Day 8
Today I spent the first of three days on the male ward at Kijabe the hospital (and it was also the kick off day for centennial celebration week). I had a wonderfully busy day. I realize I do so much better when I'm busy. Everything about me really loves being kept on my toes.
At Kijabe hospital there aren't separate floors for differnt medical conditions - instead it is split into male and female wards. Most of the rooms have 8 people crammed into them with varying health problems. For example, in the room I was working in today had a gentleman who had just had a colectomy and was on abx through a central line, someone with expected HIV, a TURP (with CBI through a regulat IV line) venous ulcer on the foot, a young man with severe electrical burns on his arms, and a couple unknown issues.
I was partnered with Leah, a new graduate from the Kijabe nursing school. I had so much fun with her today. It is quite obvious to me that she loves nursing and is passionate about caring for people. She knows pretty much everyone in the hospital and is friends with them. And she decided that it was her mission to find me a boyfriend today, introducing me to all of her single friends in the hospital. Haha. What a character!!
There are so many things that are different from nursing in Canada. I don't even know if I can comment on all of them, because .... it is just so much. But somethings just really stand out. For example, there are no saline flushes here, and saline used to flush IVs, reconstitute meds, flush central lines, dilute meds... they all use either saline drawn from an IV bag, inserting a needle into a soft plastic saline bottle, and I am pretty sure none of them are sterile - nothing is cleaned first with alcohol swabs, they sit on med carts and are handled by any number of people and are not dated once they have been opened. Meds drawn from ampules are injected with the same needle.
And the most shocking thing to me today was seeing meds given through a central line. When we got there, the clip was open. I just about had a heart attack!!! But "apparently" that is how it is supposed to be?!?!? oh my gosh. As she flushed and started the IV I stood there praying no air had gotten into the line. Thankfully, he seemed ok. Later when I was giving a med through one of the other lines I tried my best to remember all the steps...
Clean the port WELL... But all we had was cotton swabs and warm water. Don't unclamp line until the syringe is attached. Check for patency and flush with NS but don't have it available, so aspirate with the med syringe!???! Talk the the patient about whether he feels any discomfort or hears any swooshing sounds? Slowly administer med (push-pause) and monitor patient (the meds were cold, poor man was so uncomfortable - thankfully it didn't take too long). Reclamp line with positive pressure. I should have flushed the line again after the med, but again, don't have any. Yikes. I am SURE I even still missed some important steps... Again, just prayed my way through the whole thing. He seemed to do ok. Good grief.
There were other big things that I noticed... But my brain is a little foggy right now, I honestly can'f think of them at the moment. I was on the floor from 7-5, then scooted home, got changed, went up to RVA - said a quick hello to some of my favourite people. Then I flew back down the hill (6.2km day)... Then started making my supper, jumped into the shower as my rice was cooking only to discover there was no hot water (brrrrrr!!!), finished making supper and quickly devoured it, and was then picked up my Libby and went to dessert night at the Davis' house. Now its 10pm and I am definitely feeking ready for bed. I am sure there will be more interesting stories to tell as the week goes by. For now though, I really need to crawl into bed. Goodnight!!
Day 9
Another full day on the Wairegi ward... The male and female wards are named after people who had some kind of impact on the hospital and the constuction or financing of the ward. So the male ward is called Wairegi, and the femald ward Salome.
I was put on a different nursing team today and was working with Virginia. She was really nervous about working with me, and kinda avoided me at first. Her team had a lot of uncomplicated patients, so we finished all of our tasks pretty quickly. So then she kinda of-loaded me to work with Monicah. So I gave lots of meds today. It is quite a crazy system they have, and I'm always so nervous that I am going to give someone the wrong meds. They never really seem to read what the meds are and have them "memorized" well enough and know the colours, dose and packaging? I hope!!! They reconstitute meds, use half and save the rest for later even though it says on the packaging that the abx must be used immediately and the rest discarded. I asked Leah about it, and she said that it would be a waste of money to throw it away.... Ya, I get that it is an expensive med, but is it even useful after 24 hours when the next dose is due? Is it dangerous? I don't know.
One of the grossest things I've see so far happened just before we were leaving to take tea. Leah and I (ya, at this point I was back working with Leah because everyone else's work was done and she had a pretty complicated team) were about to head out the door when one of the other nurses came running after us telling us that the guys colostomy bag had leaked all over thd bed and floor. When we got to the room there he was sitting in a pool of what looked more like chai tea than what you would expect to see from a colostomy bag. On closer inspection... Not poop... It was puss. Where all thst puss came from, I really couldn't tell you. The inferior aspect of his abdominal incision was dehissed, but from what I could see it was an area about 3 inches long and 1.5-2 inches wide, and maybe a quarter inch deep... Could almost 2 cups of puss come from that? Anyways, we redressed the wound and went for tea.
Again, sterile technique, sterile dressings.... They really don't exist. How this wound is ever going to heal is beyond me. It was just covered with strile gauze and then taped up. That was that. When we came back from tea it was completely soaked through again. This time we worked s little more on cleaning the wound with sterile NS, sterile gauze... And clean gloves. No wonder wounds take so long to heal and infections are so common.
Everyone was asking me questions about Canada, about nursing school, about how much nurses mske in Canada, what me house looks like. They have come to the conclusion that I am rich - because I have a car, am going to school, will be making fairly good money when I graduate and am spending my summer break here. I'm not sure how to explain to them that I'm not. Haha. They all expect me to pay their way to come to Canada and find them jobs there. I apologized that this would not be possible, and that I don't even know what kind of process they would have to go through in order to practice in Canada. But it made me realize that I really truly am so very very blessed. There is very little that I need or want. And I so need to be thankful for all those things.
After work I went for a 13km run, ate and sat in on a little chat thing that is going on with the group that is here from the states with "Love Africa" while I ate my supper. What a lovely group of people. They all know who I am (the running-nursing-Canadian) and when I left for the hospital this morning a bunch of them called after me "bye Jacquelyn, have an awesome day" and this evening they were all asking me so many questions about nursing, running and all sorts of things. I honestly feel like a bit of a celebrity. Haha. It is so good to be surrounded by so many amazing, loving and beautiful people who desire to bring glory to God through all parts of their lives.
Alright, I've got to get to bed. I'm pooped and its onky Tuesday! Still three more big days this week!!!!
Days 10 & 11
So yesterday ended up being such a full day that I didn't have time to write (and it was a wonderfully full day). It was my last day on Wairegi, which was sad to be "leaving"all the wonderful people I had met and worked with there. The more time I spend here the more I feel comfortable with helping.
On Wairegi yesterday I did a lot of bed baths, helped change some pretty gross dressings, gave some meds, showed them what our IVs look like, and spent a lot of time talking about whst Canada is like, and what nursing is like there. They were absolutely facinated and in awe of how our IVs work... How the needle locks into a safety when you pull it out, how you can see the flashback in the line, our prefilled saline flushes, and how the syringe and IV lines lock together. One of the nurses sat there for 5 minutes trying to figure out the needle locking system.
One of the most challenging parts of my day was having one of the patients pass away. Honestly it was a miracle that he had lived as long as he did, but it was still tough to witness. On the first day that I was in the hospital when I was in the ICU, this young man was being taken off kife support. I had actually sat in on the family meeting where the doctor was explaining to the family that, because there had been absolutely no improvement over the past 4 days, and because he had been admitted with a serious head injury and had never shown any indication if brain function/recognition/response to any verbal communication, that it was highly unlikely that he would improve. It was tough to see who I was assuming was his brothers sit there in the room obviously extremely distraught over what was being discussed. The doctor was very clear that by turning off the ventilator, that it was quite likely that he would stop breathing, and that at that point the hospital staff would not be taking any measure to resusscitate him. By the time they turned off the machines, I had already left for the day. I didn't know what had happened to him until I saw him on Wairegi 5 days later.
Still he was not responsive. His eyes were open, but were fixed in a wide-eyed stare. He would "move" or tremmor every now and then, but mostly there was no movment. Yesterday one of the students and I gave him a bed bath in the morning. As we rolled him in bed and changed his sheets I realized he was burning up. I had never felt someone that hot before. I asked the student if that was normal, and she said that he had been running a temperature the last few days. About an hour later the student was taking vitals on all the patients and couldn't find a pulse. When I saw her soon after she knodded towards his bed and said "he has gone to be with the Lord". He was only 2 years older than me. What a tragic thing... That this is a country where young men die like this so frequently. My heart just breaks for his family and I pray that God with bring them comfort and peace during this time.
I am trying to remeber what else happened yesterday and I'm struggling! There is so much that is going on that if I don't write it down right away... It all blurs together and I forget what happened and when. I think that is all the exciting stuff that happened at the hospital. I left the hospital a bit early yesterday sp that I couls get some groceries and talk to people back home. It is so wonderful, such a blessing to be able to talk to my family and friends, I absolutely love it.
When I got back to the guesthouse I heated up my leftover supper from the night before and sat down to eat just as the Love Africa team was also sitting down. I invited myself to join them (sit with them) while we ate. It is such a blessing to be able to fellowship with such beautiful people - and that was only the beginning. After supper I spent time washing dishes and talking about running with one of the guys in the group. Then was invited to join them for their debrief and testimony time in the evening. Such a blessing!!!! God is so good. It was wonderful to feel so loved, accepted and included by the team.
I went to bed very tired and with a full, blessed, and joyful heart (which is why I didn't have the time to write)
Wow - ok, I'm so tired and my eyes are half closed, but I am going to try to recap today before I go to bed. First day on Salome (the womens ward) and it was SO good. Honestly, each day here just keeps getting better and better! I am feeling more useful and "comfortable" every day. Introducing myself each day is always a little bit uncomfortable for me... but I am getting better at it. Today I was partnered with Janet - and I just loved the way she nurses. Gentle, kind, knowledgable, thorough. She sent me off on my own first thing to help a blnd lady with her bed bath. Oh the language barrier can be challenging!!! Haha. I get so many "tsk tsk tsks"whenI say I don't know any Swahili.
After bed baths it was time for bed making. And then I was on my own again for 3 different dressing changes. A nasty skin condition all over one lady's back (don't know what it is but praying I didn't somehome infect myself with it), a foot amputation (due to gangreen), and a tibial fracture (post-op surgical sutures). I was extremely glad to find that the hospital does infact have sterile dressing kits, and got to use a new one for each of these dressing changes. Again- the language barrier made things quite challenging with a couple of the women. I felt like I did a good job, like I actually cleaned them and was a part of improving their healing. The hardest one for me was the lady with broken tibia. The cast only stabilized the leg on the posterior aspect so that ths surgical site on the anterior aspect could be accessed for cleaning. For both the unwrapping and rewrapping of the tensor around her cast I had to lift her leg up to pass the tensor underneath. I could see where the break was, because I could see it move. Gorss. And cool. And so painful for the patient.
Again I spent a lot of time talking with the nurses about what Canada is like and trying my best to encourage them. I'll be honest... I thought that a lot of my time here would be spent impacting the lives of the patients - and now I'm seeing that I might be having a greater impact on the nurses that I am working with. Not what I had expected, but I think equally as meaningful.
Over all, a wonderful day on the ward. Tomorrow is sure to be an eventful day. The president is arriving by helicopter at somepoint for the Centennial Celebrations and will apparently be taking a tour of the hospital. There were people all. Busy around the hospital all day cleaning, painting and making last minute changes.
After a short run I arrived back to a house full of my new friends and the smell of something delicious cooking in the kitchen. I zipped upstairs in hopes that I could grab a shower before we ran out of hot water. With a guesthouse full of adults, it had been almost a week since I'd gotten hot water - and hallelujah there was! As I was leaving, Jess (one of my lovely new friends) was just coming to take a shower... And invited me to eat supper with them - not just to sit with them while I ate my food.... But to eat their food. God, thank you for that wonderful blessing that I do not deserve but was more than willing to receive.
This team has adopted me... Made me an officially unofficial member. So many of them have said how much they love that I am here and love that I am "part of the group"... God, that is so hard to accept at the same time that it is the most wonderfully encouraging thing to hear. Over and over many of the girls have commented on how strong, brave and courageous I am for coming here alone - I guess?! Haha. I feel like because of how God brought this trip together so incredibly... I forgot how adventurous it must seem to be doing it "alone". But the best thing is, is that it is not alone - not it anyway. I eat breakfast with Tracy every morning. I work with amazing people every day. I have the Love Africa team to spend time with. I have the Halestraps house that I know I can go to any time I want (or whenever I need a hug). This evening I was also invited by anothed one of the missionary families to come and hang out at the house whenever I need. I have internet access to talk to people back home. I have phone that my parents can call me on. And MOST importantly, I know without a shadow of a doubt that God is with me through and in every aspect of this trip. The only times I am physically alone is when I am running and sleeping - and God is there too.
Alright, time for bed for me. I'm pooped. One more hospital day this week and then who knows what the weekend wilk hold. I realize that this is going to be a LONG blog post when I finally get around to uploading it... Hopefully it is interesting though, or if its not then I hopd you're not still reading!
Day 12 (Friday May 22, 2015)
Seeing as we're now on the 5th "catch up" day... I'm a little hesitant to write very much for fear that you're already bored to tears with my ramblings. So, I'll do my best to keep it short for today's entry. I think that'll be easy for two reasons... 1 - it was a fairly uneventful day, and 2 - I am very tired and just want to crawl into bed.
I spent my second day on Salome today, and again thoroughly enjoyed it. Today I was in the HDU (high dependency unit) with Joan. The HDU is similar to the step down units at NRGH, except with twice as many patients and half the resources. There are 6 beds in the room (where other rooms on the floor have 8) and these patients just need a little extra care/attention. The three patients that we had for the majority of the day were a young girl who had been pushed off a balcony on the third floor and had femur, mandibular, zygomatic and humerous fractures... A girk my age who is pregnant and has meningitis... And the third was a woman with very poorly managed diabetes and wound that needs frequent surgical debridement (she went into the theatre for the the third time today).
All the cases were pretty complex, but also quite stable... Which was good because the HDU was crowded for most of the day with people hoping to catch a glimpse of the the president who came to visit the hospital today. Pretty much life stops when the president comes to visit. Nurses and doctors all went out to see him and hear his speach, most of the schools in the area came out for the event (and all showed up fairky early because, who knows what time he will actually show up, this is Kenyan time we're talking about here!)
I really didn't do much in terms of nursing today, but spent lots of time visiting with the nurses and doctors. I was very proud of myself for asking one of the docs a question while I was listening in on rounds. With the patient with poorly managed diabetes, they were giving her D5W, which contains dextrose (sugar)... And with a patient who has consistently had blood sugars around 19 (which is way too high) it just didn't make sense to me. So I asked why? The doc was awesome with answering it. So kind and willing to explain. Apparently so often when people come into hospital their blood sugars actually droo down into their boots (which can be very dangerous) and it greatly increases their risk of mobidity and mortality. And infact, earlier this week, with actively trying to lower this woman's blood sugar with and insulin drip they had nearly killed her. SO.... The key for this patient (who also had a very low urine output) was to alternate D5W with NS to maintain, and slowly lower her blood sugar at the same time... Safely!!
Ya, I think that is pretty much all I have to say about today. Was out for 2 hours this evening for a very slow run/walk... Made some lentils, rice and veggies for supper, and now think I'm going to go to bed "early". I'm undecided about what I am going to do tomorrow, there is a 10km run as part of the final day of the centennial celebrations which I feel like I should probably participate in, but I also really feel like sleeping. It starts at 7:30 tomorrow morning, and I was kinda looking forward to not setting an alarm. I will set an alarm, but I am not going to pressure myself into it. I have had a very full/busy past two weeks, I'm tired and I woke up in the middle of the night last night with a terribly scratchy sore throat. So, I will most likely end up turning my alarm off in my sleep tomorrow morning, but if I setit I can at least say that I tried!
Day 13 (Saturday May 23, 2015)
So I definitely didn't make it out for the run this morning - for a couple reasons. First of all it was pouring rain last night, and when the ground gegs wet here it is a crazy slippery slick clay-like disaster (not much fun to run in). And the second reason is because I slept through my alarm this morning. Oops. But I'm pretty sure I needed the sleep. I have had a full/busy first two weeks here and I am currently fighting off a cold. So I slept until my Kijabe phone started ringing... And I groggly asnwered a call from my parents. What a womderful blessing and gift to be able to talk to and see (when I am able to facetime) people back home. I am so thankful for the technology we have.
After a short phone call I went downstairs and had breaky, and was consulted on a number of health issues from the Love Africa team. They went on a big hike yesterday and got quite lost, and came back with scrapes, bumps and bruises. I have been adopted as ths officially unofficial Love Africa nurse. :)
After breaky I went for a LONG 4 hour run/walk, showered and am now up at RVA to post this ridiculously long blog post. I don't think I have anything else of interest to share for the time being. Hope you're all doing well. I love and miss you all so very much and cant believe that I am already almost at the halfway point of this adventure!!!! Have a wonderful weekend!
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