ER Haiti Vs ER NYU

She had a severe allergic reaction. From what, we do not yet know. Her lips are swollen and  she has a red bumpy rash across her eyes and right side of her face. She is barefoot. There is one wheelchair available, they get her in it, but it is missing one of the leg rests. There are no other wheelchairs in sight, so both legs are placed, one on top of the other, on the one sided leg rest of the wheelchair. Her family is directed and they wheel her to her diagnostic exam which is outside, across a courtyard.In the meantime two patients with gunshot wounds are pulled out of the back of a pickup truck; we are not sure who shot whom first; or who is the instigator and who was just defending himself. There aren't enough stretchers, so a box of supplies becomes the seat for one of the gunshot victims.

It's easy to imagine these same patients in the ER at which I work. Swollen lips? Possible allergic reaction? Possible airway compromise? Triaged at level 2, MD informed and interventions initiated immediately.

Wheelchair? Nurses would grab the nearest one, and they almost always have 2 Intact foot rests.  Usually, specialized transport personell, will escort the patient to their diagnostic exam,which happens within the same building.

When our patients need labs sent, we send it up an electronic shoot. We get quite irritated about the time in our busy day it takes up, when it malfunctions. In Haiti, a lab and medication shoot is a far imagined dream. The nurse will run outside, across a courtyard with the labs and single handedly deliver the patient's specimen. Labs in this hospital in Haiti are only even drawn, once the family has paid a fee and shows a receipts as proof of payment.

Space? The forever unresolved problem in our constantly overflowing NYC  ER.  Oh, the speeches  we give families as we kindly plead with them to wait in the comfortable leather chairs of the waiting area so we can create ample space for sick individuals. We promise them every delicacy from the cafeteria if needed, and cross our fingers, in hope that they agree to abide by the rules, or at least accept our bribes. Worst case we can have security do the mean work for us.

Space in an ER in Haiti? It makes the confined quarters of the ever cramped NYC ER feel like a mansion of ERs. The square footage of the small air conditionerless room in the middle of hospital compound that is considered the ER in Haiti, becomes overcrowded and outgrown rather quickly, by its constant flow of trauma cases that flood every possible inch of its quarters. There is no waiting area and no triage center. The waiting area is the landing outside the doors of the ER. There is a table near the entrance of the room that has nurses and a doctor sitting, and they  triage the more acute patients, work them up and store them in rickety stretchers which are stored in any available space in the room. Once triaged, the medical workup can only progress once payment is made. You see, in Haiti, a patient does not even get labs drawn until a receipt of payment is shown and documented. A blood transfusion is not provided, unless the family members can donate their own blood. In situations where a massive transfusion protocol might be indicated, this process of blood transfusions, still remains in effect, sometimes compromising the patient's outcome.

Equipment; in the ER I work in, it seems as though there is an endless supply of needles, suction devices and cardiac monitors; some those simple ER, lifesaving necessities. In Haiti, much of supplies are sponsored so they often utilize equipment way beyond their stated expiration dates, and many of the equipment have defects as well.

If there were 3 words to describe my Haitian ER expereice, it would be:  loud, chaos, & traumatic. Between medical staff speaking, patients yelling and complaining and infants shrieking. Many ERs are loud, rowdy and seemingly chaotic; this was chaos on a whole new level; and the cases that rolled in were of the most truamatic that I have ever encountered-probably in my lifetime thus far.

My mind ponders and my heart quivers at the infection rates on those benches alone. Patients sit with butts touching, noses sneezing and blood gushing for hours on end. The ER has one cardiac monitor, designated for the sickest patient. At one point our second to sickest patient was crashing; we just moved the monitor from patient to patient, just to see the rhythm. At one point as we intubated one patient, the patient newar him became bradycardic, i’m just a nurse, but I gather my ACLS knowledge, yell orders for atropine, it's given, but soon the patient codes, i verbally run the code as I assist the only MD in the room at the time with intubating a trauma patient with a possible cervical spine injury. Unfortunately, the coding patient does not make it, but now our C spine injured trauma patient gets to have the monitor placed on him.

Triage in Haiti is just a bit different than the ER I am used in NYC.

The ER team: They buzz through their assignments in that ER so gracefully, like millennial versions of Florence nightingale as they improvise daily to complete even some of the basic tasks. It's almost like they are shining outcasts that bring light, calmness and a version of serenity to the loud, bustling, messy, and odorous environment that envelopes their beings as they go about their nursing duties in the sweaty, fly infested room they call an ER.

7 Ventilators, 8 Patients; Just Another Day In Haiti.

     Where I usually work, we have a triage system for the everyday emergency room flow of cases, and a triage system for disasters. A general triage system prioritizes the sickest and gathers all resources to tackle the illness in the acute situation at hand. When in disaster mode, the priority triage population is, who is the most likely to be saved. So how do you prioritize care and limited equipment when every day  is disaster mode? Do we prioritize our sickest? Or do we prioritize those with a survivable prognosis. Who do you give the ventilator to when you have one vent and two people? This is no rhetoric question, in Haiti this is the reality of another Thursday, more specifically my reality one Thursday. 

     The patient is deteriorating, his oxygen levels are dropping, he is status post motor vehicle accident, and he has a brain bleed. We are bagging the patient and call our on call volunteer respiratory therapist, we need to intubate the patient STAT. She informs us that we have no ventilators in the hospital available, all are being used by patients. She runs across the street to the hospital warehouse to check if we had any ventilators, however old they might be, in there. No luck.

     We are still bagging. He is still struggling to breath. His work of breathing increasing, despite our bagging efforts.  One ER resident goes to the ICU to speak with the ICU attending. We have reached the point of who can survive without a ventilator, or who even has a chance to live? Who can we extubate so that we can intubate this new patient? We find our patient, she had a spinal cord injury, and she is doing well today. The doctor says that she is stable enough to be extubated, and so we extubate. We gather our equipment, wheel it across the courtyard to the emergency room. Our patient is extubated, he is stable for now. Our other girl is extubated also stable for now. 

      In our mad rush to gather equipment, it only dawned on me much later what extreme levels of  triage, prioritization, and critical thinking are needed at every moment in such an environment; as well as the challenge its is to maintain a life here in Haiti. In my usual area of work, a patient deteriorates, I make a call and I have the equipment needed to save a life. Here it is so much more. 

     The next day we got a patient in respiratory distress again, he was brought to the ER by bystanders via hanging off the back of a motorcycle, the usual culprit of our most severe cases. He was responsive, large bloody lacerations, and in severe respiratory distress. We bag him and prepare for intubation.  The attending is about to intubate, but remembers that there is one ventilator available at this point. What if we use it and his family does not want it? Here in Haiti this is not so much a moral dilemma as much as a practical one as well. If we intubate and the family does not want it, we have just used our scarce intubation equipment for no reason, and what if something else come through the door and they absolute want those extreme lifesaving measures?  At first I internally and silently judged the team for the delay in making the decision to intubate, I was also getting hand cramps from bagging this patient for over an hour while decisions were being made. However, medicine,triage and lifesaving, has a completely different thought process and level of prioritization, especially when you don't know what will come in next and what you will need to have available to deal with it.  And so I continued to bag, respectfully awaiting to hear back from the family and the physician regarding the next steps. 

     Back to the girl with the spinal cord injury; Dorisca is her name, she is 15 years old and her favorite singer is Shakira, who is also a victim of a motorcycle accident, and who was extubated to intubate that 8th patient with the 7th ventilator. She is doing well; in fact we bonded during nighgt shift, as I was her nurse in the ICU. By night number two, together in the ICU, she was calling my name, giving me hugs as her arms were now able to move, and she even caught on to some of the lyrics of the music I played on my iPad for her during my shift taking care of her.

     However, sometimes fate has its way despite our best efforts to direct it in our own direction.  Ironically, patient #8 who used ventilator #7, died the night he was intubated. Sometimes we make decisions and hope to save the life that can be saved, and sometimes fate has its way and makes the decision for us, regardless of the extremes we take to make it on our own. 

The injury of the causing for the occupation of the 7th ventilator.

 Me and the patient; sweet 15 year old.

Vintage vetilator;comodity though, in Haiti!

#MISSIONHAITI2017 (#1)

Enormous red metal doors manually opened by guards welcome my entrance into the chaotic world of the healthcare compound that will be my home in Haiti. 

In the scorching heat, families, patients and healthcare workers go about their daily activities around this hospital compound. It's a hospital, but almost a city of its own, sheltered from another type of chaos that ensues daily, on the other side of the large metal doors, from the overpopulated streets of Port-au-Prince, Haiti. 

In a hospital population with a constant flow of gunshot wounds and traumas, this little compound nesting in the deadly heat of the bustling  city of Pauto prince, Haiti, faces the triumphs and struggles  and constant battles of life and death in all ages of their vast populations. 

The sun rises and roosters are crowing as I climb into my scrubs and climb down the stairs to the Haitian medical hustle, that is beginning its daily eruption on the ground beneath me. 

On the hospital compound, each unit or section of the hospital is in its own separate quarters, which requires patients and staff to walk outside when transferring between various hospital units, diagnostic tests, or even the bathroom. They may have a gunshot wound or a large infected diabetic foot ulcer, but if they need the restroom they trek outdoors, across an overcrowded courtyard that also serves as the hospital waiting area and family lounge, in order to go about their business. Sometimes they must navigate through family members sleeping on the floor of the courtyard, peddlers selling paintings and beaded goods, or vehicles unloading bleeding patients into the triage area. 

The hospital has a CT scanner and X-ray machines that are housed a trailers in the very same courtyard. But like any diagnostic tests, patients must first have a family member pay the fee before they can be rolled over for the test.  The imaging are done in trailers parked in the courtyard, and the results are sent to the US to be read, since they have no radiologist on staff.  While the local doctors can visualize the imaging for a basic read, it can take 24 or more hours to get an official read; and till then, the patient will lounge on the stiff stretcher with a plastic cover, in the scorching heat of a room they call an emergency room. 

As a hospital that receives vast numbers of trauma cases each day, blood products are often an issue. A blood bank with cross matched blood, or even o negative does not exist. The only way for a patient to receive a blood transfusion, is if a family member or a friend who is a match can donate. Sadly, some patients die waiting for blood. 

It's my first day, My scrubs are melting against my skin, I meet Emerson, he is my partner for the next few hours and with a metal cart stocked with the Barest skin and wound care essentials we begin our skin and wound rounds.

While You Wait

A simple ER visit can become a long, ruthless, demoralizing wait game; that may even change one's perspective on the humans providing emergency care. "While you wait" delves into another perspective of the ER wait game; While you wait, you live; you wait because you can wait and still live.

Post written for AllNurses.com 

http://allnurses.com/general-nursing-discussion/while-you-wait-1106689.html

You come into the ER, a lady in green sits there and asks you what your emergency is. You begin to tell her your entire medical history. She cuts you off and asks you to shorten your story and requests you to describe why you came, in 3 words. How rude! She must be burned out. She must not care. After all, you are a human being. All she does is take your information and direct you to registration and then to wait in the dreaded over flowing ER waiting room. 

You came to the emergency room to be seen emergently, hence the given title “Emergency”, but it seems as though no one cares that you are waiting, and the wait time seems endless. The person to your right is snoring heavily, and his yellow hospital socks look like he spent more than one ER wait time in them. The person on your left tells you her life story, it is kind of interesting, but you just worked a long day, and you have another long day tomorrow, but now you need to play the dreaded ER wait game; so frankly, today her story just isn't that interesting.

You see 3 people come in after you, and they get taken back to be seen right away, the nurse in green with her big red glasses, even wheeled one patient back herself. That patient didn't even have to wait to get registered. It is one unfair, never ending waiting game. You wish silently that you were the one chosen to be brought in first. 

What is it about the emergency room, that the people seem not care about the continuous pile of patients and their loud families filling the cracks and corners of the ever expanding waiting room? This must be the area of nursing that people choose when they don't care about compassion but just want to get the task done and make an extra buck. You take a deep breath and text your angry, frustrated thoughts to a friend who will listen. But you can breathe as you do so.

While you wait; I am that nurse in green with the big red glasses. I am the first person you see when you walk in the ER, petrified, in pain, and fearful. I made you shorten your story because there is a line of people behind you, all with a story, but their story might be life threatening, and I must work fast, sift through my pile of chief complaints and hear what they are, because some may need time-sensitive, life-saving interventions. 

My job is to use my senses combined with my medical knowledge to decide how sick you are, where you will need to go, and how fast you need to be seen. Sometimes I must rush someone back because a clock is ticking to the ability to give them a medication that will help that person walk again, or to fight an infection that is racing through a person’s body like an athlete on a marathon. Every time I make the decision regarding where you will go, and how fast you need to be seen, I make a silent prayer that my knowledge and instincts are correct.There are times that a patient may begin to deteriorate, and then I reevaluate my decision and up triage that person. My hope as I leave every day from that role is that I appropriately triage each patient in the correct spot in the waiting game.

While you wait my job may vary from rushing a patient back to initiate a life-saving intervention, to giving a homeless man a sandwich and shoes, as I explain to him that getting new hospital socks is not a medical emergency. 

While you wait; I get threatened by a man for reprimanding him for leaving the hospital to smoke when he said that he had chest pain. 

While you wait; there is an entire other world of chaos that erupts behind the very doors through which you are aching to enter.

While you wait; there is another entrance that opens into an ambulance bay, that is constantly flooding the ER with patients that you don't see coming in as you impatiently count the minutes of your endless ER wait time.

Behind that door, more people armed in scrubs, stethoscopes and pacing pads battle the wars of the flatlines, erratic rhythms, pulseless beats and the angels of death depriving human beings of their next breath. Some of those warriors are on their 12th hour of work and have not yet taken a break.

While you wait; a bleed infests a human brain, trickling into the folds and impeding its ability to make a man speak or walk.

While you wait; a heart makes desperate attempts to feed a body with healthy circulation, but that monster clot starves the heart of its own source of circulation, and the human being holding that heart carries the weight of an elephant on his chest.

While you wait; a being only days in this world, battles his closing lungs in his fight to live onto his next breath and nurture his miniature, yet delicate brain. As he fights, 3 teams of doctors are sweating profusely because that pipe that may be the lifeline that will allow air to trickle into his little lungs, refuses to slide in and ventilate his tiny body.

While you wait; a man who thought he had a simple stomach ache; gets a life-limiting prognosis.

While you wait; another human is battling a relentless bacteria that is poisoning his blood and shutting down his organs. Multiple medical teams calculate the benefits and risks of each intervention. Soon they are prioritizing the major organs because they are his body’s emergency generators, but now, they too are threatened by the savaging infection.

While you wait; you breath on your own, you walk, and your body fights the battles of infections that threaten your serene breaths and your steady, rhythmic heartbeat.

While you wait; we haven't forgotten you, and we want to help you, we really do and we will. Eventually.

You wait, not because we don't care, but because we must prioritize those who will not live if they wait.

But, while you wait; you are breathing.

While you wait; you live. 

You can wait; because you can wait and still live.

It sucks to wait, but while you wait, be grateful that you can.



(The perspective of an ER nurse after 3 consecutive shifts. It is all about perspective and an attempt to lend an understanding to what is not always apparent.)

ER Pediatrics

People ask me all the time. Why did you become a nurse?

I wish I had an impressive answer.  However, in all simplicity, my heart was in the medical field, and when the idea of being a nurse entered my brain, there just was no exit. Perhaps the glue that made nursing stick was my experience working with special needs children in the past, or my gap year which I spend many hours volunteering in a assisted living centers and hospitals. If I really think deeper, it was on a visit to a children's hospital: St Jude, in Memphis, TN. It was there that I saw nurses in action, in one of the hardest fields to practice, pediatric oncology. If there was anyplace in my past that I contribute my strongest unyielding desire to be a nurse, it might have been then. During all segments of nursing school, my future was with pediatrics. In my head, I was going to be a pediatric oncology nurse. I wanted to be like those humans I looked up to with so much admiration while in St Jude. But then life happened and I landed an externship on a cardio-thoracic surgical unit. And then cardiology became my dream. But then life happened again and because of Hurricane Sandy I was unable to to continue on that unit when I graduated and I became a surgical nurse. When my adrenaline got to the better of me, as nurse became my title, my passion and my being; I wanted it all. Lung, heart, brain, surgery medicine... and that's when I settled in the one place that would give me a flavor of everything; the ER. 

1 year in and it is my calling. The energy, the variety, the mindfulness, the constant movement; it took adjusting to, but now it  feels like home. 

This month I embark on on the journey that culminates the accumulation of my nurse dreams, the one field I haven't yet tasted among the flavors of medicine and nursing; the children. I have had a taste in almost every type of medicine, almost every system. I will still rotate in the main ER, but additionally I will now take on the miniature version as well. 

I'm excited and nervous for my pediatric emergency training journey, but it's time to act on my very first nurse dream, the field that attracted me to that title: "Nurse" and to the my acclaimed description as the: 5 ft tall woman with curly hair and big glasses, whom people call 'Nurse'. 

Mission, Zambia, Africa 2017: A Day and Night In Action

Some days I was greeted with a hug, a formal hand shake or a high five, and often I had herds of kids pushing to clutch my hand, feel my curls, and even jump on me to get a selfie. There is nothing these children wouldn't do for a 'sweet' or a ' selfie', and it was seldom that they didn't win my heart and have me give in. 

The daytime hours were spent screening hundreds of children for their basic health assessment, all while addressing the aches and pains of last year, yesterday, or even tomorrow; thank you language barrier. It went beyond  a nursing degree or even my pending NP degree to find a differential for  headaches presenting on a knee; or just a basic interpreter would suffice. I've listened to hundreds of heartbeats, and heard so many variety of arrhythmias, I can practically orchestrate an intricate tune if I combined all those rhythms. I looked into hundreds of ears  and saw landscapes of wax, dirt and often insects lining their ear canals, paving a bumpy, odorous, road to the frequently infected eardrum. Exploring their mouths as part of our general screening, consisted of a visual venture into the tunnels and pot holes of the cavities and rotten teeth scattered within their gums. Sometimes, it was a large hernia, other times an interesting rash or an infectious disease, but each day there was something we came home talking about. We also performed some eye assessments, and fitted kids with glasses. Using a water adjustment system in the lens; we adjusted the lens on the spot based on our assessment of how they did on the eye exam. We used up and down pictures and had the kids move their hand in the direction of the picture we pointed at instead of them reading letters, since many cannot yet read. 

Everyday, I looked into hundreds of eyes, each one deep, dark and soulful . Each one is a life, with a story, with aches and pains that I don't always understand, but with deep soulful expressions that will melt the heart of anyone catching a glance.  

Nighttime in Zambia is spent awake, because, why sleep when you are a night shift nurse?!?

Enter the labor ward in Zambia clinic. 

We have  a few clients in labor.  Some 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. Scratch that, we improvise; we send the patient's mom and aunt to go buy some drinks; and we give some oral rehydration. We encourage her to continue walking with hope of progressing her scattered contractions into active labor.  Another mom is in preterm labor at 26 weeks, so we called an ambulance to come take her to hospital; 45 minutes later we are still waiting. 

 Soon another mom shows up. Her name is Giveness, and she is expecting her 4th child. She says that she has had pains since 1000, it is now 0300. Lacking proper electricity and power, the lighting in the clinic relies on a combinations of sponsored solar powered lamps that intermittently work, candles, and the headlamp I brought from America. We do a pelvic exam, and we listen to the fetal heart rate. There are no monitors to attach the mom to, and no fetal heart 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 heartbeat.  The midwife does an internal exam, and she is fully dilated.  It has been about 10 minutes since she arrived in the clinic; and it's time to begin pushing and deliver the baby. 

One of the lamps are beginning to dim, I pull out my head lamp, the midwife lights some candles and we prepare the delivery equipment. 

 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 abdomen. 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 plastic garbage bag that the laboring women bring from home and layer it with their "Chitenga", a traditional designed cloth that has a multipurpose usage 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, we layer it with blankets brought from home. 

 We don our gloves and aprons, the midwives and I, and we are ready to deliver. Giveness (the mom) climbs onto the bed, that she made. There are no stirrups to secure her position. I hold on one side and the midwife assists 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 ready to deliver a baby?” Not in the least bit, was I ready. The last time I delivered a baby was a year prior in pure candlelight, in this very clinic, with the same midwife, 'Mwamba', as they call her. However, what changed in the past year is that now we have some light, I have done this before, and I have since become an ER nurse; which means whether I am prepared or not, I must deal with whatever situation faces me at that moment. As an ER nurse,  I have learned that I must always be ready to deal with the unexpected, if not physically, then at least mentally, because no one plans an emergency.

She begins to push, and she is definitely in pain, but she doesn't make a peep. The bed is flat, there are no pillows, and she is laying on her back, so as we hold her legs She holds up her own head as she pushes. Before I can blink, the head is out and I begin to position it and guide the shoulders. The cord is wrapped loosely around the neck, I fumble my fingers through it and hold it down as the midwife helps pull the baby out. It is a tight squeeze, but the baby is out. We dry her off with a towel, she yells out in a strong, loud, shrill and we place her on the mom for skin to skin. I give a proud sigh of relief, we are done; a new life is born. Still slightly holding my own breath, I clamp and cut the cord with a sharp needle because, the razors which they usually use, are out of stock. With a candle, still flickering in the background I hold the baby up to the mom so she can see the miracle that she just painfully but bravely delivered. 

It's a  girl!!!

As we are cutting the cord, I mention to the midwife, that the cord seems a bit short. She looks at the cord and touches the mom's still firm belly, and says " Sister, there is another". I quickly take what has now become baby #1, weigh her, 2.0kg, wrap her in layers of blankets and head back to the mom. 

The mom is not aware there has been not one, but two humans growing inside of her. When  we used the fetoscope to listen to the heartbeat we didn't think to listen out for another. As Mwamba does an internal exam, she says that she feels a limb, and the baby is in a breached position. However, because the membranes are still in tact, and we have no ultrasound or other diagnostic tools to assist us, she has difficulty determining the exact position. The midwife wants the place a urinary catheter, because she needs an empty bladder to allow for more  space to assess and maybe reposition the baby internally. Slight bump in the road, we are  out of catheters. Mwamba thinks fast and grabs the IV tubing we had out for the mom who needed fluids, but had no IV bags. She tears the tube and places it inside the urethra as she would with a catheter. The bladder drains, and she begins an internal exam. However,  before we can think further, the membranes open, and the mom insists that she needs to push. Before, we can do anything else, she gives a strong push, and I look down at her vagina to see what looks like feces squirting out of a butt, and a miniature vagina, as well as a tiny hand, staring back at me. The little girl, baby #2, made her surprise entrance into the world, butt first! 

We fished around a bit to find the other arm to pull out, and the mom continues the hard work of pushing. Soon the head is revealed with the cord around her neck, we untangle it, perform aggressive suction, and hold our breath, until baby #2 reveals her voice, and ability to breath with a loud cry. Now, we breath. 

As I fumble to find oxygen and tend to babies, Mwamba tends to the mom, to deliver the placentas and to stitch her up. Baby #2 is 2.1kg. 

 One of the overhead lamps that was flickering a dying light, suddenly comes back to life with  a brighter shine. Once she is stitched up and cleaned, the mom then gets up, carries her bucket of belongings and sets herself up in the postpartum room. A short while later, after we cleaned, dressed and wrapped up her babies (in layers of blankets and mini towels as diapers), the mom rests in bed, sheltered by her mosquito net, we hand her the babies to be fed and stay with her for the next few hours until she goes home. 

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 until the morning. 

We now refocus our attention to the other laboring moms. The ambulance finally came to retrieve the mom in preterm labor; 1.5 hours after it was called. The mom who had been drinking fluids is reassessed and she is more dilated; success, labor is progressing. We allow her continue resting and walking in the postpartum area until she is ready to push. We can't bring her to the delivery area, because we have only 2 beds there, and both have been filled by two moms who have just walked in in active labor.

 It's nearly 0500 (5AM). The midwives of G'Nombe Clinic didn't get to jump into their on-call bunk beds for a nap tonight, because it was just too busy. As the sun is beginning to rise, and I am preparing to leave so that I can go home, change, and take a quick nap before I return to schools and the clinic for my day time role, two more babies are born. One of those babies, is born in the postpartum area, our lady with the 'slow' labor progression, caught up pace rather quickly. 

I head out of the compound just the roosters are crowing in their morning tunes. The sun is beating strongly. Patients begin to flood the lines of G'Nombe Clinic, and new day has begun  in a little compound in Zambia, Africa.

Striving Novice On A Mission, Zambia, Africa 2017: What Am I Doing There?

Hundreds of schoolchildren, many clothed in similar uniforms, some wearing shoes, some barefoot, form lines leading to the large tented area in the center of the school yard. Some waiting more patiently, and others, well, less patiently, for their turn to express all their aches and pains to any of the health clinicians who will listen. The process of this system will entail, baseline health screening for the students, referrals as needed and medication prescriptions and administrations as necessary. But how can we ensure that the prescriptions will be filled, that the meds will be taken as prescribed, that follow ups will be carried through, and that our interventions are helping to heal the symptoms?

To make this scenario more applicable, in a world where a 6 year old child is more literate than his mother or father, where the nearest health clinic, may be miles away but transportation unavailable, and where disease and illness are rampant and deadly; how can this continuity of care be maintained? How can one ensure that the child who came to clinic with an ear infection will actually pick up medications and receive follow up to assess whether the infection has healed? 

Here in Zambia, the focus is on the educational system, the most steady and reliable atmosphere in most villages. We recruit some of the more  literate populations, the teachers and the students mostly, with occasional medial professionals or medical professionals in training to participate in health maintenance programs. Many of the teachers undergo a basic health training session, and serve as the pioneers who maintain the connection between the students/patient,the parents and their healthcare interventions, as well as assessing outcomes of interventions and intervening when necessary. The teachers help the medical staff by gathering the children, collecting basic information and bringing their students to the clinic. The role of the teachers who participate in this program, is to help facilitate some sort of continuity of care, via serving as the string that holds the patient and their healthcare resources together. 

This program produces a multifaceted outcome, since many who participate also acquire health education and knowledge through the process of receiving actual medical care. The teachers learn through their training and interactions. The students learn from their teachers and through the health screening programs. And some parents even learn from their children. Even the foreign nurses, such as myself, who travel across the world to participate in this incredible operation learn so much through working in the screening process or just seeing patients at the local clinic. As a nurse, my assessment skills have sharpened, since I assess so many patients each day. I have heard more heart murmurs than I heard when I worked on a cardiac unit, I often make decisions that are way beyond my scope of practice in the states, and I see cases that I would never see working in a large city hospital. 

Everyday that I wake up in Zambia, Africa, to be a part of this project, is like waking up to a new learning experience, and a new world of medicine to experience and acquire knowledge from. It is like waking up to a new, fabulous, brain stimulating adventure each day. 



Devorah Goldberg RN, BSN

Sent from my iPad.

StrivingNoviceMissionZambia2017

From paved roads and sturdy bridges which compile the concrete jungle  that I call my home; to a rocky unpaved African village with rickety wooden bridges, and hand made, cardboard structured homes. My nursing journey will once again take me across oceans on to another continent where I get to combine my various passions for travel, adventure, nursing and of course meeting new people and exploring new cultures. Entering this other world of living, health, and nursing is like the spark that rejuvenates my passions for the work I do and live for.  That passion that sometimes drifts into my daytime naps and sleepless days, and but is so needed to help uplift my stamina to provide care with a full heart and complete devotion. Volunteering and using my nursing skills in such an arduous setting serves as an energy boost that simultaneously humbles my everyday practice and revives the spark of interest of a #strivingnovice to challenge my nursing spirits and to humble myself in the work I do.

Last year when I scored the opportunity to travel on a nursing adventure, to practice the work of my passion, in a foreign country that was lacking the essential necessities that I use each day at work, but often take for granted, the accessabilities which myself and my patients are privileged to attain; my thirst for another opportunity to combine my two passions of traveling and nursing, only became more parched. Before I ever went on a travel mission, the idea was more like a freign dream, something similar to my once imaginary vision of nursing, that consisted of a hero shocking pulseless humans and performing compressions. A dream that was void of disgruntled, odorous patients yelling, demanding and requiring the little bits of my nursing capabilities. That hero nurse fizzled into the air as my life became consumed with the real life world of nursing, school, and my ongoing attempt to fit life, health and some sleep hours into the almost non existent time slots in my schedule. But I learned, that everyone has a busy life; even people with the passion to creep outside the lines that mark their schedules, and which overtakes the minutes we hope to sneak into our limited lifetime to make some of our dreams come alive. So if it meant giving up on sleep for the few days before the adventure, some extra organizing, and pleading emails to be granted time off, I was going to  give one of my dreams some life for the second time.

So,it is just a few weeks into my second to last semester of NP school, and after completing 3 ER night shifts and 3 NP clinic days;and after few flight cancelations and other airport drama- thank you- #winter2017snowstorm, I have finally embarked on what will hopefully be another educational, fun and fulfilling adventure; as I fly across the some continents to dive into a world of nursing and healthcare that is void of computer systems that dictate what I did and what I can do, lacking essentials such as power and electricity, and bare of what I used to think is essential in the life of healthcare and life saving environments. With vaccines ingested, and injected, bags packed with random basic items to fill the bare supply rooms in the small clinic and labour ward,such as lights ( as in candles and electric headlamps), gloves, resuscitation devices, and sanitizers; and some kosher food; a tired but adrenalized #StrivingNovice, with a newfound energy obtained from the mare exhilaration for what  will greet me after my 20+ hours of travels, as well as ambition; to bring light, smiles, candies and healing to some remarkable human beings inhabiting some small, rocky,  unpaved villages in Zambia, Africa.-#StrivingNovice takes on #MissionZambia #2.

#alwaysstriving

#StrivingNoviceTakesZambiaMission2

#ERNurseDMissionZambia2017.

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#StrivingNoviceMissionZambia2017.

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Devorah Goldberg BSN, RN