Wednesday, December 21, 2011

Hey all, I apologize that I haven’t written in a while.  I was intending to post once a week, but that has proven to be an unrealistic ambition.  Also, I’m just going to stop apologizing for how long all of my blog posts are becoming.  By now, ya’ll know that I’m my mother’s child and I always have a lot to say, so you’ve been pre-warned.
On Thursday December 8th, I had officially survived the first month of living in Kenya.  (I say ‘survived’ because when I first arrived, I didn’t think I could make the one month mark, but just like a big move anywhere, I had a period of adjustment and I’m finding myself quite fond of the area and especially the people.)  I would’ve settled for a Tusker as a celebratory gift, but I think God had different plans.

New Pavements
Since I had last posted, I continued to find my sea legs in the pediatric department for a few weeks.  I started interacting with patients more and more as I’ve had many Walimu  Mzuri (good teachers), so I can actually communicate with my patients and their mothers (in short broken sentences) and because of this, I’ve gain some much-needed confidence in myself.  I have realized that technical nursing practices are much different here than in the States and I was getting frustrated with myself for not knowing more.  However, after having contemplated my worth here, I had an epiphany: I know that as a nurse, a little compassion can go a long way with a patient.  With my short career in hospice and the training I received at CSB based on the Benedictine Values, I believe that I have really grasped and embraced this concept and I know that if nothing else, I can teach the students that empathy is a crucial key in nursing.  I think God was waiting for this young punk to throw my temper tantrum, get over it, and realize that my purpose here may be different than I expected.  Soon after I had my revelation, He sent me a great gift: a fresh batch of first year nursing students.  When they came onto the ward that first day, it was literally their first day working in the wards and that had that doe-eyed look in their eyes that I once did when I first arrived on the med-surg unit at St. Cloud Hospital.  It’s the look of: “Oh crap, I actually have to talk to these patients.  I have no idea what I’m doing”.  (Side note, in my case, my clinical professor pretty much had to shove me into the room to even say ‘hi’ to my patient.)  There are just so many students here and not that many patients, so I think sometimes, like any new student, they all cling to each other in hopes that they won’t make a mistake or the teacher won’t pick them to answer the question.  That’s exactly what happened when I asked who would like to take the patient’s vitals.
Those doe-eyes just stared back at me, seemingly pleading for mercy.  I grabbed the vitals cart and gestured for some of them to come with me.  They all slowly crept forward, as though they were all atoms in a tightly fused chemical bond.  Nervous giggles at bay, we arrived at the first patient and I told them that ONE person needed to take the vital signs.  I can’t remember who it was, but after a long silence, one brave soul finally broke the bond and gingerly took the mercury thermometer from my hand.  Of course, once one atom splits from the bond, the bond loosens and more atoms leave, and thus I had three or four students trying to take each individual vital sign from the child, who was not in the mood to be surrounded by what he perceived to be his executers.  While the students struggled to work with the noncompliant mtoto, I quizzed the others on the normal ranges of the vital signs for a child of this age group.  As new students, they did have some trouble coming up with the correct answer, but I do understand that it’s hard to memorize all of the ranges and pull them out on demand.  However, knowing vital signs is, well VITAL for the safety of your patients, so I made sure to stress that they needed to have them memorized the next day.  After about fifteen minutes of data collection with that one client, I ask that dreaded open-ended question that every nursing student hates to hear: “How do you think that went?”  After hearing what their thoughts were, I gave them a few pointers about trying to cluster their cares (such as taking the pulse and respirations while they are taking the temperature) and then I told them my number one rule: if you aren’t communicating with your patient, you aren’t being a good nurse.  After about an hour of taking vitals, which probably would’ve taken a regular nurse about 15 minutes, we reconvened at the nurses’ station and I asked the standard sum up questions: “What went well?  What can we improve the next time?”  The students were actually very receptive to this and made some very wise comments, but I was so elated when one student said: “We should’ve talked with the patients much more, and told them what we were doing”.  By George, I think they’ve got it…

The New Frontier
While working in her office one day, Patricia discovered that there would be a small group of Wazungu (white people) coming from the States for a couple weeks to do an outreach clinic in the nearby villages.  Patricia decided that she would go to work with them for the weeks that they were here.  What a great opportunity.  She came home that night exhausted, but full of stories and told me that along with seeing clients for minor complaints, these Americans were also implementing a Mass Drug Administration (MDA).  A Mass Drug Administration is one in which a treatment, or preventative medication is given to a large group of people in one setting.  Apparently, in this area, there is quite a high prevalence of a disease called Lymphatic Filariasis (a.k.a elephantiasis), which is a horrific disease spread from human to human through mosquito bites.  Basically, the disease involves the lymphatic system, so the client will typically present with severe swelling of the limbs, which is very painful and immobilizing.  (This website is an excellent source, if you’d like to know more about the disease: http://www.who.int/mediacentre/factsheets/fs102/en/)
Once a person has experienced the crippling symptoms of LF, those symptoms can never fully be reversed, although they can be significantly improved with proper treatment.  However, by receiving the proper preventative drugs (1 oral dose per year for 4-6 years), a person will never get Lymphatic Filariasis.  Moreover, the two drugs that they administer, Ivermectin and Albendazole, are anti-helminthic drugs, which will get rid of worms in the body, which not only increases that person’s nutritional status, but also decreases their risk of contracting Malaria by 50%.  Are your heads spinning yet?  In other words, by administering two drugs, you can do a whole lot of good.
Patricia informed me that these Wazungu were encouraging us to start an MDA in the schools around this area. We both were so excited of the prospect of doing this work here.  If we could start this program and the hospital could sustain it, over the next 5ish years, we could potentially eradicate Lymphatic Filariasis in this area, not to mention decrease prevalence of worms and Malaria.  It’s a big idea for only two people, but I believe that if you have a positive and flexible attitude, God can do great things through you.
The next week, I decided to join the ranks, to see how this MDA works.  There were about twelve people from the States—most of them doctors and nurses—and 8 students from the Kenyan nursing school here, who acted as translators.  My goodness, these people work hard.  They hardly took breaks and barely even stopped to take a sip of water.  Each day, they went to a different village, where they set up a check-in site, about 6 consultation areas, and a small pharmacy.  I was impressed with the amount of organization and meticulousness that they were able to keep, while moving from place to place every day.  When I was there, we saw around 400 patients every day.  I was placed with a doctor’s wife in the MDA branch of this group, in which we would go around to each client, administer 2-3 pills (depending on the approximate size of the person), give them some water to slurp down the drugs (using the same two cups for all 400 patients), and mark their hand with a ‘X’, indicating that they’ve received the treatment.  It was a fairly simple procedure, but proved to be somewhat grueling because ensuring that we’ve reached all 400 people, who mostly don’t speak English, and giving them the information they needed was not the easiest task.  I’m pretty proud of myself because I was able to us what little Swahili that I know to communicate a lot of the important information (in broken, poor grammatical fragments).  At the end of the day, we packed up all of the leftover pharmaceuticals and walked about a half mile to the van that would transport us back home.  I was so tired, I could barely make myself dinner, but it was a good feeling knowing that I had put in a hard day of labor and that I may be able to do something really significant here in Kenya in the future.
One is the Loneliest Number…
Over the month that I had been here, Patricia had not been feeling up-to-snuff and we had both been getting more and more concerned about her health.  After much deliberation, she was forced to fly back to the States the week of my one month anniversary.  Given her poor health status, I don’t know whether or not she will be returning.  I will never forget the moments of sheer panic, confusion, hilarity, and awe that we were able to share together.  I sure do miss having her here, but I know that her decision was very wise and I believe that God’s not leaving me in the middle of nowhere.  Well, I’m not completely alone: Blackie is always willing to provide company.
Okay, so this is a side-rant, but the Blackie clan has prevailed, despite my best efforts to dispose of them with the remaining rat poisoning I had.  Either Blackie is a super-rat that is completely immune to rat poison, or I’m now dealing with Blackie the sequel.  The other night, I was sitting in the living room, and just like clock-work, I catch a glimpse of a dark ball of fur scuttling into the kitchen for an evening snack.  I swear to you, this ‘new’ Blackie came out of the kitchen about a half hour later, looked at me with a cheeky little grin, and scurried back into the kitchen to finish his meal.  He’s becoming bold enough to barely even make an effort to RUN anymore.  I think he believes he owns the place.  Well, Blackie II, I hope you enjoyed your last meal, because it was chock full of rat-poison.  Of course, now I have no more poison and when I inquire about the poison in the main stores of Kakamega, they look at me confused like they’ve never heard of rat poison!!!  A couple of nights ago, the WWF smack-down commenced above my bedroom, so obviously the poison didn’t do much good.  If I have to use all of my pharmaceuticals to concoct my own deadly rat poison, I WILL!  These rats won’t know what hit them.

Nat and the Terrible, Horrible, No Good, Very Bad Day
The second evening after my wonderful roommate had returned to America, I plopped down in front of my computer, exhausted and slightly dehydrated from another day with the Americans doing MDA.  It was a pretty standard night; I heated up the leftover kunde for dinner, cracked open a Tusker, and began to research the possibility of starting the MDA program here.  Soon after, I succumbed to my fatigue and visions of my cozy bed and retire for the night.
Unfortunately, my slumber was not as peaceful as I expected.  I awoke in the middle of the night with terrible stomach cramping and a strong pressure in my lower back.  At first, I convinced myself that I just needed to go to the bathroom, but in the back of my mind, I knew someone wasn’t quite right.  I just knew that I had malaria, but in fear of stepping on a cobra or being kidnapped by someone in the middle of the night, I made up my mind that I would suffer through the night, and check myself into the hospital in the morning.  After several hours of increasingly more and more severe pain, complete with tossing and turning and pacing the floors of my house, I decided that if I didn’t brave the terrors of the night, I would surely be in a much worse position by the morning.  So at 3:00 in the morning, I dressed myself-no matter how much pain I was in, I was not about to face a young handsome clinician without hiking up the ‘girls’-strapped on my headlamp and ventured out into the dark.  Luckily, my house is within the hospital compound, making it about a two minute walk from my doorstep to the Out Patient Department (OPD), which is the ‘triage’ area of the hospital.  As I neared the OPD (all the while scanning the ground for any stick that remotely resembled a snake) I woke the guard at the gate an asked him to help me find the doctors.  After a little banter back and forth, due to a slight communication barrier, he escorted me the rest of the way to the OPD and after confirming that there was no Clinician sleeping in the side rooms, he told me to wait there while he called someone.  The pain in my abdomen was the perfect drill-sergeant, it raged and pulsed anytime I sat still, despite my body’s pleas for rest, I was forced to pace.  The noxious smell of kerosene loomed in the room, as the electricity (Ol’ Reliable) had gone out, and the only other beam streaming through the dark beside my headlamp was a lantern (nurses and doctors of America: imagine inserting an IV with only the soft glow of a lantern).  After what seemed like an eternity, the guard returned with two clinicians.  Right away I told them that I suspected I had malaria, and after relaying my symptoms to them, they agree with my suspicion.
In this area of Kenya, malaria is an extremely common condition and malaria can manifest itself with any number of a large array of generalized symptoms, so sometimes it is over-diagnosed—as one clinician joked, “If you’ve hurt your finger…you have malaria.”  Of course, they take blood for a smear can see malaria rings in your blood, but they typically start you on the malaria treatment before they receive confirmation, because the form of malaria around here is very severe.
Anyway, after I told them that I probably wouldn’t be able to hold down any oral medication (and proceed to vomit in the trash can), they started an IV via the light of a lantern (I was impressed) and gave me an IV push of diclofenac, a common NSAID (mild pain reliever).  At this time, I called my parents and CMMB and informed them that I had malaria and was being admitted.  The clinicians took my weight (it looks so much nicer in kilograms), and escorted me to the private wing of the hospital, where, as the name implies, patients have their own rooms.  I thank the lord that I am fortunate enough to be able to afford the private ward, because over the next few days, I had some pretty revealing and uncomfortable procedures.  I am grateful that after the nurse left and shut the door, I could keep my cussing and whining out of earshot of the patient next to me.
Needless to say, the mild pain reliever I was given, didn’t have much effect on the drill-sergeant in my abdomen, so I paced for another hour until the nurse came in and gave me a different oral pain killer (another NSAID), and the pain decreased enough that I could lay down on my bed.  It was in the early morning, so I waited until later in the day, before a doctor could come to see me.  Meanwhile, the pain medication that managed to act as a chill-pill for “The Sarg” wore off and I was back to pacing.  Sidenote, anyone who wants some motivation to burn off those Holiday calories, “The Sarg” is a great motivator.  :-P  At this time, my nurse entered and saw that I was having very severe pain.  She apologetically told me that someone had informed her that I was just having my menstrual cramps and she quickly ran to get me an IM injection of pain reliever.  For those of you who don’t know, IM shots are usually given in the gluteal region.  During my hospital stay, I received many IM injections, and frankly I believe that far too many poor Kenyans saw my big illuminatingly white ass.  As “The Sarg” was overcome, my body gave in to fatigue, but not before I made a mental note to find and kill the ignoramus who started the menstrual cramp rumor.
In was slightly awkward to be in the hospital here, because I knew most of the staff that took care of me—making my previous statement about ‘butt viewing’ even more humiliating.  The doctor, Dr. Mahasi, who came to see me, actually does rounds in pediatrics, so I knew well that he is an exceptional doctor.  He was the first person to actually examine me further than my vital signs.  By the time he came to see me, I started spiking high fevers, despite feeling freezing, and I began to shiver, so I was convinced that I had malaria.  As he palpated my abdomen, it became clear that “The Sarg” was most prevalent in the region of my appendix (I had to refrain from punching him in the face when he touched the area).  He immediately told me that he suspected that I had appendicitis and not malaria.  When my lab sheet returned, there was no detection of malaria rings, but my white blood cells and granulocytes were extremely elevated.  After having an ultrasound confirmation that in fact my appendix was inflamed, the doctor informed me that I needed surgery.  Immediately my gut reaction spewed from my mouth, “Do I HAVE to have it HERE?”  In retrospect, I think this statement was probably really offensive, but I tend to shove my foot deep within my mouth when I’m not thinking properly.  Luckily, the people in the room didn’t retort at all, but I could tell some of them were miffed.  Dr. Mahasi told me that he recommended that I get my appendix out within the next 48 hours, which sort of put a damper on my initial idea of going home.  When I called my parents an informed that that by the way, I didn’t have malaria, I had appendicitis and I needed an appendectomy, they were eerily calm.  After weighing the options quickly, we all agreed that it didn’t make sense for me to go back to America for surgery.  After informing the right people of my decision, I was told that I would undergo the surgery next day around 9:00 am, since the surgeon wasn’t at the hospital that day.  I called my parents back to tell them the time and in the midst of our conversation, I ran out of minutes on my phone.  Cell phones here are generally pre-pay only, so once you run out, you have to go back to the store and buy more.  Well, seeing that I was bed-bound (and any movement I made was under strict supervision by “The Sarg”), I couldn’t really get to the store.
My wonderful night nurse had the unfortunate duty of prepping me for surgery.  I’ll leave most the details to your imagination, but my least favorite procedure was the insertion of a catheter.  First of all, the hospital must have been out of sterile gloves, because my nurse failed to use them, although she really did her best to keep everything else as sterile as possible.  For those of you who aren’t medical folk, the insertion of a catheter is a delicate (not to mention sterile) procedure and you have to choose the correct size catheter for your patient.  She tried the bigger of the two catheters first and, well, nicely put, it took every ounce of my strength to refrain from knocking her out.  When the procedure was finished, I stared goggle-eyed at the ceiling and refused to move at all because it felt like someone had scraped away a generous portion of my urethra with a cheese grater.  I know that it wasn’t her fault, but at that moment in time, she was the enemy and if looks could kill…  This was one of those moments, when I was grateful to have the private room, so I could freely express my displeasure in the form of poetic profanity.  Having endured this procedure, I will never again insert a catheter without giving significant thought to the discomfort that it will cause.  I think it should be a requirement for every nursing student in the states to have a catheter inserted once, as an exercise in empathy for their patients.  I wonder how many of my patients have crafted voodoo dolls of me after having a catheter inserted.
So there I was, lying in bed without the luxury of communicating to loved ones at home, and only “The Sarg” to keep me company.  Oddly enough, I was at peace, and I know that in my heart this was when you all were praying for me.  I had this strange feeling of confidence and awareness that everything was going to be just fine.  Not to sound like the eccentric black lady from the Pinesol commercials, but ‘that’s the power of Prayer, Baby!’
Well, the surgeon was running on “Africa Time”, so though I was told my surgery would be at 9:00 am, I wasn’t wheeled into the Theater (a.k.a. Operating Room), until 2:00 pm.  I wasn’t put fully under, rather I had a saddle block, so I couldn’t feel the bottom half of my body.  The anesthesiologist was extremely nice and when I told him that I was nervous, he talked me through the entire procedure.  I don’t know who the DJ was, but they played a lot of premium Christian music, which also was very soothing.  Again, I knew many of the people working in the theater, so I was pretty embarrassed that they were all witnesses to all of my intimate parts.  One of my Kenyan guy friend’s, who is doing a year-long internship at the hospital, held my hand and I jokingly told him to tell the surgeon to suck out some mafuta (fat) while he was down there.  He didn’t really understand what I was saying, so I quickly told him that I had been joking—surely I wouldn’t mind a little liposuction or tummy-tuck, but I’d prefer to avoid unnecessary trauma to my body during such a major operation. J
Before I knew it, my surgery was complete and I was wheeled out of the theater to wait for my nurses to come get me.  As I was wheeled from the room I gave a quick thumbs-up to the exceptional DJ, while another surgical case was wheeled passed my stretcher into the theater, since there is only one operating room.  The surgeon came out to write some notes about the surgery in my chart and proceeded to make snide remarks to me that appendicitis was a rich person’s disease and that he counted on rich people like me to pay his salary.  If I could’ve felt my legs, I would’ve climbed off that stretcher and shoved my foot so far up—well, you get the picture.  I would like to note here that this is NOT the attitude of the majority of people here.  In fact, most people are very thankful and welcoming, but for some reason this surgeon woke up on the wrong side of the mosquito net that morning and I was not in the mood to be stereotyped.  I have to admit that there may have been a silent hand gesture under my sheet.
When the nursing students who were acting as my nurses came to pick me up, I was too heavy for them to lift me (and my dead legs), so they told me to roll myself onto their stretcher.  This is not a fun experience after having been through surgery, and wouldn’t really be an acceptable practice in America, but I did what I was told.  I felt so helpless as half of my body moved onto the new stretcher and the other half stayed on the old one.  I would also like to point out here that I was only wearing an extremely short operating shirt, so I again exposed myself (and “The Great White”) to the world as I performed this maneuver.  Fortunately, the anesthesiologist to my rescue and brought my body back into alignment on the new stretcher (I was also happy that he scolded the nursing students for not doing their job).  From the theater, my stretcher was transferred outside and rolled across a very bumpy sidewalk.  By the time, I got back to my room and into my bed (which was another struggle), it had been almost an hour since I had been in the OR with pain relievers, so “The Sarg” came back with a vengeance.  This was the worst pain I had ever experienced and the nursing students had left me alone in my room, unable to press the call button.  I focused on my breathing (it had become painful to breathe anything more than “chipmunk breaths”) as I rhythmically pounded the wall with my fist to alleviate some pain.  I’m pretty sure that I asked God to kill me a few times and proceeded to confess some last minute sins, in case He obliged.  When the student finally came back in the room, hot tears began to run down my cheeks and when she realized that I was maybe having some pain, she quickly administered an IM shot of pethidine (strong stuff).  Within 15 minutes my pain was manageable, but I was exhausted from struggling with it for so long.  That, along with the sedative effect of the drug put me to sleep.  I vowed that I would never let my pain get that bad again.
By the time I was able to get someone to run out and get minutes for my phone so I could call home, it was 5:00 or 6:00 pm and my poor parents thought something had happened to me.  Though he tried not to convey it, I could hear panic in my dad’s voice when he answered the phone.  I could only talk for a few minutes, but I’m thankful that my friends here were able to get me phone minutes because my parents were so relieved to hear from me.
During my stay, I was so surprised to see the many people came to visit me, including administrator of the hospital, Stanley, who came every night and visited me for at least an hour.  I had so many, that the day nurse was forced to lock the door periodically, just so I could sleep.  The Americans, with whom I’d been working, had become worried when I didn’t show up with the students for work, and when they found out what had happened, they came bearing gifts of trail mix, Crystal Light packets, a hairbrush, and much more.  I felt so blessed to have such wonderful people surrounding me during this time.
It took forever for the doctor to allow me to start eating again, so when I was finally able to have a cup of broth, I was in a euphoric state.  The cook, Janeveva, had instantaneously become my new best friend—I practically kissed her and told her I love her.  I quickly realized that I had pleased the right person because the next morning, she slipped me the only egg left in the joint.  Hands down, it was the best egg I had ever eaten.  Now that I’m discharged, I miss having Janeveva’s delicious cooking, especially her exquisite tea.
After a week in the hospital, I was finally discharged and ready to be totally independent.  At least my brain decided that I had enough pampering; my body had other ideas.  The first night I came home, I was exhausted and the task of cooking for myself seemed like trying to climb Mount Everest, so I broke into my reserves settled for a piece of bread slathered with a spoonful of peanut butter.  I also took advantage of the trail mix my American acquaintances had brought me.  After that extravagant meal, I heaved my useless body into my bed and drifted off to sleep.
The realization quickly hit me that my body simply wasn’t going to work at the pace my brain demanded.  It was exhausting for me even to walk from the bathroom to my bed.  Moreover, CMMB wisely told me that I needed to take a month off of my nursing duties for recuperation, which left me with very little to do.  I believed that I was going to be a burden to the people here, when I was supposed to come and help.  I pondered my worth here and contemplated going home.  These negative thoughts were bolstered by comments made by some very well-meaning people.  “You’re just a new grad.  Are you really making a difference here, anyway?  You should go home.”  Although, those people were not intending to put me down, their words hit a soft spot, deep down in my heart because they were words, I had once let escaped into my mind and I had been struggling to force them down ever since.
The next morning, I conferenced with two of the coordinators from CMMB.  I told them I was not able to cook or clean for myself and  I confessed that I was contemplating going home for a month for some good old American TLC, but I wasn’t sure what I wanted to do.  The coordinators were very respectful of my wishes and told me that if I would like to go home for a month to recuperate, I was more than welcome.  They also told me that if I wanted to stay then I should talk with the administrator and find someone to cook and clean for me, until I became well enough to perform the tasks myself.  My brain was saying “America?  Yes, please.”, but my in my heart, I felt a nagging tug.  I just didn’t feel like leaving was the right thing to do.  The overwhelming feeling of uncertainty maxed out my emotion-o-meter—and cue uncontrollable bawling.  My apologies to the poor guys who had to scoop me off the floor and tell me I was going to be fine.  I have to say, they did a pretty good job, if I ever need a free therapist, I know who I’m calling. J  I think Richard, the director of the volunteer program, could tell that my complaints were just on the surface of a much deeper concern.  He wisely told me that if I was concerned that I may have further health complications, his recommendation was for me to go home.  However, if what I was really worried about being a burden to people, he recommended that I consider sticking it out.  He had hit the nail right on the head.  Deep-down, I felt frustrated that I couldn’t preform basic daily tasks with my body on strike and further, I was frustrated that instead of functioning as the aid-worker, I became the one in need of aide.  He explained that the American culture tends to value ‘doing’, and when a person cannot ‘do’, they are of less value.  However, the African culture doesn’t place as much value on ‘doing’; rather, more value is place on just ‘being present’.  What a difficult concept to grasp for me.  After this profound conversation, I knew that the nagging and tugging that I felt was God telling me I needed to stay.

A New Arrival
After communicating my needs with the administrators here, the Lord brought me a fifteen year-old girl name, Jael (pronounced ‘jy-EL’; for days I called her “Jail”.)  She has recently finished class 8 and is on break for one month.  Normally, Jael lives with her aunt and 5 other siblings, while she attends school, but since she is on break, she is living here with her mom, Everlynne, who works as a cook at the nursing school cafeteria.  Her mom graciously offered her daughter’s services to help me, until it came time for Jael to go back to school.  At first, I was nervous to have such a young girl doing my work, but I was reassured by the administrator that it is normal in Kenya for a girl Jael’s age to do this kind of work.  The first day she came, I figured that I would have her do my laundry and cook my supper, but Jael had different plans.  Along with the laundry and cooking, she cleaned the entire house, which had previously been a disaster zone. I couldn’t believe how much work she did in ONE day.  She now stays overnight at my house to keep me company.  What a blessing God has placed in my life…
The first day was pretty hilarious because neither of us could understand what the other person was saying.  We have now been together for four days, and fortunately, though we still struggle, we can understand each other much better.  Her sister, Sylvia, is her best friend, so Sylvia comes to visit every day.  They both are teaching me more Swahili, although after an incident in which I said a dirty word, instead of saying “10”, I am much more careful when I speak.  J  (I also made Jael take an oath to tell me if I ever said a naughty word again, which kicked off a whole conversation about other naughty words people say here.  I politely told her that I needed to first master the good words, before she taught me the bad.)  She was so shy at first, but I think that blunder may have broken the ice.  Now, we both ask each other about the other person’s culture.  I have learned so much more about Kenya through these last 4 days, than I have in the whole first month I was here.  Plus, I’m learning how to cook traditional Kenyan food, so that I can survive on my own when I’m healed.
Jael had never used a computer, so when I pulled out my laptop to watch a movie, she stared at it goggle-eyed.  I told her that in America, it is a very important skill to know how to use a computer, so most children take computer class in school.  She seemed very curious about the computer, but was too shy to even touch it, so I have begun to teach her how to use the computer.  It’s so difficult explaining a computer to someone who has never used one before and there’s also the trouble of the language barrier, (now teaching Mom and Dad to use Skype will be a breeze).  The process is slow going, but she is a very bright girl and catches on quickly.  In one day, she learned how to play two games, Solitaire (she had never heard of that game) and another hand-eye coordination game; she knows how to open and close a program; and she knows how to minimize and maximize.  I’m very impressed at how fast she learned these things.

Impressions
Overall, my one month anniversary was definitely full of unexpected twists and turns, but what God has taught me through those experiences is worth far more than that Tusker I originally fancied.  After contemplating my worth here, I decided to truly embraced Mother Theresa’s words: “We cannot do great things in this world, only small things with great love.”  I believe that I will have made a difference if I had shown love and kindness to each individual that I encounter.  It’s not within my abilities to change the world, that power lies with God, but if I face each day with an open mind and, more importantly, an open heart, I believe God will provide opportunities for me to bless others the way He has blessed me.  I hope that if nothing else, you can take that message away from this blog post as well.  As I’ve stated before, Americans have been given copious blessings by God, but with those blessings comes the responsibility and opportunity to share those blessings with others around the world.  Maybe you want to donate your time on Christmas at a homeless shelter, or maybe you want to sponsor a child so they can go to school.  Maybe it’s just showing kindness and understanding to that waiter at the restaurant who dawdles when you are famished, and gives you a burger with extra pickles and onions, instead of the juicy porterhouse you were supposed to receive.  You are so very blessed, so spread that gift to others.
I promise that I’m stepping down from my soapbox (for this post anyway), but lastly, I just want to thank all of you for your prayers.  When my mom told me how many people, parishes, and schools were praying for me, I was shocked and amazed.  You have no idea how much of a difference those prayers have made in my life.  I know that the peace I felt before my surgery was because of your prayers and the easy recovery I’ve had is because of your prayers.  Know that prayer works and you all are such a blessing to me.  I love you all very much.  Merry Christmas!

Saturday, December 3, 2011

Black Thursday Shopping in Kakamega

Thanksgiving Day and the Unforgiving Cow
This was my very first Thanksgiving celebrating without my family, but Patricia and I were bound and determined to make it special.  Therefore, we both requested the day off from our superiors and planned on venturing into Kakamega to dine at our new-found favorite eatery in the main supermarket.  As we flagged a zooming matatu, we set sail for the most bizarre Thanksgiving of my life.

Whenever I see a mtoto (child), be it in the pediatric ward or on the street, I pull out my trusty bag of stickers (compliments of Asha Poepping) and let them choose one.  They all proudly display their newfound treasure on their hands (or their heads, if they are feeling silly).  Unfortunately, I am running out of these stickers and I had a few nursing students nab some while I had my back turned, so I was determined to find some stickers in Kakamega.  I scoured the dusty streets for any shop that may carry stickers--my quest for the Holy Grail commenced.  In every shop I inquired about stickers, the workers would look at me with puzzled looks, but after a brief explanation of what I was looking for, the shopkeepers would all seemingly understand what I needed.  No joke, every single one would scurry towards the back of the store and proudly present to me Sticky-Notes, which is what they believed I meant by “Stickers for Watoto (Children)”.  After carefully telling them that we weren’t exactly on the same page, they all informed me that they had no stickers.  To my dismay, despite a valiant effort, my quest was unsuccessful.

This was the first time that we travelled to Kakamega on a weekday, but it was still just as busy.  Patricia and I had to ‘top up’ our phone minutes, which took an eternity and a half because the workers at the phone store weren’t understanding that Patricia wanted both minutes for calls and minutes for the internet on her phone.  However, I wasn’t too distressed by this because I was excited that it was Thanksgiving and that we were going to have a nice lunch.  As we left the phone store we continue on our path to Nakumatt.  We saw so many Mzungas (white people) at Nakumatt and I, being excited to see them, went up to one and exclaimed, “Happy Thanksgiving”.  The woman gave me a weird look and I realized that she probably wasn’t a Mzunga from America.   My deduction proved correct when she told me she was from Australia.  Oops!  We chatted for a while and she said her church group would be in Kenya for 3 weeks working at a local orphanage.  I asked her if she by any chance had any stickers with her.  Unfortunately, she said that  the ones she had brought were back at her hotel. L

As we parted ways, Patricia and I continued on our journey towards the restaurant.  There, we dined on cheeseburgers (like I said in my last post, I don’t really think it’s beef, but it was magnificent), chips (fries), and despite the fact that it was 11am we both saddled up to the bar and had ourselves a tall Tusker Beer (Hey, it was 5 o’clock somewhere).  We sat outside, so we definitely received a fair amount of glances in our direction and one man asked us why we were drinking so early (and also why we were drinking our beer cold).  It was definitely a memorable Thanksgiving meal, although I couldn’t help but miss the traditional moist turkey legs and homemade stuffing (just thinking about it now, is making me salivate).  After our $10.00 Thanksgiving meal, we stopped at Nakumatt to buy groceries that we aren’t able to buy locally.  At the door, we were searched for weapons with metal-detector wands, and after a brief explanation that the metal object in my purse was a camera and not a gun, we proceeded inside.

After exiting Nakumatt, Patricia realized that the internet on her phone wasn’t working, so we needed to go back to the phone store.  This is of course post-Tusker beer and after walking around the busy streets all day, not to mention that we were carrying a full load of groceries.  Needless to say, we were exhausted by the time we were able to cram ourselves into a Matatu with our groceries stacked on top of us.  As we were driving back to Mukumu, we both stared glossy-eyed in front of us, dreaming of a much needed bath and our welcoming beds.  Well, in the midst of our day dreaming, we lost track of where we were and thought we had missed our stop and frantically we yelled at the Matatu driver to stop.  The Matatu driver looked at us puzzled, but obliged our desperate request.  As we exited the Matatu, however, we realized that our stop was still to come, so we began walking home with our full load of groceries.  I couldn’t help but laugh hysterically because as the matatu drove away and we had our realization, a cow on the side of the road mooed at us, and I was sure that he was mooing in pity.  However, as Patricia trudged passed the cow, he decided to pushed her into the road, at which time I realized he wasn’t mooing in pity, rather he was snarling at us to get off the grass that he had been peacefully munching on before the stupid Wazungu disrupted him.  I only wish I had the chance to grab my camera in time.  Unfortunately, Patricia quickly realized what was happening and moved out of the way of the grumpy cow.  Well, I guess I’d be pissed too if someone was stepping on my Thanksgiving dinner. J

Working as a Nurse in Kenya

Working here in Kenya has proven to be a challenge for this Mzungu.  Most of the medications are under a different trade name (I rarely hear the generic names being used) and further, the medical staffs here use abbreviations for many of the medications.  It took me a while to realize that Paracetamol is just acetaminophen.  Also, all orders, not surprisingly, are hand-written and I have struggle with reading them.  The hospital here is very short staffed, so the main bulk of nursing care comes from the many students here.  On the pediatric ward, we’ve had an average of five patients on a given day and usually about four nursing students on duty.  I find myself wanting to be a role model for the students to show them what is correct and incorrect, but unfortunately nursing care is much different here and being a new nurse myself, I have a hard time figuring out what is completely incorrect care and what is simply different from the way we do it in America.  Finally, one of the biggest challenges is the language barrier.  As I stated before, most of my clients don’t speak English or if they do, it is very minimal.  Any good nurse knows that the crux of proper nursing care is communication.  Of course, I have been trying to communicate nonverbally, but that only goes so far when you are assessing a patient.

I had become a little discouraged because I felt like I wasn’t doing much here, but I had an epiphany, thanks to some wise words from my Dad, and I realized that all I can do is show love to these patients.  Thus, I have tried very hard to play with the children who are well and give as many stickers as I can.
There is a little mtoto here (I’ll call her Katie) that has been at the pediatric ward for almost 3 weeks now.  At this hospital, when patients are unable to pay their bill, they are required to stay in the hospital until they can pay (adding $150 shillings every day that they are discharged in).  In the case of Katie, her grandmother is unable to pay the bill, so they have been discharged-in for almost 2 weeks now.  Katie is probably the most sociable mtoto I have seen, in fact I refer to her as our little P.R. representative for the hospital because she goes around to everyone and quickly become best buddies with them.  Soon after my arrival in pediatrics, Katie decided that I was HER Mzungu, not only because I have stickers, but also because I have become her personal airplane pilot, flying her all around the ward.  The first time I met her, she was completely covered in dirt and didn’t exactly smell like flowers, but her inviting smile and infectious giggle helped me to move pass my germ-o-phobia and play with her.  Later on, I noticed these circles on her shaven head and the nurse casually informed me that the child must have ringworm!  I had a slight internal freak-out, since I had been playing her for two weeks and ring worm is pretty contagious.  However after careful inspection, I have not found a single ring on my body.  Thank you, God!

Finding my Sea Legs

In the US, patients are usually pre-medicated with an analgesic prior to a painful procedure such as doing a wet-to-dry packing on an open wound.  Here, patients aren’t given pre—medication, not even children.  There was a little boy (I’ll call him Elliot) in the pediatric ward with a large wound on the back of his leg from a bicycle accident and the dressing on the wound was to be removed and replaced every day.  The first day I had observed, Elliot struggled and screamed and his mother was forced to hold him down.  It was very heart-wrenching to watch such a sweet little boy writhe in pain and beg his mother to make them stop.  The next day, I decided that I would try my best to make him a little more comfortable.  I knew Elliot spoke a little English, so I told him to squeeze my hands when it hurt and that he was going to be my Kiswahili mwalimu (‘teacher’).  As I held his hands, we counted together in Swahili up to 50.  Elliot barely even screamed and I felt proud knowing that in a small way, I had helped the boy to remain calm in a normally traumatic experience for him.  For the rest of the day, I called him ‘mwalimu mzuri’ (‘good teacher’).

On Wednesday, we had four patients discharged (which is actually quite a lengthy process).  One three year old girl (I’ll call her Sophie) was just about ready to leave—in fact, her mother had just gone with a nursing student to the billing office to pay (the final step in the discharge process).  Another nursing student and I were serving lunch at the time and the grandmother came to us and said that her granddaughter felt very warm.  Upon assessment, I discovered that Sophie had a fever of 39⁰C axillary (which is extremely high), her breathing was rapid and shallow, and she was restless.  A fever this high can result in convulsions, so I knew we needed to act quickly.  I removed all of her clothes and instructed the grandmother to tepid sponge her.  Meanwhile, I went to the nurse’s desk to find the head nurse, only to discover that she was gone.  I was now supposed to act as the head nurse with several nursing students, who didn’t seem to grasp the severity of the situation.  I delegated the task of finding the doctor to a student, but she responded that the child was being discharged and she was working on something else.  I decided that I needed to go myself to search out a doctor.  Thankfully, I found a doctor just a few minutes later, and begged him to see my patient.  By the time I had returned with the doctor, in had been about 20 minutes since I last checked Sohpie’s temperature, so I felt it necessary to check again: 39.4⁰C!!!  The doctor ordered a stat IM injection to lower her temperature and readmitted her.  After just one day of receiving new medication, Sophie’s temperature was back down to virtually normal and she was toddling around the ward.  It goes to show how important it is to take vital signs on pediatric patients because their status can change as quick as lightening.  This was the first time I felt like a real nurse since I’ve been in Kenya.

Patricia…where’s my chocolate bar?!

Patricia and I have a habit of hiding our money in various places around the house just in case we have uninvited guests (we’re not talking about rats here), so on Wednesday, when I went into my purse to double check that I had 350/- shillings left ($3.50) and found nothing, I didn’t think much of it.  Of course, I am positively the most absent minded person I know and so I figured I must’ve hid it in one of my ingenious hiding spots.  I explained to Patricia that I have already begun to lose my mind at 22!  As I sifted through my inventory, Patricia came out of her room with an empty satchel, one which she had kept a large sum of money.  By this time, we began to realize that maybe we weren’t just being senile.  We had been robbed!  What was bizarre was that there were no signs of a break in, no broken windows or open doors.  Since we are compulsive about locking our doors (even when we are in the house), Patricia and I have hypothesized that whatever bold person traipsed into our house must’ve had a key (we are missing the key to the door for my bedroom).  As I looked further, I realized that they had also stolen a $100 US dollar bill from my wallet.  Luckily, they hadn’t taken any of our electronics (computers, cameras, ipads, etc), which hadn’t even been locked up.  The administrators of the hospital as well as the security guards have been extremely on top of the situation and have ensured us that they will be changing the locks.  In the mean time they have bought us pad locks to secure on the doors we don’t use.  Of course, I decided to take matters into my own hands and I now sleep with an Ugali stick in one hand and my Bible in the other.  (For those of you who don’t know, an Ugali stick is a long wooden utensil used to stir Ugali, it sort of looks like a Cricket Bat).  I informed Patricia that if I saw anyone (or thing) gallivanting through my room at night, I would swing first, and ask questions later.  Needless to say, Patricia has wisely decided to stay out of my room during the night. J

The next day, Patricia had gone on an outreach trip and I was eating lunch by myself in our house (of course, I thoroughly inspected each room beforehand, Ugali stick in hand).  After I finished lunch, I decided that I had been through a lot this week, so I resolved to treat myself then with a scrumptious piece of Cadbury chocolate from the fridge.  I scoured the fridge for our stash of chocolate bars, but I found nothing.  I thought that perhaps Patricia had taken the chocolate for sustenance on the outreach, but when she returned home devoid of the chocolate later that evening, I decided that I started getting suspicious.  Although it wasn’t like Patricia to take anything of mine without asking, I politely asked her anyway if she had had an overzealous sweet-tooth and had finished off the chocolate.  She looked at me puzzled and shook her head.  After a thorough hunt through our food stash, we realized that the naughty robbers had taken our stinkin’ chocolate.  That’s right folks, they seized our chocolate, but they left the computer?!  What is this world coming to?  I mean, it is one thing to steal all my money, but taking a girl’s chocolate bar after such a taxing week…that’s just a low-blow, man.  That’s not kosher in my book! J

In all seriousness, Patricia and I are safe.  We are so thankful that we weren’t home when the robbers were here, not only because I would have crapped my pants and packed my bags for America, but also because we might have been seriously injured otherwise.  We are also extremely thankful that they left all of our credit cards, passports, and electronic devices.  Finally, we are extremely thankful that the hospital has taken this matter so seriously and ensured our safety is their priority here.  Thank you, Heavenly Father, for taking care of us while we are here.