Too Much To Say...

Last week we were at a new clinical site. It was really interesting to see the differences between this clinic and the clinic we have been at. This clinic, East Boom, is very big and seems to be better off financially, although both clinics are government-run. It had a much more “get in- get out” appeal to it, which I like, but other people may not. I like that the patients do not have to sit around all day, and more people are working together to get the little things done. The other point of view is that it is nice to have one person doing most of your care, instead of being tossed around to different nurses or doctors.

Anyway, I worked in the antenatal (prenatal) area doing head-to-toe assessments. The women I saw were all at their first visit in their pregnancy, and I was surprised to find that some were quite far along. I learned it is recommended to go to your first appointment between 8 and 20 weeks. Some of these women were at 28 weeks, or even farther along. Several were HIV+.

On Friday we spent the morning performing pap smears on HIV+ women. It is part of the protocol before they are started on ARV’s. Nurses don’t perform pap smears in the US, so this was a very new and unique experience for us. If you would like details or stories, email me and I’d be happy to share. It was hard seeing how dirty the procedure was. I am sure it is worse in other parts of the world, but compared to America it is awful! The women laid on the same linen sheet, with the same pad underneath them, and the lamp that the nurse used to shine light on certain body parts was NOT clean. She would touch it with her bare hands or with gloves… before, during, and after touching the patient. I panicked part way through when I realized that not only is there germs being spread, they are HIV + and HIV is passed through these fluids. I wore gloves, washed my hands, and didn’t have any open wounds on me, but it is still hard to handle at times, regardless of HIV. After seeing what I saw, you just want to jump into a steaming hot shower, even if all you did was observation.

It seemed for awhile that the nurses, at least at our other clinic, did not use gloves because of lack of resources. There were times when they did not have paper towels to wipe their hands with after washing them, which led to less hand washing. Yet, at this clinic, which seems to have lots of paper towels and gloves, the nurse I observed taking blood for HIV tests did not wear gloves OR wash her hands between patients. It was just weird to see. It wasn’t a messy procedure, and I didn’t physically see any blood on her hands, but it is hard knowing they are dealing with infected blood and not washing their hands. I guess the rate of transmission is low, but I am just so used to wearing gloves all the time. I think we overuse them in the States, but it’s hard seeing how little they are used here.

The hardest thing I saw last week was a dying girl. I know I have seen many people close to death with AIDS, but this was patient heart wrenching. She could hardly walk. She could hardly talk. She had no strength and was SO skinny. Her chart said she had been hospitalized 3 days prior for incessant vomiting and dehydration. They hooked her up to an IV to rehydrate her and discharged her. I couldn’t believe she was discharged. She still couldn’t hold food down, still looked dehydrated, and her CD4 count as of a few weeks ago was 9. She was only 20 years old, and had not started ARV’s yet. I hope she is able to start in time, but I would not count on it. I thought she would pass away at any moment. I wanted to just hug her and hold her, even if that meant her dying in my arms. Instead the nurse just performed the pap smear, let her go, and called in the next patient.

The sickest thing I saw was a STI that had been there for over 10 years. I’ve never seen anything like it. Pictures on the internet or in books do not compare to what I saw. I was shocked that she is pregnant, too! Again, email me if you would like details.

A nurse last week explained to me just how much people do not understand STI’s. A man had warts, and the nurse told him to get them removed. He refused and said they were his nerves, and claimed that his wife enjoyed them. The lack of understanding about diseases and physiology is hard to deal with. People believe their ailments are curses from their ancestors. The big picture here is such a mess.
It is hard being a nursing student here. I came to South Africa for the unique experience of learning and performing nursing skills in a foreign country. I also came for the missions side of things. I want to HELP people, help the situation, make an impact, or do SOMETHING. It’s hard to see these things daily and know that you cannot make a big enough impact to cause change. It may be even more difficult for the students who are not nurses, because they see all of this happening in their community service sites, and they become frustrated because there is “nothing” they can do. At least I have the excuse of treating this as a learning experience. It’s still so hard. It’s amazing, but hard. I am seeing what you see on tv! I am seeing the sickest of the sick and the poorest of the poor. I know prayer is the best thing, but sometimes I wish I could give more.

Here is a somewhat funny story: at our previous clinic, Yvette and I were sitting in a room with a nurse. She was assessing a patient and speaking in English with us about the patient. It was awkward because we could tell this patient only spoke Zulu, and the patient knew we were talking about her. The nurse ACTUALLY said: “Look at her face. See how it does not have much expression? I’d say she’s retarded, do you agree with me?”
I was shocked and speechless. Yvette and I screamed and laughed about it later. YIKES!

I am still playing “camp nurse” here. The other day I returned to my chalet to see a note on my door that said, “Nurse Katie, Thank you for caring about my bowel movements. You are awesome!” haha! The bandaids that were given to me by Stacy and the Richardsons have definitely come in handy. I carry them with me at all times, and they get put to use! The anti-itch cream Stacy gave me has been a miracle- I get SO MANY bug bites here! I have also been able to teach the other students here about HIV and TB since they are now interacting with the community and running into these issues. (The rest of the students do community work for four weeks).

I'll post more soon! I had an extremely adventurous day, and yesterday I returned from an overnight backpacking trip in the Drakensberg Mountains!