DAY OFF, BIRTH ON #MISSIONKENYANURSING2018 (4)

It was a Sunday. We all had a rough morning on our respective units. Deaths, lack of supplies, understaffed, sick patients, and the usual list goes on.  It was meant to be a short day, or even a day off, but we are nurses who love what we do, and so on our day off, we spent it nursing too.

After our hectic morning mentoring students on the wards, we took a short break, donned our nursing hats rather than mentor hats, and found the hidden gem of Busia County Referral Hospital. The NICU. The shelter among the Busia hospital storm. 

 In this quiet, warm room, hiding out within the chaos of the African hospital is a nurse walking barefoot, tending to the miracle babies of Busia. Every birth, every living child is a miracle, but surviving any birth complications in a hospital that lacks basic supplies and resources, is a true miracle. So we sat, on our break day, in this serene spot among a bustling, chaotic hospital, cuddling these miracles, and feeling their heartbeats against ours, as we awaited our laboring mothers to give birth. Coming from wards where we battle and surrender to death daily, it was refreshing to inhale the heartbeat and hopefulness of a fresh life... that was until we resuscitated an even newer life on the same table that these two premies lay,  as they struggled to inhale their own miracle of life. But that comes later in this story. 

We held human beings who fit into my palm. Their rapid heartbeat vibrated against my, now calm one. None of these humans had names yet.  Many won’t have a name untill/unless, they earn an exit from this serene, yet enclosed room. Their battle for entry to survive this world was still being fought, and until then they were just a tiny bundle with a heartbeat. Sitting there cuddling the brand new bundles of life,but fighting to keep their life, brought on a feeling too surreal to put into words or images, because it had to be felt.  

Our calmness was interrupted, a 28 weeker was eager to make an entrance into this world. We settled the babies, 3 babies per baby warmer. Fetus was 28 weeks, mom ran away from home, and had no prenatal care. There we were with white rubber boots and green plastic aprons ready for the 8cm dilated screaming 20 year old to deliver. We coached her breaths, we held her while she screamed in pain,we gave her no pain meds because there weren’t any to give, and it took 4 of us to hold her down and hold up her legs,as we guided her through each push. 

Out came the baby, reddish, blue in color, but with a weak cry. Leah and I tended to mom and Ivy followed baby. Minutes later while Leah and I washed up mother, Ivy began resuscitating, baby, who turned bluer and dropped his heart rate shortly after delivery. We joined, Ivy; and it was only us, the 3 mezungus. We teamed up and resuscitated, all hands, all nurses, no docs, and no meds. Kenya has their own rules for resuscitation, we followed them, because we are in Kenya; 5 compressions and 5 breaths. We kept going at it, determined to bring this miniature human back to life. We stood there, each of us focused on our role, yet communicating as a team.  Breaths, compressions and suction. We remained hopeful, and we continued our resuscitation efforts, all while twin premies shared the same baby warmer we were resuscitating on. We were sweating and having palpitations ourselves. After what seemed like ages, baby gave a weak cry, and so did we. Three muzungu nurses and a baby with a cry.  It was an exhausting day off, working, and witnessing the miracle of life, but it felt so well worth it. 

 Our days on the ward are spent fighting for lives, and we  often lose the battle, or can’t even fight. In this Kenya hospital, everyone is DNR, because even if we did resuscitate them, we lack the means to maintain a patient in that state of health once they are resuscitated. We have no ventilation equipment, no sedation meds, nor any resuscitation meds. When a patient dies we let them go. Each day that  we are on the ward, teaching our students, we struggle to keep our patients from hitting that road block that leads them to that DNR state. We teach our students how to care for patients while they are alive, so that we can keep them alive. We can only save them while they live, but we cannot resuscitate, nor can we really teach them how to.  Sometimes I feel like I watch these pulseless patients, and I want do CPR or give them a few breaths,whatever it takes to save a life, but my hands are tied. We had a few patients die because of glycemic issues, which we may have been caught if we had something as simple as a glucometer. But there is one for the whole hospital. So really we try to maintain lives, because even with the minimal supplies, we can still attempt at that. 

So, there we were, finally with the means to save a life we went for it, long as it took, and we finally felt like a nurse, like a life saver. 

We came home in a light mood,and  we debriefed. It felt good to bring a life into the world, and then bring it back to life, only minutes after it entered the world.

That night we each prayed for that nameless baby boy. The next few hours would tell, or at least indicate whether he will win the victory over his nameless NICU sentence to a world with breaths, sunlight and growth; oh, and a name!

We came back to work still thinking about our baby, but got busy on our wards. That day, each of us, working on 3 separate wards, lost patients who had managed to crawl into our hearts. We knew we only had minimal means to try save them, and try we did, as we taught the students to do so as well. After one of the deaths that morning, the family member went to the nurse and with the most genuine, yet heartbreaking words, said “thank you for trying”. Sometimes, try is all we can do, especially in Busia, Kenya. 

Needing some life and hope for the work we do, we went to check on our baby boy in the NICU. Our boy, had no name, no identification band that matched him to the mom who birthed him lay there, still with a beating heart, not great breathing,non impressive color, but alive; and so we went to have our lunch. 

Hours later, we get the news. Our nameless baby boy, lost the battles to his nameless state in the NICU. 

It was a rough day, with lots of deaths, including those who barely had a chance at life. I kept on thinking about our being there to deliver the child, and then being there to resuscitate him. The “butterfly effect” came to mind. We, the 3 muzungu nurses had to be there on our day off to deliver this baby and save him, even if it was just long enough for his mom to meet him and hold him. Long enough for our unnamed NICU baby to be held and cuddled by the human who birthed him. Our being there, allowed this mother to hold a living child, for the short time he was in the world to take his own shallow breath of life. 

Working in a developing country, with 3rd world medical availabilities, we often feel short handed, and often hopeless when we can’t save when we know we can, and want to. Then, sometimes, we are someplace, at the right moment, to breath some air, compress a tiny heart, and allow a mother to meet her child while it still breaths. 

We can’t always save a life. We can always try to in some way. However, sometimes, all we can give is moment in a life, a lesson for a lifetime, create a memory, for ourselves and for others, that may last a lifetime. 

TB X-RAY VIEW; #MISSIONKENYANURSING2018 (3)

A TB X-ray view of a hospital ward  in Busia, Kenya. 

This view  shadows the bustling,vibrancy, the clutter, the  challenges, the struggles and yet the bareness of the hospital conditions. 

A window into a ward that is so busy, and so full of sickness, yet bare of basic life saving necessities. Infectious disease, rampant, wild, deadly, ‘un-isolated’ and unprotected within a small, confined space; Where disease is rampant and treatment is limited. So is the saga of Busia hospital, through the TB rib view, of yet another infected patient

Wards are one big room; beds lined with plastic mattresses, linen-less unless the patient brings their own. All beds are lined close to one another, no matter the severity or contagiousness of the neighboring disease. In some wards, when beds fill up, mattresses are laid out,or patients share a bed (usually in peds). 

1 nurse covers an entire unit. Sometimes 40+ patients under the charge of one nurse. Each patient, a paper chart with multiple handwritten diagnosis and an endless list of illegible medications. Patients purchase medications and keep them at the bedside, and when they can’t buy their meds, they just don’t get them. When a stroke patient can not afford a CT scan, he doesn’t get one.

Nurses work in the barest conditions. Much of the shift involves  deciphering the illegible, handwritten med list and attempting to acquire the meds from the pharmacy way across the hospital grounds. Most medications are unavailable, including life saving meds such as epinephrine, and bicarbonate. I have yet to find a code cart, and 2 oxygen tanks are shared between 4 adult units/wards. 

Nurses must roll their own gauze for dressing changes. Sugar is used for would care. Rubber gloves are used as ostomy bags. Water bottles are used to house iv fluids. Iv tubing are used to hold broken equipment together. Working on the wards, I use nursing knowledge, and I teach, but I must also find a creative part of me to be able to improvise,so that I can provide basic nursing care.

With so much responsibility, the nurse will delegate medication administration to the nursing students. Many who don’t know what the meds are for, why they are giving them, and how to reconstitute the doses. Doctors rarely pass through the wards. Wards are managed by the one nurse, clinician/ medical interns, and nursing students. 

Families are usually at the beside and they help with feeding patients, cleaning, and moving patients from their bed to diagnostic exams or to the restroom. Family will also feed the patients, even the stroke patients and the unconscious. Some family will help feed patients of other families. When a neglected, ill child was abandoned in the peds ward, another patient’s grandmother, would coddle him and feed him with the same tenderness she provided to her own grandchild. 

Supplies. 
What supplies?

We run out of NS daily. Gloves are a commodity. And sanitizers don’t exist, I brought my own from the US.
Infection control, what is that? TB, pneumonia, meningitis, cancer, malaria, AIDS...all together in one room, coughing and touching each other,and sometimes, even sharing food. 

Every patient is DNR, there are no codes, no intubations or resuscitations; there are no supplies, tools, or medications to manage such conditions. When a patient has reached the dying stage, they just go, we hope someone provides a certain level of comfort care. When they do die, they hang out, uncovered in the big ward, side by iside with their still living, neighboring patient, as they await family to come clean them and pick them up.

The last thing I see, as I leave today, is a dying patient with wet breaths, fluid overloaded, and using every accessory muscle to breath. A nursing student scored a face mask, Leah ( my fellow volunteer) adjusts him for comfort. The family is standing around him and they are praying. 

Today was a heavy day, but I also saw my students apply some of what I taught. 

I leave with a heavy heart for the dying and the sick patients I didn’t truly get to today. I leave with some pride when my teaching is applied. In the US, after a hard day I feel power and pride for my part in helping save a life. 

When I leave after a day in Kenya, I sometimes feel pride for the small things I manage to accomplish, but with a stronger sense of powerlessness, for the things I had to let go of, because I had nothing with which to hold it with. 

The shift is over and a dark cloud is threatening to burst in a downpour. So I leave the gates of the hospital, run along the motorcycle, infested streets of Busia, and make it home just as the skies burst into mosquito, swarming downpour.

A STOOP VIEW: #MISSIONKENYANURSING2018 (2)

I sit on a stoop in Africa. 

I watch the people of Busia, Kenya. 
I learn about the humans, who will be my patients.  

The dust from Busia dirt roads, blow in my face, fogging the view from my sunglasses. 

Motorcycles with more than four people riding its padded,tail edge, motorcycles with moms holding babies, Motorcycles whizzing past me, barely missing the humans crossing the busy streets. 

I watch the humans manning the fruit stands, and the families who stop by on their way home from church for a refreshing snack. 

Families on bikes, elders with canes, teens playing hard at soccer, and little boys intrigued by a bike tire. 

One little girl gets pulled down from high bar of her fathers bike, and he instructs her to go greet the Mezungo’s(white
people), she uses her right hand and greets me with “how are you?”. “I am fine”, I reply, as is expected of me. I feel really popular, as almost every child and even adults I see, greet me with same few words in English thag they know to greet a ‘Mezungo’ with. 

I watch from the stoop I sit on, and they wave at us ‘Mezungo’ sitting there, out of place, in their town of Busia. 

How often do we as providers sit back and try to know the humans we treat at the bedside. View them as the humans in the streets, living life, just like you?

Life goes by fast, almost like the speed of those motorcycles, that often fill the hospital beds with their riders. Sometimes it’s nice to sit back, as the outsider, the ‘mezungo’, and watch those lives as they live. 

Today I’m a nurse, an outsider, a ‘mezungo’, watching from be sidelines. 

Tommorow, I will still be a nurse, I will be a teacher, yet still an outsider, still a ‘mezungo’; but I will take it in, from within the inside trenches of the hospital, with the people I see today in their streets. 

Just a nurse in a mission. 

#KenyaNursing2018

#MISSIONKENYANURSING2018 (1)

Traveling to remote, underserved countries, has been a dream of mine since the spark that influenced my career choice as nurse gave its first flicker. 

Now, here I am at 2am, in a deserted airport in Nairobi,Kenya, just myself, my metallic bags and the airport security officer manning this 
deserted terminal, as I wait for my next flight. I m using this time to reflect upon on how I got here, as I anticipate my experience in Kenya for the next few weeks. 

5 years years into nursing, a few months as a certified NP, $3000 of fundraising, and 2 plus days of travel later,  my 4th medical mission is underway. 

Back when I graduated nursing school I had written a proposal for my ideal medical mission that I wanted to start. I had felt that many medical missions that you see in the media function as bandaids for issues in those undeserved countries. Volunteers go and do great work patching up the wounds, but when another wound appears or this one gets infected, that volunteer is long gone. Thus, my ideal international medical mission, was not
 just to patch up wounds but to help the humans 
living in these countries learn to patch their own wounds. 

My past few missions incorporated teaching, but this one is all about it. My vision, together with my friend Leah, and DeAnn, who organized this grassroots organization, is to provide clinical, hands on skills to both nursing students and practicing nurses in this little land at the edge of Kenya, at the border of Uganda. 

This one is my longest mission yet, and I can’t wait to share my experience. 

Lights in the airport are turning on, and suited people are flocking in with their coffee jugs,ready for a new day. Time to give them back their airport terminal that I moved into for the past few hours, and embark on the final leg of my journey for #KenyaNursing2018. 

USA>ISTANBUL>NAIROBI>KISUMU>BUSIA