Regarding the Middle East crises that are occurring, I wanted to write a blurb on freedom. Something I've been reading and thinking about quite a bit lately, because I think we forget that freedom isn't one entity at one time with the swipe of one movement one day. You don't just win it like a lottery prize. Its a process. And at minimum it has two essential phases: freedom from and freedom to.
It is only a first step to be free from slavery, imprisonment and oppression. It is another step altogether to have a vision, en masse, of what kinds of rules you want to agree to obey, after freedom from. Choosing to have freedom to write however you want, move and pray however you want, believe whatever you want, vote however you want, and also have rules w/ enforcement to educate all, take care of the health of all (at some level), build the roads for all is a vision a leader, or group of leaders, has to propose and dream up essentially. A people need to manifest this vision together with a common purpose in mind. It takes immense will and determination for people who have been oppressed for generations to have this kind of faith, optimism, and collective charismatic agreement to make new wise rules for the benefit of all and have the infrastructure and finances to secure that these rules be enforced.
Seems like an impossible task.
Why can't anyone look at how long it took us, the United States, to pull ourselves together with a vision? The American revolution started in 1763. George Washington didn't take office as president of the United Statues until 1789. That's 25 years of of not having it together.
In short, we may be able to help Libya be free from Gaddafi by brute force. For better or for worse. For richer or for poorer. We also know it won't solve the more long term needs of what people want to agree upon as a set of rules.
We can't bomb that into anyone.
Monday, March 28, 2011
Thursday, April 19, 2007
My last two home visits
So these were my last two home visits for the year.
:(
We did two of them - me, Dorothee and a visitor from the U.S. Sad but true. I don't even really feel like telling you the stories. The abandoned and recently battered wife with 5 children - who also does not know how to read, with no land to grow food for her kids, of course she is going to have kids who fall into severe malnutrition; this is not a country that can afford social services; the mother and father who have no land to grow any food on. But the kids are, as always, beautiful. And there is absolutely no where I feel more at home than on home visits. Like, I know my favorite safe space. At least one of them. That provides great meaning for me. Fortunately, I was able to make my last home visit an even more constructive one, by taking one of our visitors from the U.S. around too. I always hope that these visits make a positive impact on others as to the reality of the majority world. And I hope it doesn't discourage either, as my battle horse cry is always...there is hope for the poor. We can change severe degrees of poverty with efforts from many angles. But we have to start pitching in.
Homeward Bound
I cannot believe it everyone, but I am soon homeward bound. The end of an incredible year. I don't even know where to begin, or how to some it up. I will have to think about.
The toughest job you'll ever love?
God's country?
These are the front lines my friends, these are the front lines we should be investing in.
These children who die are the casualties of an unspoken war. More nebulous and complex in many ways then the one we are creating in Iraq.
Living on the brink of life and death and cruelty and generosity. I will have to mull over it - for final words.
I will look forward to daily hot showers and hard water pressure. Living in a place where I can drink out of the tap, flushing toilets and all the amenities that come with a modern metroplis - of fresh cut flowers, of cafe latte's and goat cheese salads. But I will miss the meaning. The depth. In truth - the trenches and the heart.
But I will stay involved. I just don't know how yet.
Attached are some pics of my last days getting Claudine's littlest brother into a home. That is a heart breaking story all into itself. I will tell it later this week.
Thursday, March 08, 2007
A Wheelbarrow Race in Kili
The first night we stayed in Tanzania we were in the mountains of Kilimanjaro, up a ways in a far away village about an hour and half from Moshi. These were some children near where we were staying that we played with. I think this was the first time anyone showed them how to run a wheelbarrow race. You can see who won!
Snows of Kilimanjaro
We made it!!! 20 km total and uphill the whole first half. But it was beautiful and well worth the journey. I was the only one who power walked it, everyone else valiantly ran and some did quite well placing in the top 135 of ~550 runners. The winner of the full marathon was a Tanzanian who ran it in about 2h18min. The snows of Kilimanjaro were there indeed but thinning according to a local friend of a friend who summits regularly as a tour guide. According to Inconvenient Truths, there will be no snows of Kilimanjaro in ~10 years. Despite thinning snows, the mountain was a true jewel. We did plenty of celebrating afterwards as can be witnessed by our Kilimanjaro beers.
Tuesday, February 27, 2007
Une Famille from Tuesday's home visits
This was a 2 week follow up visit for this little baby who was originally admitted to the malnutrition ward at 3.5kg/4 months old. That's about the weight of a newborn in the U.S. As I see so often, this mom says she is not producing any breast milk, and 'till this day I think that so many moms I meet in the malnutrition ward aren't producing breast milk because they too are malnourished. They may have weight on them from a diet heavy in starches but I don't think they're getting a enough fluids or nutrients. The boy and girl shown below are the older brother and sister and upon my asking the mom how many children had she given birth to all together, she said 6, but 3 have died along the way from various illnesses. The mom is 31. This is typical of the kinds of familes I see.
Dead On Arrival
He was not dead on arrival. He was gasping for breath, like a child does with severe respiratory distress. It was not more labored than any other child who comes in with severe pneumonia or respiratory distress. And I've seen some really bad cases in the past year here - much worse than he was. He was a transfer from Kirehe, our other district hospital and my first step was to send for oxygen. Oxygen is not readily available in this hospital, it is not available on every ward, so one of the staff went to go find some in another ward. As I am accustomed now to the fact that nurses run to other wards to fetch oxygen, I went quickly to buy the father some basics and start getting him settled: a basin, some soap, a towel to wash up the child - things nurses do not provide here, nor does our hospital. I have tried to instill this practice here, but as it is nothing that any public hospital does in Rwanda, and probably East Africa for that matter, going to buy a patient a basin and soap down the hospital driveway is above and beyond a hospital staff’s call of duty. Some supposed international health experts call the organization I work for gold-plated for things like this: like walking on your own to a store and pulling out your own 2 dollars to buy a needed commodity for a patient. They tell us we cannot expect international aid organizations to hold this standard of care for patients and be scaleable and replicable. Creating dignity is, so I’m told, not scaleable.
So after my running back to the ward about 3-5 minutes later, the child is still upset, nurses are still pulling oxygen equipment together (this part of oxygen administration drives me crazy here, that it takes 20 minutes to get oxygen gauges attached to tanks, attached to tubing, wrench found, then used, to be able to turn the tank on - I still do not understand why there is no sense of gravity of getting equipment prepped in advance - before the patients start decompensating - no one takes ownership for this - even those who are told it's their job), I take off his pants to clean him. I would say he smells horribly of soiled underclothes, but three year olds do not wear underclothes here. Underclothes are a luxury too amongst the rural poor of Rwanda. My little friend is about 3; he is thin but not marasmic. I pull off his pants to clean him myself because cleaning a child are basics to U.S. nurses, but here, nurses do not bathe or wash patients, the family does, so again I hope to set a different example, I wash the child myself. Then I hear from the 4th year Harvard medical student who is with me, “He’s not breathing.” I am incredulous, it’s been maybe 30 seconds since he was sitting up, visibly agitated in his dad's arms and eyes open. I put my fingers in front of his nostrils, his mouth, to feel his breath, he is laying back, I don’t feel anything. Then his eyes roll back. I listen to his chest with my stethoscope. Not a heart beat to be heard. “We gotta’ run a code,” I say. I grab the ambu bag and place it on his mouth and start squeezing, the medical student starts doing chest compressions, but the kid is dead. I am unfortunately all too familiar with the look now. Air is not going down by my squeezing the ambu bag. His cheeks are filling up with air like a chipmunk – air is not reaching into his chest or belly. Something is lodged in his throat or deep in his lungs. Mucus plug? We have no suction. We have no way to intubate. And within a matter of maybe 20 minutes of coming to us from the ambulance, he was dead. Not quite dead on arrival, but almost.
I don’t know what to do in cases like this. I have no idea what he had. He had intense crackles throughout both lung fields. Pneumonia? A bacterial bronchitis? The father said symptoms of cough started Tuesday. It’s Saturday. What kills a kid between Tuesday and Saturday? I think about our oxygen again. When are we ever going to get it operating better here? When is there going to be oxygen for all beds, all kids, all patients, whether they need it or not. Oxygen for all. Is that a civil right? It should be. All over the world. That should be free, like clean running water should be free. But not to this child. Today was another day in the day in the life of working as a nurse practitioner here.
There are days I wouldn’t rather be anywhere else because the joy of these children is like no other, when they are well. And there are days when I cannot believe 3 year olds die partly because of no oxygen, partly because of a lack of basic emergency medical equipment and know-how, that would have been provided in, literally, a matter of heart beats at MGH. According to WHO, Rwandan child mortality for the lowest wealth quintile is 246 per 1,000 live births. Belgium is 4 per 1000 live births. ~50% of children in Rwanda rural areas are stunted in terms of growth for their age. And only about 20% of births in rural areas are attended by any skilled health personnel including traditional birth attendants. What are we going to do here? To me there is hope. There is definitely hope. Children get better with trained staff and medicine. So do moms and dads. But we have to start investing in these communities. To me, I feel like this is the war we should be fighting. Why aren’t we investing in the war and defense of these front lines?
So after my running back to the ward about 3-5 minutes later, the child is still upset, nurses are still pulling oxygen equipment together (this part of oxygen administration drives me crazy here, that it takes 20 minutes to get oxygen gauges attached to tanks, attached to tubing, wrench found, then used, to be able to turn the tank on - I still do not understand why there is no sense of gravity of getting equipment prepped in advance - before the patients start decompensating - no one takes ownership for this - even those who are told it's their job), I take off his pants to clean him. I would say he smells horribly of soiled underclothes, but three year olds do not wear underclothes here. Underclothes are a luxury too amongst the rural poor of Rwanda. My little friend is about 3; he is thin but not marasmic. I pull off his pants to clean him myself because cleaning a child are basics to U.S. nurses, but here, nurses do not bathe or wash patients, the family does, so again I hope to set a different example, I wash the child myself. Then I hear from the 4th year Harvard medical student who is with me, “He’s not breathing.” I am incredulous, it’s been maybe 30 seconds since he was sitting up, visibly agitated in his dad's arms and eyes open. I put my fingers in front of his nostrils, his mouth, to feel his breath, he is laying back, I don’t feel anything. Then his eyes roll back. I listen to his chest with my stethoscope. Not a heart beat to be heard. “We gotta’ run a code,” I say. I grab the ambu bag and place it on his mouth and start squeezing, the medical student starts doing chest compressions, but the kid is dead. I am unfortunately all too familiar with the look now. Air is not going down by my squeezing the ambu bag. His cheeks are filling up with air like a chipmunk – air is not reaching into his chest or belly. Something is lodged in his throat or deep in his lungs. Mucus plug? We have no suction. We have no way to intubate. And within a matter of maybe 20 minutes of coming to us from the ambulance, he was dead. Not quite dead on arrival, but almost.
I don’t know what to do in cases like this. I have no idea what he had. He had intense crackles throughout both lung fields. Pneumonia? A bacterial bronchitis? The father said symptoms of cough started Tuesday. It’s Saturday. What kills a kid between Tuesday and Saturday? I think about our oxygen again. When are we ever going to get it operating better here? When is there going to be oxygen for all beds, all kids, all patients, whether they need it or not. Oxygen for all. Is that a civil right? It should be. All over the world. That should be free, like clean running water should be free. But not to this child. Today was another day in the day in the life of working as a nurse practitioner here.
There are days I wouldn’t rather be anywhere else because the joy of these children is like no other, when they are well. And there are days when I cannot believe 3 year olds die partly because of no oxygen, partly because of a lack of basic emergency medical equipment and know-how, that would have been provided in, literally, a matter of heart beats at MGH. According to WHO, Rwandan child mortality for the lowest wealth quintile is 246 per 1,000 live births. Belgium is 4 per 1000 live births. ~50% of children in Rwanda rural areas are stunted in terms of growth for their age. And only about 20% of births in rural areas are attended by any skilled health personnel including traditional birth attendants. What are we going to do here? To me there is hope. There is definitely hope. Children get better with trained staff and medicine. So do moms and dads. But we have to start investing in these communities. To me, I feel like this is the war we should be fighting. Why aren’t we investing in the war and defense of these front lines?
Sunday, February 25, 2007
I'm doing a Kilimanjaro 1/2 marathon this Saturday
So about 10 of us from PIH are heading to Kilimanjaro on Friday to go do a half marathon. I here it is all up hill. Hmmmm. I've already declared to everyone I'm walking it and running if and when I get bored from the walking. Sort of like, I like a little espresso with my milk. I don't know if I've ever walked 13 miles in a matter of hours. Maybe hiking and camping. And I haven't really been training except for my morning walk/jogs of about 25-30 minutes. I'll keep you posted.
PS Sort of spooky right now, there are guys outside all chanting. I've never heard that before. It's past 9pm. All dark outside. I have no idea what a large group of men would be chanting about at this time of night. Hopefully it's about a soccer game or something. But sounds more militaristic to be honest. Maybe it's the soldiers that live up the hill near here? Maybe I'll have someone walk me home tonight.
PSS I have a rat problem. This rat has been coming into my room everynight and I can't get rid of him. Most of my impetus to put my mosquito net down now and make sure it's tucked in well, is so that the rat doesn't crawl onto me at night. Every night now, I stuff clothes in the bottom of the door where he's getting in, 'cause I saw that that was his entry way the other day. The audacity. He is definately a rat. Grey, ugly, his body alone is 1/2 the size of a 250mL water bottle. Hairless long tail and all. So the question is, he got into one of my drawers and seems to like nesting there... and the most devastating discovery of all was that he got into my one and only stash of chocolate bars I brought from the states. Apparently he has similar tastes as me: Cadburry Fruit & Nut. Chocolate is hard to come by here. At least the kind I like, and that was my special private reserve for the rest my stay here. So he nibbled into ALL the bars, but only on one corner. Like he want straight down the stack. Like a piece of corn on the cob.
I was going to just chop off the part he ate... to salvage my one big food treat here, but now I've decided that's kinda' gross and I'm just going to give the rat it's winnings on this one.
PS Sort of spooky right now, there are guys outside all chanting. I've never heard that before. It's past 9pm. All dark outside. I have no idea what a large group of men would be chanting about at this time of night. Hopefully it's about a soccer game or something. But sounds more militaristic to be honest. Maybe it's the soldiers that live up the hill near here? Maybe I'll have someone walk me home tonight.
PSS I have a rat problem. This rat has been coming into my room everynight and I can't get rid of him. Most of my impetus to put my mosquito net down now and make sure it's tucked in well, is so that the rat doesn't crawl onto me at night. Every night now, I stuff clothes in the bottom of the door where he's getting in, 'cause I saw that that was his entry way the other day. The audacity. He is definately a rat. Grey, ugly, his body alone is 1/2 the size of a 250mL water bottle. Hairless long tail and all. So the question is, he got into one of my drawers and seems to like nesting there... and the most devastating discovery of all was that he got into my one and only stash of chocolate bars I brought from the states. Apparently he has similar tastes as me: Cadburry Fruit & Nut. Chocolate is hard to come by here. At least the kind I like, and that was my special private reserve for the rest my stay here. So he nibbled into ALL the bars, but only on one corner. Like he want straight down the stack. Like a piece of corn on the cob.
I was going to just chop off the part he ate... to salvage my one big food treat here, but now I've decided that's kinda' gross and I'm just going to give the rat it's winnings on this one.
Thursday, February 08, 2007
From Kwashiorkor in 2006 to Rickets 2007
This little child came to us last summer with Kwashiorkor. He was 3yo8months in this photo which was near his discharge. Unfortunately, today I saw him again for the first time since last year and now he has rickets (lack of vitamin D and calcium) along with his older brother who has had it for many years. He's 4 1/2 years old now. Unlike last summer, one of his legs is deformed now causing him to not be able to walk well. He wasn't able to step forward with his right foot today. Or at least not without my help. Sad thing is, he was fine summer of 2006. Ughh.
I'm back in Rwanda
So I’m back, spent some time back in the states and now have arrived back. Safe and sound. -1 piece of luggage that had all of the watches MGH’s Chief of Nursing gave me. Plus 2 new headphones to use for Skype, ½ of my clothes, and a bunch of other gifts for staff. I’m keeping my fingers crossed though that it is found. I’m worried though.
I have to say I was a bit nervous to return. Nervous that I wouldn’t get right back into the swing of things, but post day 3, life here is oddly familiar. My room, the landscape. Everyone around. I was surprised to feel at home. The welcome backs and hugs I have to say are great. And the ultimate compliment today was the “Lucy!” called out to me by one of the kids from the neighborhood. “Lucy! Lucy!” I heard from her, she just was so excited. And then another couple people called out my name whom I didn’t recognize, but it felt so good. I was remembered. And most importantly Tuyishime gave me a huge hug…which in truth is why I love being here…those hugs from the kids, it is the priceless bonus of this job.
So that brings me to the chemotherapy of Tuyishime. She is still here post-operatively now receiving a second round of chemotherapy. I gave her chemo today. Dactinomycin, Vincristine, and Cyclophosphamide. I’d like to say that another nurse was responsible for the whole thing and everything went flawlessly, but it was more difficult than that. Frustration level 10 on a 0-10. I left a nurse (one I really like and who is 100% competent) to find a vein. I left her side because I was helping another boy with rickets outside, and now his little 4 year old brother who came into our malnutrition ward last year has rickets too. His father wanted help. They were at our ward door wanting help so I told him to just let me get things started inside with Tuyishime and that I’d be right out. I got their x-rays, thorough histories, the rickets started in the 4.5 year old 6 months ago, I gave them the Vit.D and Calcium Dr. Sara had given me to give to them. Explained what the meds (vitamins) were. That this is caused because of malnutrition. I asked how many times the kids had milk or dairy. Once a week? I asked (trying to stretch it to something I thought wouldn’t embarrass him.) And he said, “Probably once a month” “Ok, we’ll get you some milk powder.” Gotta’ put that on my to-do list. I then got side-tracked on email, and by this time, it’s 2 hours later, the chief nurse came to tell me they still hadn’t found a vein. “You’ve been trying for the past 2 hours without stoppying?” “Yes,” was the answer. At which point I said, let’s take a break. But I was furious inside. 2 hours of a nurse trying to find a vein. To no avail. It’s very hard for me not to let my blood boil at these points. How in the world could you stick a poor kid for 2 hours straight. I went to the ward again, told the sweet nurse who was still stabbing away to stop. That we’d try again after lunch. Then we’d get the anesthesiologist to help us sedate her after lunch time (after Dr. Sara was very disappointed the job wasn't done yet - I always feel useless explaining the circumstances). And well, of course Tuyishime herself was a crying mess.
Later once again, when the anesthesiologist tried to give her an IM shot in the rear, she was once again crying, flailing, nurses trying to hold her down to give her pain medicine and diazepam. Eventually, three men picked her up and man-handled her basically to get her on her back so the shot could be given in her rear. And you know what the patients and staff were doing at this scene? Laughing. Yes laughing.
People here, Rwandan staff and Rwandan parents, laugh at this kind of thing. It is a cultural aspect of being here that until this day, I do not understand. Why would you laugh at a suffering child? I just don’t get it. I ask if they’d laugh at their own child in pain? And they say no, but then again, I think they very well may. Pain here is not something you suffer, it’s something you watch in humor, it's something you tolerate. If not, people laugh at you. I have not made any headway on this front. It is so disappointing.
To make a long story short, the morphine and diazepam didn’t stop her resisting from getting an IV. I ended up giving her 25mg Ketamine (a very strong sedation drug) which is about half to a third of what a child her weight needed, but with the Diazepam and Morphine on board, I didn’t want to overload her. That still didn’t put her to sleep. We still had to hold down her arm so she wouldn’t resist. Poor kid. Anyway, it’s post work hours now, probably about 6pm because it’s getting dark. I’ll go in there and make sure fluids are running still. Make sure documentation looks OK. 99% chance says no one has charted anything since I left. I don't know what to do about it anymore.
I have to say though, it’s frustrating to return to the nurses giving care in a way that I think is sub-optimal. I just don’t feel like they care. My battle horse cry with injections before I left was “3 strikes and your out” meaning, you can’t poke a kid any more than that without going to get another person to try. And if that second person fails. Stop. Let’s figure out another way. One of the nurses said to me today, “Here, you try until midnight if you have to.” Responding in a sentimental and empathic way to the patient’s reaction is not a part of it. At least it doesn’t seem to be to me.
Probably, the toughest part of working on the in-patient ward for me is the seeming emotional disconnect of nurses when a patient is suffering, what I would call lack of “nursing” a patient through pain and tears. When I don’t see nurses doing that…what I would call “their job” which is to be there emotionally on top of the medication administration, when I don’t see that at all…when I see worst of all, laughter (which to me is even worse than apathy) that is the toughest, most frustrating part of this job for me.
And that aspect of care doesn’t make me feel at home at all. Or like I’m making any difference in nursing care. In fact it makes me want to go into the teaching side of things, not the clinical practice of things, not work in the pediatric ward anymore, because I’d like to somehow figure out how to get nurses to care about needless suffering and do something about it, and I haven’t succeeded on this front at all. Clearly, as I saw today, they still laugh.
PS Just found out they found my luggage! Yeah! Watches for all nurses in Rwinkwavu here we come!
I have to say I was a bit nervous to return. Nervous that I wouldn’t get right back into the swing of things, but post day 3, life here is oddly familiar. My room, the landscape. Everyone around. I was surprised to feel at home. The welcome backs and hugs I have to say are great. And the ultimate compliment today was the “Lucy!” called out to me by one of the kids from the neighborhood. “Lucy! Lucy!” I heard from her, she just was so excited. And then another couple people called out my name whom I didn’t recognize, but it felt so good. I was remembered. And most importantly Tuyishime gave me a huge hug…which in truth is why I love being here…those hugs from the kids, it is the priceless bonus of this job.
So that brings me to the chemotherapy of Tuyishime. She is still here post-operatively now receiving a second round of chemotherapy. I gave her chemo today. Dactinomycin, Vincristine, and Cyclophosphamide. I’d like to say that another nurse was responsible for the whole thing and everything went flawlessly, but it was more difficult than that. Frustration level 10 on a 0-10. I left a nurse (one I really like and who is 100% competent) to find a vein. I left her side because I was helping another boy with rickets outside, and now his little 4 year old brother who came into our malnutrition ward last year has rickets too. His father wanted help. They were at our ward door wanting help so I told him to just let me get things started inside with Tuyishime and that I’d be right out. I got their x-rays, thorough histories, the rickets started in the 4.5 year old 6 months ago, I gave them the Vit.D and Calcium Dr. Sara had given me to give to them. Explained what the meds (vitamins) were. That this is caused because of malnutrition. I asked how many times the kids had milk or dairy. Once a week? I asked (trying to stretch it to something I thought wouldn’t embarrass him.) And he said, “Probably once a month” “Ok, we’ll get you some milk powder.” Gotta’ put that on my to-do list. I then got side-tracked on email, and by this time, it’s 2 hours later, the chief nurse came to tell me they still hadn’t found a vein. “You’ve been trying for the past 2 hours without stoppying?” “Yes,” was the answer. At which point I said, let’s take a break. But I was furious inside. 2 hours of a nurse trying to find a vein. To no avail. It’s very hard for me not to let my blood boil at these points. How in the world could you stick a poor kid for 2 hours straight. I went to the ward again, told the sweet nurse who was still stabbing away to stop. That we’d try again after lunch. Then we’d get the anesthesiologist to help us sedate her after lunch time (after Dr. Sara was very disappointed the job wasn't done yet - I always feel useless explaining the circumstances). And well, of course Tuyishime herself was a crying mess.
Later once again, when the anesthesiologist tried to give her an IM shot in the rear, she was once again crying, flailing, nurses trying to hold her down to give her pain medicine and diazepam. Eventually, three men picked her up and man-handled her basically to get her on her back so the shot could be given in her rear. And you know what the patients and staff were doing at this scene? Laughing. Yes laughing.
People here, Rwandan staff and Rwandan parents, laugh at this kind of thing. It is a cultural aspect of being here that until this day, I do not understand. Why would you laugh at a suffering child? I just don’t get it. I ask if they’d laugh at their own child in pain? And they say no, but then again, I think they very well may. Pain here is not something you suffer, it’s something you watch in humor, it's something you tolerate. If not, people laugh at you. I have not made any headway on this front. It is so disappointing.
To make a long story short, the morphine and diazepam didn’t stop her resisting from getting an IV. I ended up giving her 25mg Ketamine (a very strong sedation drug) which is about half to a third of what a child her weight needed, but with the Diazepam and Morphine on board, I didn’t want to overload her. That still didn’t put her to sleep. We still had to hold down her arm so she wouldn’t resist. Poor kid. Anyway, it’s post work hours now, probably about 6pm because it’s getting dark. I’ll go in there and make sure fluids are running still. Make sure documentation looks OK. 99% chance says no one has charted anything since I left. I don't know what to do about it anymore.
I have to say though, it’s frustrating to return to the nurses giving care in a way that I think is sub-optimal. I just don’t feel like they care. My battle horse cry with injections before I left was “3 strikes and your out” meaning, you can’t poke a kid any more than that without going to get another person to try. And if that second person fails. Stop. Let’s figure out another way. One of the nurses said to me today, “Here, you try until midnight if you have to.” Responding in a sentimental and empathic way to the patient’s reaction is not a part of it. At least it doesn’t seem to be to me.
Probably, the toughest part of working on the in-patient ward for me is the seeming emotional disconnect of nurses when a patient is suffering, what I would call lack of “nursing” a patient through pain and tears. When I don’t see nurses doing that…what I would call “their job” which is to be there emotionally on top of the medication administration, when I don’t see that at all…when I see worst of all, laughter (which to me is even worse than apathy) that is the toughest, most frustrating part of this job for me.
And that aspect of care doesn’t make me feel at home at all. Or like I’m making any difference in nursing care. In fact it makes me want to go into the teaching side of things, not the clinical practice of things, not work in the pediatric ward anymore, because I’d like to somehow figure out how to get nurses to care about needless suffering and do something about it, and I haven’t succeeded on this front at all. Clearly, as I saw today, they still laugh.
PS Just found out they found my luggage! Yeah! Watches for all nurses in Rwinkwavu here we come!
Thursday, November 30, 2006
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