To blog or not to blog?

Blogging isn't for everyone but I wrote this over a week ago and went back and read it. How little I knew when I wrote it! decided to post it before updating the current one. Pictures will be added!

 Such are the things that way (that was up for days until I went back and read WEIGH)  on my mind. I have been here in Lira for a month and it has been an interesting time, filled with challenges and with an adjustment, which one would expect. I do enjoy the students and find most of them to be engaged and warm. I had a near melt down on Tuesday the 15^th as my Mac went on the blink. When one thinks of the greater scheme of things here in Lira a non-working laptop might not seem huge but in that it holds my lessons, my financial information, my connection to family and friends and my out reach to the rest of the world it was pretty scary.  The touch pad was simply frozen and worked sporadically up until the time my classes started. I spend a great deal of time on my power points as often times I think that this is truly the only way I am understood by the students at all, which is fair play as I still only pick up slightly over half of what they are saying.  Much of what I am saying can go floating right by the classroom with 40 students in it and very high ceilings that make the acoustics difficult for everyone. These students pick up on some great jokes and I have tried to add some humor into the power points which the faculty here (in Uganda) enjoyed. Some times when we aren’t getting through on the intellectual level trying to seem more human and approachable seems the route to go.

Imagine someone else who agrees with my teaching philosophy! 

 I was fortunate that one of the young men came up to help me and we attempted to play one of the DVD’s that the students find so interesting that is designed for nursing students. It looked to be very good but sadly stalled a few minutes into it and we could not get it to work on the student’s laptop, meanwhile I just kept pressing my non-functioning keypad and wondered how I might possibly fix my Mac. I had read that the nearest repair for Mac’s is in Gulu. No idea how to even gets there but was feeling determined to find it.  As it was the projector was showing the DVD with the warning in huge letters across the screen, “Trojan Virus Detected” but I seemed to be the only one even remotely interested in that, considering that they had just had the same thumb drive in my laptop I was even more than concerned. At some point we decided that nothing was going to work so I gave them their assignment for the following days clinical experience and told them to work on that and to leave about 5 minutes early. There was silence to the point that you easily could have heard a pin drop, that many students in one room and yet complete silence. At last someone else came to my aid and told the students that they were dismissed but everyone still sat there staring at me.  My son Dan who is teaching in Viet Nam can read this and weep, his students are so disruptive that he would simply not believe this. The students can be so silent that I often show them questions on the power point throughout the lecture to make sure that they are following. They will read the question then look at me, I can prompt them for an answer two or three times until I hear a vague reply in the back ground as though they are terrified of guessing wrong. I imagine that if I were to visit a primary school here I could better understand this, I have heard that the teachers are quite strict and that the students are taught to sit down and be quiet and that behavior seems to have carried over. In all they are starting to get more comfortable with me but it has been hard work reaching this level. I would be miles behind if they had not had a good experience with the previous volunteers but still they are very quiet!

I reached home and managed to get on to you tube and watched several presentations on how to repair my computer. Most start off by asking you to take our your Phillips screwdriver (didn’t travel with one) and to prepare to take off the entire other side of the laptop. This started to look impossible and then I came across a suggestion on the Apple website that said to clean the tracking pad for two minutes by rubbing vigorously with a cloth.  Sounded like something even I could do and …… it works. I also got close in around the track pad and cleaned out the areas surrounding it, as I fear that the very dusty roads might mean that it is collecting debris in the tracking pad. It has worked fine ever since my emergency repair and our entire house breathed a sigh of relief, as there wasn’t much of a chance that I was going to calm down until it was fixed. I apologize to all those Peace Corps workers out there throughout the history of the PC that are not yet dependent on power points and generators and Mac books but that is the way it is. The fact that my students could listen to heart sounds and breath sounds and actually experience a nursing assessment from video’s from the US and Africa will be very helpful in the future, I hope.  That was one of my few successes of the week. The fact that Denver pulled off a near miraculous win over Baltimore might have been the other highlight but back to Nursing, Nursing Education, and Life in Uganda. On a funny note Janet watched the game with me which started at about midnight here and I kept running around the room saying “I have to turn it off, I can’t watch this, we are going to lose, I am going to die, no I have to watch it” and “Oh, no, I’m dying” didn’t seem to bother her too much. It was all normal behavior that we expect from avid grandmother football fans. Beth, Sue and Ron were on line with me and at one point Beth said, “I can just hear mom” She probably could and maybe our neighbors too. When Talib intercepted the ball and made the touch down which brought us closer to the win I probably shattered the night air. In all it was good healthy fun and I was elated. I haven’t been too elated about much else of late so always nice when the Bronco’s give me such happiness.

The good news is that the two Nurses who went to Arua are coming to visit from GHSP this weekend along with Irene (Uganda)  and Eileen from Seed in Boston. I am in serious need of some people to talk to and just discuss how I sometimes feel about things and how things are going in full complete sentences and not in blog format where I am terrified I will seem too petty, too judgmental, or insult someone, somewhere or sound like an American fresh off the bus, which I am. I am so excited about their arrival even though two of them are staying here at my place and Janet has typhoid. More on that.

On Monday we had a staff meeting that started at 10. I of course arrived about 9:30 and began searching for where we would have the meeting and located a few people, finally at about 10:30 a few other lectures drifted in and we were off and rolling by about 11:30 or so. One of the major tasks I have taken on is to help assist in developing a curriculum for the University. Of the GHSP guests who are arriving we have Dr. Janet  (another Janet) and Genevieve, both who have a great deal of experience and who are going to be bringing information with them on the curriculum that is being planned for their University so that is a huge benefit for me. If I were to develop a curriculum I would probably go back to Year 1 and start all over but new students will benefit. This is a very new University and has not yet had their first group of nurses graduate.  

Yesterday was our clinical day. I arrived at the hospital before 8 and the students arrived on the impressive new Lira University bus, which is a very large, nice transport that they only got up, and running last week. I know that transporting the students was a major issue so this is a blessing for the students and the University which is located at least 12 km out from the hospital and which most of the students reach by bicycle or walking. I had asked the various groups to assist me and make my first day working with them at the hospital as easy as possible and to greet me, introduce me if they could, and they did that, I got a warm welcome.  I went to the Male Medical ward with the students and was received by one of the interns who did his best to fill me in on what type of patients they normally have. Seems that Malaria, HIV, HEP B and cirrhosis (due to the local whiskey) for further information please see the Vice Documentary, “Uganda the Drunkest Country in the World” Or some such title. It is in typical Vice format with some humor from Thomas who comes to Uganda and goes to various villages where they are making homemade brew. The price if of course quite cheap but the ramifications of this are patients lying about over at the hospital with severe liver disease.  We were shortly joined by the nurse who is in charge of their unit who was extremely well informed, well spoken and pretty discouraged at their lack of supplies and the needed equipment. One thing that both the doctor and the nurse impressed upon me was that our students need stethoscopes, I was thinking of appealing to people on “The View” as Mrs. Colorado and telling them that nurses do need stethoscopes and even people in Uganda recognize it. Sadly it seems that only two of our students have a stethoscope and they are not even available on the ward. I feel like starting a Go Fund Me page to raise funds for the basic supplies for each student but think I have read that we cannot, I’ve read so much of late and know for fact that a GHSP nurse in another country gave some supplies. I’ve read about it. Perhaps I can ask the others who are coming in their opinion. The Doctor had asked for the students to begin collecting vital signs on the patients and requested this from all three groups of nursing students. With our 4 students there also a total of eight others from other nursing schools in the area, which meant 12 students. It was explained in very low and quiet voices that they could not yet get the vitals because they did not have a thermometer or the necessary equipment. By the time we were finally able to make our rounds they had managed to locate a cart that had the necessary supplies, meaning a thermometer and a bp machine. We came first to a patient that I will simply say shares a name with my second son. I have warned my students repeatedly about handing in paperwork with patient’s full names on them to protect confidentiality and have requested that they only provide initials so can’t start breaking my own rules. Long before we reached patient “D” I could hear him trying to breath. Here was a boy of about 11 years of age huddled on the plastic mattress and covered with a thick blanket despite the heat just gasping for breath. So much for the power point the week before with all these breath sounds, here it was. I did ask the students to describe them and they did well. The doctor did a good job in explaining that the boy must have had strep in the local village, received herbal treatment and had been brought to the hospital as a last resort and of course now is suffering from Rheumatic Heart Disease. Our intern was doing a great job with teaching and I thought his explanation was extremely well done. The boy had severe edema in his lower limbs and a filthy bandage on feet that could have been on a 90 year old patient they were so broken down and nails damaged. His lower leg had a terrible wound partially covered with a yellow bandage that was about to fall off. The boy was laboring with every breath and his oxygen saturation was below 90 with a temperature of about 101. At some point, when there was a bit of a break in the action I realized that we had been joined by two more nurses wearing blue uniforms, and at least two more interns. I asked if it would be possible to give him oxygen and was told that they do not have oxygen for these “type of cases” I then suggested that we elevate the head of his bead as when his father had lifted him up he seemed to have a little bit easier time breathing. I did this as a suggestion and the doctor warmly received it.  With twelve nursing students surrounding us with pens and notebooks out and a host of other onlookers the doctor and I struggled with the bed and eventually figured out that it was broken, finally the father and I managed to wedge a blanket under it and the boy was breathing a bit easier. The intern thanked his “Senior Colleague from the US for this excellent advice.”  I’ve been talking to my students for a month now about A, B, C’s, and how important airway, breathing and circulation is and this patient was compromised in every way. My students were attentive and actively taking notes as the physician and father and I managed what I would have considered to be common sense nursing practice so we have a good point to talk about tomorrow in that none of them moved to help in any way. How to translate what we are talking about in the classroom into the clinical setting has been weighing heavy on my mind. I figured that the least I can do is to at least put it in writing to help myself plan this out for tomorrow. I proceeded on having already been given so much praise and asked if the students and I could change the bandage and was told that they do not keep bandage materials on that ward and that the only way for the bandage to be changed would be if they changed him to another ward, male surgical I think. I asked if they had oxygen there but was told they did not.  By this time the Senior Physician joined us. I give him credit for being one sharp cookie; we suddenly were involved with a serious game of jeopardy with him firing medical questions at everyone surrounding him. He was naming off syndromes and acronyms that I haven’t heard of and that left us playing a game of “name that ailment” as by the time he asked a question he was moving on to ask another one of someone else and scolding the intern for not answering faster. Our students did a pretty good job considering they are in their second year and most of his questions were more on an MD level. The other students from the other schools were not called on and looked relieved to have escaped. At some point he managed to compare white blood cells with a host of rebel soldiers disguised in regular army uniforms and went into full military descriptions of bombing and attacking of the heart by rebel soldiers with animated arm movements and a description of how and why of not being able to use steroids for this child and then into ethical decisions regarding blood administration to Jehovah Witnesses, all the while the boy struggled to breathe and the parents looked on at us probably convinced we were going to come up with some solution for their child while we had moved long past him. When we did return to the subject of this child the doctor took the interns to task about several things in the child’s treatment plan. Some of these included that there was no antibiotic’s and then a lengthy discussion about how if they were to treat him with steroids he might end up sterile. My feelings about where he most likely will end up were more on the fact that his breathing worsened every moment we were standing there. We moved on and there was no change at all in the treatment other than the fact that the bed had slipped back down and he looked much worse. There was some discussion about antibiotics but that seemed to have been ruled out too. The fact that I was standing at the foot of his bed listening to these terrible gasping sounds made it hard for me to concentrate on the next few patients and to keep track of the rapid firing of questions. I wanted to go grab and oxygen tank from somewhere. The students kept pens out taking notes, I would love to get my hands on those notes because it was so random and rapid that I could hardly keep up and I am imagining that they were faced with something similar. It was entertaining I will give him that and if this country needs someone sharp this guy knows his diseases and how to describe them but I’m not altogether certain that our students were quite there at this point in their medical career. For one moment in time I found myself back at Univ. of MN. where I spent some time earlier this year with the doctor on rounds, we are more than a world apart in how we are approaching medical care. That physician was all about making sure the parents had a complete understanding of what was going on with their child and yesterday, I never saw one word exchanged with the parents. I’m not saying that no one has ever talked to the parent’s; only that no one did yesterday as a huge crowd stood by the bed for an hour. Our day proceeded on with pretty much the same, each time we came to new patients we had to wait for the vitals to be taken and I plan to talk to the students tomorrow, seems at least Lira University can shine in that department, I mean surely we can get in there and do the vitals as we have been working for weeks on assessments.  If only we had our own thermometers, etc. I can see the physician needing to ask for them once in the shift, or twice, but at every bed side seemed a bit extreme with the cart sitting right there yet it seemed rude or not appropriate at that moment to ask them to leave the conversation which was being put on with great enthusiasm. I did not encounter anyone else nearly as energetic during the rest of the day.  One of my stops was at the out patient department which is truly “out” and filled with patients, people were critically ill and there was a very long line. One of my students came running to fetch the intern from there and then returned to inform me that the patient had already died. Not sure if this patient was even admitted but bringing people in when it is already way too late seems the norm. Earlier in the day the nurse said that they have had days when they lost as many as eight patients.

I arrived back home feeling like I had been in the eye of the storm with thoughts of how I can get my students to transfer what we are learning in the classroom into the practical area of the hospital. My head was swimming and when I entered Janet was sitting at the table looking miserable. She has been saying she didn’t feel well for a few days and I assumed it was “that time of the month” which I have tried to talk to her about several times as she is a healthy 16 year old girl, she says she doesn’t know anything about it but that her friend had told her that something happens to girls every month and that she “knows someone” in the village who had that happen to them. I have know idea if we are talking about the same thing but she seems to be totally unaware of what I am explaining, or trying to with our limited language, it was easier to explain a touchdown to her then this!  I had my thermometer in my lab coat, reached down to touch her arm and realized she was burning up; here she was at 101.4 and looking terrible. I nearly dropped over. Back to Lira Hospital and the line? I was lucky that one of the guys who works here knows of a clinic nearby so back to the medical world. I was told that it would be better if I let them take her in because if I went it might cause a problem as they are not use to seeing white people. Having already caused a few minor disruptions in the work today I decided to let the guys take her to a clinic nearby. I sent her with the car with a detailed note and described exactly what her temperature was and asked if they could do blood work for malaria and whatever else they felt appropriate. Janet was insisting that it was malaria and who am I to doubt a sick teenager who says she gets it every week? I gave my phone number and they called to say that the blood work did not indicate that she had malaria but that the patient had asked to be tested for typhoid and so they did. This teenager knows it all. Sure enough, it is typhoid. I asked the doctor what they would recommend and he advised Cipro. Well enough and I said that was absolutely fine.  They proceeded on after leaving the clinic with Janet in the car, still burning up with fever and they took the car to the garage to get air pumped into the tire, then they had to get the tire fixed and then they went to the shop to purchase some water and other things and came back after a few hours with a depleted looking Janet. No one seemed to have realized that since the clinic was so close it might have been wise to bring her back first or maybe I am just getting way too carried away with myself.  I rushed her in, took the temp which was now 102 and said let’s get her settled in, rushed for cold towels and told them to give me the medication. What medication? They explained that I had asked the doctor to test her for malaria; she did not have malaria so they did not know that I wanted them to get medication. I explained that I had spoken with the doctor and that the doctor had recommended Cipro and they said that because it wasn’t malaria they didn’t think they should purchase the medicine without my permission (a dollar or two or a phone call to me to ask? ) this necessitated them going back to the clinic, waiting to get the prescription, then to the pharmacy hours after the initial diagnosis. Janet seemed quite okay with it all and was more worried about the fact that she had wanted water but that they told her they had bought it for me. Sigh. You know nothing at all Cherie Clark. I gave her Tylenol from my own stash and of course they brought the medication in, handed it to Janet while I was on the phone and I came in to find that she had already popped two paracetamol.  All four of them did bring the temp down at least. Things began to settle down here around 10 last night with a normal temp, medication, and the only real problem I have at this point is house guests arriving on Sunday and I do not have mattresses, sheets or pillows. I have reminded Douglas about this 3 times now and he has assured me he has additional mattresses in storage that he will get “tomorrow.” I have also read the GHSP email that was forwarded back to the US stating that they would manage the fact that I have already said I don’t have bedding. I imagine that we will manage this at about the same time the guests are here looking for their bed, as that seems to be the way things are going.  Well, not exactly. The power went out as I was in the process of droning on and I thought just our routine outage then Janet came to inform me that someone was here to see me and needed papers. I found an angry looking man on the door with some tools and another dressed with a helmet on disconnecting the electricity. They said that the complex at the back of house where Douglas the caretaker lives is illegally tapped into the main source and we are not paying the electric bill. He insisted that it could take weeks to sort this out. I finally convinced him to at least let me try to get Douglas on the phone and they had a spirited argument. Somewhere in the middle of this the fact that this house belongs to a high placed General who is currently out of the country came up and the guy looked up and said “The General” and I nodded. He was swift to say that he could leave the power on tonight and that he would meet Douglas here in the morning. Let’s hope this gets sorted out or mattresses will be the least of our problems not that we usually have power on the weekend any way. Lira is okay when there is electricity but when we don’t I suffer, and when I suffer so does the world despite my reminding myself a hundred times a day that most of Uganda doesn’t have any power at all, they certainly don’t have it much at the hospital. Sadly due to my advancing age my thermostat no longer works as well as it used to.

I welcome the idea of seeing others who have been with me on this journey since DC and who I have not seen for a month. I am eager to hear their stories and to be able to kick back with them and at least be able to speak in full sentences about how I am feeling. My sense of urgency, or my sense that things need to just get done seems to be at direct odds with my life. I can cast blame on the hospital staff but truth is they don’t have what they need to operate and they are probably as helpless to change that as I am.  What would I do if I were them month after month, case after case, aside from the fact that I would elevate the head of the bed and console the family maybe not much. I can’t say. I can’t seem to manage to take care of one child without endless drama, should I mention that I had not yet read the lab report and when they went to the pharmacy they actually forgot to pick it up and had to return for it because obviously I wanted to see the blood work.

I have some good ideas of what I can take away from my hospital experience. I have made a report for each student and have asked one student from each group to do a presentation and assessment on one patient. I hope that we can take real life experiences and make them work at the hospital and that I can at least effect some small change, if I can’t provide stethoscopes or thermometers for each student maybe I can at least get them to use the one in the hospital if they can find it and get vital signs done. I hope I can most of this is not just the “Scientific Process of Nursing” but also more like rationale problem solving. Maybe I am expecting way too much since yesterday was my first actual day working with students in the clinical setting, the classroom is going to feel like an Oasis, and I have a power point and lesson plan ready. I would hope that among this group of students there is one that will rise up to the challenge and be the one that arrives on the ward, rushes about changing bandages, takes vitals, finds oxygen and makes things actually work but the feeling that there were about 20 of us staring down at one little boy gasping for air on probably what was the last day of his life while we discussed if it was ethical to give him medication when he might end up sterile left me puzzled all night long.

Janet all better 

Janet is rallying and my “mother” the woman who hosted me in her family came to visit today. I had informed them that Janet was ill. She came to mainly tell me that she heard that we stayed up late watching the football game late at night and that staying up watching football games is a major cause of malaria, despite the fact that I have told her over and over that this is typhoid.  Aside from that I have stayed up past about 9 pm twice to watch pre season games since arriving in Lira and this was Janet’s first late night. Somehow we haven’t managed to blame the Bronco’s yet for typhoid but it is still early evening that knows what the day might still hold in store. This also Janet’s fault for something that she might have done years ago and because her father died, her mother left her and she hasn’t had good parenting so she doesn’t know how to behave and so she got sick, nothing to do with the actual causes of typhoid. In the end I hope that it was an okay visit, Janet doesn’t seem to be adversely effected but at times I sincerely believe this women does think she is my mother and just wasn’t my host mother, they are very kind to me and very good people and if anything were happen to me they would move heaven and earth to help care for me but sometimes between Janet giving me advise on what and when to eat and the neighbors supervising my diet I begin to wonder who is the grown up around here.  Mom walked over here in the heat of the day to simply give me advise on what time to go to bed never mind visiting Janet. I did mention that Janet had recently been to her village and might have picked up something there. In all, I have survived the week and have it has been one of worked very hard on my power point for tomorrow, my laptop is working, I haven’t lost my sense of humor, the Bronco’s are playing Thursday night football which means I get at least a few hours of escape, if they manage to win the game, if they don’t I’ve decided just to get typhoid and change teams, all in one night.  Eileen is arriving from Boston and brining me a package from Sue, which includes a Bronco shirt for Douglas and Janet and a Bronco bumper sticker, YEAH although the way things have gone this week they may end up bringing a Brady shirt. Perhaps my next post will be focused only on how well my laptop is working and communication is improving.