Sunday, October 31, 2010

Halloween, poisonings, and frustrations



The younger kids Trick-or-Treating

Donkeys

A huge slug I saw, the toe of my sandal is in the picture for perspective

some kids who wanted to get there picture taken, the benches in the background is there church

More Kids

Every thing that is in my pockets as I work all day. I wish I could fit a bagger in there and an full oxygen tank and a...

Last night (Friday) was the Halloween celebration for all the MK’s (missionary kids) here at Tenwek. I was not sure if they would do Halloween here as it is not a Christian holiday. Halloween was a lot of fun. They had games for both the younger and older kids as well as trick-or-treating of course. The kids had some amazing costumes, some home made and some store bought. It took me a while to figure out what was different about the costumes but it eventually came to me – they were not a few sizes to big so the snow suit could go underneath. The older kids trick or treating was made into a scavenger hunt of sorts and we had to give them a clue (with the candy of course) when they came to the door. The clue my roommate and I were to give was a scream. We did a decent job of it I think, I am sure some Kenyans in the neighborhood wondered what was going on (Halloween does not exist in Kenya). The night ended with a fire and smores as well as a scary story in the dark. I think it is so neat that there is such a large community of missionaries here that the kids can have friends with similar heritage to their own and make events like this possible.

I don’t know if Halloween weekend had anything to do with it but Friday was a very busy day at the hospital. I felt like everywhere I went there was someone else acutely ill who needed intensive care- if we had a rapid response team it would have been called a few times, as well as the code team. There are many illnesses here that I never/rarely see in Alberta but something that I see much too much of is suicide attempts. The method of choice here is poisoning, the poisons of choice are chemicals used to kill the bugs on the cows or other such chemicals, the words triatics and organophosphate are all too common here. These patients generally come in unconscious and require getting their stomachs pumped, they often require intubation to protect their airways. The other day I went to casualty (ER) to help them intubate one of these patients, the smell in the room was overpowering, but familiar, it took only a few minutes to place the smell. It was the same smell I would smell if I went into the chemical storage room on the farm. I do not know how they are able to drink so much of this stuff, the taste must be horrible. I am not sure of the exact number but we seem to get 2-3 of these poisonings a day, thankfully not all require intubation. A few of these suicide attempts are successful and it is sad to see these individuals, often quite young die. A difficult challenge with these patients is they frequently require ICU care, this is hard as we have a limited number of ICU beds and ventilators and giving these resources to someone who tried to kill him/herself can be disheartening at times. I wonder if there is a solution to this problem. I have heard the Kenyan staff say we should send these individuals to jail (attempted suicide is illegal here). I don’t know if this will deter more poisonings from occurring but I tend to think we need to look at the route of the problem, how can we help these people mentally, spiritually, emotionally and physically. This is a challenge and a difficult one; please pray for all of us here as we struggle to find a solution to this mess.
Despite the frequency, or maybe because of the frequency I am, at times, frustrated with the nursing care, or more lack of nursing care, and lack of readily available supplies (we have the supplies just in central storage) that these patients receive. Here is an example I was called Friday to casualty to help them with the intubation of a poisoning patient. Before we intubate the Dr had to figure out if we had a ventilator and a bed for the patient, once we had something figured out we went to casualty and I saw the patient, a boy of 17. He was in the side room of emergency, breathing through an OPA, no nurse in sight, not being monitored. Being a RT who always likes to know a patient's SpO2, I decided to check. Remember at this point the patient had probably been like this for at least ½ hour if not more- the Spo2 – 50%. At this point I asked the staff for an ambu bag (I have to call it an ambu bag or they do not know what I was talking about).  I also started looking, the only one we could find was pediatric, (I guess the patient was 17 but…) so I bagged the patient and the Dr ran to ICU to get a bagger. I later learned that this bagger was taken from the bedside of a patient we had just reintubated and was therefore dirty. I don’t think the first patient had TB. At this point someone else started to bag so we could get setup for intubation. The battery in the laryngoscope was burnt out so once again we ran to ICU, ICU was willing to part with the handle but did not want us to dirty their blade – I don’t know why they just clean it by wiping it down with there version of an alcohol prep. Finally we were set up for intubation, the patients SpO2 had quickly improved with bagging – I even had them up with the pediatric bagger. So we put the tube in. The ventilator was ready for us but ICU wanted the casualty nurses to put a foley in (some things are the same as at home). However before the nurses put the foley they discovered a code brown. So first they had to clean him up, this entire time I was bagging the patient but thankfully I was standing by an open window so I stuck my head out and got some fresh air. Finally we brought the patient to ICU, the oxygen tank was empty so we just ran up the ramp with the patient. When we got to ICU I put the patient on the vent and before I could even check the setting I was called to the next bed as that ventilated patient was coding. I had to look for a bagger (we had stolen his bagger for the other patient). The code proceeded from there as codes normally do CPR, drugs, more CPR, get him back for a while codes again and pronounce. Well, at least we have another ventilator to use now.
My fellow RTs are probably reading this and can see my frustration; for the non-medical people who are reading this I am sorry if most of it did not make sense. I am getting used to things not being available, or functional, I have not decided to if this is a good thing or a bad thing. On Monday I am doing a presentation to the nursing staff; pray that they put what I tell them into practice. The nurses are all well educated I just find there is often a gap between what is said and what is done.

Back to life outside the hospital the weather here has cleared up I think the rainy season is over. It is great to have a clear sunny sky, maybe a suntan/burn will cover up my mosquito bites. At least I think they are mosquito bites, I have them on my arms and ankles. I sleep with a mosquito net but still frequently get bitten. Pray for me that these bites do not carry any diseases (I am on anti-malarials). I think I will end this post (that ended up being longer that I thought) with something to make you laugh. I was walking the other day and I passed by three young men who prior to my passing were talking and laughing. As I walked by they stopped talking and stared, not discreet look and turn back to your buddy checking out stare. This was a full blown staring contest stare.  I said hello and continued to walk on, when I was a little ways off I looked back and yes they were still staring. I thought of saying “take a picture it will last longer” but wait that’s already been done. A teacher took a “discreet” picture of me with her cell phone as I walked by, she should have turned the sound off, I heard the shutter sound. The crazy thing is these people live at Tenwek where white people are a common site; I know I am pale and redheaded but still.

So I thought I finished writing this post this morning before church. However as I was at church this morning I realized something. I will not elaborate as this post will become really long instead of just long but this week at the hospital was a tough week, many patients died. I found it hard at times to keep going and to keep focusing on Christ. At church this morning we sang the song "How Great Is Our God". While we were singing I was reminded of the fact that God is Good this is something we are quick to day when something good happens but in looking at the week I struggled with this. I realized this morning that although the man who was extubated (as he was severely brain damaged from his heart stopping during surgery) will probably die in the next few days but God is Good. This man became a christian prior to his surgery and said he was going to see Jesus. Though one of the newborn premature twins died, the other one is still alive. How great is our God, pray that I will remember this in the coming weeks and even though we do not know why something bad happens God does and he is Good.

5 comments:

  1. oh annette! i'm sorry to hear about your bad week. I'm just thankful that you are there! I pray that God will do AMAZING things through you; He gives more than we expect or even ask for, yah?

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  2. also, thanks for posting the donkey picture. i love them, they're so funny-looking. it was a real pick-me-up to see them chilling on the lawn! i was talking about donkeys with a patient here from Senegal, and he said donkeys are no longer "in"; instead horses pulling wheeled carts are all the rage in Senegal. =]

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  3. Useful information, many thanks to the author. It is puzzling to me now, but in general, the usefulness and significance is overwhelming. Very much thanks again and best of luck!
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  4. I guess the word that comes to mind is INTENSE. Wow. Yes, God is good and He walks with us through all of this. His love is INTENSE too. May you continue to see your hands as HIS hands, ministering love to those who are physically ill and emotionally ill. Sterkte. spot

    ReplyDelete