Babies on their Mama's back

The wards opened up this week. It has been busy! We are all learning how to work in this new environment. The new to Mercy Ships nurses are learning how to be a nurse on the wards. The day workers are learning how to do their jobs, translating, cleaning and helping. The seasoned Mercy Ship Nurses are learning how to work with the new day workers and nurses. And, we are all learning the Congolese culture and way of life. It has been a bit bumpy, not horrible bumpy like driving on an earthquake ruined road, but more like a bumpy old dirt road with ridges that you can't drive too fast on.  It is good. We are building relationships with each other and learning to work as a team.  A big part of learning how to be a ward nurse is learning how my nursing practice fits into this global nursing community. Each country does things pretty differently. Some countries manage more nursing care than I am used to, and others manage less. For instance, some nurses in other countries  all the ventilator changes and vent management. In other counties, nurses do not listen to their patients with a stethoscope, that is left for the doctors to do. To complicate the learning a bit more, different languages, cultures and accents are also thrown into the mix.   The nurse that was orienting me was from Norway, so I was trying my best to learn the wards from her while I was having to really focus on what she was saying in her very thick accent! In the midst of the challenge, it's a lot of fun, we are learning to be gracious and patient with one another. There is usually a lot of laughing as we blankly stare at one another when trying to explain different practices.

As the week passed by the wards filled up with many different patients. Some who have already been discharged home.  Some surgeries have been routine, plastic surgeries, tumor removals. Others have been a bit more dire. Sometimes a tumor will start to grow within ones mouth in a way that is slowly begins to suffocate them. I was told that sometimes patients like this make it to the ship just in time, as their airway is nearly occluded. The walk up the gangway and go strait into the OR for surgery. Others, sadly, do not make it in time. This week we took care of a 2 year old little guys who had a tumor growing in his mouth in this way.  He stayed two nights pre-opperatively and was gasping for air with stridor and great work of breathing.  He finally went to surgery after what seemed like years to the nurses that had to hear him breathing with great difficulty for two days. It was a relief. The surgery went great. The tumor was removed! Post operatively though, he began to struggle and his respiratory status diminished. He was taken back to the OR to be intubated. In orientation, our charge nurse told us that ICU patients are quite rare, and that last field service there were 3-4 total ICU patients in the 10 months. This little guy started us out with a PICU patient week one. I was able to take care of him the day that he got extubated. He did great! He was ready to do all the work on his own! It was nice to be in a PICU role right off the bat. It was different. But I think I will get used to it. A lot more independence. I was making all the vent changes as we were weaning him tp be extubated.  The drips were mixed and ran very differently, morphine was ran at a rate of 1ml/h, and mixed at a concentration of 13mg/50ml, so for the 12.7kg child, 1ml/h was 10mcg/kg/h. I guess this is the English standard.

After he came back to his bed from being extubated, he was agitated and fussy. He was coming out of all of his sedation and was trying to become oriented to what was going on around him. He was difficult to console. He kept being an alligator in his bed, rolling over and over, getting all his wires and tubes tangled up. His mama crawled into bed with him trying to console him. We gave him extra pain meds. I tried all my toddler nursing tricks, showing him my flashlight, giving him my badge to play with, and gave him toys to play with. NOTHING worked, he was done. Over it! My 8h shift came to an end as he was still in the midst of his crying. I hated to leave as he was so upset. It is always difficult to leave a shift on a bad note. When it happens, I feel as if I am leaving the on coming nurse in a huge mess. But, I was exhausted from all the newness of the ward and worn out from trying to console him for the last 3-4 hrs.

Later after dinner, while I was walking my dirty plate up to the dish drop off cart, I passed the nurse in charge for the evening shift. This is one fun aspect of living and working in the same place, we are able to check in with one another often. I asked for an update on how he was doing. She told me that after about another hour or so of crying, his Mama picked him up and tied him to her back, like all Mamas do here.  The Mama's have a piece of fabric about 2 yards long that they wrap around the childs bum after shifting them to their backs, they then bring the two ends around to the front, tuck the top corners in and loop the botom corners around each other twice and then tuck them in. It is amazing to see! I cannot wait to learn how to do it my self. After she did the, he was instantly asleep.  It was such a relief to hear this! It was one of the moments that I have had many of since I've been here, an "ah, so that is how it is" moment. I am sure I will have many of these as I learn how to be a nurse in Africa.

I will post pictures of all this soon. I am waiting for them to be released! I will post them as soon as I can!