St. Joseph Hospital. Moshi, Tanzania.
My first day at the hospital began with a stomach full of butterflies, but actually every day does. I stumble around not knowing really where I am needed, what needs to be done, and who to work with. Somehow my blue scrubs from the goodwill stand out so vibrantly amongst a sea of brightly colored kangas. I ward off constant staring with a smile, a wave or a "habari" and I'd say 90% of the time I get a smile or a neutral "nzuri." The other 10% are hard blank stares.
Fellow nurses- imagine your first day on the floor not even really knowing how to spike a bag of fluids or where to get a pillow. But, on top of ALL that you can't talk and you are deaf. How the hell are you going to do anything or learn anything. Well, you manage and adapt. I have things like a cheat sheet with very specific Swahili phrases. My worn down paper has phrases like "lie down" or "take one at night" or "PUSH!!." But other than that I have almost zero form of verbal communication. I try to talk with my face, my eyes, my hands. The biggest lesson learned here is how darn important communication is in the healthcare profession. The language barrier between myself, the staff, and the patients is less of a nuisance and more of a road block. The importance of communication has been darn well drilled into my head during nursing school but was just really hammered home during my stay here in Tanzania. I have to admit, I was naive and quite ill-prepared for this.
I spent most of my first day playing with pregnant bellies. Measuring fundal heights, palpating for fetal position and using a fetoscope to measure fetal heart rates. It is simple work but a foundation to caring for preggos. And, it is an amazing thing to connect to a living baby within another person. I almost feel like I am intruding on a special relationship when I listen for the baby's heart beat. I worked with two nurse midwives and saw upwards to 60 patients. I also gave a ton of vaccines to newborn babies and expecting mammas. I'd say that was a solid first day... except for getting lost on the way home. The hospital is about a mile and a half away from my accommodation with a total of three turns, somehow I missed turn #2. I befriended a little school girl named Janet and in exchange for some pocket change she led me to my home. Sweet girl. I walk to and from the hospital every day past houses, motorcycle taxi drivers and a few shops. There is always the same house bustling with 5-6 young toddlers half naked yelling gibberish at me. As soon as he sees me coming one little boy, with out fail, twice a day runs to the edge of his driveway waving his hand screaming "yayayayayayayaya."
The next day was mostly observing. It being my first day in the labor ward and not actually being a midwife AND not being able to talk to anyone led to a day of feeling like a useless pile. So I did what felt natural, I carried babies when I had no idea what else to do. As soon as I walked into the labor ward someone was being carted off to the "theater" for a cesarean section due to prolonged and obstructed labor. This was my first c-section to watch and what a treat for it to be in Africa. One of the more moving moments of my time at St. Joseph's Hospital was when this baby was pulled from the horizontal slit made in a young mother's lower abdomen. Eyes squeezed shut and mouth gaping the baby was silent and for just a little too long. The physician (from here on called Dr. Awesome) picked up the baby and started to stroke him in a downward motion. I, slightly teary eyed and in complete emotional awe, looked at the scrub nurse who was talking me through the operation and interpreting bits of swahili. He said, not yet. Not yet? Don't sigh with relief until you hear the baby cry. A few more moments passed and finally, the first cries of this baby immediately breaks the tension in the room. Dr. Awesome closed his eyes in silent prayer for what was probably only 2 seconds but as I watched him it seemed like eternity. It was such a slight gesture but in my eyes so incredibly moving.
It would be an understatement to say that the health care system and hospitals are different than those of the developed world. I would say try to imagine what health care and hospital wards would look like in the 1950's and put mud and dirt all over everything. No judgment, just observation. It is an antiquated system here speckled with technology and modern practices. The waste produced here is LIGHTYEARS less than that made in an average US hospital. All of the drapes used during surgery are cloth and can be seen drying on a clothesline outside the operating room prior to getting autoclaved. Everything is sterilized and reused, even the nasal cannulas. No one gets a bandaid after a shot. Every glove, every dollop of alcohol sanitizer and every piece of cotton or gauze is used with special care and consciousness. Nothing is wasted as there is little to waste. However, there is a definite disconnect in infection control but a definite lesson to be learned in resourcefulness.
During my time in the labor ward I wondered... with no name tags, no wristbands, how the heck do the nurses and moms know whose baby is whose?? Well, African women live and breath the Kanga- the multi colored cloth one would imagine the quintessential African woman to have wrapped around their body. Kangas are used as clothes, as a receiving blanket, as a carrier for an infant, as a sheet to put over the examination table in the clinic, as a peri pad wadded up placed in their underwear literally 5 minutes after popping out a baby. The kanga and how a woman uses or wears it gives them a way to express themselves and define their personality. And with their newborns? They know exactly what patterned kanga they own... very seldom are two alike. Newborns are swaddled in a matching Kanga to the mother or the grandmother. Ingenious and pretty fool proof I'd say.
Safari- Tarangire National Park and Ngorongoro Conservation Area
My first and only weekend in the Kilimanjaro area consisted of riding in a bumpy jeep, craning my neck to see out the window, standing in a jeep, snapping hundreds of photos, having a good time, and trying to sleep in a bouncy jeep my head bobbing to and fro like never before. I did a two day safari in Tarangire National Park and the Ngorongoro Crater, a collapsed volcano with tall walls encasing a menagerie of animals that seemingly live harmoniously together. I managed to see four of the big five- Lion, Buffalo, Rhino and Elephant. Among many other spectacular creatures. My favorites were the warthogs, giraffes, and zebras. The terrain just looked like where the dinosaurs would have roamed and it was equipped with gigantic beings like rhinos... slowly lumbering, placidly chewing grass. I was lucky enough to view this animal as they are extremely endangered and there are only 26 in the crater. Deeper in the jungle and at higher elevations I drove in the jeep feeling like I had just jumped out of Jurassic Park. A t-rex was just around the corner.
After the first day I did some luxury camping equipped with a five course meal and scotch with scots... although I recently learned that "scotch" is an American butchering of what really is whiskey. I, not really being a drinker, knew none of this and made a fool of myself. I joined a father and son duo from Scotland on the safari trip and had a blast with them. The son was quiet but kind and his father quite cheeky and fun. Both are doctors, the son doing TB research and the father doing primary care visits in the Bush of Zambia.
When someone thinks of a safari I imagine topless jeeps, khaki outfits and telephoto lenses. Well, Scot Sr. nailed it... minus the cheesy safari hat. And surprisingly about 80% of the other safari goers had their all khaki/telephoto camera outfits on too. I had no idea it would be this stereotypical. Nonetheless, standing in a jeep and peering out the top while driving through rough roads and trying to spot animals was extremely fun! It was like a disneyland ride for 8 hours. But, by day two I was done. My back ached from the uncomfortable seats and bumpy ride and I was exhausted. Am I getting old?
Everyone in Africa moves with a sort of grace that is just not seen in the US. The people here move deliberately and purposefully. Women walk along a busy street with 50 pounds of bananas on their heads as cars, buses, and motorcycles rush by. I bring this up because on my jeep ride to Ngorongoro crater at 6AM I saw two african men running. Running... what?? I haven't seen anyone run since I saw a tourist go for a morning run on the beach in Zanzibar. People don't even run when they cross a street and a bus is 5 feet from hitting them. Well it is ironic. The best runners in the US are black... but after two weeks in Africa I finally see someone running. Probably a Kilimanjaro guide.
I'd say my first week at the hospital was a success. I managed to help people but also sit back and observe a lot. There is much to learn from watching. I see what people view are important and what can be let go. I saw babies saved and mothers give birth. I've seen bravery and the tolerance of pain that I have never seen in a US hospital. I've seen women survive the most gruesome births and I've seen midwives use their gentlest touch. Aside from this environment I've seen much of the Tanzanian countryside. From my walks to and from the hospital to driving to the national parks. I've seen majestic animals and just the craziest looking creatures. Huge trees 800 years old and a pride of lions lazily napping in a field of daisies. I have seen children herding goats and old men playing what looks like checkers but probably isn't. I have seen a lot.
I have much more to say about the healthcare system here and about my time in the hospital but this post is long enough and you are probably bored ;)
1 comment:
Never bored!
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