Nope I do not think they will make a L&D nurse out
of me yet. However, I am finding the work a little more interesting than I
thought. I think part of that is due to the fact that I want to be doing
something clinical and at least when I am in the L&D unit here, I am closer
to being clinical. But no, I am not delivering babies. I have watched many deliveries
now, which has been pretty amazing.
I am interested in learning more about their work in
maternity and doing more on the clinical side of things, but not the actual
deliveries themselves. I have begun to ask them for things that I can do to
help. Most of them do not want to ask me to assist. I am unsure why. However,
with the help of Taban, my midwife friend, one or two of the other midwives
have begun to give me little things to do.
The other day we worked on cleaning the unit. It is
very dirty, literally. Because of all of the dust that comes in from the open
windows and doors and the fact that dust is everywhere here, things get dirty
quickly and then the layers build up. So, we worked on cleaning the unit a bit
more thoroughly and identifying where there are some needs and where more work
should be done.
Another day one of the midwives asked me to help hang
IVs. The first was relatively easy. It was one that was just open to gravity as
a fluid bolus for hypotension. Simple to do but it was still new to me. IV
sites look different than what I am used to in the US. They do not have the
ability to flush lines here so there is none of that. And there are no pumps so
everything is calculated and then done by hand. So, my second IV that I hung
was not just done to gravity but had to be titrated by hand to run at 60 drops
a minute. Not as easy as it sounds, and even though I did it in nursing school,
it still took me some time to get adjusted.
I already mentioned the dirty unit, well it is a
complicated matter. Sometimes supplies are limited. Sometimes water is limited.
Sometimes people bring in things like dead chickens into the unit. I cringe
when I saw that one and wanted to shoo the person away but thankfully, he left
shortly after. There are toddlers covered in dirt wandering around. It hard to
keep the place clean, especially in Yambio's PCHH where they are completely
open to the public and have no way to limit who walks in or out of the
facility.
In an earlier post I wrote about how I look forward to
Fridays because I get to go to Nzara. However, this Friday there was an issue
going due to lack of a vehicle so I ended up spending the day in the maternity
unit in Yambio. We scrubbed the unit down completely: walls, floors, furniture.
Everything we could. It took a large team and still took us a while. I wish I
could show all of the dirt and filth we got cleaned. It is great, but by the
end of the day dirt and trash have started to creep back in.
In Nzara there is a guard at one gate of the facility
and it seems that less people wander in and out there. However, I don't spend
as much time there as I do other places so maybe I am just not seeing things.
Nzara's unit is bigger and seems cleaner. However, it is also built
differently, higher from the ground and therefore the wind cannot kick up as
much dust, and people are not permitted to wear shoes in the clinic unless they
are workers. When they tried that in Yambio people's shoes were stolen. There
is no easy answer to keeping the unit clean but there are suggestions and
things being worked on so let us hope for progress.
There is a general lack of resources in the hospitals
here, and in maternity it can mean some very challenging situations. One of the
first ones I was told about was the fact that it is not uncommon for the unit
to run out of gloves. Most times it is a matter of calling whoever has the
storage room key to get more but sometimes there are simply no more gloves.
That means IVs are placed without gloves, and babies are delivered without
gloves. I cringe at the thought, but what are they supposed to do? The baby has
to be delivered so no gloves it is.
Other times the lack of resources comes in the form of
light and electricity. There are nights, I have been told, when the generator
and solar power was not enough for the night so mothers labor in the dark.
Babies are born and delivered by the light of a battery powered light or by the
light of a cellphone flashlight. Other times the midwives rely on a headlamp to
deliver a baby. Electricity can be scarce.
It also means that when it comes to getting
ultrasounds for the expectant mothers a decision must be made. Is better to
scan more women who come in for an ultrasound and risk not having light for nighttime
deliveries and possible emergencies or do they conserve electricity? This is a
daily discussion. An ultrasound could diagnose a potential problem, but could
it wait until the next morning when the battery has more time to charge and
less chance of draining the little that is left for the night. I don't know how
they choose but they have to.
Sometimes the lack of resources comes in the form of
having basic items, similar to the gloves. Medicine is not always available or
runs out at the clinic. At those times the staff will send the co-patient to a
pharmacy to purchase the needed medication for the patient. Sometimes there is
no ability to make a phone call to Nzara from Yambio to tell them of an
incoming emergency the Yambio PHCC is sending to Nzara's Hospital because it
cannot be handled in Yambio. Supplies are conserved and used carefully, and
things are repurposed, like IV fluid lines cut and used to hang other IVs. You
have to think before you use something here, not the careless waste of supplies
in the US hospitals.
Like I said earlier, I am no maternity or L&D
nurse but I do see a purpose to me being in the maternity unit, though it can
be hard to acknowledge at times. Over the past two weeks I have watched the
staff, particularly the midwives, become more and more frustrated and stressed
in their work. There are conflicts here, especially between different
disciplines and ways of practicing medicine. This happens in the US too. But I
am watching the staff struggle and watching as people become increasingly
stressed and frustrated.
So, this presents an opportunity for me to try and
help. I have spoken with management and doctors at both Nzara and Yambio to try
and provide support for the staff in the form of different mental health
improvement opportunities. I want to start a group or at least have a few
debriefing and discussion sessions with staff. There have been several
challenging deaths of mothers, and several fetal and infant deaths since I have
come. This is not new but I have been alerted that there are some staff that
are struggling with this. That is expected, so if I can help then that is good.
I am hoping to have several opportunities to teach the
staff about ways they can help each other and help themselves. I want to work
with them on self-care and stress management. I want to work with staff of
debriefing and discussion situations in constructive, productive, and
therapeutic ways, especially the challenging cases. I hope that I will be able
to encourage the staff to do what they need to do to better take care of
themselves and to deal better with the heartbreaking work that they sometimes
face.
Soon rain season will be here and I am warned that the
number of deaths will increase and so will the potential issues for patients,
families, and staff along with this. I can try and help them prepare and better
face the challenges and struggles. I have plans on how to help and am starting
those discussions now, but I am sure more challenges will arise. However, I am
glad that the management and teams are willing to discuss the situations and
proposed ways I can help. Over the next few weeks, we will see how I am able to
actually do these things. We shall see...
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