#NurseDTakesZambia #9 #PeopleOfZambia

Only a 18+ hour flight and the reality of the Zambian life, its people, its culture, and its lack of electricity fade into a sweet memory. I left that world where my white skin frighted the children who passed me by, and the curls in my hair, a tangible museum exhibition for its viewers. I felt as though my trip had reached full circle, as I boarded my flight and met the travelers whom I assisted with my nursing care on my flight to Africa, as well as the physician who also participated in caring for the sick traveler.

Reflecting on this life journey I had just traveled on; my appreciation for life, electric power, paved roads, brick homes, enough shoes for both my feet; and all the other life's basic details has increased fourfold. 

I speak to my seat mate on the plane about my adventures and they are fascinated. After my parents were assured that the only souvenirs that I brought home for them we some of the Zambian market's "chachkas" and not diseases, they too found great amazement in my pictures and the stories of my adventures.

In many of my posts regarding my various interactions with my patients in a hospital environment, I have mentioned the life that went beyond the bedside, and the human being that transcends the body we care for. Here I was in their world, I spent time walking on their unpaved roads, I sat in their small hot shacks lacking electricity, and I was opened to their world where malaria and HIV was as frequent as a common cold in the states. Yet, sometimes it takes both being in their world, and view their world from afar in order to fully capture the complete storyof their  existence.

I met beautiful souls, all with a life, and all with a story. In each photo, I captured only an image of a moment in that life. My photographs are only the cover page for what each human being's story has to tell. My photos portray humans with a story that goes beyond what an observer or visitor can capture in words. Writing can limit that human's story into what fits the pages and completes the sentences. However, each image opens the window to those people's worlds; more complex, and more admirable than my words can write.

A picture can zoom out to view the portrait of a living moment, yet also holds the ability to magnify the story portrayed in the ink prints of the photos. Photos can capture a story that one is unable to read even as one stands at the scene in real life. 

One of my photographs showed a group of children gathering around to collect some sweets. In real life I saw barefoot children,pushing their way through their peers to grab a sweet.It was when I shared the photo with my brother, that he spelled the story of two children on the side of of those pushing to get another candy. He identified  2 identical flip-flops, one worn on the left foot of one child who went barefoot on her right, and the other wore its identical pair on her right foot and went barefoot on her left. My photograph said a story of children who literally shared all that they had, with one who may have had less, and are still so visibly joyful and happy. 

Enjoy some more pictures of the #PeopleOfZambia. They are not merely objects of fascination that captured my interest; each picture is also the window through which I can view the humans I encountered on my journey, and my nursing experience in Zambia, Africa.

 What stories do you read from my photos?

#NurseDTakesZambia #7 #ZambianSchoolChildren

#NurseDTakesZambia #7 #ZambianSchoolChildren

It's break time, and the schoolchildren are running around the narrow cemented area between their overheated, dark classrooms. Nurse/Sister Devorah and Dr. Paul stroll into the yard, stethoscopes around our necks, ready to share some health information with the eager students. As we squeeze between the dozens of children playing in the school yard, our now familiar white faces are met with excitement. By the time we reach our designated classrooms, both Nurse and Dr. have our hand full with and entourage of little fingers belonging to some of the schoolchildren. We are trailed by many others and must settle the struggle for a piece of our hands to hold. We enter the classroom, with our little army of fans peeping through the doorway, hoping to get a glimpse of our lecture, before they are whisked away by their teachers into their prospective classrooms. 

It is a 7th grade class but with students ranging from various different ages. There are over 60 students sitting in the classroom, with 3-4 students squeezed into each bench with a table. The rooms are dark, hot, and crowd; the power is out. We walk in and 2 children run to get us chairs. We are then greeted with every child standing and a loud "good morning Dr. Paul and a good morning Sister Devorah".  They don't sit down until we both respond and verbally allow them to be seated. Their respect is admirable. 

During our limited time in Zambia, what were the medical staff doing in school, while the clinic lines remain an endless wait to be seen for often serious medical issues? Aside from working in the clinic, a part of our mission in Zambia and working with the organization 'Healthy Kids, Brighter Future", was our involvement in the schools. 

Teachers in Zambia are an extremely respected profession, and they are looked up upon by both the children and the  adults. Our way of assuring that the work that we do does not just place band-aid on the wounds that can likely reappear, we sought to lay some groundwork for wound maintenance for after we leave. We aimed to educate the teachers to share with their pupils the causes of the common illnesses that present itself within their populations; how to detect symptoms, and how to seek treatment. During our stay we reached out to the children themselves, to teach them about malaria, HIV, asthma, and other virus that are prominent within their towns and populations. The students chose the topics to be discussed for the next time we came to their class. 

I taught them about asthma. I showed them pictures of lungs and what the airway looks like during an asthma attack. Most of the students were animated and very involved in the discussions. One student said he wished to be a doctor when he grows up and wanted to spend some time with us in the clinic. We gladly made that arrangement.

 I don't love teaching, but as a nurse a part of your  job is to educate my patients. I usually teach my patients about their medications, wound care, drain care, and when to call their doctor with concerns. However, teaching these students, and simplifying a common illness to their level of understanding was surprisingly enjoyable. 

Children's brains are sponges thirsty for knowledge and information. They are the best target to initiate future positive changes. They challenged me with their questions, and I gained an immense amount of satisfaction as I watched the information I shared, as it got absorbed into their little, curious minds. 

It's easy to gain satisfaction when I work hard with a patient and I see their would heal, or watch them walk again after a long illness. It was a whole new level of satisfaction to see that the information I taught was understood with enthusiasm and will hopefully be utilized to prevent and treat these illnesses as they present itself in the future; ultimately painting a larger picture of health for the designated population.  Sometimes satisfaction in work is acquired by seeing the finished product, this time it was acquired just by seeing the work in progress and its promising ability for small people to help create big changes. 

This was written on the chalkboard of one of the classrooms. 

#NurseDTakesZambia #6 #ChildrenofZambia

#Zuzu 

(or at least that is what he muttered when I asked him his name.)

They say not to favor some children over others, but this boy is definitely high on my #TakeAZambianChildHome list. When I asked him his name he would just giggle and mumble something that sounded like Zuzu. He followed me around the Compound giggling and with his hand out for more candy. He also loved taking selfies with my phone, his joy in seeing himself in my camera screen was incredible. 

#NurseDTakesZambia #5 #N'GombeClinicMidwives

The time is 2300 (11PM). The power is out. We have two clients in labor.  Both are first time moms. One is in active labor, one has been having contractions all day, but with no progress. One mom needs IV fluids, I offer to place an IV, but the clinic is out of IV bags and tubing. Scratch that, we improvise; we send the patient's mom and aunt to go buy some drinks that apparently helps to "safely" accelerate the labor process. We encourage her to continue walking with hope of progressing her scattered contractions into active labor.  As expecting mom #1 is pacing about in the dark waiting room, we shine our flashlights and candles on mom#2, her contractions are occurring more frequently. We do a pelvic exam,and we listen to the fetal heart rate. There are no monitors to attach the mom to, no fetal heart rate waves to examine. We use  a manual fetoscope that we place on the moms abdomen to measure the fetal heart rate. I put my ear to the fetoscope,and I hear the fetal heartbeats. Her labor has progressed, it's time to begin pushing and deliver the baby. 

The power is still out. One flashlight's battery is beginning to go. We light another candle. I make conversation with the laboring mom as she is wincing in pain. Her name is Mercy and she tells me that she thinks it is a girl. 

There is no such thing as pain medications or epidurals in this birthing ward. The women just wing it. They also pull themselves up onto the elevated bed. No machine adjusts the bed's height to convenience a body with a huge painful belly. They climb onto the beds on their own. The bed is clothed in linens that the expectant mothers bring with them. We layer the bed with plastics garbage bag that they bring from home and layer it with their "Chitenga", a traditional designed cloth that is also used as skirts, dresses, hair wraps and baby carriers. Here it is used to dress the bed that they will deliver their baby on.  We prepare the baby warmer that is not working due to the power outage, we layer it with blankets brought from home. The blankets are pink; the moms says its a girl, she feels it. 

She climbs onto the bed, and she begins to push. The nurse midwives and I don our gloves and aprons.  There are no stirrups to secure her position. I hold on one side and the midwife assist with the other. She has no family there for moral support,  so she squeezes my hand with every push. She is crowning. The midwife turns to me, "Sister Devorah, are you going to deliver this baby?". I've never delivered a baby on my own. I work on a surgical unit, the closest I had even come to caring for a newborn was handing them to the mom who was my patient. I had been spending my nights in the labor clinic in Zambia assisting with the births, and I felt hesitant but ready to accept the huge responsibility being offered to me. 

The head is out and I begin to position it and guide the shoulders. The cord is around the neck, I fumble my fingers through it and pull it over the head. The neck is free, and the rest of the baby is delivered. I place the baby on the mom, skin to skin, for kangaroo care.  I clamp and cut the cord, and I wipe the baby with towel; it cries a loud, string shrill. I hold the baby up to the mom so she can see the miracle that she just painfully but bravely delivered. It's a boy!!!

I wrap the 2.6 kg baby boy in layers of pink blankets and a pink hat. The lights turn on. The power is back. We deliver the placenta and clean the mom. She then gets up, carries her bucket of belongings and sets herself up in the postpartum room. As she rests in bed, sheltered by her mosquito net, we hand her the baby. Not one crib exists in the postpartum room, babies all sleep with the moms in the same bed. Most mothers stay in the postpartum room for six hours until they are discharged. Since it is late at night this mom will stay till the morning. 

With mom and baby #1 delivered, we reassess the progress on mom #1. It has been 4 hours since her last exam and a total of 16 hours that she was admitted. We write a referral and call an ambulance to take her to the hospital. An hour later the the ambulance shows up, we jump on board and escort the mom to the hospital. No seat belt and no stretcher, we all pack into the back and begin the bumpy 10 minute yet seemingly endless journey across unpaved dark roads to the hospital. We grab a rickety old wheelchair and bring the mom to labor ward in the hospital. There we give handoff and the hospital nurse take over. We say goodbye and head out to take the ambulance back to the clinic. I peek into the  postpartum hospital rooms. There are 9 beds per room, no curtains to generate privacy, and some mattresses on the floor due to patient overload. On our way out we grab some IV bags, tubing and some other minor yet necessary equipment lacking at the clinic. We get back to the clinic just as another mom, who had come in while myself and one of the midwives were at the hospital. She is ready to deliver her baby. We don our gloves and aprons and get to work. Another miracle is born; this one is a girl. After that mom is settled under the mosquito net with her baby, we get one more admission in early stages of labor. We do our assessment and settle her in. 

It's nearly 0500 (5AM). The midwives of G'Nombe Clinic jump into their on-call beds just as the sun is beginning to rise, for a quick nap.  Soon the roosters are croaking their morning songs. The sun is beating strongly. Patients begin to flood the lines of G'Nombe Clinic, and new day has begun in the little compound in Zambia, Africa.

#NurseDtakesZambia #8 #NgombeClinicTales

You know those diseases you learn about in textbooks and you read stories about in magazines, the ones about foreign countries? As a nurse working in a city hospital in a large developed country, certain diseases are not frequented within the populations we treat. Even when we do get those rare cases of exotic diseases and injuries, we have teams of doctors to address the cases and caseworkers and social workers to help ensure the maintenance of the care. 

While many cases presented in our clinic included malaria, various STDs, HIV, respiratory infections, hepatitis, schistosomiasis and UTIs; we have also addressed severe asthma attacks, spinal chord injuries, possible cervical cancer diagnosis. Some patients only come to visit the clinic weeks after the onset of symptoms; when their disease has significantly progressed. Many attempt to self treat their diseases with home remedies. Just a few days working in the clinic, and I was exposed to illness and disease of various age groups, which I have not seen in the 2.5 years working as a nurse. Although I'm not in this field for that long, it has been mind boggling to address so many of those cases that I've learned and read about in those textbooks, in real life.  I could fill a textbook with the tales of the cases presented to the two by two walls of our clinic. Here is one tale:

  

 In America bullying is often done in the form of teasing or coloring the victim with a black eye. My 7AM adorable 9 year old patient, half limped and was half carried by his mother into the clinic. His lips didn't mouth many words, but his silent facial expressions spoke the loud moans of pain that he was likely experiencing. We managed to collect data from his mother regarding the history of his current presentation. One day prior to coming in, this boy was knocked down by a group of boys his age, who then continued to pounce on him and kick him as he lay on the ground.  

His description of symptoms and our initial assessment, led us to  suspect a  spinal cord or head injury. He was  dizzy, had severe headache, neck pain, increased pain with passive range of motion in  almost all lower limbs, vision changes, impaired mobility , weak peripheral reflexes and +Babinski sign on his right side. 

  

 It's took me over 30 minutes to figure out how to get  hold of the ambulance post to order emergency transport to a hospital. As I ran around the clinic figuring this out, and had the triage operator hang up on me multiple times as I described my need for the ambulance, the boy began to seize. Soon or rather later enough the ambulance turned up, by that time I had a patient having a severe asthma attack and heart palpitations who I wanted to carpool to the hospital via the ambulance ride as well. I gave a quick report on the patients, and requested a backboard to stabilize him.  In Zambia, the request for a back board from the ambulance crew was as foreign as asking for a helicopter transport from Brooklyn to Manhattan for cut on a finger. The ambulance driver literally laughed when I asked him to help me at least carry the patient. Left with no choice the mom and I lifted the patient onto the ambulance that lacked any stretcher or seat belts. I said goodbye and waved good luck as the little boy began his bumpy journey, over unpaved roads to the local hospital.