time my heart broke. And there are many more to come. We have experienced four deaths in the last two days, and each time, my heart mourns, breaks, and I feel like I leave a piece of me with each family that I have worked with.

Despite the sad times, there are many good stories too. On my first day we had 26 children, and about half of them have been discharged home. I have seen children not be able to breath one day, and be completely better the next day. I have given many medications and seen improvements.

And my favorite part is making people smile. The women just laugh every time I try to communicate with them. They attempt to speak to me in Swahili and thinks its so hilarious when I shrug my shoulders and giggle.

Oh! And today I whipped out some nailpolish for the mommies…. So with about three people, in about a minutes time, there were fifty or so women waiting to get their nails painted. For about an hour I sat and painted and then some of the other girls had finished in their ward and came to join me. Thank goodness or I would have been there all night long! They LOVED LOVED LOVED the nailpolish. It was such a wonderful feeling to be able to make people smile and just see their eyes light up. Hands were flashing in our faces, people were begging us to take pictures with them. It was a good way to end the day, and by end the day I mean head back to the house for dinner before we go back for rounds. For now, I need to go set the table because I am on dinner duty.

Usiku mwema (Goodnight)

Please continue to pray for us all, the team, the sick, the mourning, the families, and for our hands to do the work of the Lord. To God be the glory.

Meghan

(as the Africans say MEEGIN)