30/3/12 - On the move...

This has been a tough week...

On Monday I was told to move from the house where I have lived for the last six months. There was a new midwife coming, together with her 18 year old daughter, and since I have just lived there on Bergen and Haukelands good will, I was now told to move, to make room for them, even though there is still a spare room. It was not Tone or Fridas decision that I had to move, they both wanted me to stay very much. And I wished I could have stayed there, cause now I’m living at this “expensive” (for my budget) and not too nice guesthouse/lodge, while I’m looking for another place to stay. And there could be a lot of good places to stay, but my issue is that I need it to be in walking distance to the hospital. I am not a stranger to take the minibuses, but you can never rely on them, and you can never know when you get to be at work, or even home in the afternoons, especially with my colleagues coming to work whenever they feel like it, and I am not comfortable with the thought of walking alone outside after dark.

A foggy moist morning

So the last few days have been up and down, some crying, some helplessness, some frustration, some sadness. This was mostly down I guess, but that’s how it feels.

And if I don’t find a place to live soon, I cant stay in Malawi for much longer, cause I’m gonna spend all my money on expensive guesthouses. But I think it will work out, it always does, for good girls...

I’m gonna go see some places tomorrow, and I have taken some days off to get everything sorted and in place, I just told the people at work that if I can't take these days off, to find a new house, I’m gonna have to leave soon. So they were OK with it! ;-)

Cross your fingers for me!

Eliseo and Maureen

On Sunday Maureen, Eliseo and Svein Elias came to Malawi. Maureen is in Livingstone, Zambia, doing some practicals as a social worker student. She arrived in February and is staying for three months. So when Elias and Eliseo came to visit her, they are now taking a round trip to see different places. And luckily I had taken my day off on Monday, to have a long weekend, and it was perfect, cause they came quite unannounced. It was very nice to see them, and also a bit strange to have them here in Malawi.

Since there is not very much to see in Lilongwe, we just had a quick drop-in in town, before we went to my former house to enjoy the pool. They left already the next day for Lake Malawi.

Gunhild has also left Malawi now, she went to Zambia on Tuesday, for one week, before she goes to Ethiopia, and then Norway. I’m gonna miss her big time! She has been a dear friend here!

So today its Friday, I’m in my room, listening to music, not too keen on hanging with all the backpackers that stay here. Or maybe I should...? Just to do something? Get my troubled mind focused on something else? We'll see...

14/3/12 - Back to life, back to reality

My trip back home was a little bit longer than planned. I felt when I came home that I was very exhausted, and needed some time off from work. And it was good! I’m back now with some new energy!

Who would have thought?

The story of my grandma has not yet ended, she survived the battle, but in a fair condition. Now she has been offered a permanent place at a nursing home for old people, and we are happy that she won't be sent home, cause she is very mentally and physically impaired.

Back home I did different things. Trying not to spend much money, and I managed quite well, I of course stayed for free, I ate for free, and I don’t think my budget is suffering yet. I spent the most of my time in Bergen, with my mom and dad, but I also saw some of my friends, I missed them a lot, and I also went to Finse a couple of times to see Mike, I guess its not until you meet someone again, you really know how much you miss them. That was very nice! I was actually a bit nervous when I was going to see him! I also met his friends and colleagues there, a lot of nice people. And it was nice to see Merete again! But Finse didn’t show itself from its best sides when I was there. I have never been in so many snowstorms, and of course I was feeling colder than everyone else, I came from Malawi! Even Mike was laughing at me, he doesn’t have any problems with the temperature now.

To top up a little bit in my account, I took a few shifts in my hospital, in the ward I have been working in for the last nine years. It was so nice to see the people again, and to work as I’m used to again.

I am now back in business in Malawi, and things are even worse than how I left it. Its like things have just fallen apart since I left, they don’t give a shit, or they don’t care... I don’t know. The place is in a mess, people seem to be more lazy then before, and they have given three nurses time off (leave) when we in general are short off staff! Imagine! So my first day at work was hell, we were two nurses at work up till eleven, a long operating list, and a lot of things out of stock. It was a bit frustrating... But my second day was better, we were more people and not so busy.

The country is going to hell...

The government here is so messed up, I don’t even know where to begin with the different problems. The one that we see, that is most visible, is still the shortage off fuel. The two weeks before I left for Norway, it was actually quite good, there was fuel most places in the country, and no lines at the filling stations. But since I left, and also before (I think I have told of this earlier), there is empty filling stations, and if there is a rumor that there will be fuel coming, the lines from the stations goes for kilometers!

And you can hardly find foreign currency here, and they say that a lot of companies and shops have to close soon, cause they don’t get the currency to buy the things they sell or do, and they go bankrupt.

The World Bank and different other donors are trying to help the country, but they put some demands for the president, and he is a man that doesn’t like being told what to do, so he actually told a lot of organizations and donors to what? Go to hell... Charming guy. He definitely doesn’t want whats best for his country and people, only for him self. He has the biggest mansions, I don’t even know how many, and his private jet, and all his cars, and all his trips abroad to go shopping and enjoy life. While his people is starving and suffering in all kinds of ways back home. How can anyone have the conscience to do that?

There are some organizations here that have set a deadline today, for something drastic to happen and improve here, and there are some meetings going on as we speak, but it will probably take some days before we know anything. I am not too optimistic about it all...

12/2/12 - I'm coming home...

My grandma and me in October 2006

On Thursday I got the terrible message that my grandma home in Norway is seriously ill, admitted in the hospital. So on Friday, after getting some more information about her condition, I decided to go home. Europeiske Insurance helped me a lot, they were wonderful and efficient, and they are paying for my ticket. I got a ticket for Saturday evening, and are supposed to arrive in Bergen tonight at 10.40pm. So I’m here in Amsterdam now, have some hours to spend, and its not my favorite hobby, to hang out in airports. And I just feel like I want to get home immediately, why am I here, doing nothing? But of course I understand, I just feel so hopeless sitting here.

The last days my grandmas condition has varied a lot, one period it seems like shes not going to survive, and the next she is sitting there, talking, drinking, eating, so nobody knows what will happen. But the doctors didn’t seem too optimistic. She has been strong before, but she is now 89 years old, and only time will tell. I both can't wait to see her, and also I don’t want to see her the way she is sick now.

Because I’m working in a hospital in Malawi, I have to take a MRSA test, and wait for the results before I can go in to the hospital. It is a bacteria that is quite harmless, to healthy people, but if a sick or old person gets the bacteria and infection, it can be very serious. So they will not allow me to enter the hospital without a negative test. So we will see when I can get that done. I will probably have to wait till tomorrow morning, I will probably go to Haraldsplass and do it. Hopefully they can do it fast fast!

I don’t know for how long I will stay home now, maybe two weeks, I just have to see what happens.

4/2/12 - M&M - Mental Meltdown, Missing Mike, More Mabvuto

Yet another month has passed. Time flies, I thought Christmas just ended... Its already four weeks since we were at the lake. Mike has been away for six weeks. I’m coming home in less then 24 weeks. Its actually quite surreal. Even though it feels like I have been here forever, I also just arrived, 19 weeks ago.

Recovery room

Work is work... Busy days most of the time, long days even more often, the other staff keeps up the good work of coming in LATE. The latest I have left work now is at 5.40pm, one hour and 40 minutes later then I’m supposed to. But I have started not accepting it, but tolerating it. There is nothing I can do about it. I can report I as much as I want, but there is no consequences for them. They cant get fired, cause we need the staff, and its almost impossible to get new ones. It will not effect their salary (when they finally get their salary) and they really don’t care. If I tell them (in the beginning I said it quite nicely, now I shout at them) the just laugh and have some stupid excuse. And I cant find myself to come late at work, even though I sometimes want to come in at 9.00am and not 7.30am. Of course I sometimes come in ten minutes late, but then I feel bad. Imagine!

We have big cases every day, Monday to Thursday its booked for the consultants and their patients, Monday – Dr Chiudzu, head of department, very good, tough and persistent lady, Tuesday for Dr Phiri, really good effective guy, Wednesday for Dr Bonongwe, stupid guy, full of him self, Dr Chiudzu's right hand, Thursday is for Dr Foba, UN volunteer from Cameroon, very good and funny guy. So my favorite days in theatre is Tuesdays and Thursdays, and some Fridays, cause that day is for emergencies only, and for scrubbing theatre if we have time.

On Wednesday I had one of my worst days at work since I started, just because of this idiot of a doctor. He made my day hell, difficult to explain, he is just so important that everything he says is the law. But I’m getting there, I have started talking back to him, and it might seem to work, its just that he was worse then usual on Wednesday.

And when Friday came my day was also bad. I think I’m in a bad period here now... I am so angry and irritated with these people that always come late, I thought I could handle it, and just don’t give a shit, cause I am here to help, and that is my main aim here, but I have reached a point where I really am upset about this. So yesterday I went to talk to the Matron, to say that if this continues, which I think it will, I am not interested in working there, at least be the in-charge. I really don’t want to quit working in theatre, but I cant just be working and not having any life outside of work in the weekdays. She understands me, she says, and she wanted us to have a meeting with the other staff, and she wanted to talk to the head of department (Dr Chiudzu) and she hoped this was something that we could work out. She didn’t want me to leave theatre either. So when I came back to theatre, I said to one of the nurses that today it was her turn to wait for the night staff to come. “No, I’m so tired” was the reply I got. I could understand that, cause she had also been on night duty he previous night, so I went to the other nurse, and she said she would do it, if I wanted her to get robbed on her way home. And she laughed, and I told her how sick I was of always being the one to wait for the night staff, and that I every day sit there until 5pm, if not later, and she just laughed again. I told her I was serious, its not funny, but people here are not good at talking serious to each other. But she said she would do it. So I scrubbed for the last case, and while I was there assisting the surgeon, this nurse left... I was so angry I could cry! (that’s what I do when I get really angry..) So the one that was so tired were there with me, but I couldn’t give a crap! I left at four, leaving her there, and I was so upset when I walked home, I was about to cry several times. I’m so sick of these people here now, I don’t know if its just a bad period now, or if I’m for real fed up, we'll see. Thankfully I have Tone here, which I can talk to about my frustrations and problems!

One morning I came to work, I found a bird
in our recovery room...
Just outside our theatre... Imagine!

We are still struggling with getting the things we need at the hospital, but at least it seems like its getting a little better. I have given my staff the surgical caps, and they look so nice all of them. I should take a picture one day and post it. But I haven’t given to all of the once I wanted, I’m just waiting for some more to be made.

But the pharmacy and stores at the hospital are acting like they own the place and the items they are supposed to hand out to the different wards and departments. Several times now I have experienced that the order book comes back from stores, and it says that most of the things are out of stock. But if you go there and check for your self, you find that they have a lot of things. The system and politics in these stores are messed up! I don’t even know how they are thinking!

Last weekend I went to Nkhoma to see my friends. I stayed at Gunhilds house, and I was hooking up with Jessi, Amanda and Keith. It was nice to see Keith again, he was my best friend in Nkhoma last year, but I haven’t met him yet, cause he has been in Blantyre at school, but now he moved back to Nkhoma.

Friday I just had dinner with Gunhild (risgrøt! Yummi!) and Saturday we went to the market to do some shopping, buy too many chitenjes, and we had lunch, not at Mr Banda, but at Gunhilds place. In the evening we had dinner there with Jessi and Amanda. Sunday I left for town around noon. It was a nice and relaxing weekend.

Rain season is really getting to us now. Well, its not like its raining all day, but when it first starts its crazy! It can even be days where there is no rains, but the days it does, it is so amazing. All the thunder and lightning, every ten seconds, the downpouring, the power of nature is breathtaking!

Thursday I walked home from work, as I usually do, and the minute I stepped outside it started pouring, seriously! I was so wet when I came home, I had to “swim” across rivers, draining systems in this country is not the best, and surprisingly I didn’t meet many people on my way. Its like the city stops when its raining heavy, nobody wants to walk in the rain, cause then they get malaria... Yeah, what ever...

This weekend Gunhild is coming to town, hopefully we can go out on Saturday. I am so up for a night out, getting some drinks, dancing, meeting people! I really hope so. There isn’t much I do during the week, I’m usually late home from work, and tired. So I stay home, working out, watching some Scrubs, chatting with Tone, basi... And talking to Mike of course! Who I miss like crazy these days. And it doesnt make it better when I’m having a hard time at work as well.

18/1/12 - Challenges: bring them on!

The new year has started good, nothing unusual, just working as normal, if you can say that its normal for a general nurse to be in charge of the main operating theatre in a maternity wing...

Midwife: no. Theatre nurse: no. In-charge experience: no.

As I have said before, the challenges don’t come to rare...

I have finally started getting used to bossing around, both with nurses, maids and doctors. Routines are in place, and I’m getting used to the different surgeries. All though there is a lot of things I don’t know yet, I don’t feel so completely lost as I did in the beginning.

Some other challenges we meet every day at work, is the problem of getting the things we need. I can say I’m so “lucky” not to work in the other wards, where the biggest problem is to get the medications that saves peoples lives, we don’t have many medications in theatre, only the anesthetist use them, but every day the order box comes back from the stores with only a small amount of the things I have ordered. For example, surgical sterile gloves, we only get in size 7, which is perfect for me, but for most other people, especially the male doctors, it is a big problem. Last week one of the surgeons got cramps in his hands because of poor blood flow since the gloves are too small!

And urine bags for catheter use we don’t get anymore, so we have to run around borrowing from other wards, but they don’t get it either of course, so I wonder what we will do when there is none... Imagination should come to a rescue I guess.

And every week I see disturbing and terrible cases and destinies. Yesterday we had two (!) cases of , Google it if you wonder what it is and want to know more about it, but it is a cyst that grows on the ovaries (don’t know if they can appear other places), its called a teratoma, and the cyst doesn’t consist of fluid only, no, it was actually filled with hair, and there was also a tooth in there. OMG! I felt sick when I saw it! And I was the nurse scrubbing in for the surgery, so I had to look, had to touch. It is not a very common thing here, so we were very surprised when the next case was the exact same thing! I wasn’t even over the first case, and there comes another one making me sick again!

And another thing we see here a lot, is patients that comes in, maybe a week or so after a cesarean section, laparatomy or other big surgeries, they had the surgery at a district hospital, and they have terrible complications. Peritonitis, necrotic uterus, wound infections, perforated bowels and bladder, you name it, they have it. And they come in to be fixed up, and it is not a pretty sight! The sight, the smell, everything... And we do our best to fix them, but if they make it through at the end, I don’t know. That is a thing I miss from working back home, the possibility to follow the patients and see results and outcome. I don’t know if I ever will specialize in this area, we'll see!

Dinner at Cool Runnings

The weekend after new years weekend, Tone, Frida and I went to Senga Bay and Cool Runnings to get some beach and sun. We left the Friday afternoon, came there around seven, it was raining (…) but we enjoyed the perfect Chambo (fish from Lake Malawi) dinner, the only thing I eat for dinner there. They prepare it so nicely! That night it never stopped raining, lightening, thundering, and it continued till next morning. We were not too happy about that, but around noon, the sun came out and we could enjoy some hours on the beach, get some sun. it was amazing! Bathing, reading, sleeping, and no sunburn!

In the evening the rains started again, but the next morning it didn’t, so we had some hours to enjoy again, but the sun didn’t come out completely, but it was actually nice, it wasn’t too hot. At lunch hours we headed back home. It was a nice and relaxing weekend with good company! And it was nice to see Samantha, Felix, Tiger, Isaac and the others again, people that work there. They know me by now, I have been there so many times! Its one of my favorite places by the lake!

Last week and this week we have had a “visitor” in theatre. She is Nicole, a German theatre nurse, has worked in Norway, Haukeland University Hospital, in many years, and is now in her third year of working in KCH theatre. She is very good, and very experienced, so she came to us in EMMW theatre to see what things we need to improve, find good solutions, and just help us out where we need it. It has been very good, she is a nice girl, I enjoy her company.

Update on Malawians in Finse:

Tuta is going home on Friday... Things are not good at home when he is not there, his grandma is sick, too many unsolved problems before he left, bad planning I call it. Call me cynical.

Mike will stay, it is not too nice for him I guess, but he is determined to stay and work, and I support him 100% on that. It would be a waste of money and effort to go home now, he hasn’t even made enough money to cover for the plain ticket. But we will see if he stays there as long as planned, now that he will be alone. For my self I hope he doesn’t...

2/1/12 - HAPPY NEW YEAR!

Christmas and New Year has past, with no big problems. It has been quite OK, even had a tiny bit of Christmas feeling on the 24^th (that’s the day we celebrate in Norway). Pinnekjøtt was prepared (our traditional Christmas meal), and that smell is magic! It was even emotional! Fridas dad had arrived on the 22^nd, and he had brought some meat for us! And Toro kålrabistappe, better than nothing.

So on that morning, we watched “Tre nøtter til Askepott”, a movie that runs on TV every Christmas eve morning, I almost cried when it was starting! Also a good contribution to my Christmas feeling! We made a Christmas tree out of two palm leaves we found on a palm tree in our garden, and decorated it with whatever we had and could make. Its was quite nice in the end. And then we had something we could place the presents under.

"The family" at the dinnertable

Christmas day we were invited to Nina and Vidars house, for a late lunch, a lot of Norwegians were invited, and it was a nice party. Good food, good drinks and good people.

The following days where lazy. We didn’t do much, and the weather was not nice. Its been raining a lot the last two weeks. Frida, Tone and Torben (the dad) went to Zambia on safari, from Monday to Thursday. They had a great time there, I know the feeling, I was there myself in March when my mom, brother and Renathe visited me.

I was working for only two days last week, we are in a holiday time at work, so we don’t fully staff the theatre. But the days at work was busy, even though we didn’t have full operating lists, mostly emergencies.

I’m also off today, but going to work tomorrow, Wednesday and Thursday. This week is also a holiday here.

New years eve was good, I went out with Mikes sister and some other friends. We went to different clubs, dancing all night up til 6am! So New Years day was a bit lazy. Slept most of the day, up till 3pm, went out to get some junk food, and even slept early.

The petrol and diesel situation in this country is a tragedy! It has been like this since I arrived, and even before that. There is hardly any gas to get anywhere, and this is because the country doesn’t have US dollars to buy it with. So most of the week there is absolutely nothing, and when it finally comes, the lines are so long you can only dream of getting any. People are actually lining up for days, just to get some gas. The ambulances are struggling, some times they cant go, cause there isn’t any petrol. And its not only gas, there is a lot of things missing here, like I have written before, about the medications and equipment, and the shops are missing a lot of things. But that is not as bad as the gas situation. Cause it effects everybody. They even raised the price from 270 MK pr liter, to 380 MK. So the prices for buses, taxis, and all public transport, is so much more expensive and people are even struggling to get around, to work, whatever. Its effecting everyone! I cant write why the problem is as it is, but I guess most of you can understand.

Update on the two Malawians who is in Finse:

The are freezing cold, struggling to adjust to eat dinner at 4pm, challenged with walking on snow, and even more skiing. But I think they will get used to it soon. I just miss them very much, especially Mike. I wonder how long they will manage to stay there. They are planning to stay, and have work permit for six months, but I think they want to come back earlier. We will see!

So a happy new year to all of you, see you soon!

(Tried putting some photos, but the network was too slow today...)

15/12/11 - Long days, but still exciting!

Beautiful sky in Lilongwe

Lucia Day (is it like that in English?) and my grandmothers birthday was on Tuesday. Different things to celebrate, but I was home from work, sleeping most of the day, cause I was sick. Had an infection, started Monday morning, I was early to identify it, left work after lunch, treatment started early as well, so already felt the effect next morning. But I was still knocked out, had fever on Monday, so I stayed home Tuesday.

Work is still challenging, but getting more and more into things, so every day is a bit more easier. The roster is a pain in the ass to write, but I guess it is also something that comes after some time.

The challenge I see as the most difficult one, is the bad work ethics and morale some of the people I work with have. I have seen that some of the nurses, especially the youngest ones, are sometimes lazy at work, but the worst part is that they don’t show up to work on time. The shifts here are ST – Straight shift, from 7.30am to 4pm, and N – Night shift, from 4pm to 7.30am. So the part that they are lazy, somehow feels wrong to say, cause one of the nurses last week worked from Tuesday afternoon, 4pm, and constantly till Thursday afternoon, 4pm. Because there are so few nurses and no one to cover all the shifts, they work their asses off! But that doesn’t mean you can show up two hrs late for your shift. On Friday I couldn’t leave until almost 6pm, cause no one had shown up. And then there was supposed to be two nurses coming, both came too late. One thing is if it is agreed upfront, but just not to show up, not answering the phone, I told them, this is not acceptable, and disrespect of me and my time. But they always have excuses, transport, visitors, what what, and doesn’t seem to care. So if this is something that won't change, I have to talk to the Matron, cause I am not interested in working my ass off just because other people don’t want to come on time. I'll keep you posted!

Malaria prophylaxis sign

Last weekend was mostly relaxing, on Saturday Tone and I went out to buy a TV and a home theatre system. So now we have a TV, but no channels yet. I think we will fix it this week. It is not the biggest bouquet we are getting, but just the to have the possibility to watch some news on BBC and CNN. That will be nice!

The project that Tone is on from Norway is paying for all of this, so it is nothing that I take from my money that I raised... Don’t worry! I don’t misuse.

Saturday I went out with some friends, but we didn’t stay for long, came home around 1.30am.

Sunday: Lazy day. Treated my body with some peeling and other beauty products, felt nice.

Yesterday my good friend Tuta arrived in Norway. He is Malawian, and he is going to work at Finse 1222 with Merete. It is so strange, the thought of him being there in the freeze ass cold, and as far as I have heard, he is having a bit of a hard time. But I guess it is an adjustment, he will hopefully get used to it soon! And then Mike, my other very good friend here, is leaving, for the same purpose, just after Christmas. It will be sad to miss them!

The day at work today was chaotic! Not that it was too busy, I guess it could have been, if it wasn’t in Malawi. We had a good theatre list with six or seven patients, mostly hysterectomies, but also some elective cesarean sections. We started with the two c/s, and finished around eleven (cause of course, we didn’t start until ten). Then there was some hysterectomies planned, but there was an emergency coming, so we waited. The anesthetist went to the ward to review the patient, and she never came back. When we called for her, after 40 minutes, the situation was that there wasn’t only one emergency there, but four! So that’s why she took long. And at twelve, 20 minutes later, she was supposed to knock off, so she didn’t want to start with any procedure. So we waited for the other anesthetist to be free, and when he was, we couldn’t get hold of the patient from the ward, cause they never picked up the phone there. And when we finally got them, and the patient arrived, we couldn’t get hold of the surgeons. And when both surgeons finally came (of course we couldn’t get them both at the same time), it was 1.30pm, we hadn’t done anything for the last two and a half hours, because of the “emergencies” all the other six elective surgeries was canceled... TIA! This Is Africa! I finally knocked off something to five, cause I had scrubbed and couldn’t just leave at 4pm, and of course, no one else had come for night shift yet... Sigh!

Yes, this is a part of colon...

1/12/11 - WOW!

I came to work this morning finding out that there was only me and one other nurse at work. Of course there are patient attendants and ward attendants, but they don’t do anything in theatre but to clean and pack the sets for surgeries and sterilize them. So the two of us, working in two theaters, it means it doesn’t work out very well on our behalf. So today, I scrubbed in on five surgeries, standing up all day, taking my lunch in five minutes at 2pm, and knocking off at 5pm. I am exhausted! And I was also supposed to make orders for surgical stuff (witch I managed before 8am) and write the duty roaster for next week (witch I didn’t manage, cause I have never done it before, and there was NO time). So at 10am the Matron came to assist us, and she stayed in theatre with me, the big one that I had to work in, with all the major and big surgeries, cause the other nurse was not so experienced. And what am I? Five weeks (not even that) with theatre experience! And another challenge was that we didn’t have enough sterilized sets when we started off this morning, so I also had to pack them for the different surgeries, one for hysterectomy, one for cesarean section, one for laparostomy and so on and so forth. And never have done that, it took time! But thankfully there where lists of all the different things that is supposed to be in each set (not that I know the name of all the things yet) and I had some students with me that could help. I did my best and that’s what counts! If I hadn’t done it, it wouldn’t have been done at that time.

But the best thing about this is that I love it! I really enjoy the work, all of it, so I am very thankful for that! All the people are so nice and funny, and the surgeons are good and nice! We have a lot of fun there, telling jokes, making fun of each other, it is just a good vibration all over! So even though my feet and back is killing me (in an exhausted, not painful way), I am looking forward to going to work tomorrow! Imagine! I would never have guessed it would be so nice! I am so thankful that they trusted me and gave me this opportunity!

So now, a well deserved big glass of wine after a cold shower (not voluntary, there was no other option, it hasn’t been for the last two weeks) out side in my “wintergarden” is just what a girl needs!

But I have to admit I am looking forward to the weekend and days off work. But then so ready for Monday and new challenges!

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!

26/10/11 - Sick, pool party and visitor coming

Lucky

Buddy

I have been sick for two days now. Stomach trouble. No fun at all. Every time I put something in my mouth I have to run to the toilet... Exhausting! I have no idea if it is something I ate, but my mum thinks so, she says I eat too many strange things.
I am feeling a bit better today, so hopefully I can go to work tomorrow. And I am sick of my bed and my room, my computer and True Blood and water and ORS (Oral Rehydration Solution that tastes like shit!) and dry bread and my toilet. And the fact that I have a beautiful garden and pool but don’t have the energy to use it!
At least I am in a new room here, we changed on Monday, so now Tone and Frida has a bedroom each upstairs, together with Kari and Ole in the master bedroom, and I am downstairs. I really like my new room, and finally I can make it a bit personal and decorate it, I didn’t do that before, because I knew I was gonna move.
There is five people in the house now. Last week two new people arrived, Kari, a midwife for Voss, and Ole, a gynecologist from Voss/Denmark. They are both gonna work in Ethel Mutharika Maternity Wing, the same wing as me, but Kari will be in the labor ward, and I think Ole will be in Gynae with me.
This weekend we had a pool opening party at the house. It was really nice, the weather was of course very nice, and people came from Nkhoma (Gunhild and Webster) and I also had some friends from town here. We had prepared snacks and there was a lot of drinks. We really enjoyed, and later on we went out to a club, Tone, Anne, Gunhild, Webster, Mike, Rich, Ben and me. We went to Zanzi Bar, there was a DJ from South Africa, DJ Cleo, playing, and it was so crowded! We could hardly dance for the crowds! But it was fun! We also met more friends there.
Sunday we all spent the day by the pool, I of course got my first real sunburn now, on my back, nowhere else, cause I spent most of the day on a floating mattress in the pool.

We have a maid in the house now, she is here every weekday, and she cleans and dusts and irons. I love the fact that I don’t have to iron my uniforms. The other stuff is OK, but ironing, I hate it!
And we have two dogs! One we have had for a while, Buddy, but on Sunday Tone went and got us a puppy! She is so cute! Lucky. They are both from Lilongwe SPCA http://www.lilongwespca.org/
Buddy was about to be buried alive, after a life with abuse and neglect, when he was rescued by someone that had contacted LSPCA.
Lucky was being sold by the road. People do that a lot here, you see it almost everyday, people standing by the road, holding up cute puppies or kittens, to sell them, something that is illegal in the country. So every time we see someone that does this, we call the LSPCA and they can collect the animals.

Last week I got a nice message from Merete from Finse. She is coming to Malawi, to visit me and also to go to Mozambique and other places. Its always nice with visitors! Especially since I haven’t seen here in at least two years! And I will get my “Norway Bag”, a bag full of things from Norway! Makrell i tomat! Mårpølse! Melkesjokolade! Nam nam!

19/10/11 - Kamuzu Central Hospital

I have finally started work now, after almost four weeks of holiday.
I now work in Kamuzu Central Hospital, at the Gynecology ward. It is a big ward, divided in to two, one for the critically ill patients, and one for the stabilized ones. There are 36 beds on each and from 7.30am to 4.30pm there are six nurses working there. From 4.30pm til 7.30am there are two... Imagine! Working for 15 hours straight! Of course they rest on shifts during the night, but anyways! I feel I have been taken good care of since I started, but there isn't much of orientation to talk about. If I want to know things I have to ask. But everyone is friendly and easy to talk to, so I feel its good.

Kamuzu Central Hospital is Malawi’s second largest hospital, after Queen Elisabeth Central Hospital in Blantyre, and they have 750 beds. They have different wards, Childrens (medical, surgical and NRU – nutritional resuscitation unit), Medical (female and male), Surgical, Burns, Eye, OPD (Out Patient Department), Lab, X-ray, Pharmacy, and the Gynecology ward that I work in, that has several different units, Labor, ICU, Gynae (my ward), Antenatal and Postnatal and Private ward.
The most common diseases we have in the ward, is incomplete abortions (both spontaneous and “criminal”, as they call it here), total abdominal hysterectomy ofogdifferent causes (cancer, fibroids, complications after birth), ovarian cysts, different pelvic abscesses and anemia in pregnancy. So this is a completely new area for me! But I like the challenge, and I think I will learn a lot! And about that; I have to do my CPD (Continuous Professional Development) for Nurses and Midwife Council of Malawi, that means I have to find different aspects under 1. Skills, 2. Knowledge and 3. Appearance. And I have to find goals and things I don’t know much about, and things I want to learn. This is something the nurses here have to do every year. I feel like a student with workplans again! That my teacher have to approve! Well, I just have to do it, so I will. And I had a meeting with the Matron again today, and she helped me a lot with how to do it and what goals to have, so I don’t see it as difficult as I did before.

The hospital is quite different from what I’m used to. Not only the size, but mostly the standard. Yes the building I work in is new from last year, but already it looks like crap! People in this country is not fond of keeping their workplace tidy! There is mess everywhere, and they don’t even try to keep it nice. And this is something I want to try fix!
And the other thing in this place, since it is a government hospital, they don’t have a lot of money. So things are out of stock all the time. There is so much things missing, there is hardly any gloves at the ward, and surgical gloves not at all, the only cannulas they have are grey, sometimes you can find a green one, the strapping we use is useless (!), but what is most disturbing is about the medications. This week there is no Paracetamol, Ibuprofen, Pethidine, Ceftriaxone, Metronidazole, Ciprofloxacin, and these are all crucial medications in so many of the cases we have in the ward. But the medication is just not there. So what can we do? Our best...
The post-operative patients gets pain relieve from Tramadol or Diclofenac. And this is some heavy shit surgeries they go through! Today I met a girl, 16 years old, at 6am this morning they fixed her ileus, open stomach surgery, (why she was in my ward is a mystery), and this morning at 9am we came to do her bed, and she was told to sit up and get mobilized, and to take deep breaths to prevent pneumonia, and this girl didn’t even make a sound. I couldn’t even see at her face that she was in pain. The people here (especially women) are so tough, they take pain so different from us, they don’t even cry giving birth. And when we came to the next bed, there was a lady who has had a different surgery yesterday, and a different scar, she complained trying to sit up, but the nurse told her to not complain, “cause look at that other girl, she had a bigger surgery than you”, and she didn’t complain. She just kept quiet. I think it will be very challenging. And yesterday we had a girl who was to drain an abscess, and when giving the local anesthetic she was in so much pain, she screamed so loud, and then she just lost it. She was not completely unconscious, but didn’t respond to any pain or verbal approach. Her pulse was OK, respiration a bit fast, and I wanted to take a bloodpreassure. But could I find a stethoscope? The doctor that was there didn’t have his, and there was no in the ward, and no one knew where I could I find one. So I couldn’t take her bloodpreassure. We gave her intravenous fluids and after a while she came to herself and was completely normal. I don’t know what happened. Maybe the pain just knocked her out!?

I started off good yesterday by walking from work, and today I walked to and from. It is a 50 minutes walk, and I enjoy walking long distances again. At home I walk alt, but the time I have spent in Malawi, and last time, I hardly move around on my feet. We drive everywhere!
And this week I tried the pool for the first time, cause the weather now is very nice, a bit too hot in the middle of the day, so it was so nice to come home yesterday, hot from walking from work, and jump in the pool! I will try to keep it up, and do some rounds with swimming, its good exercise!

Enough about work. Last weekend I was at the lake with Gunhild and Ingrid, and we enjoyed! We went to Cape McClear and Mufasa Lodge, it was a cheap but nice place, and nice people. We mostly relaxed and enjoyed the sun, and came back Monday relaxed and ready for a new and exciting week.

11/10/11 - Enjoying the last days of the holiday

Lunch at Mr Banda's

Nkhoma Saturday market

Dancing at the birthdayparty

Gomez with her Gift

Bertha preparing a chickenfoot for the braai

Things are now starting to settle here, holiday is coming to an end, and the real life here must start soon. I had a meeting at the hospital last week, with the Matron at the ward where I'm going to work, gynecology ward, and she was a really nice lady and had a lot of good plans for me and my stay.
And she also told me I had to go to Nurses and Midwives Council to register, something I had hoped I didn’t have to, since I did it last year, but this is actually something every nurse in the country has to do every year. So I mentally prepared for a long day of waiting and planning and organizing, and I showed up at the office, but then they say that registrations are only on Wednesdays, so I had to come back. I asked very nicely to please have it done today, and as the system here is not always so easy to come around, I was surprised when she told me OK, but come back after lunch.
So I came back after lunch, at 2.30pm, and the lady I’m supposed to meet is not there. Where is she, after two and a half hour lunch break? Out to get a snack!!! So I waited, for 30 minutes, and she returned from her snack break. I got my papers, and I have to write a log to document my achievements and goals, and return to them after a while. So I got my things and went off to pay my fee (20,000MK, approx 700NOK, 120USD). But the guy at the account office was not there, and nobody knew where he was. So I waited... And waited... He finally came back, I payed and was happy it all was over. I was actually surprised that I could do it all in one day!

So next week I'm planning to start work, and tomorrow I will go to the hospital for an orientation. Just to get to know the hospital and routines, and meet my coworkers.

Last weekend I was in Nkhoma, to spend some more time with Isabelle and the other people there. I came there in the afternoon, and it was Gomez's birthday, so she had a party. And as all Malawians it was a late party, supposed to start at seven, started at eight or even later. It was a braai, good food, sausages, chicken, buns, salad and non-alcoholic drinks. We danced, chatted and had a lot of fun! It was a different birthday party than what I’m used to. Finally there was cake and birthday song for Gomez.
Saturday I want to the market with all the azungus (white people) and we did some shopping and after a while I had lunch at Mr Banda's restaurant with Isabelle, James, Sarah and Louis. Louis is a five year old kid that really know how to eat nsima (the traditional local dish, maize mash). The five of us ordered the same amount of food, he was the only one finishing! Imagine! It is really heavy food, gets you full very quick if you are not used to it. But this small boy has a good appetite!

In the evening I just spent time with Gunhild and Ingrid, as Isabelle had dinner at the Vietches house. Sunday morning Isabelle, Jessi, Ute and me went for a walk to Linthipe river. Its a nice walk through a lot of different villages, and the nature is beautiful (even though its quite dry and brown now). After this I took a minibus in to Lilongwe again.

The pool we have here is now filled with nice clean water, it was ready this last weekend, but I have still not tried it. The weather is not too nice, a bit chilly some times, and the sun has not been out today, so it still has to wait. But I’m sure it will be a good thing to have the coming months!

The weekend I will spend by the lake, in Cape McClear, with Gunhild and Ingrid from Nkhoma. Hopefully we will leave on Thursday.

4/10/11 - Lake Of Stars

Thursday we picked up Isabelle at the airport. It was so nice to see her again, missed that sweet girl! Its sad shes not staying for more than two weeks, and that I am not in Nkhoma to spend more time with her. I will try to go there more this week to see her and the others, since I'm not starting work yet.
I spent Thursday to Friday in Nkhoma, had dinner at jessis house, and slept at Gunhild and Ingrids house. Gunhild and I left early to go to Lake Of Stars. Its a long trip to Mangochi, about four hours driving, its hot and sunny, but the roads are not too bad.
We arrived around 1pm, and the place is just as beautiful as I remembered! We set up our tents and jumped in the water. More people came later that afternoon, and the party started! There was a lot of good concerts, and we just sat in the sand listening, sometimes up dancing, and the mood is just perfect! Everybody is so happy and chilled, and the whole festival is just perfect! That night some of us just stayed up all night dancing and enjoying, and the next day was a bit exhausting. Chilling in the shades, sleeping (in the shade!) and the evening came with more good concerts, and the best was Freshlyground, a big band from South Africa
http://www.youtube.com/watch?v=9nUAarErp5Y
This evening was not a late one for me. I went to bed around midnight, Slept like a baby all night through, and was ready and fit next day. We spent some hours in the sun, in the water, chatting, chilling, and most Nkhoma-people wennt back earlier. Since I was going to Lilongwe I didnt go with them, cause I went with Mike and his friends that also was going to Lilongwe. But in the afternoon they all found out that they where not going this day, because the driver was too tired, and I was happy to hear that, cause to go that far, and even at night, with a tired driver, does not feel safe. So the responsible driver he was, he went early to bed that night, and was ready to leave the next morning at 7am. The others of us stayed up late, dancing, chilling, and there was stilll a lot of people there, and also my friends from Holland, Piet and Enno.
I think I could stay at that place forever, its so beautiful, and so much fun. Wish we had festivals like that at home.
Monday I spent the afternon at home, just went to town to do some shopping for dinner, and I made fish fingers and rice for Tone and Frida. But I didnt manage to finish the dinner completely before there was a blackout, but we had a few fish fingers and the rice was finished.

This week I hope to have a meeting with the nurse in charge of the ward i'm going to work in, I emailed her so we'll see when I get a response.
And I hope to go to Nkhoma.

I have now a postbox here, so if you want to send me something, I recommend to send not to big packeges, and I think it will be good if it looks kind of official, it tends to come faster then.

Linn-Kristin Hatlebrekke
P.O. BOX 3360
Lilongwe
Malawi

And my phonenumber +265991590095