What a week
on Rachael's VSO experience (Malawi), 26/Mar/2011 08:09, 34 days ago
So this week has been hard for me. It's becoming increasingly frustrating that apparently all they want me to do is work. I tried to explain that that's not the point, I'm meant to be building capacity and improving skills not just working. The problem is it's hard to be a nurse in Malawi when you don't speak the same language, especially with paediatric nursing.The Nurse in Charge of the paeds ward and I had a chat on the way home today said, you've been working these shifts for too long we should just rota you in to our off duty. I said I need to speak to the matron as my job description says mon-fri 7.30-17.00 and I am not prepared to work nights and weekends here I'm not being paid for it! I mentioned I would like to work between ETAT, Paeds and the nursery and she said well you can't do ETAT alone and you shouldn't spend time in the nursery! I pointed out that I'm not supposed to work alone at all I'm supposed to be improving skills and she said that she didn't think that would happen.So what did I do about it?Well the day after the nurse in charge annoyed me I spoke to the matron and gave her my job description and asked her to spend some time and think about what she wants me to do. This time she actually came and sat down with me and thought of some objectives. She wants me to see about getting DFID funding to set up a skills lab for the ward. She also said she would speak to the nurse in charge and explain that when I'm working I should be working with someone (this still hasn't happened yet) she feels the best way for me to teach is to do it on the ward which I am happy with but on my own I feel like I'm doing all the work. She also wants me to work with the CPD matron but mainly focus on improving skills by working hand in hand with the nurses. She also asked me to work with the in charge of the paediatric ward to help out with appraisals. She really liked the idea of me providing them with a weekly plan of what I'm doing so that everyone knows where I am and what I'm doing, I'm also going to include some specific objectives, if I am going to write the policy for inserting an NG tube of something then I'll write those specifics in and what I want to achieve from working on the ward, like improve documentation. The only problem we now have is that she felt it was inappropriate for me to ask the director about the office she'd offered us she thought it would be better coming from Czar so I think if I do any work I'm going to have to either do it from home or in the library. The problem with doing work at home is the nurses will think I'm slacking off but they often shut the library at lunch time and some days the library doesn't open at all. So I'm still not really sure where I'm going to be able to do some work, I think I'm going to have to work from home but at the moment I don't really have much work that I can do at home! I could plan some teaching sessions and a few other things but it'd hard to know what to do really.Friday was a really bad day at work, one of the babies in my HDU with pneumonia was grunting in the morning already on oxygen then unfortunately some how we managed to trip the power to the medical part of the ward. Sadly this is where my HDU is and even more sad when you understand that our oxygen concentrators are electric and have absolutely no battery back up. The oxygen concentrator was too heavy for me to get off the wall so I ran to the next ward to borrow their Oxygen concentrator. I came back and plugged it in to the surgical bay grabbed the baby and shoved him on some oxygen. Sadly very quickly he gave up grunting... We had the chief doctor of the northern region of Malawi visiting our ward so I shouted for his help and we attempted to resuscitate the baby at which point our ambu-bag fell apart! It would have been entertaining if it wasn't so fucking tragic. Tragic and unfortunately so pointless, it's the hardest part of this job that a child dies needlessly. Children who come in malnourished or with severe meningitis you kind of accept that they are going to die as there is only so much you can do. Often children who are malnourished are so sick by the time they get to us that there is very little you can do. You can't push fluids too quickly as their hearts just can't cope and obviously with permanent malnourishment you alter the child's electrolytes too quickly by pushing too much fluid. It's hard but it's the preventable or avoidable deaths that are the worst. It is hard but you have to use these deaths as learning opportunities and use it to force yourself to try harder for the next time! As sad as it can be this is one of the most rewarding things I've ever done. To see a child with horrendous malaria or meningitis get better because of things you've done even very small things like ensuring they have IV fluids and regularly checking blood sugars. What's even more rewarding than that is when a nurse documents something in the notes or washes their hands or puts on gloves when dealing with patients or any of the other basic nursing skills I spend my life nagging people about. I went to pharmacy stores to try and replace our ambu bag but apparently they are out of stock!! Oh OK that's not important!!!!! I tried to get Czar to go and speak to the director but no one seems interested. It's a very hierarchical in Malawi and it's not acceptable for nurses to shout and scream too much but if there is no ambu bag by Monday I'm going to the director myself because it is ridiculous.So away from work, last weekend I went to a local lodge to watch the rugby, it was great it's a very small place and it was very like sitting in someone's living room, it was a great atmosphere and we only lost power briefly albeit when England scored but hey you can't have everything. I went out for dinner on Wednesday and Thursday evening. Obviously Czar moved out last weekend so it's been lovely having some space and be able to turn the place into my own. The night guard of our complex is really driving me mad at the moment he is desperately trying to sell me one of our guard dogs puppies. I've kind of named her Socks and she is beautiful but I can't afford a dog, well I can but I can't afford to take the dog back to England and emotionally I don't think I could leave it in Malawi as they don't have dogs as pets they have them to guard properties. So I have to be so strong and keep saying no but am desperate to say yes but I think it'd be more unfair on the dog as I'd spoil it and then just abandon it. Sadly I am so keen that I'm going to check out how much it'd cost to fly a dog home... too much I imagine!!! GrrrI'm going shopping tomorrow to see if I can get some internet at home, apparently the easiest way is with a dongle but I've had problems at home with my laptop not recognising dongles but one of the girls told me you can get a portable phone that works as a landline that you can get internet through but I'm not sure how much it costs so I'm going to figure it out! It would be really good to be able to check my emails when I want to.Oh well bye!