March in Malawi
on Rachael's VSO experience (Malawi), 05/Mar/2011 07:47, 34 days ago
What I have learnt this week: Malawians don't get sarcasm. This was displayed when some colleagues and I walked passed a suggestion box which was unfortunately spelt 'sugestion' I said maybe I should suggest they spell suggestion right! Ha ha ha. They were all a bit confused and said well don't you think that would be a bit rude, I think they are hoping for constructive comments..... Well OK!! Note to self sarcasm is not funny!!! (except it is...and weirdly more so when no one else gets it!!)Well new month in Malawi, this also brought my last day on paeds ward and the start of ETAT! Eeek. For those of you not in the know, which is all of you I guess, ETAT stands for Emergency Triage And Treatment and I have heard nothing good about ETAT, apparently it is hectic poorly managed and very chaotic... sounds like heaven!!!! ETAT is like a combination of A and E and an review clinic, if children are discharged from the ward they often have to go to ETAT to be seen by a clinical officer a few days later. This is separate from the outpatients clinic that we also offer which sees children with long term complex problems, mainly those with heart problems or diabetes as these tend to be very poorly managed in Malawi.So how was peads I hear you ask? OK to be fair no-one asked but if you're reading this I'm going to pretend that you might be slightly interested so I'm going to tell you!Paeds in Malawi is depressing and very challenging. It's hard to explain what it's like to watch a child struggling to breathe and all you can do is give them 2litres of oxygen and position them appropriately. We had a child on the ward on Tuesday who we think has cardiomyopathy. He has horrendous pulmonary oedema just sounds like he is drowning, he is also HIV+ and very malnourished oh and he has TB. At one point today his oxygen saturations were 79%! After a long discussion I persuaded one of my colleagues that we ought to give an extra stat dose of furosemide to see if we could improve things and they ought to think about having him fluid restricted until we can get an echo.... allegedly we have someone who can do the echo in MCH so we are hopeful!! Anyway whatever is wrong with him he was a sad little thing laying in his bed crying cos no matter what position he gets into he still can't breathe. (Sadly said Child died at 10pm the night that I wrote that) You just feel so helpless and at the moment I feel so frustrated as the nurses just don't really seem to care. In the UK if that were happening you would hope a nurse would at least stroke the childs head or try to calm them down. I don't recall seeing any nurses here do any kind of positive touch, which I think I find most tragic, no matter what people say about nursing in the UK I don't think I've ever worked with a nurse who hasn't either said something reassuring to a patient or touched a patient in a therapeutic manner. The nurses here really do seem to think that patient recovery has got nothing to do with them and is all about the drugs. I wonder if perhaps they can't care as a lot of children do die, I suspect about 40 children have died in the two weeks that I've done paeds and they are only the ones I know about. Children with malaria often have seizures and the nurses don't seem to care that children might have been lying in urine soaked sheets for two days, occasionally the parents will wash the sheets and the child but not often. I guess that kind of demonstrates the point in me being here!!The nurses here can pronounce death, the other hardest thing I've witnessed and been party to is doing nothing. Basically a parent will start wailing and screaming so a nurse walks over checks the pulse, respiratory rate and pupils (although they have no pen torches!) then they take them into the dressings room bandage orifices and wrap the child normally in the mothers 'chijente' which is a piece of material that women wrap on top of their clothes like a second skirt and use it to carry their babies on their backs. Once the child is wrapped the nurse in charge then writes two pieces of paper with the childs name date of birth date of death and village they came from. One of these pieces of paper stays with the child and the other goes in the front of the fridge in the mortuary. If the parents want to they can take the child home with no documentation, this lead to a very weird conversation with the nurse in charge.Me“So they can just leave? They don't need any paperwork?”NIC“No we don't need to inform anyone, they do it if they want to?”Me“What if they have an accident and people don't know she's already dead?”NIC“I think they'd guess when they saw all the padding!”Me“So they can just do whatever they want with the body?”NIC“Yeah she's their daughter they can do whatever they want?”Me“You don't inform the school or the local clinic?”NIC“No that's not our job the family will inform them if they want them to know”Me“What about a death certificate they don't need anything to prove in the future that she is dead?”NIC“You give people a certificate for dying?!!!”Me“ummm yeah! (I realise this isn't going well! So I change tact) How do the government know what the population is if you don't issue birth or death certificates?NIC“Do you think it matters?”Me“Well yeah I do”NIC“Oh well I dunno”Interesting huh! So as you can imagine my job is kind of huge, it's scary that no-one even tries to save these kids. The ones that die when I am near by get bag valve mask but only because I can't bear to just stand back and do nothing. It almost killed me not to do full blown CPR on the first child that died, but as I discussed with the paediatrician there is no after care for these kids (he said well you're a PICU nurse you can do it!) Brain damage is a very taboo subject here from conversations I've had most parents would rather their child was dead than had any kind of lasting impairment.So Thursday was a public holiday more on that later so Friday was my first day in ETAT. The morning was good, for MCH obviously. The afternoon was not so good. The clinical officer told me when I returned for lunch that he had been working all lunchtime and was due to finish at 14.30, 14.45 he tells me another clinical officer is on his way and he's going home. I speak to the Nurse and explain the situation. She returns and tells me she has spoken to the ward and they are sending a clinical officer to ETAT now and she informs me that the hospital are taking money out of her pay that they aren't entitled to so she is going to sort that out! So she leaves, I am now standing alone in the ETAT room with a queue of parents and children (probably about 25) and I realise now that all I can muster up in my head is“yayi doktola” (No doctor). By 15.15 I have phoned the ward twice and they assure me a doctor is coming. My 15.30 I spot a nurse who is doing the adult clinic and I speak to her. She says she'll phone the ward and comes straight back and tells me that the doctor didn't realise he was doing ETATand will be with us soon. She helpfully goes on to explain that there should always be a nurse in charge of ETAT as these kids are sick!! No shit!! I explain it is my first day and I actually can't yet speak Chitumbuka fluently enough to explain what is happening to the parents. She then becomes incredibly nice and talked to the parents a lot of whom are now shouting at me! In the end I say to the nurse that I will phone my VSO colleague and get him to come but she'll need to stay and translate. She agrees so about 15.45 Czar turns up with a medical officer! The other medical officer eventually arrives just before 16.00. By this point I have sent 3 kids that look like hell to the ward because I thought they'd be able to do more than I can and another 10 have stormed out. So the doctors see the remaining 15 or so patients and then we finish. Unfortunately for her the ward manager of the paeds ward happens to walk past in the middle of all this and I explained very clearly to her why this wasn't acceptable and she said ah well at least you're resourceful and have sorted something out!!! Well gee thanks....OK enough of the boring work side. Although actually work is the interesting part, the other volunteers have been nice but it is quite dull up here there isn't any partying we occasionally go to each others houses for dinner and stuff but that's about it! In fact I had a drink the Monday we got here which was valentines day and I haven't had a drink since then!! I think my liver is suffering from some alcohol withdrawal. I try to spend as much time out and about at weekends, sometimes it's nice, occasionally it can be a bit creepy as you don't know what people are shouting at you! I'm hoping to buy two paintings this weekend to brighten up my rooms a bit. Czar has decided that he is going to move out into the other flat, part of me suspects that this is because our shower and oven are broken! But I think it is mainly because I am already living in the bedroom so I think he thinks it's easier for him to move out of the living room and let me have the whole flat. I'm quite excited as I'll be able to decorate it as I want and smarten it up, it's hard to clean it at the moment as Czar is very anti cleaning and I end up feeling like an unappreciated house wife, spending 2 hours cleaning the kitchen to realise it is disgusting again by morning, I am desperate to clean up the shower room but won't do it until he moves out as it is so disgusting once he's finished it's just awful! The mixer tap is broken completely in the shower, the maintenance people tell us they are looking into where they can get a new one, I thought I saw one in town but I'm not going to bother buying it as we are waiting for them to fix the water boiler as there has never been any hot water while we've been here. It doesn't really bother me I've got my morning and evening wash down to a fine art. That said I can't wait for a proper shower!! I bet you are all thrilled to de updated in my domestic chores... some things never change.So Thursday heralded our first public holiday in Malawi, it was Martyrs day not entirely sure what the point is but it has something to do with the British empire being quite violent!! Our contract as volunteers says we don't work public holidays although very kindly the ward did tell me that I could work if I wanted to!! How generous.....So Czar and I spoke on Wednesday evening and decided that it'd be nice to go to Nkhata bay for the day. Nkhata bay is one of the popular back packers resorts on the lake, it is the nearest nice part of the lake to us and takes about an hour to get there by car. It was gorgeous, very chilled out and relaxed just what we needed after such a hectic few weeks. It rained for a bit in the morning (it is rainy season!) but once the rain cleared it turned into a stunning day, to be honest it was crazily hot and very humid and unfortunately as with everything in Malawi if you don't own your own car you have to walk a fair way to get anywhere so Czar and I were so hot by the time we walked back from one of the bars along the water to the town we decided to come back. We were back in Mzuzu for about 4pm. It's very cheap to get there, we paid MK500 which is about£2 each for the shared taxi. We met up with some other volunteers and other people who have chosen to work in Malawi independently from an NGO. I've now finished reading both the books that I brought out with me so I'm going to stop by a bookshop at the weekend and see if perhaps I can pick up someother books cheaply. Nkharta bay has definitely helped to chill both of us out a bit and forget about work.On a sad note unfortunately today my new friend 'Gekki the gecko' passed away, I would say peacefully but in the beak of a crow I suspect it was as far away from peaceful as it could be. It was my fault that Gekki died, I was outside trying to persuade him to stay still (actually surprisingly easy when you use horrible flying ants as bait) so I could take a photo and the evil crow came and grabbed the poor little bugger. Obviously in my state of shock I bloody well forgot to get a photo!! Oh well plenty more gecko's in the garden.Oh Two more things, firstly if you are interested in seeing more photos add me on facebook as it is really difficult to get photos to upload on here. Secondly a big well done to my dad, you're doing us all proud old man x