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.
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.
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