28/11/11- Theatre nursing and rainy season

Two ovaries removed from a very sick lady...

I have had a few days in Ethel Mutharika Maternity Theatre now. I started there on Thursday, so three days to be exactly. The one in charge for now, Jessie Banda, is really nice and a good nurse. So she teaches me whatever I need. The challenges I have seen so far is that this is a much more busy theatre than the main theatre in the hospital. They have elective cases every day, but there is also so many more emergencies. The first two days I was mostly observing the way they do theatre nursing here and being a circulating nurse, but today I scrubbed in. It was an emergency case, a young girl full term pregnant, but the baby was stillborn and the uterus was ruptured. So she had bled a lot, and even more during surgery. And of course there was no blood for her in the blood bank, but we had to operate anyway. So they did a total abdominal hysterectomy, and it took about two hours. When they removed the baby, they just threw it in the bin. It was quite brutal, and not a nice thing to see. But I didn’t manage to get too involved, I had more than enough to think about there, being the scrub nurse. But I did good, even the surgeon was impressed, so I am happy! It is just the fact of getting used to how the different surgeons work, and the names of all the equipment, and what kind of sutures they use for what...

And the in-charge bit doesn’t seem too bad, for now at least. Hopefully things will work out fine, and people are very helpful and nice to me.

I'll keep you updated on that part.

It seems like the rainy season has started here now, there has been raining since Thursday or Friday, and its a bit chilly. So no need to use the pool when I get home from work, it would actually be too cold!

Last weekend I went to Nkhoma to meet friends, just stayed for one night, and on Saturday Gomez and Bertha came back with me to town, we where going out, and they would stay at my house. And all Sunday they where in the pool! I think they had a lot of fun.

And this weekend I had Jessi and Ute visiting, from Nkhoma. That was very nice, they really enjoyed the pool and the nice house (as everyone does), and I think especially the fast internet! Updates where downloaded, emails checked, and Skype was being used!

On Sunday I went to the hairdresser, there is a salon with a Zimbabwean that has specialized on “white” hair. And he was good, so now my hair style is nice and fresh again! I didn’t do anything special, just shorter then what it has been. But it was nice, and it all ended in a very nice scalp massage! And that for 2000MK. About 1/10 of what I pay at home, for the same thing!

I am alone in the house these days, Tone is in Addis Ababa on a FK preparation course, witch she should had attended before she left from Norway, but there was no time then. So now after almost three months here, she is going to be prepared for staying in a developing country... Understand it if you can! And when Tone is there, Frida is staying at Nina and Vidars house, cause they have two kids that goes to the same school. So all alone, but I don’t feel unsafe, it is actually quite nice. I am used to having my house to my self, and I can enjoy my own company!

Tomorrow I’m going to invest in a Trojan “stepper”? I would like to get a treadmill, but they are too expensive, so a “stepper” will have to do. And I can sell it when I leave, so its not too bad money-wise. I still keep up the good work of walking to and from work, but now that rainy season is coming, I don’t think it will be so nice. Cause when it rains it RAINS!!! Norway rain and I guess also “Berit” can go to bed, they have nothing to say here. That's baby rain! And with the rains comes more insects, especially these flying ants, when the dark comes, if it has rained during the day, they are everywhere! They are not dangerous or biting, only irritating, cause they are actually everywhere! I think Maria can recall from last year, and all others that has been here, and they are a delicacy, they take their wings off and fry them. Yummy!

16/11/11 - Visitor Merete 1222 and a whole lot of more challenges!

A lot of things have happened since last time I blogged. Of course its a long time now, but my best excuse is that I had a visitor.

Merete Aarskog from Finse 1222 arrived here on 30^th of October, 24 hrs late because of delay at Flesland (!), but she made it safe here after a night in Paris (not the worse place to be stuck...?).

So that night she was of course a bit tired after the long two days of coming here, so it was early to bed for her case.

She brought a lot of nice things from home, chocolate of course, makrell i tomat, comic books, other candy, mårpølse and other good things I had wished for from home! It was very nice.

I of course had to go to work most of the days she was here, but I took the day off on that Monday after she arrived. On Thursday she went to Zambia for safari, the same safari I went on with my mom, my brother Lasse and my cousin Renathe. She enjoyed a lot! And she has enjoyed my pool and nice house, I think she needed a good holiday with only relaxing! We also went out clubbing some nights (of course) and I think she definitely enjoyed that!

Concerning work, a lot (!) has happened. Grace Chiudzu, the chief doctor of Ethel Mutharika Maternity Wing, came to me on November 3^rd to talk about how I felt about work so far, what I saw as challenges and if there was anything I saw I wanted to change. She was the first person I had contact with when I wanted to come to KCH and work as a volunteer. After a while when we had spoken, and it was a good conversation, she asked me if I had any experience with theatre. And since I don’t, I of course said no, none at all. And she asked me if I was interested in learning and working as a theatre nurse, in the Ethel Mutharika Maternity theatre, and I said of course! That is a big and exciting challenge! And then she asked me if I was interested in working in theatre as a nurse-in-charge, cause the one that is there now is going back to school after new year, and they where really I need of someone! Even a bigger challenge. So I told her what I thought, that this might be too big a challenge for me, but I am willing to give it a go, and I am a fast learner, and I am really excited about it. And I thanked her a lot for the confidence she had in me, I hope I don’t let her down!

So already the next week, November 8^th, I started to have orientation in main theatre in KCH, where they do everything except maternity cases, just to get the feeling and training to be a theatre nurse. And it is so exciting and interesting. I have seen a lot of bad cases, all different things from abdominal emergencies,traffic accidents, breast cancer, hydrocephalus, putting VP shunt on a two week old premature baby, and it is not something pleasant to see. This is just a few of the things I have observed so far, but I stay out of the orthopedic theatre. Many of you might know how I feel about bones and fractures. And for those of you that don’t; I hate it! It makes me sick! Like really nauseas!

So I had four days last week with just observing and trying to learn the routines and the names of all the equipment, the way to hand the things to the surgeon, how to arrange and prepare the table to be most effective and tidy. And I like it so much so far!

So this week, on Monday, I scrubbed in for the first time! And I was all up there, just next to the surgeon, handing him all the things, and it wasn’t that hard! People said that this had to be something I had done before, but I have never! Maybe I watched too much Chicago Hope and Greys Anatomy!

But it is so much fun. So I guess next week I will go to the Ethel Mutharika Theatre and start getting orientated there. Cause I think the easiest part is to know how to prepare and scrub in and handle things over the operating table, but to be a nurse-in-charge will be the biggest challenge I think. I just hope things will work out. I think it will, the chief doctor and Matron are really nice, so I think they will help me a lot. And I have the rest of this month and all of December to be trained by the one in charge now. Cross your fingers for me all!

So today I also took a day off, cause Merete was leaving back home, and I just said goodbye at my gate, waving her off in a car. Hope you arrive safe without any delays! I loved having you here, it was a lot of fun!

So everyone, think about me and my challenges, and if anyone have some good nurse-in-charge tips, let me know!

3/11/11 - May contain strong images

The wing I work in, Ethel Muharika Maternity Wing

I was not fully recovered last time, but thought I would be, but I wished! Things came back even worse, but this time I had had enough, so I just started with Metronidazole straight away, and it did miracles! I love that drug! It is just an antibiotic, nothing more serious, for those of you that are not into medical stuff... So I had another day off work, well actually half a day, cause I went to work in the morning, thinking all would be OK, but it didn’t, so I went home at lunch hours. But started the medication in that morning, so in the evening I was a completely new person (at least I had a new stomach)!

A lot of thing go around in my head these days (not only my stomach...).

Work is going OK, but there are some difficult cases coming in, and the conditions are really serious. And not that it has to be, just that they are because we are in a developing country.

I will give you a few examples. Last week there was a 16 year old girl that came in early in the morning, around 6am. She was 5 months pregnant, and had severe malaria. The morning before she had went to a health center (Nanthenje), about 40 km from Lilongwe, because she had fevers and was not feeling well, they had found that she had very low Hemoglobin and started her on Quinine for malaria. But because they don’t have the possibility to transfer blood, she had to go to Kamuzu Central Hospital in Lilongwe. Her condition would have given her an ambulance, but because of the fuel crisis the country have now, they didn’t have any, so she had to arrange transport for her self. She had her mother there to escort her, but they failed to get transport (read 40 km) because they didn’t have the money for it, and when they finally got the transport, and arrived in the hospital at 6am next morning, the young pregnant girl was gasping for air, pale as a ghost, and her Hemoglobin was at 0,3g/dl! That is so extremely low that it is amazing she even got to arrive at the hospital alive. She died just few minutes after arriving to our ward.

And I have the last two weeks had two cases of young girls (7 and 8 years old) that had accidents when they were out playing, having sticks and nails to enter their vagina and causing trauma. When I hear this I only think that this must be a terrible excuse for child abuse. Of course this can only be my fucked up mind, but I cant see how a child can fall on a stick or a nail that can penetrate all the way into the cervix. I’m sorry if this is a bit strong for some of you to read.

I have discussed the issue with some of the nurses and doctors in the ward, and they all agree with me, and say that they sometimes get cases like this, and after a while the mother admits that the child has been abused. I just hope I don’t have to see more of these cases. It is just too much.

So the hospital is short of everything... Blood for transfusion, painkillers, antibiotics, intravenous fluids, disposable gloves, but if we don’t have disposable gloves we use surgical gloves, and next week we don’t have surgical gloves for sterile procedures, the laboratory doesn’t take full blood count (hematology), electrolytes, kidney- or liver function tests. They don’t have the reagents for the machines. And if we want a urine analysis, we have to send it before 10am, cause after 10am they don’t do urine analysis... There is just so many things we have to accept every day, that should be unacceptable. But we make the best out of it. What else can we do?

Today there was a lady that came from a district hospital, after a removal of a cyst in her uterus two weeks ago, and she has not recovered as she should. So after two weeks of not recovering, they found out that she probably has a bowel perforation after the surgery, or maybe a fistula, and feces are coming out in the abdomen. So they cut a small hole in her stomach, and now the feces just runs out freely, and she went for surgery just before I left work today. I hope everything worked out, I am eager to see tomorrow. I had a lot of work with her today. Thankfully there is a lot of nurse students in the ward these days, so they do a lot and help out, and it is great help! They work harder than the nurses in the ward. Thankfully!

I hope this blog didn’t depress any of you, it is just how I work these days. But I feel I’m coping quite well, I take things as it is, and I cant do everything. I am only me. And I love the challenge!