Karah Waters
Karah Waters
Tanzania 2017
VIEW FINAL REPORT
Mambo! I am a recent nursing graduate seeking to experience healthcare and African culture in Tanzania. I will be working in a hospital in Dar es Salaam as well as a clinic in the Kidodi village. Join me as I embark on this escapade of being engulfed in healthcare abroad.

Simba vs. Yanga

August 23rd

Today I really got an amazing cultural experience!!!

I went to not only a football (soccer) game in Tanzania but also my first one ever!

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It was absolutely unbelievable! We took a bus and said we were with the U.K. embassy. This football game was so popular because of the teams playing so we had to tell a little lie to be able to be let in. We of course already prepaid for our tickets and everything. The President and Parliament were even there. Everyone in Tanzania LOVES football! The game was being broadcasted in Kenya, Uganda, everywhere! When you’re in Africa you literally feel like a celebrity simply because you’re white. We had a big bus take us to the game because everyone in the house went and three of the staff members so 23 total. When you have 20 mzungu’s (white, foreign people) people S T A R E.

When we walked into the stadium trying to get to our seats everyone stood up and started cheering for us. It was the funniest thing! Everyone was shouting at us cheering us on and taking pictures. I can’t even tell you the number of pictures that are of me on strangers phones. People would come up to you and put their arm around you and just take a photo. However, we ended up having to change our seats. The football games get extremely heated and especially these two teams because they are big rivalry teams. The crowd is literally splint amongst Simba fans and Yanga fans. For our safety we had to move because Yanga fans have the reputation to get a little bit rowdy. I was SO happy we did because I was wanting to root for Simba! Last year Yanga beat Simba so I always like to go for the underdog. Before the game it was really cool because people would come by with Polaroid cameras and take a photo of you. If you liked the photo you could buy it.  IMG_5636

IMG_5674Random people would even come up to you to take a photo with you and buy it simply because we were white. There was a little boy (probably 9 years old) sitting beside Alex and I and he was at the game all by himself. The stadium was absolutely huge! It reminded me of a UT football game! I was amazed that this little fella was so brave to come to the game by himself!

The game was absolutely unbelievable!!! Both teams were playing so good and no one was scoring any points because of how good both teams offense and defense were. The game ended up going into overtime and then that tied so then it pretty much went into sudden death. I was so captivated and into the game! It was unbelievable! Luckily I was surrounded by my England friends so they were able to answer any questions I had about the football game!

And!!! Simba won! The fans went crazy!!!

They had these red explosives that were shooting off in the stands and everyone was going wild. However, Faraja (one of the men from Work the World) became very serious and told us to put our phones away. Supposedly people can get very out of control at football games and Faraja didn’t want any of us to get hurt or get anything stolen. As I looked down at the field I could see ambulance after ambulance and so many police officers. People from the other team were beating on Simba fans because of the win. Supposedly on game day if you walk near one of the sports clubs in the other teams colors you will get beaten and can even die. We got escorted out by police officers and made it safely on our bus. It was so cool seeing all the Simba fans prancing around fully hyped. One lady kept twerking on the hood of every car since we were in dead stop, bumper to bumper traffic. It took forever to get home but it was a bomba bomba game and one that I’ll always remember!

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Rafikis!

The Pink Ladies


 

8/19/2017
I met these lovely ladies when I was back on the mental health ward. They just welcomed me with open arms at Muhimbili. They’re second year nursing students about to go into their third year! The day I went to the methadone clinic they were there as well. We talked for hours and hours and they invited me over to their student hostel after placement.

They made me feel at home and introduced me to all of their friends. We had dance parties and they did my hair. They showed my their rooms and we talked about our family and just life in general. How Africa differs to America. The various tribes they’re in. Even though we come from two different parts of the world we’re still so similar. They made me dinner as well. They invited me back another time and waited for me to get off of work. They made me even more food like maandazi, pilau, and tambi na maharage. Different ladies would make me various things and bring everything together for me to eat. I really love trying Swahili feed and eating it like they do, with your hands. They even bought me sugar cane juice from their mini store downstairs that’s for students.

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This is Beatrice with dinner she made me in her room!

This dish in particular that Beatrice made was very interesting! It was sweet spaghetti noodles with beans.

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I definitely have gone out of my comfort zone so many times here when it comes to food! Luckily, I haven’t gotten sick or anything from things yet!

During our various conversations I learned that they had never had a burger nor pizza. They explained to me that very few people in Tanzania have actually had “white people food.” They said that if you eat “white people food” then you’re doing very good in life and you have a happy life. I tried to explain to them that in America you can get burgers for very cheap. Like on the Dollar Menu. However, they asked how much is $1 USD compared to Tanzanian shillings. $1 USD equated to 3,000 Tanzanian shillings. They said that they could eat three meals with that much money in one day. This kind of took me back and really opened my eyes. I insisted that they let me take them out for burgers, my treat. I just had to introduce them to their first burger experience!

We met up on a Saturday at Salt which is this Western restaurant near Oyster Bay and Coco Beach. It’s the only Western restaurant around and one of the few places that sells burgers. They were in awe at the restaurant! I have never really been put in the position where I’ve had to explain what everyday typical things are. For instance, they’d ask me questions about the menu like what ketchup was or what macaroni and cheese was. It was kind of funny because typically they’re the ones telling me what all of the different things in Tanzania are but now I was able to share a little bit of home with them even though we weren’t in America.

There’s a lot of different and unique types of burgers on the menu. Of course your regular beef burger, chicken burger, salmon burger, etc. They would ask me to explain what each one was and what everything on the menu meant. I ended up asking each of them what they like in Swahili food like if they prefer spicy over sweet, etc. and made my assumptions that way and based that off of how I ordered for them. It was such a fun meal!

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We made a toast for them almost being done with the semester. The school year is switched here. They’re about to have summer whereas in America summer is ending.

After lunch we went to Coco Beach and strolled along the shore and I took them to the cliffs. My friend there, who’s a lifeguard, walked with us to the cliffs. It was just so much fun relaxing with them. It was also nice having them there because they were able to translate what everyone was saying to me.

This is definitely an experience that made me very honored and humbled and a memory that I’ll always cherish.

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OR Day

August 21st

My experience in the OR was absolutely amazing!!!

 

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It was a nice break to get away from my second week in the ED. We got to go to the theatre at 8am and stayed in the OR until 5:20pm. There was one surgery right after another with no breaks. By the end of the day I was very hungry! I had the chance to see five different operations.

CAUTION: if you don’t like reading about gross things like details of surgeries you may not want to read any further!

Without giving out patient information I’ll summarize everything I saw! The first surgery was a laparotomy. It was crazy watching the surgeon pull out all of the organs. I was able to see how the liver was black due to the illness and see the small intestines and large intestines out of the body. I’ve seen two operations back in the United States but none of them dealt with the abdomen.

The second surgery was a radical mastectomy where they removed an entire breast. This was very interesting to watch and observe! You could see the muscles once they removed all of the adipose tissue. It was very insightful! It’s so important for a woman who’s had a mastectomy to not have her blood pressure taken on that arm because of the removal of the lymph-nodes on that arm. During the surgery I was able to see how much of the breast they actually remove. It almost goes into the woman’s armpit which is where the lymphatic system runs.

After that surgery I was going to see a proctoscopy and biopsy. However, due to the patients condition once he got on the operating table they canceled the surgery.

The fourth surgery was an insertion of a GFT. The patient had dysphasia due to severe tongue cancer. I was able to see the surgeon take out the stomach and place the tubing in. Since the patient can’t swallow properly the insertion of the tube will allow them to feed her through the tube and bypass the throat and go directly into the stomach. They wanted to try this first before they looked into radiation.

Now... the last surgery was UNBELIEVABLE. I had never seen anything like it before. The patient had KS, Kaposi sarcoma. People were also saying elephantiasis. The surgeon said that what this patient had was a rare tropical disease! His leg was 20 times the size of the other one and he also had a fungal infection on top of it. The surgeon said I could take a photo and the patient gave me his permission but unfortunately I’m not sure if I can share it on social media. The patient began having this condition 7 years ago but he couldn’t afford medical help so it progressed to this state. They had to do a AKA: above knee amputation on that leg. I had never seen an amputation take place. I always had wanted to but I never thought I would be able to stomach it. With it being the last surgery of the day as well I was starving and really wanted some food on my stomach because I had a headache and was a little light headed. All of those things aren’t a good combination when you’re about to see a lot of blood and an intense surgery. However, I made it through the surgery without getting queasy or anything! It was absolutely amazing. Just watching the surgery take place was unbelievable. The patient wasn’t put under anesthesia so he was awake for the entire surgery; which blew my mind! He had a sheet dividing the lower half of his body and his face. This is similar to what they do when a woman has a c-section. They gave him a spinal tap so he couldn’t feel anything below his abdomen. However, he could hear everything going on. When it comes to patients I just really put myself in their shoes and imagine how I would be feeling if I were them. For this patient I kept thinking of all the sounds he was hearing and smells he was smelling. Sorry if I’m going into too much detail but during operations they have to burn through the flesh to stop the bleeding. Especially in a leg where there are a lot of veins and arteries they would have to stop the bleeding by burning off the vein in a sense. The smell that comes with that isn’t the best thing in the world. Also, you can hear the sound of flesh being cut. Having to hear the sound of my leg being cut off and smelling my skin burning would not be okay. I just couldn’t imagine what he must have been thinking. As I’m still working on my Swahili I’m able to carry out a conversation in greetings, goodbyes,  and introduction. However, for more in depth in conversations I’m still learning. So I could just small talk with him. The biggest surprise with this surgery was when it came down to the bone, literally. So the appliance they had to saw the bone kept breaking and they weren’t able to cut it. So they improvised. They ended up pulling up the leg and bending it backwards manually breaking the femur. There was a loud pop and the bone was officially broken. When in Africa you see things like this. I couldn’t believe it had happened! Remember that the patient is AWAKE. So he heard his own bone crack! Can you believe that?!?! CRAZY! Furthermore, the doctors and nurses were laughing about it.

Overall, I was very happy about the clinical practice that goes on in the OR/theatre. They have a “Time Out” session right before the surgery just like we do in the US to make sure they’re operating on the right patient in the right place. They did their best to obtain and retain a sterile field. I still saw some not so good things like re-sticking the patient with the same needle or beginning the surgery as the nurse was going over the time out sheet.

Though it was a long day it was a bomba, bomba day! Bomba means fantastic in Swahili. I had only ever seen 2 surgeries in the OR in the US but here I saw 5 in one day!

My Experience in the ED

August 19, 2017 Saturday

I’m currently writing this in the pitch dark. It’s night time in Tanzania and all of the electricity just went off. A few nights ago after tossing and turning all night because of hearing various sounds throughout the night I woke up in the morning at 5:30am to the sound of heavy rain, electricity no longer working, and a leak in the room. All of the electricity goes out periodically here; both at the house and hospital. There are a lot of things that I’ve experienced here on a regular basis that I wouldn’t typically experience at home.

Sometimes the water goes out when you need to wash your hands or even while you’re in the shower. The toilet will stop working, sometimes the toilet is an actual hole in the ground,

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having to hand wash clothes, not having any toilet tissue in any of the public restrooms, constantly having to have bug spray on because misquotes are everywhere at all times, no AC anywhere, etc. However, I can’t even complain. There are so many people here who don’t even have a proper toilet. I’ve seen people washing their clothes in puddles of water and in the ocean. A lot of people in Africa don’t even have electricity. I am very fortunate both here and at home.

When I look back on this week I’m not gonna lie, it has been a really hard one. I’ve just really had my ups and downs. Especially with seeing so many painful and tragic things in the ED. Today as I reached my half way mark I had a mix of emotions. At first I was excited to be halfway done but the more I thought about it, it made me very sad. Of course I miss my dear family, boyfriend, friends, and the little things that America has like oatmeal chocolate chip cookies or AC but I’ve finally made some really great friends with the Tanzanians and feel like I’ve got a good bearing of this city. The people at the Work the World house have been amazing and I’ve been great friends with everyone since day one! However, it’s just different with making friends with the native people. A lot of people come and go at the Work the World house. Everyone that was here when I arrived has left now. The two girls from Belgium that arrived the same day I did just left an hour ago. It’s been so hard saying goodbye to everyone. There’s been people from all around the world: England, Belgium, Netherlands, and Australia. So far I’ve been the only American which has been hard. But everyone has taught me so much about their healthcare systems and cultures.

When I met with the Lumos committee I will never forget what one of the people on the committee told me. He said to be sure to

really make an effort to get to know the local people.

I couldn’t express how it has been the best and most rewarding thing I have done since I’ve been here. The people and culture are literally my ultimate favorite. I’ve never met people as kind as I have here. If you show them a little interest they will pour into you times a million and give you four fold. Everyday is literally a new adventure. I never know what’s in store. Of course I know I’ll be waking up at 5am to get ready for the hospital and it’ll be an hour commute. I may or may not have a seat on the dala dala. But, the hospital is always a surprise. Which nurses or doctors will I see today? What patients will come in? What new friends will I make? What will my evening be like? I hardly ever leave the hospital at the same time in the afternoon/evening. It may be 3:00p or it may be 6:00p. Sometimes a nurse will take me to her home or student nurses will make me dinner and let me come into their hostel. Everyday is literally a new adventure!

My first full week in the ED was extremely eye opening. Everyday felt like I was in an episode of Grey’s Anatomy. I won’t go into too big of detail because I know how some people don’t have super strong stomachs and because of patient confidentiality but I would see patients all over the spectrum: SEVERE motor vehicle accidents, SEVERE burns, accidents with bombs, gun shot wounds, several head hemorrhages, tetanus, TB, malaria, many cardiac arrests, machete accidents, and so much more.

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I’ve seen tragic things at the same time. There was a patient who’s blood pressure was 300/200 and was having a stroke. She didn’t have the money to afford a CT scan which is about 170,000 Tanzanian shillings which is about $60 US Dollars so they wouldn’t let her have one. When I asked what’s going to happen to her they said she’ll remain there until her condition improves or worsens. If it worsens she’ll be sent to palliative care. It was midnight and she had arrived early afternoon. Her condition was only worsening. She was struggling for each breath, she was bleeding out blood, and her blood pressure wasn’t dropping. The only thing they were giving her in the IV was dextrose. I was so confused and upset on the inside but I simply had to remind myself of this phrase, “It is what it is.”

I’ve faced a lot of ethical dilemmas while I’ve been in the hospital. There are so many ethical decisions being made that I don’t always agree with or understand but I’ve learned to just observe everything going around and accept what is happening. For instance, my last day in ED there was a patient with 3 wounds to his head. We believe they were gun shot wounds. He started going into cardiac arrest so we began CPR. However, when we would do rescue breathing for him the air would come up through his head and more blood would gurgle out. Eventually he went back to a normal sinus rhythm but shortly after he was somewhat stable his B/P dropped and he went into cardiac arrest once again. Right then and there all of the nurses and doctors began talking about whether they should do CPR again. They stated his pulse was gone and asked if anyone had any issue with leaving him as is. No one advocated to continue so they just left him. My insides flipped over in that moment. I had just never seen that happen before. From what I’ve seen in the US the doctors and nurses will try everything in their power to keep the patient alive unless they have stated they’re a DNR. This patient was probably in his late 30’s. I honestly haven’t seen anywhere on any patients charts if they’re a full code or DNR so I’m not sure if they have that here but I’ll have to ask. This is an example of just one of the many situations I’ve seen where ethics go into play. I could see where the healthcare team didn’t see a purpose in continuing CPR because of the overall outcome of this patient. However, it was just hard to see people giving up on someone to live.
There are two other patients that I would like to talk about that really stood out to me during my time in the ED. I had both of these patients on the same day. Let’s call the first one Rob and the second one Jim. I won’t be able to go into too much detail due to patient confidentiality.

Rob was an older man who has been suffering from various health conditions one of which was cancer. He came into the hospital with a chief complaint of overall malaise and weakness. He didn’t seem 100% orientated and he was struggling to breath. We put a non-rebreather mask on him to increase his 02 level. However, he kept trying to pull it off. The doctors and nurses ended up restraining his hands to the bed so he would keep his mask on. When I was in the SICU at Vanderbilt a patient was so delirious because of the lack of oxygen that he kept trying to pull off the mask, just like the patient was doing here, so the doctors and nurses gave him a light sedative to keep him calm. I thought it was the best thing they could do since they didn’t have the sedatives available. However, he was really having a hard time breathing. It’s always so important to observe your patient and listen to what they’re saying. A teacher at Belmont once taught me that a nurse is nothing without their assessment. However, they kind of just left this man in the corner of the room. About an hour later his breathing stopped all together as they were attempting to intubate him. Due to his various health conditions they didn’t feel it would be a good overall outcome if they attempted CPR. Almost an hour after his death various doctors were still practicing how to intubate. They had the device in his mouth and one after another doctor would practice and clean up their technique. This made my stomach sick and made me so sad. With patients I always try to think of them as an actual family member. This man was just a few years older than my Dad. I wouldn’t want anyone doing that to my father! No way could I do it on this man. Some of the doctors asked if I wanted to practice but I said no. I understand their reasoning so they’d know how to do it on future patients (some American intern doctors were teaching them how to properly do it). But I still didn’t feel right about it. After they all practiced intubating him they just left the room leaving him there. My mind immediately went to what I had learned in my Adult Health 2 class about postmortem care. During my SICU clinical experience back in the US I had experienced my first death of a patient and that was the first time I had done postmortem care. I was incredibly thankful for that experience because it helped me in that moment. Although the postmortem care was a bit different here I was able to do it. One of the hardest things here in the hospital is not being able to speak Swahili fluently. From context clues and simply observing the situation I was able to identify who his daughter was. I wanted to so badly be able to speak with her in her language but all I could say in Swahili was that I was very sorry. It was so interesting to watch how the healthcare professionals treated her. It’s just not what I’m used to seeing in the US. I just kept putting myself in her shoes. If my father had just died I would be a basket case. She called her mother on the phone to let her know. It was all so heartbreaking. To make the situation even worse I was watching what the nurse was doing on the computer screen. She was JUST NOW PUTTING IN HIS TRIAGE INFO and how he presented upon being admitted. She wasn’t even the nurse in the room that saw him once he got there so she was making up a lot of it. It was over an hour after his death and she was just now putting in all of this info that had happened upon his initial admission which was about 4 hours ago. This just surprised me so much. She was documenting on a dead man from when he was alive hours ago because it wasn’t done yet. The situation with this patient really made me sad. What if I had just listened to him when he was taking off the mask. Maybe he was just trying to show us he wasn’t breathing properly with it on and that’s why he was trying to take it off and we should’ve intubated sooner. I’ve faced a lot of situations in the ED that made me question how good my nursing skills are. I don’t have that many clinical skills under my belt since I’m a recent graduate but I just can’t help but think if I maybe had more experience I would’ve been able to save more patients lives.

Later on in the day the second patient that I would like to talk about came in, Jim. He was about my age and was a very fit young man. Looked like someone that nothing could hurt. He was very muscular and healthy looking. Just full of life. However, like many of the patients he was involved in a motorcycle accident and was laying on the bed lifeless. The doctors put me in charge of suctioning and manually bagging him. I did this for about an hour before we transferred him. As we were transferring him I was still bagging him. We took him all the from the ED to the surgical intensive care unit. Which was a good 10 minutes walking distance. They were strolling him and I was bagging him while I tried to dodge running into people. Once we got to the SICU we were able to get him hooked up to the ventilator. However, the SICU was the most eerie place ever. I felt like I was on an episode of The Twilight Zone. The windows were tented with this dark pink/purple tone so you couldn’t see out of them and there were all of these constant noises that would come on every few seconds and play in harmony with one another. It was pure white on the inside and all the patients were lying across from one another in the ward not moving or talking since they were mostly all on ventilators. It was just a very creepy feeling I got. And all the doctors were dressed in a different outfit with white shoes on. The facility seemed great though. It seemed like they had a lot of money going towards that ward which was nice to see.

The teachers at Belmont have taught me SO much! I hold onto everything I learned while at school like a treasure. It’s really helped me while I’ve been here.

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Mental Health Ward

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August 15th

I’m sitting outside with the sun shining on me as it begins to set. This Saturday is coming to an end and as it’s ending I’m reflecting on these last 2 weeks that I had at the hospital. I have been in the Mental Health Ward and it has been such an eye opening experience!!! At first I was really worried because I didn’t know what to expect. I had heard how it was very different in some aspects. However, I absolutely loved it.

I spent my first few days in the male acute ward and fell in love with the patients. In the psych ward they have an acute ward for males, a general ward for both females and males, PPI which are private rooms for people with private insurance, Occupational therapy unit for groups, a day clinic for pediatric and adolescent patients, and a methadone clinic. I had a chance to go to each of these units; however, I spent most of my time in the male, acute ward because I was able to see and learn a lot there!

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This is the outside of one of the acute male rooms. It looked a lot like a prison and you had to use a key to unlock the gate to get in

When patients first arrive they are immediately admitted into the acute ward (if they are males) and then when they calm down they’re admitted into the general ward generally after being in the acute ward for 24 hours (sometimes longer). A lot of the male patients upon admission are aggressive. I witnessed quite a few. The family members that bring them in as well as the staff hold them down to the bed and restrain both arms and legs. At first I had a hard time dealing with this. In America, restraining patients is a last ditch effort. We go from least invasive to most invasive. Once they get the patients tied down they then administer medications. Both through the vein and an IM (intramuscular). However, when they administer the medication through the vein they don’t insert an IV cannula. They do it strictly with the needle into the vein. It’s quite a big needle and sometimes the patient is thrashing around on the bed. Typically the needle is jerked out and the nurse re-inserts it several times until they’re able to get it all in. In America we never restick the patient with a needle. This was quite different to see. I’ve never seen medication injected directly into the vein without the use of an IV cannula. It also made me nervous for a needle stick injury. It would be very easy to accidentally stick yourself with the needle with the patient is trying to fight you putting the needle in.

A lot of the patients were admitted with psychosis due to drug use. The most common drug of choice was cannibus. Patients were also admitted because they weren’t being compliant with their medications. Therefore, the patient may come in because they’re being manic from their bipolar disorder. There were also patients there who had schizophrenia, grandiose due to psychosis, aggressive/agitated patients, major depressive disorder, etc. A lot of the patients were highly educated and had a college level education. A lot could speak English as well. In the acute ward there are two rooms. Each room has 6 patients so a total of 12 patients. However, the rooms didn’t really look like rooms. They looked a lot like a jail cell. The male patients wore blue scrubs and the female patients wore red.

Inside the acute ward there was one patient that absolutely broke my heart. He was found on the street (they think his family just dropped him off and left him) and brought to the mental health ward. He is mute and seems to have some sort of mental disability. A lot of patients with mental disabilities are seen as someone who has a mental health problem. They tried sending him to an orphanage but things didn’t work out there so he has been in the acute ward for 2 years now. T W O Y E A R S. I just couldn’t believe it. The rooms aren’t that big and there’s nothing to do inside the room. Every now and then the patients are able to leave for OT but that’s not that often. Since he is mute he’s unable to tell anyone his name. In addition, he’s not able to write so he can’t write his name. He’s literally known as Unknown. They don’t have a name for him. They’ve tried putting his picture in the newspaper, on the news, and on radio broadcastings to try and let his family know he’s at the hospital because he’s unable to give the staff any information about his family and where he’s from. However, know one has shown up. In one regard it’s wonderful that the government pays for him to be there and that he’s not left out on the street but it’s very sad that he’s been there for so long. They’re trying to get him a permanent home but it’s still in the making. I’ve learned that you can’t change things in the hospital but you can have an open mind and just understand that’s the way it is. Before I came here a native had told me to

Be compassionate but not emotional.

That’s the one phrase that I’ve kept in mind over and over again. I’m not here to compare and contrast how we (America) do things compared to how people in Africa do things. I’m here to see how they’re able to manage and use the resources they have here. Countries can learn a lot from one another. Whether that be a developed or undeveloped country.

The man in charge of the acute male ward is named Clemence.

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He is SUCH a sweet man and taught me so much!

He’s been there for 10 years and went to college at Muhimbili. He’s such a sweet man with a huge heart and shows compassion to all of the patients. He was so good at explaining how a lot of people in Africa aren’t educated on mental health conditions and people may think the patients are bewitched and such. He also explained how the police force aren’t educated on mental illnesses. A lot of the times the police officers will see a person acting out. Maybe the person is being overly manic and destroying things or acting out in public and the police officers will beat the person and then bring them into the hospital. There was one patient who would scream in pain any time you would touch him and his upper lip was extremely swollen, bruised, and bleeding. When I asked what happened to his lip Clemence explained that he was acting out in public so a police officer bit (yes... bit) him on the lip and they beat him before they brought him in. They did this simply because they weren’t aware that he couldn’t help what he was doing due to his condition.

Moreover, a professor and clinical instructor invited me to a class presentation that his students had where they presented a case of a patient. This was very eye opening! I learned a lot by getting the chance to attend the class. They use a lot of the same terms we use in America for their patients and they also use NANDA! Which is North American Nursing Diagnoses. So a lot of the same nursing diagnoses we use in America they also use in the mental health ward.

Getting to go to the Methadone clinic was a very unique experience. A lot of the patients who have addiction problems to drugs and/or alcohol will go to the clinic to get methadone which is a type of opioid. It is bright green and they drink it at the clinic. It’s in liquid form so the patients can’t try and sell it which they could if it were in pill form. The patients who are seen here have to want to get help and have to no longer use the substances they have been using. Each and every day the patients come to the clinic to get the methadone and then leave.

A lot of the patients who suffer from addiction and have risky behaviors tend to also have risky behaviors sexually. Therefore, a lot of the patients being treated at the methadone clinic also are being treated for HIV. Since they HIV and their immune system is lowered they tend to also have TB. Almost all patients with HIV also have TB. Before the patients can get their methadone they have to come and get their TB and HIV medications. Since the patients really want their methadone, it helps increase the compliance of them taking their other medications first so they can get their methadone. I know back in America it is extremely important for patients with TB to take all of their medications each time. Patients are typically on TB meds for an entire year and take up to 6 pills. At the health department if patients don’t come to take their meds then staff members will call them and even go to their home. It’s so crucial to be compliment with the medication regiment. I thought it was very smart for them to put all 3 medications (methadone, HIV, and TB) in the same clinic. Since there is methadone in the clinic there is a risk for people coming in with guns to try and get the methadone. They said that it’s happened in the past where people have come with guns. So I was extra cautious. However, nothing like that happened while I was there. I also got the chance to see a patient in the clinic get reassessed with how he’s doing with his addiction and no longer using drugs. During the interview there was one thing that really stood out to me. When he was asked what his annual income was he said 350,000 Tanzanian shillings. This is less than $200 US dollars. I just couldn’t believe it. On a typical week here I usually take out 200,000 which is $89 US dollars for food and commuting each day on the bus and tuk tuks. I just couldn’t fathom it.

The methadone clinic was different then any other clinic I’ve been to in America. The experience I’ve had in my mental health rotation and my senior practicum which was in a child and adolescent psych unit back home in America  was quite different compared to here. There aren’t rehab programs here or a place for children to stay in patient. The day clinic for children and adolescents doesn’t admit children for overnight. In addition, there is not a problem with self mutilation among pediatric patients here. The most common issue with children and adolescents are drugs. This was a great thing to here! I had to explain to the doctor and nurses how children in America do self mutilate and will sometimes try to kill them selves. It was the first time they had ever heard of self mutilation. However, one of the nurses did tell me that on the adult unit a patient would bite at his fingers and literally chewed them off. Other than that, the patients don’t tend to harm themselves as often as I’ve seen in America. Furthermore, there was also a difference with not having a geriatric unit. The older patients tend to stay in the acute ward and aren’t put in the general ward because the other patients are too intense there and there isn’t as much observation in the general ward. There are about 30-40 patients in the general ward and they all share one room. So the older patients just stay in the acute ward until they are discharged.

Overall, I was able to see a lot of admissions, discharges, and transfers. During my time in mental health I learned a lot! The biggest issue I see is the need for educating others on mental health and imploring more time for the patients to have in OT and getting out of the room on a day to day basis. There are some things they can’t help like being understaffed and not having as many psychotropic drug options as we do in America. However, I was able to learn a lot here from the patients, nurses, and doctors. I’m excited to see what my next two weeks will be like in the Emergency Department! I did a night shift once in the ED already and it was a very interesting experience.

Nane Nane Day

Nane Nane Day is a holiday in Tanzania known as Farmers Day. Nane in Swahili means 8. They call it Nane Nane because it the 8th of August. And August is the 8th month. This was last Tuesday and we got the day off at the hospital. I chose to spend the day going to the local, public beach which is walking distance from my house. It’s called Coco Beach. I went with my two guy friends and upon our arrival we were greeted by this lifeguard.

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His name is Daniel

He was so kind and showed us around the entire beach. It was absolutely breathtaking. The tide was extremely low and where we’re sitting was filled with water within 2 hours of the photo. Something Daniel kept mentioning was to be true to your heart. He explained how he’s a ‘survivor’. He came to Dar with just the clothes on his back and no money nor place to live. However, he now has an apartment where he can call home and enjoys his life greatly just by living simply. Daniel was a huge example to me of what it means to be humble and to be a hard worker. He would like fun of me and just find laughter in the smallest of things.

After going to the beach a group of us from the Work the World house had made an appointment to go to the local orphanage. I had brought a few things from America to give the children like playdough, pencils, crayons, glow in the dark stars, etc. But I collected a few more items at the local market like coloring books, clay, food, water, candy, etc.

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This is the outside of the orphanage

Going to the orphanage was so hard. I just kept thinking what would happen to the children in the future? They were so precious and so happy to see us. I felt uncomfortable about the orphanage home and how it was run. A lot of the supplies we brought the children would go in the backroom and just give it to the owners. We had heard that the owners take most of the things we bring and give it to their own children. There were two children who really stood out to me. One was this little girl on my shoulders and the boy in the middle. IMG_5226

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A lot of the children have never seen a phone before and are SO amazed at taking photos

Some of the children just didn’t seem like children to me if that even makes sense. You could tell they had not been properly loved or shown affection. There was a little boy who was no older than 3 years old and all he did was sit and cry. His face looked so sad and he seemed so despondent. It was heartbreaking. You could also tell they have had to fight for everything their entire lives. When I opened my backpack to hand out goodies they were pushing and fighting and trying to rip apart my backpack. I had a hard time getting them to calm down and then once they’d get a pack of crayons or pieces of candies they’d just hide them in their hands and pockets and not really even use or eat them. There were some children who had never even seen coloring books before and didn’t know how to use crayons.

After leaving the orphanage I was so sad and didn’t really know what to think of what I had experienced. A lot of the orphans are there because their mother died during childbirth and the father couldn’t stay home to take care of the baby because he had to work to provide food for the family so the family had no other option but to put them in an orphanage so they could be properly seen to.

Mcha from Zanzibar

Adventure with Mcha

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It’s hard to believe I’ve officially been in Africa for an entire month. The first few days and weeks it didn’t feel real. I would wake up every morning in disbelief that I was actually in Africa. It wasn’t until the trip to Zanzibar which was when I finally accepted I was in Africa. Throughout the week I’m at the hospital, Muhimbili National, from 8a-3:30p. The commute to and from work is about an hour. The weekends are when I go on adventures. Two weekends ago was when I went on an adventure to Zanzibar. We had a tour guide by the name of Mr. Alewei and we did so many amazing things. We left Tanzania early in the morning by ferry and met Mr. Alewei upon arrival. I learned that Tanzania’s original name use to be Tanganyika. It wasn’t until 1964 that Tanganyika and Zanzibar joined together. The “Tan” is for Tanganyika, the “Zan” is for Zanzibar, and the “Nia” means to come together. The first day we got a tour of Stone Town which is a very historical part of Zanzibar. We took a boat to Prison Island where we had a tour. When slaves would act out to their owners in Zanzibar they would send them to the island to be prisoners. There were huge turtles on the island that we got to feed and play with! The oldest one was 192 years old.

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They are protected by Zanzibar and have a safe home on the island. We snorkeled on the island and then went to a place where we had a spice tour. There were SO many types of spices! They would pull off a leave on a plant and have you smell it and guess what it is. I ate the bark from a cinnamon tree and it tasted just like Red Hot gum! After smelling all of the different spices we watched a man climb the coconut tree and throw down the coconuts. They then cracked the coconuts open for us and we got to drink the juice. The people from the spice tour made us grass crowns, bracelets, rings, and necklaces.

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Mr. Alewei is the gentleman squatting. And these are some of the great friends I have made who are also working in the hospital.

It was absolutely amazing! Afterwards, they fed us fresh fruits that are all grown on the island. There were fruits I ate that I had never heard of before like laichi and jack fruit. The next day we got the chance to swim with dolphins and go to Jozani which is a national park. The forest was so breathtaking! I got the chance to see SO many monkeys in their natural habitat! It was unbelievable. The monkeys would run right in front of you or right beside your feet and swing from branches just in front of your face. There are two monkeys native to the island. One of those monkeys you can find all throughout Africa; however, the Red Colobus Monkey is only found in Zanzibar.

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This is a baby monkey being nursed by its mother.

I also got to see Mangroves all throughout the forest. These are trees that can only live in salt water and the roots of the trees actually grow above ground because of the lack of oxygen under ground.

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Zanzibar was such a beautiful place and it was quite different compared to Dar es Salaam. You felt a lot safer in Zanzibar. I could actually carry my phone in my hand while I was walking out in public and carry a bag with me. Thefts weren’t as prevalent there as they are in Dar. The economy of Zanzibar relies so heavily upon tourists whereas Dar doesn’t have as much tourists. There is a lot more poverty in Dar compared to the people who live in Zanzibar. However, there is still poverty there. I passed by many homes and villages that were very rural and looked poverty stricken. Moreover, the population of Zanzibar is very diverse! 90% of the population is Muslim. A lot of people spoke in Arabic and there were many buildings that had Arabic writing. Luckily, a guy that was on the trip with me, Saqib, knows Arabic and was brought up Muslim. He taught me a lot and I had the chance to hear him speak to some of the natives in Arabic. It was really cool to see. A lot of people were in hijabs and modestly dressed. There are also a lot of Muslim people in Dar but not as much as I saw in Zanzibar. Dar is about 50% Muslim, 50% Christian. So although I had an absolutely unforgettable experience and trip to Zanzibar there is one person that I really hold dear to my heart and was my favorite part of the trip. Everyone, please meet Mcha.

Mcha from Zanzibar

Mcha from Zanzibar

He’s a 15 year old boy who’s a fishermen. I was attempting to go out to the sea with a friend from Work the World named Saqib, because the tide was really low and there was about a mile or so of shallow water and then you could reach the reef. He approached us with his fish he had caught that day, which you can see in this picture

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and asked if we were trying to go out. He spoke very little English but we were still able to communicate with the broken Swahili we new and the broken English he knew. He led the path and along the way he showed us his world in the water. This was a time that I really learned the importance of non-verbal language. Even though we couldn’t communicate through words I could still understand everything Mcha wanted me to. He would find beautiful sea shells and just hand them to me. He would find star fish after star fish and I never once spotted one.

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He would find these sea creatures in shells and told us the names of all of them. There were sea urchins EVERYWHERE! He would make sure we didn’t get hurt by them. As we were heading back there was a little rock in the water. All of a sudden he said there’s an octopus underneath there! I had NO IDEA how he even saw it! It didn’t look like anything would be underneath the small rock. He reached under the rock and I saw ink everywhere in the water! HE WAS RIGHT! There really was one!!! After battling and battling and the tide rising and rising  he eventually won the fight. Thr water was at first just below our mid-calves and it was now way above my knees. The tide had risen a good 2 feet and we still had a good mile to go to get to shore. We made it back just in time and that’s when I captured the first photo up above. This little boy has a heart of gold and is such a hard worker. Could you imagine supporting your family at the age of 15 and fishing all day long so your family has food to eat? He had an even younger brother too who was also fishing. Him finding things so easily in the sea taught me how I need to change my perspective.

If you’re walking blind and not looking for things around you then you’ll miss them. Just like I missed all of the beautiful things in the sea until he showed me. That’s something Africa as a whole has taught me. To really open your eyes.

What a Journey so Far!

WOW. WOW. WOW.

How do I explain the experience I have had so far with words. I am in love with the culture and people here. I can’t believe it has already been almost two weeks since I arrived! I will try to start from the beginning! I loved all of the people that I met on the flights. When I landed in Istanbul I was very nervous just with everything that I have heard going on in Turkey. However, I was greeted at the gate by two fellas that were both from Dar. Just seeing their bright, warm smiles put me at ease. The one thing that was so shocking to me was when I was flying over Africa. It was night time and it was pitch black outside. It looked as if we were flying over the ocean. No lights anywhere. Every now and then I would see a twinkle of light down below but the only light that really showed was the moon. Once I landed in Africa it was 2:30AM. All of my flights ended up getting messed up so I was about 5 hours late getting in. However, I was as excited and energetic as ever! I was a bit nervous with getting my Visa and Business Permit but it all worked out great. As I walked outside to meet the people picking me up from the organization no one was there. It was almost 4AM at this point and there were people everywhere. Taxi drivers were trying to get me to go with them.  People dressed in hijabs and everyone was speaking a different language. I backed up against a wall just so I was aware of my surroundings. After traveling over 24 hours and hardly sleeping on the plane all I wanted was a person that I knew to come pick me up. I was a little frightened with being in a foreign country at 4AM. I made a few phone calls and they were there in about 30 minutes. I was so happy to get to the house and take a shower. I was so excited to see what was in store for next few days!
This first picture really represents how it’s been in Tanzania so far.

Half way walking blinded because of the unknown but loving every step.

The people in Tanzania are absolutely amazing and so loving. My admiration and love for these people is abounding. Every day I am more and more astounded. The people here are so hardworking and gentle hearted. They reach out to you with open arms. These photos are from last week. A nurse that I had just worked with for 2 DAYS simply said to me,

“You’re coming home with me today, okay? I get off at 12:30PM.”

And buh-bam, she drove me all the way to her home from Dar. She has 3 beautiful daughters and 1 handsome baby boy who is the youngest. Just like my family. Her husband is a pastor and they welcomed me into their home.

I had dinner with them and got to play with their children!

and they took me to their church. They are Lutheran and that church service was absolutely unbelievable. I have never had to place myself in a situation where I was the minority and didn’t understand a language being spoken around me. Although I could not understand the words of the songs at church I was so touched. Everyone was so happy and dancing to the songs. I could understand what they were saying even though I didn’t know the words.
Then she drove me all the way home. Simply just because.

The nurses and doctors I have worked with over these last few days have been the ultimate kindest healthcare professionals I have ever worked with. On my first day one of the guys took the bus with me and walked me home because all of the other interns had left and I was worried about going home by myself. It was about an hour and a half of his time and he did it just because. A nurse bought me a Pepsi on my first day as well simply because I looked tired. There have been multiple times where people share their food with me during lunch. This was my first official meal in Africa:

and this is actually what I had for dinner this evening!

untitled  Octopus !!!

I have been very adventurous with the food and I try to eat everything I am offered!

Everyone has been so helpful with teaching my Swahili. The nurses love teaching you new words. I also have a Swahili teacher at the Work the World the House. His name is Jacob

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Swahili teacher He is such a sweet man!

One of the main words I hear ALL the time is:

MUZUNGU

This means white, foreign person. Everyone says it and will call you that. It is kind of funny. People will be talking in Swahili and all of a sudden you will hear “muzungu” and you know they are talking about you even if you don’t know what else they are saying. Whenever I walk by everyone stares. The children love playing with my hair. I am definitely the minority here and it is a very interesting perspective to be the minority. People will try to raise prices if you’re a muzungu. Whether at the market or on the tuk tuk which is a type of transportation kind of like Uber but very different at the same time. They call it the “Muzungu Price.” You have to bargain the prices so they don’t rip you off, haha. Another type of transportation that I take every day to and from the hospital is the Dala Dala which is kind of like the local bus. My first time walking to the bus stop (which is about a 10/15 minute walk) I had tears that just filled my eyes. There were people sitting next to garbage. So many of my senses were being affected: visual, sound, and smell. I was so glad I had sunglasses on because my eyes were very watery. However, I have gotten used to it now.

Susha mocho This is a view from inside the bus

view from the dala dala

This is the bust stop I get on in the mornings and off in the afternoon. It is called Mocho. In order to get off the bus you say,

“Susha Mocho”

Dala Dala time

This is a picture of us heading to the Dala Dala in the morning. At the hospitals they ask us to change into our scrubs once we get there and change back into our street clothes before we leave to limit the spread of germs.

Typically in the morning you will get a seat. However, in the afternoon after the hospital you have to stand. They cram everyone onto the bus and you literally feel like a can of sardens. I like to look at it like Dala Dala yoga. What pose can you get into? Sometimes I will have a persons face right next to mine or a mans armpit or three children right beside my face.  It costs 400 shillings for each ride. Tanzanian money is very cool. For every 10,000 Tanzanian Shillings it is a little less than $5.00 US dollars

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This is my favorite bill because it has an elephant on it.

I have learned a lot of street smarts here. For instance, you should never have your phone in your hand or even be talking on it while you’re on the bus. Someone will just reach into the window and take your phone. Even when at work you want to keep your phone and money on you at all times. Also, you never want to carry around a purse. If you do, then someone will come up behind you and cut off the string and run with it. I’ve also learned how to wash my own clothes by hand!

Washing clothes time This is Heather from Canada!

The last thing I will be talking about is my clinical experience over the last two weeks and a couple of places I have been to on the  weekends when I am not in the hospital. I have been in Ward 36 the NICU (Neonatal Intensive Care Unit) and Ward 33 which is Antepartum and Postpartum. It is very fascinating to see what the babies here have compared to back home. A lot of babies are born with congenital defects as in hydrocephaly and encephaly. The other day I saw twins that were conjoined together because the mother didn’t get enough folic acid at the beginning of her pregnancy. A lot of the Mom’s suffer from pre-eclampsia. Most of the times it is caused from Malaria. All women are supposed to get a prophylaxis during their third trimester whether or not they have malaria just as a precautionary measure. However, not all mother’s get it. In addition, you hardly ever see father’s with the babies. Every three hours the mother’s come and breast feed the babies. It is very different compared to the US. The Mom’s will literally walk into the unit with their tanga’s down (which is a type of fabric they where) and they breasts just hanging out. At first it was a shock. I walked onto the unit and saw 100 + women half naked. And they breast feed right beside one another. During birth the father’s are not allowed to be in the room. It is just the mom and the nurse/midwife/doctor. Also, the Mom’s take full care of the baby. For instance, one day when I was helping weigh the babies I noticed that a diaper was soiled. I asked where a diaper was so I could change it and the nurse looked at me like I was crazy. He said that the mother takes care of it. And that she will be back in a while to do that. Very different compared to the US. If a mother came to the hospital where her baby was and found it in a soiled diaper that would not go over very well. More over,  in the NICU, the babies are so close together. Sometimes there will be 6 babies in one bassinette. Germs and infection is so crucial to be aware of in the NICU. It is very different compared to the US. Also! They have no IV pumps in the hospital! I hung a bag of blood that was being transfused but there was no IV pump to set it up with. You just have to estimate how fast you want it to drip. Moreover, there are quite a bit of orphan babies from their mother’s dying at child birth. The hospital is allowed to keep them for 3 months. During that time they wait for a family member to come and claim them. At first I thought that was CRAZY. Why wouldn’t the Dad come that instant to come and get their baby? However, the Dad has to work and would not be able to take care of the child. If he doesn’t work then the rest of the family will starve. Therefore, sometimes the Dad has to save up money over those three months so they can pay to have the baby taken care of in an orphanage. So, so sad. Lastly, it is very interesting being in a country where it is 1/2  Christian and 1/2 Muslim. Going into work on one side there is a mosque and on the other there is a temple.

Some of my fellow co-workers in Ward 36 NICU

Some of my fellow co-workers in Ward 36 NICU

Overall, I have had good nurses/mentors during my OB/GYN clinical rotation. The next two weeks I will be in Mental Health! I am very interested to see what I will learn there. Although I’ve seen such heartbreaking things with babies dying and seeing people suffering, my eyes have been opened up so much. It makes me so upset when I hear people call people from Africa “poor” or “unfortunate.” The people here are living life to the fullest  and are so rich in culture and tradition. Yes, they may have poverty and tragedy, but the people here are so kind hearted. What happened last week in Tanzania with the nurse inviting me to her home would have never happened back in America. We can learn a lot from the people in Africa. I feel that people back home have heard so many negative things and have a picture painted of what it’s like in Africa, but you simply need to see it with an open heart and mind. People are most scared of the unknown. Which is why I feel people in other parts of the world can become so frightened of places they have never been to.

 

 

Side Adventures:

So breathtaking!

Bongoyo Island! So breathtaking!

Bongoyo boat

 

Getting to go to a Graduate level Midwifery class for the evening after work!

Getting to go to a Graduate level Midwifery class for the evening after work!

Blessing came to visit me at work and we played Doctor!

Blessing came to visit me at work and we played Doctor!

Made a stop at Slip Way to play with crabs and get the best ice cream ever!

Made a stop at Slip Way to play with crabs and get the best ice cream ever!

Sunset Cruise

Sunset Cruise

Fishermen we met on the cruise. They greeted us with dancing and "Mambo!"

Fishermen we met on the cruise. They greeted us with dancing and “Mambo!”

My journey so far

I’ll write again sometime soon!

Heartbreaking Day

Today was probably the

hardest day I have ever had with being a nurse.

It all just felt so unreal. I was doing rounds with the nurses and getting report on the babies when we stopped at this one baby who was not breathing. The night nurse simply stated that he had aspirated the milk the mother was feeding him at midnight and the doctors did not tell her anything was wrong. Then at 4AM she continued feeding it and it aspirated more milk. The nurse said he had been like this for a while. They merely poked his chest and just stared at him. I looked at him and could see that he had a heartbeat but no inhalation or exhalation of the lungs. His toes were purple/blue. A nurse was fumbling with the ambu-bag. She was trying to get the air to go in while she was doing compressions. She didn’t have a proper seal on the mouth. I didn’t know I had this in me but all of a sudden I just took control. I grabbed the bag from her and began doing rescue breathing. I told her there was no need to do compressions because the child had a heartbeat. A lot of the times here I try not to enforce my way of doing things which is the way things are done in the US. However, this was a special circumstance. Every second counted. But in Tanzania, there is never an urgency or rush when an emergency is taking place. Everyone is very “hakuna matata” and don’t worry about things. The nurse wanted to suction the baby and do a blood glucose test before giving oxygen. There were no noticeable secretions. Prioritization here is very different. ABC’s are key: airway, breathing, and circulation. I continued doing rescue breathing. Then a doctor walked in and asked if I could show him how to do it.

NO ONE knew how to do CPR.

I was flabbergasted deep down inside. As we were trying to save this babies life I taught 3 people how to do CPR. On top of all of that, the NICU room that we were in has a heater to insulate all of the premature babies. So on top of no AC in the hospital the room was at 38 degrees C which is 100.4 in F.

As we continued doing rescue breathing then all of the mothers came in for breast feeding. In addition to having 20 babies in the room we now had 20 moms and 8 healthcare personnel. The room is not that big. The mothers just watched as we were trying to save the babies life. In my head I knew the baby needed to be intubated and hooked up to a ventilator if he was going to make it. With him already having enough lack of oxygen to turn his toes blue he was bound to have had brain damage which wasn’t allowing him to breath on his own. The doctor’s explained to me that they only had two ventilators and they were both being used and it would be about a month before we would be able to get one for the baby. I asked if there was anyway to get one from another hospital. But there was not any way. My heart broke into a thousand pieces. As I was bagging the doctors were giving the baby adrenaline to help the heart continue perfusing all of the blood and they hooked him up to normal saline. They also gave him 3 boluses of dextrose. Some of the things they did I questioned but they were doing all that they could. One of the doctors asked me when I could stop bagging. She wanted to just hook the baby up to a nasal prong and give him oxygen that way. I explained that since he is not using his lungs that oxygen wouldn’t work. We are being his lungs by doing rescue breathing and forcing the air in which the nasal prongs would not do. Another nurse was too scared to try and do the respirations for the baby. It was very frustrating and sad to me. If this baby was in the US they would make it. As soon as they had told me there was no ventilator I knew in the back of my head this baby was going to die. Throughout this whole process I kept seeing red ants crawl on the baby. I was confused as to where they were coming from. I pulled back the babies diaper and they had bitten him so much that he was bleeding around his private area. I looked down beside my scrubs that were pushed up against the table that I was leaning on to give him the rescue breaths and there was a cockroach the size of my pinky toe.

This was the first time in my life where I was the one in the hospital who knew what to do. There was no one else I could turn to higher up to help me or have a solution to the problem. It was a scary thought. I just kept doing what I had been taught in nursing school. In the back of mind I was just so thankful to have such amazing professor’s who taught me all that I knew in that moment. After 3 hours of rescue breathing for the baby I knew I had to be ethical and use my critical decision making. I was only prolonging the baby to live. As soon as I stopped breathing for the baby I knew he would die. There was no way I could do this continually for days. However, I didn’t want to stop until the mother came back.

It is custom here to let the baby die and then tell the mom after it has already happened. They feel that it is too painful and causes more suffering whenever the mother has to watch the baby die. However, I just couldn’t settle with that. I wanted the precious baby to be in his mother’s arms during his last few moments on Earth. None of the doctors or nurses would tell the mother for me that the baby was dying. It made me so sad that I couldn’t communicate with her in Swahili to let her know everything that was happening. I simply walked her to the baby and was able to get her to understand the heart was working but not the lungs. I placed her finger in the babies hand and patted her on the back. As I shut the door behind me I tried my best to keep the tears inside of me. I walked down the long corridor to get to the stairwell. As soon as I was out of sight from everyone the tears just poured. I was so overwhelmed and heartbroken. It was around noon at this point and I really wanted to just go home. But I forced myself to carry on with the day. After this situation, it only went down hill. I found two other babies that had a heartbeat but were not breathing. I also did rescue breathing for them. One of the babies pupils were fixed and the oxygen sat was 44%.

All three babies died today. I left work with my head held down as the sun shined on my back. I know the babies are no longer in pain now but I just had a really hard time with accepting how it all happened. In the US it would have never gotten to that point. We have the NICU babies hooked up to machines that constantly take their vital signs. They don’t have anything like that here that would alert them to a babies V/S dropping. There is also 1 nurse to 35 babies here whereas in a NICU at home it is more like 2 or 4 babies to 1 nurse. Today was just a very heartbreaking day.

Leaving the states!

Today is the DAY!!!

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I can not believe that today is the day that I am heading out of the states to begin working internationally. In Africa.

A place I have always dreamed of going to. It doesn’t feel real. All of my bags are packed and I have so many thoughts running through my head. I am currently sitting in the Nashville airport at my gate. I have a 3 hour delay because of “air-traffic.” This is going to be the beginning of a very long journey! haha. But hey, everything happens for a reason. A few extra hours to the trip doesn’t even compare to the time I have been waiting to do this! Everything all feels so surreal. It has been such a journey transitioning from college and being an adult in the “real world.” However, this trip is something that makes me not feel uneasy or question what I am doing. There is nothing else I could picture myself doing than doing this right now in my life. It is something I have always had a desire to do and now it is officially happening. People that I am sitting beside probably think I am crazy because I am just smiling from ear to ear because this moment is finally here and they just see it as an annoying 3 hour delay. I was supposed to land tomorrow at 9:00PM, Tanzanian time; however, now it is looking a bit later. I have a few stops before I get there: Newark, Zurich, Nairobi, and then finally Dar es Salaam!!! I guess the most exciting and at the same time scary thing I am looking forward to is simply the unknown. I have no idea what the culture is going to be like once I step off of the plane in Africa. I have been doing my best on my Swahili! Hopefully I’ll be able to understand some things when I go to pick up my Visa and Business Permit once I get off of the plane. I can hardly eat anything because I am so excited and anxious. Hopefully all will go smoothly with the next flights and no delays will happen!

I guess the main thing on my mind right now is just all of the support and love I have seen in these last few days. I wish I had more time before I left to see all of my friends and family. I got back from being a camp nurse in WI (which was quite an interesting experience at an all boys camp!! I LOVED it!) this Monday at midnight and I have been preparing and packing my bags for Africa ever since! I have received so much support, love, and words of affirmation. I knew I had an incredible support group but it really hit me over this week how many amazing and caring people I have in my life. I hope to carry that with me to Africa and really engulf myself in their culture and get to know the people who live there. I know I will see so much hardship. Hardship I have never laid my eyes on. In those moments of hardship, and pain and suffering that I see I hope to be able to help in anyway that I can and freely commit myself to service. I have been blessed with so much I hope to pass that on to everyone I come into contact with.

I guess I will be writing you from Africa in my next post!!! Kwaheri (goodbye)!