I have learned how to hear a fetal heart rate with the fundascope! In fact, I unfortunately trusted myself enough to know that I was not able to hear a 36 weeker....I handed the fundascope to the "nurse midwife" (a male nurse) who also couldn't hear it. We had the doctor, who happened to be in the room, listen and he, too, could not find it. So we sent her to ultrasound. She returned an hour later with a slip of paper with the letters IUFD. This was easy for even me to understand. (Intrauterine fetal death) The mother was a 40 year old with HIV and only had one leg. She walked with a large stick for support. It was sad, and clearly is not handled with "kid gloves" but instead is told matter of factly to the mother and she is send on her way. She is to report back for induction when possible.
Otherwise today was good. No baby's hit the ground! And I'm becoming much better at fundal height measuring with my hands as well as with a measuring tape. I can typically estimate the fetal age with my hand measurement as close as 2-3 weeks (assuming their dates are correct in the first place). So I am learning as well as being able to help. Today we must have seen 50 pregnant women, you see there are no appointments they just arrive and are seen in the order that they arrived. So some days there are very few patients and others there are a lot.
I believe we have worked out our plans for the weekend. We will be taking a "dalla dalla" (not sure of the spelling in swahili but it means a small bus of sorts) to Moshi which is an hour drive. There we will meet with Dr Hoon's friend John, and will have a tour of the waterfalls at the base of Mt Kilimanjaro. John is the hiking guide Dr Hoon hiked Mt Kili with. We might spend the night at a friend of a friend of a friend of mine's house. But that has not been worked out yet. We might also just return that same night.
So far my only loss is 300 US dollars, due to an ATM not giving me money! But it is posted to my bank account as removed! No longer just pending, so it is truly gone! Fingers crossed that will be the biggest loss during my trip! And yes I have tried to contact SunTrust, but they wrote me back and stated that they could look into it but my card would have to be canceled...which is not an option.
Wednesday, January 20, 2010
Tuesday, January 19, 2010
2nd day at the hospital
Things were a bit more my speed today. I worked in the outpatient MCH department (maternal and child health). The day was spent getting weights on children under the age of 5. They are to return monthly for wt checks when they are under a year old. But that is all that is done on that visit, just a weight. They do not see a doctor or have a physical. Their growth is plotted on a card and given back to the mother to keep for the next visit, there is no second copy of this recorded medical information. The most horrifying thing was when the strap broke that was holding the child being weighed and he fell to the ground hitting his side and his head on the cement from about 4 ft. If that wasn't bad enough, nothing is done exept to let the mother sooth the child and put him back in a new sling and try again! It was very hard to watch!
Several children were underweight or had lost significant weight since their last visit, I tried to show my concern but was told that is was only because the mother had been sick a week or two prior! (This was not a good enough answer for me, but for now it has to be!)
I also preformed maternal checks. At each visit (also monthly until the 8th month when it becomes weekly) a Blood pressure, weight, fundal measurement, and listening for fetal heart rate is preformed. Some mothers have labs drawn and receive malaria medications (depends on how far along they are) Also HIV tests are preformed 3 times during the 9 month pregnancy. The most difficult task is trying to hear the fetal heart rate through a wooden fundoscope. This is a skill that requires a bit more practice, especailly on the 20-30 weekers!
I am feeling more confortable and even a bit helpful, the hardest part is not being able to communicate in Swahili. I know some basic phrases "Thank you" "Thank you very much" " You are welcome" "Enjoy" "How are you?" "Whats up?"
Our 10 minute walk to the hospital is all on dirt roads and passes by a primary and secondary school. On the way home the children are out of class and tag along behind us chanting different english phrases like "hello" "morning" "good morning" and "how are you?" Today we cut through the middle of a small soccer game (taking place on the dirt road) and the ball was passed to a young boy near me, so I joined the game! Took the ball and proceded to go and shoot on the child in goal. He saved it but all the little boys thought this was great. After missing my goal, I continued walking to the house! I have a feeling these kids might become part of my after work activities at some point, even if it is just playing soccer a few times a week. :)
Several children were underweight or had lost significant weight since their last visit, I tried to show my concern but was told that is was only because the mother had been sick a week or two prior! (This was not a good enough answer for me, but for now it has to be!)
I also preformed maternal checks. At each visit (also monthly until the 8th month when it becomes weekly) a Blood pressure, weight, fundal measurement, and listening for fetal heart rate is preformed. Some mothers have labs drawn and receive malaria medications (depends on how far along they are) Also HIV tests are preformed 3 times during the 9 month pregnancy. The most difficult task is trying to hear the fetal heart rate through a wooden fundoscope. This is a skill that requires a bit more practice, especailly on the 20-30 weekers!
I am feeling more confortable and even a bit helpful, the hardest part is not being able to communicate in Swahili. I know some basic phrases "Thank you" "Thank you very much" " You are welcome" "Enjoy" "How are you?" "Whats up?"
Our 10 minute walk to the hospital is all on dirt roads and passes by a primary and secondary school. On the way home the children are out of class and tag along behind us chanting different english phrases like "hello" "morning" "good morning" and "how are you?" Today we cut through the middle of a small soccer game (taking place on the dirt road) and the ball was passed to a young boy near me, so I joined the game! Took the ball and proceded to go and shoot on the child in goal. He saved it but all the little boys thought this was great. After missing my goal, I continued walking to the house! I have a feeling these kids might become part of my after work activities at some point, even if it is just playing soccer a few times a week. :)
Monday, January 18, 2010
First day at St Elizabeth's Hospital in Arusha
I spent my first day at the hospital. It was mostly walking around meeting all the staff, doctors, nurses etc. After we met EVERYONE! We went to the surgical theater ( Operating room) and watch an eye doctor preform 3 surgeries and start a 4th but the woman decided not to have her cataract removed after she had been given a needle to the eye to numb and had a 10 pound weight on her eye to "reduce the pressure so that when they start not everything pops out" (that is a direct quote from the doctor) So you can see it was an interesting day.
Bottom line it is so different and so rural that it is difficult to fit in everything I experienced today. But will put some "highlights" to give you guys an idea.
1) The smell (mom you would die!!!!) Everything from plain BO, to bowel movement, to vomit, to rotting flesh!
2) The shear number of people in one area. And the limited doctors and nurses.
3) The constant wet floors that are being cleaned, yet drip from the steps of the floor above because the water is never actually dried, but instead is left to dry by mother nature.
Now about the OR..... WOW
4) Sterile is not really a known word.....I mean of course it is but a very different attitude about how sterile one must be. Examples, the doctor used the same scrub gown for all the surgeries, they re-used instruments between patients.
5) The patients are FULLY awake with no meds! other than lidocaine locally!
6) A nurse even almost caught on fire from the caughtery system! Need I say more....
ok my time is up at the internet cafe and it is about to start POURING so I better go...more later this week.
Bottom line it is so different and so rural that it is difficult to fit in everything I experienced today. But will put some "highlights" to give you guys an idea.
1) The smell (mom you would die!!!!) Everything from plain BO, to bowel movement, to vomit, to rotting flesh!
2) The shear number of people in one area. And the limited doctors and nurses.
3) The constant wet floors that are being cleaned, yet drip from the steps of the floor above because the water is never actually dried, but instead is left to dry by mother nature.
Now about the OR..... WOW
4) Sterile is not really a known word.....I mean of course it is but a very different attitude about how sterile one must be. Examples, the doctor used the same scrub gown for all the surgeries, they re-used instruments between patients.
5) The patients are FULLY awake with no meds! other than lidocaine locally!
6) A nurse even almost caught on fire from the caughtery system! Need I say more....
ok my time is up at the internet cafe and it is about to start POURING so I better go...more later this week.
Sunday, January 17, 2010
The first real post!
So I arrived without any problems, all my bags made it, I was able to pick up my VISA in the airport without any hassle and my ride was even there to take me to the host family's house. The only down side was it was night time so I was unable to see the area until the next morning.
I am sharing a small bedroom with another nurse from the US. Her name is Cassie (so if I use the term we I am generally refering to Cassie and I). It has two twin beds and nothing else. It is a bit crampped but works just fine. Fingers crossed we have seen no Mosquitos yet, so have begun to assess the situation each night to decide on whether or not to use our net while we sleep. But don't worry I am taking my medications religously!
The house is a 4 bedroom 1.5 bath. The 60 year old host is called "Mama" and she has a live in maid who is roughly 14-16 years old, named Jennifer. The other 2 bedrooms have volunteers as well. Although 3 of them are on a Safari this weekend so I have not met them yet.
Food is good thus far, different but good. Last night we had stewed green bananas in a light tomato sauce with spinach. Tonight is curried rice and goat (so I have been told)
We were given a tour of the town by someone "A Broader View" hired. He was excellent. Very friendly spoke good english and was always watching our back. So now that I have said that, it isn't that Arusha is unsafe! But pick pocketers, especailly with a focus on the white people are on the streets! Also we have been told that we must be back at our host family house by 6:30 pm and no later if we are walking. We also can take cabs if it is after those times. This is not merely a suggestion but something even the locals live by. So this will all take a little of time to get used to but sure will be fine in the end.
Dinner is generally at 8pm, so the first full day was very long getting adjusted. But this morning was a touch better even though we got up extra early go to Roman Catholic church with Mama. The entire service was in Swahili, but the music was very enjoyable! Mama tells us the 3rd mass of the day is in English, Cassie and I agreed we would try and make that one sunday, just to see how it is.
We are working on getting our weekend trip figured out but at this point are set on doing a 5 day camping safari. With an unknown date at this point. I will keep you updated as I start working on Monday. I think our day is from 9am- 3pm (must be nice)
Thats all for now....hope all is well at home!
I am sharing a small bedroom with another nurse from the US. Her name is Cassie (so if I use the term we I am generally refering to Cassie and I). It has two twin beds and nothing else. It is a bit crampped but works just fine. Fingers crossed we have seen no Mosquitos yet, so have begun to assess the situation each night to decide on whether or not to use our net while we sleep. But don't worry I am taking my medications religously!
The house is a 4 bedroom 1.5 bath. The 60 year old host is called "Mama" and she has a live in maid who is roughly 14-16 years old, named Jennifer. The other 2 bedrooms have volunteers as well. Although 3 of them are on a Safari this weekend so I have not met them yet.
Food is good thus far, different but good. Last night we had stewed green bananas in a light tomato sauce with spinach. Tonight is curried rice and goat (so I have been told)
We were given a tour of the town by someone "A Broader View" hired. He was excellent. Very friendly spoke good english and was always watching our back. So now that I have said that, it isn't that Arusha is unsafe! But pick pocketers, especailly with a focus on the white people are on the streets! Also we have been told that we must be back at our host family house by 6:30 pm and no later if we are walking. We also can take cabs if it is after those times. This is not merely a suggestion but something even the locals live by. So this will all take a little of time to get used to but sure will be fine in the end.
Dinner is generally at 8pm, so the first full day was very long getting adjusted. But this morning was a touch better even though we got up extra early go to Roman Catholic church with Mama. The entire service was in Swahili, but the music was very enjoyable! Mama tells us the 3rd mass of the day is in English, Cassie and I agreed we would try and make that one sunday, just to see how it is.
We are working on getting our weekend trip figured out but at this point are set on doing a 5 day camping safari. With an unknown date at this point. I will keep you updated as I start working on Monday. I think our day is from 9am- 3pm (must be nice)
Thats all for now....hope all is well at home!
Saturday, January 16, 2010
Tuesday, January 12, 2010
Down to the Wire....
Well, it is officially 2 days before I jet off to Africa. Am I ready??? No! Am I still running around doing last minute things??? Yes, of course! I'm sure it will come together by Wednesday evening but until then I have plenty to do.
This will likely be my last post before I leave, I just wanted to say Goodbye to everyone and thanks for all of your encouraging words. I will be thinking of you all, often. I will try to keep this going once I'm in Tanzania. If it won't be possible for what ever reason I will find a way to let you all know, but fingers crossed you should be able to receive regular updates on here.
Also here are pictures of my new hair cut that everyone has been asking for. I donated the rest and now have a fabulous short Africa friendly hairdo.
This will likely be my last post before I leave, I just wanted to say Goodbye to everyone and thanks for all of your encouraging words. I will be thinking of you all, often. I will try to keep this going once I'm in Tanzania. If it won't be possible for what ever reason I will find a way to let you all know, but fingers crossed you should be able to receive regular updates on here.
Also here are pictures of my new hair cut that everyone has been asking for. I donated the rest and now have a fabulous short Africa friendly hairdo.
Wednesday, December 30, 2009
From Square One
On December 9th 2009, I graduated from Johns Hopkins School of Nursing with my masters in nursing. While I wait to take my certification exam for my new career as a Pediatric Nurse Practitioner, I have decided to take a 6 week trip to Tanzania Africa and work at a local medical clinic in Arusha, Tanzania.
Preparing for a 6 week stay in a 3rd world country providing care for the local population takes more time and effort than one might assume. There are the obvious things like booking your flights, finding an organization to connect you with a community in need, and your inevitable VISA's you will be required to obtain prior to departing the US. The real headache begins with the multiple travel vaccines which your health insurance will not cover, even though they are to help PREVENT disease and illness of their insured customers. Once you have figured out which ones you need, you must then find a clinic who will administer them (keeping in mind the out-of-pocket costs). After your vaccines, you are STILL not in the clear for traveling. You need to obtain anti-malaria medications which must be taken daily starting before you even leave the US and continuing through anywhere between 1 -4 weeks after you return. Don't forget to pack a good broad spectrum antibiotic, just in case! As a nurse, don't get me started about all the "just in case" medications that should be highly considered on a trip like this.
After working all the medical aspects out, I focused my attention to collecting donations for the local people of Arusha that I will be encountering. I send out numerous e-mails to different "big name" company's (who shall all remain nameless since they all turned me down). In the end my e-mailing efforts resulted in 100 donated toothbrushes! I was thrilled! This generous donation got me motivated again. I sent out several more e-mails to "big name" companies in search of small packs of crayons for the children at a near by orphanage in Arusha. Again denied! With the air knocked out of my sails once again I turned locally to my Baltimore community. This seemed to have resulted the best turn out. I obtained 5 sets of hospital issued scrubs (for my own personal use), gauze pads, 2 boxes of medical gloves (also for my own use), a box of masks, a very large box of condoms (1008 to be exact), a huge stack of HIV/AIDS/STD information pamphlets, over 80 packs of flash cards (addition, subtraction, multiplication, division, alphabet and sight words for the kids at the orphanage) and variety of smaller medical supplies and small soaps. I now take a step back and am thoroughly impressed with my family, friends and community for helping me gather all the items to take with me to give to those in need. While this was definitely the most time consuming part of my pre-travel plans, it has resulted in the most rewarding outcomes. But I am certain it will be nothing compared to the rewards I receive from my travels.
Preparing for a 6 week stay in a 3rd world country providing care for the local population takes more time and effort than one might assume. There are the obvious things like booking your flights, finding an organization to connect you with a community in need, and your inevitable VISA's you will be required to obtain prior to departing the US. The real headache begins with the multiple travel vaccines which your health insurance will not cover, even though they are to help PREVENT disease and illness of their insured customers. Once you have figured out which ones you need, you must then find a clinic who will administer them (keeping in mind the out-of-pocket costs). After your vaccines, you are STILL not in the clear for traveling. You need to obtain anti-malaria medications which must be taken daily starting before you even leave the US and continuing through anywhere between 1 -4 weeks after you return. Don't forget to pack a good broad spectrum antibiotic, just in case! As a nurse, don't get me started about all the "just in case" medications that should be highly considered on a trip like this.
After working all the medical aspects out, I focused my attention to collecting donations for the local people of Arusha that I will be encountering. I send out numerous e-mails to different "big name" company's (who shall all remain nameless since they all turned me down). In the end my e-mailing efforts resulted in 100 donated toothbrushes! I was thrilled! This generous donation got me motivated again. I sent out several more e-mails to "big name" companies in search of small packs of crayons for the children at a near by orphanage in Arusha. Again denied! With the air knocked out of my sails once again I turned locally to my Baltimore community. This seemed to have resulted the best turn out. I obtained 5 sets of hospital issued scrubs (for my own personal use), gauze pads, 2 boxes of medical gloves (also for my own use), a box of masks, a very large box of condoms (1008 to be exact), a huge stack of HIV/AIDS/STD information pamphlets, over 80 packs of flash cards (addition, subtraction, multiplication, division, alphabet and sight words for the kids at the orphanage) and variety of smaller medical supplies and small soaps. I now take a step back and am thoroughly impressed with my family, friends and community for helping me gather all the items to take with me to give to those in need. While this was definitely the most time consuming part of my pre-travel plans, it has resulted in the most rewarding outcomes. But I am certain it will be nothing compared to the rewards I receive from my travels.
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