Delving into 2012

Every time I write a blog post, I always struggle to decide which topics I should tackle.  There is simply so much I could speak about, but if I wrote about everything, I’d be here all night, and so would you.  If anyone has questions about anything or wants to know anything about the culture that I haven’t addressed yet, comment on the end of this blog or email me and I’ll be sure to address it next time.

Sick Again!

I’m sure most of you heard through the grapevine that I have been sick AGAIN!!  Don’t panic people!  It’s not as serious as last time.  The last weeks and a half I had been feeling very nauseated, loss of appetite, and fatigued.  At first, I thought that I may have malaria, but after taking the full round of anti-malarial treatment with no relief, I realized that I had misdiagnosed myself.  Actually, I had been going to one of the clinicians here, who kept telling me that I was probably worried about something and not physically sick.  I started believing that my symptoms might just be in my head—after all, any health care worker knows that any sort of emotional illness can lead to physical symptoms.  I was very discouraged, but I tried once more with a good friend, and colleague, Dr. Kamau.

Let me just tell you a little bit about Dr. Kamau, to give you some perspective.  He comes periodically to the pediatric ward to check on the patients.  I knew that he and I would get along just fine when he bluntly told one of the nurses, after a ridiculous incident, that he expects nothing less than for everyone to do her job.  I was thinking, “Hell Yes, you tell ‘em.”  Then, Dr. Kamau and I seemingly sealed our friendship over an incident in which he barked at me to bring the Pethidine (that I was already in the middle of drawing up).  I, already tending to be a hot-headed American, felt my temporal vein begin to pulsate, but I swallowed the petty insults that were beginning to flood the very tip of my tongue and ran to give him the medication.  However, I had a slight moment of weakness when he barked some orders at one of my students, and I retorted “TEFADHALI” (which is Kiswahili means “PLEASE”).  Oops…so much for swallowing my petty comments…instead, I opened my mouth and shoved my big foot so far inside that it came out the other end.  Thence commenced a word battled that last 10 minutes.  He informed me that he would not say please because he expected everyone to do her job.  I informed him that with an attitude like that, he would make enemies with American nurses very quickly and moreover that if he didn’t say ‘tefadhali’ when he barked orders at me, I would not get it.  We both ended up cracking up as he said, “God Bless American Doctors”, which really was code for, “Lord help those poor saps!”  Now anytime he greets me, he says “Hello, tefadhali!”  Ha-ha.  I don’t know how, but instead of becoming enemies after that situation, we became colleagues—friends even.

Anyway, I dragged myself to Kamau feet and begged him to cure me, tefadhali.  I told him that I was sick of being sick and I felt like a nuisance, instead of helping.  I swear God was speaking through this guy because he told me that I was too worried that I was being a burden, and really that fact that I came by myself to this country was help enough.  I can’t tell you how much I needed to here that simple statement.  Sometimes, I have that American “I HAVE to save the world” complex, and I don’t let myself rest.

I apologize for the digression.  Anyway, after relaying my symptoms with Dr. Kamau, he did a full history of where I travelled and what I ate since the symptoms started.  Side note, I was very impressed by this because this sort of history taking isn’t often seen where I work, but it is an excellent way to narrow down what is ailing a patient.  He concluded that I was sick because I had drunk some water which was not boiled the weekend before.  I know what you’re thinking; it was not exactly the brightest move to drink the water that wasn’t boiled, but in my defense, I did question the water, but was reassured that the water was treated.  Despite the fact that the water was treated, the water here has bacteria that my body isn’t used to—just like when you go to Mexico and you can’t drink the water that the native people drink every day without problems.  I’ve been on Flagyl for 3 days now, and I’m feeling much better (I have to say though, Flagyl is a fairly vicious drug that can make your symptoms feel worse than before you started the medication).  Thank you again for all the prayers and support.  You all are a blessing in my life.  My goal is to avoid illness for the rest of the time I’m here.

Over the River and Through the Woods

Since Jael came to stay with me, I have grown very attached to her and her family.  In fact, I have gone to visit her family in Tindinyo twice now.  I call them my Kenyan family, and her parents call me their second-born child (they have one son who is my elder by one year).  Currently living in the house are Mama Everlynne, Baba David, Auntie (Baba David’s sister), and Jael and her siblings: Dancan “Dan” (23), Delwitt (18), Derrick (16), Silvia (15), Jael (15), and Dalton “Tony” (12).  They also have several hens and roosters and three dogs which are Tony’s responsibility: Tusker (I knew I liked this family), Rex, and Rex (Tony became bored of naming the dogs, so he just used the same name twice).  Staying at their house has really given me a perspective of how the average Kenyan lives daily life.

I have to admit that I am very spoiled in my house, which is actually bigger than Jael’s house that houses 9 people and has running water.  Jael’s house is a very quaint house in rural Kenya with a spigot outside of the house as their only source for water.  What does this mean for them?  No porcelain sinks, Jacuzzi bathtubs, or flushable toilets.  Instead, they wash their utensils under the spigot, bathe with a small basin filled with water, and ‘do their business’ in a latrine, which for this family is a hole in the ground formed with cement.  I know that this is like a camping nightmare for most of us Americans, but for them, it’s normal life.  Actually, some people don’t even have a cemented in Latrine; many just dig a hole in the dirt.  I have to admit that when I first came to Kenya, I vowed that I would never use a latrine, but being without a flushable toilet for 4 days gives a person no other alternative.  Although you probably won’t find me constructing a latrine on my future property, I will admit that the ergonomics of latrine-use are excellent—completely beneficial for proper elimination. J

Cooking in the standard Kenyan house is a little different as well.  In Jael’s house, the kitchen is separate from the rest of the house.  It is not permanent, which means it is made from mud (more specifically cow dung).  The stove consists of three large stones which support a large sufuria (a cooking pot without handles) over an open fire.  Since the kitchen has no chimney, it becomes extremely smoky and the fire along with the already scorching temperatures of Kenya’s dry season make the kitchen feel like a sauna.  Auntie does most of the cooking in the house, although the girl’s, Jael and Silvia, help.  Auntie has shown me the intricacies of cooking ugali and mbogo (vegetables) over a fire like this.  I feel like a pro already.

Behind the kitchen is a small shamba (garden) filled with corn, sugar cane, potatoes, and other self-sustaining foods.  Baba David was completely shocked when I informed him that my parents don’t have a garden like this.

As a guest, the family honored me by cooking a hen for dinner.  Baba David says that if you don’t have hen for dinner in Kenya when you are a guest, then you are not being welcomed properly.  When it comes time for dinner, everyone sits around the table, which is more like a conglomeration of coffee tables, and one person goes around to each person and washes their hands, using warm water, soap, and a basin.  It’s considered very rude in Kenya if a person does not wash her hands before eating.  This especially makes sense because the staple food, Ugali, is eaten with the hands.  Then grace is said and the person who prepared the food says, “Karibu!”, which means, “Welcome”.  In fact, if the person does not say, “karibu” you aren’t allowed to eat.  I thought about this as I pictured the first time Jael and I sat down for lunch at my house.  I had cooked a shabby meal of instant mushroom soup with bread, and after grace, I just told her to ‘help herself’.  Luckily, I think she took it into account that I am a Mzungu and don’t know the “Karibu” policy.

During dinner, we watch a variety of music videos of Kenyan artists, who mostly sing Christian music.  In fact, everyone watches these music videos, and they absolutely love them.  I am quite convinced that if MTV was able to get a TV station in rural Kenya, they would hit the jackpot.

The landscape of Tindinyo is varied with beautiful hills and valleys (and I’m told there is a waterfall, but I haven’t seen it yet).  I went for a few long walks with the girls, and I could see the lush, green hills erupting from the earth and picture-perfect streams glistening in the sunlight.  Unfortunately, I have been having issues with my camera, so I wasn’t able to take photos.  The paths that we were walking on were narrow and steep, and interrupted with many stones and roots.  In other words, my not-so-ballerina-like feet stumbled several times, and I was surprised and proud that I hadn’t completely wiped out face first into a nice fresh cow pile the entire time.

Jael’s father is the head teacher of the primary school in Tindinyo and this past weekend, since school was back in session, Baba David asked me to come to visit the school and talk to the children in Class 8 about how to succeed.  I was so nervous, but I felt it would be rude to refuse.  I absolutely loathe public speaking, let alone to students who may or may not understand my language, but my speech turned out to be not too shabby.  I think the kids were more excited about seeing a Mzungu in their classroom than hearing me speak, so that made me a little less nervous.

School is different here than in America.  The students wear uniforms—in fact, this is a nationwide policy.  If a student does not have a uniform, or cannot afford one, they are not allowed to attend school.  The students are typically in a classroom of 75 to 90 children, so one-on-one time is rare.  At the end of each year, the students must take an exam and if they do not pass, they must repeat the grade.  Also, if students are being disruptive or if they fail an exam, the teachers are allowed to use corporal punishment.  When I told Baba David that in America if a teacher were to hit a child they would be in huge trouble, he nearly fell out of his chair.  He inquired how the children behave?

Like Jael’s kitchen, Mwoko Primary school is not permanent; rather it is made from smeared cow dung.  The students must help to re-smear the classrooms every Friday.  This is very typical of schools in Kenya because it’s not usually affordable to build a permanent structure.  I wish my camera had been working so I could’ve taken pictures.  Jael’s father asked me if we have schools like his in America and I sheepishly replied that we did not.  We are so blessed in America, and we don’t even realize it.  I mean, have you ever had to spread cow dung on the walls of your classroom every Friday?

I have been told over and over that I should never hesitate to visit Jael’s family in Tindinyo.  In fact, Silvia makes me promise every time I leave that I’ll come again.  To think, I would have never met them if I hadn’t had the appendicitis.  God has surely blessed me with my Kenyan family, and I want to bless them back.  This family is sending two children to secondary school this year, and next year, they will send three.  It is very costly for a Kenyan to send their children to secondary school and often times, the children are not able to go.  It costs roughly $500-600 US dollars per year for each child to go to school.  If anyone reading this blog would like to donate money in order that Jael and her siblings can go to secondary school, please contact me via nasultze@gmail.com.  I think the most precious gift you can give anyone is education.  Please pray about it and if you have the means to donate any amount, small or large, let me know.

Hi-Ho!  Hi-Ho!  It’s Back to Work I Go

After being on sick leave for three weeks, I started the New Year back at work.  Work has been much better.  Being on the other side of the bedrail made me realize that I need to be more forward when I see that a patient isn’t being treated well.  One of my first days back, the rest of the morning shift and I received report about our patients from the night nurses (who were only students).  The first patient was a 3-month-old child with severe pneumonia on oxygen via a nasal cannula (typically in the US we like to use a face mask on babies because they are normally mouth-breathers); I’ll call her Mia.  It was obvious that the Mia was restless, breathing rapidly, and retractions were easily visible: the baby was struggling to breathe.  I asked the night students if they had seen this and what they had done to help this child.  They said that they had called the clinician a half hour before.  I felt exasperated because 1) the clinician should have come in less than 10 minutes and 2) if the clinician didn’t come with in 10 minutes, the students should have called him again.  The students shrugged and moved on.

They gave report on the other children in the ward, most of which had malaria, which is a common disease found in the pediatric ward.  Finally, they came to a patient who happened to be a student, who came in with sickle cell crisis.  Sickle cell anemia is an inherited disease in which the red blood cells are abnormally shaped (like a sickle, instead of a nice circle).  During a sickling crisis, the sickled cells ‘clump’ together more readily and cause vasocclusion, or clogging of the capillaries in the body.  Because of this, the tissues of the affected areas don’t get the oxygen they need, which causes severe pain.  This is a very serious disease from which many youth in rural Kenya don’t survive.  One of the priority nursing goals in these patients is pain control.  Upon entering this girl’s room, it was obvious that she was in a great deal of pain.  The night students hadn’t stayed on top of her pain.  I told the head nurse that we needed to get her pain medications STAT, but she said that we would simply wait until the doctors came to give her something.  I couldn’t believe that she wanted us to wait for the doctor.  Seeing this girl writhe in pain helplessly in a dark room, brought flashbacks of my hospital experience here.  I grabbed her hand and told her that I promised that while I was her nurse, I would do everything possible to keep her comfortable.  When we left the room, I took all of the students aside and told them calmly, but firmly that it was unacceptable that these two patients were in such bad conditions.  After explaining to the patients the disease processes of these patients, they seemed to understand the seriousness of the matter.

I spent the entire day back and forth between these two patients.  Mostly, I stayed with little Mia who was extremely critical.  We needed to fix an IV line quickly because she was severely dehydrated, so managed to call an anesthetist.  As I gently held her small frame to position her, she began having a tonic seizure.  Feeling Mia’s tiny body completely stiffened in my hands was one of the worst experiences I’ve had.  When the doctors came, they gave her a bolus of dextrose and water, along with a stat dose of diazepam to control the seizures that she was continually having.  By the end of the day, Mia seemed much more stable, though not quite out of the woods yet.  I thought I was seeing a little light at the end of the tunnel.  Before I left from work, I taught the students how to properly give a nasogastric tube feeding on the baby, since she couldn’t take anything orally.  The next morning, I came to find that despite our efforts of the previous day, Mia had lost her fight, only 1 hour before I was supposed to report for duty.  I understand that she was very sick, but I can’t help but thinking that if there had been a nurse on duty with the students, little Mia may have survived.  I know that when I was a student nurse, there is no way I would have felt competent enough to handle a patient who was that sick without the assistance of a nurse.  Because of this, I decided that I would start night duty.  This way, the students will never have to be put into a situation like that of baby Mia.  Rest in peace, precious child.

I also learned from this experience that CPR is not part of the nursing curriculum here.  In fact, most nurses do not know CPR.  In the case of little Mia, the students had to wait until someone came who knew CPR.  I feel strongly that these nurses should be taught how to provide CPR in emergency situations.  Therefore, I’m in the midst of proposing a curriculum to the principal of the school which I will be teaching.  I’m extremely nervous about teaching CPR (as explained previously, I don’t like public speaking), but I’m hoping that my stage fright will subside slightly for these small classes.  We’ll see if it works out.  Prayers would be appreciated.

Thanks again for all of your support.  Parishioners of Immaculate Conception Church, students and staff of Bishop Kelley Catholic School, my friends and my family, and all of my other brothers and sisters in Christ, you are truly amazing people.  God is so good.

~~Love and Blessings Always~~