Sunday, November 6, 2011

Full days


I haven't written in a couple days. There is so much going on it's hard to find time where I have interest in writing on the computer. It seems so trivial after the happenings of the day.
Today.... I did rounds with James, it was good to see some of the patients that I've seen for a few days. Some I haven't seen, and a couple that I actually helped operate on. There is such a mix in the room. Burns, post op, infections, sickness, pre op, beat victim, it kinda smells. Especially when some of the dressings are taken off. I like Jame's style. he has the patient undress their dressing. This seems like the way I'd do it and have done it in the wilderness. Always try and get the patient to do as much as possible, have them be self sufficient as possible. But since nursing school, it seems like everything is done for the patient. I'm sure I'll find my niche. A couple of the post op patients are now pre op. One had a hernia repair and now there is a hematoma in his testicle and it needs removed. Another had a hydra seal and now has a mass and pain in his abdomin. James says it's possible he has the kind of hernia that could be squezzing and killing his colon. Everyone is so polite and greets you with a smile and a hand shake. One of those kinda limp one's, but it doesn't matter because their smile makes up for it. The older women that I helped repair her hernia greets me and we laugh as I say "Lapia" the Nanjeri greeting.
There is NO privacy, there is not a curtain to be pulled, or anything, penises, scrotums, breasts, they all hang out. If someone talks about a problem, everyone can hear... if they speak the right language. Dulba, one of the local nurses is rounding with James and translates what James can't get across in the fluent French he speaks, or Nanjeri, or Arabic he can get across. Where else is there a hospital that cares for people in so many languages everyday.
We move in the the Maternity ward where family members have set up camp and are sleeping on the floor next to pots of food. James asks if they would eat inside at home where they sleep, they all laugh and clean up and go out side, because of course this is ridiculous and they would never do this. I help by listening to two of the women's babies heart beats, it was so exciting, especially because one we weren't sure if there would be a heart beat.
We finish and I'm helping Dulba, one of the nurses change dressing. I am starting in with a women to take out her stitches. A couple of the patients and patient family members from across the room are pushing a young boy towards me and doing hand motions to tell me to look. He walks up to me, puts his head down and pulls down his pants. His penis is wrapped in some tape that looks kinda old and yellow. He seems to have had a circumcision. Which I had just seen a couple down a few days before and learned it's common for boys at age 7 to have them, along with a HUGE party (which my backyard neighbors had yesterday for their boy). Had I not known any of this I would have been horrified at the sight because it looked infected. I tried to clean it, but it looked pretty bad. He was in so much pain and just standing in the middle of the room where everyone could see. I get him to sit and tell Dulbai to get James or Samadi (one of the best nurses/surgen in the hospital) I think he needs an antibiotic and some pain killer. It's such a process.
This little boy is the brother of the boy with full body burns. They are both orphans and their aunt takes care of them but Benzeki and his wife pay for everything for them. I spend the next while trying to get him medicine. I go to the piedeatric bloc (building) to look for Benzeki and run into him and Doug who had just finished rounding. I ask how it went and he said this 6 year old just died and they tried CPR on him and I turn to see the mother sobing. He died of Malaria that could have been prevented had the parents excepted suggested treatment. UGGGHHHHH, I am so frustrated and sad with this situation. These kids, these people, everything is dirty.
I'm back with the little boy and his infected penis and a little boy, probably 1ish walks in a drops something, glass goes all over the floor. Of course all the patients are barefoot. He goes to pick up the glass and I scoop him up and take him out side waiting for a parent to claim him. There is some straw tied together, so I ask to borrow it from a women and sweep up what I can. TOTALLY not even close to any protocal in the US. I just can't believe this day, there is so much going on. This is just like everyday here, so much.
I go to the OR and I gave my first shot, which happens to be Ketamine. A drug used a lot here. It knocks people into lala land. James is going to remove his hematoma. The guy is making sucky and kissy faces, we chuckle a bit, I'm making sure he doesn't touch the sterile area and Simione is holding his feet. When James makes the cut into his testicle he reacts and I am holding him down the best I can. He gives a local anesthetic which helps but the kid is squirming a lot. It is so common to use this drug for procedure, but the reaction was so intense. He has to have his testicle removed, but the procedure goes well. whew! I did not like holding down this kid for a surgery.
I finally go for lunch around 2:30. Doug and James and I seemed to all be wondering in around the same time and got some left over pasta from Tammy. I felt so nurished and satisfied. Doug was going to do a lumbar puncture and I went to help, not really knowing why he was doing one. The boy is non responsive, he's not 10 years old, has an IV and won't respond. Perhaps Meningitis or Cerebral Malaria. Doug brought Corey, Tammy's 15 year old son to translate from English to French and Corey brought his friend to translate from French to Nanjeri. Sure why not bring 15 year olds into the piediatric ward to help with a lumbar puncture and translate! I roll the boy and realize he had urinated on himself and doesn't have a catheter. Oh yea, I took out my first catheter today on a women who had lost her baby during birth and had pulmonary edema and was unconcious. The father is holding the boys head and I am holding his arms and legs, hoping to hold him still if he responds to the pain of a spinal tap. Doug inserts the needle, the boy barely flinches. I am sadened that he doesn't because it means he's worse then we thought. That's a lot of pain not to react to. His eyes look serious and they well up with tears as he stares at his father. My heart is breaking. Is he in pain and just trapped? The spinal fluid isn't as cloudy as Doug would think for meningitis, so he guesses Malaria. We'll see what the lab says.
These days fly by. I wish I could do more. I sat with my homestay family and they showed me photos from past nurses/doctors who have stayed with them, we sat on the matt under the bannana trees, clear night, stars and moon. The 3 year old broke into a drum beat and the mom and oldest daughter sang a bit. We laughed as I tried to talk in French, but they always listen with intent and patience.

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