People from home
on Rachael's VSO experience (Malawi), 16/Jul/2011 08:07, 34 days ago
6th July signified Malawian independence day, the anniversary of the day Malawi was given independence from the Great British protectorate that had ruled them. The president came to Mzuzu and at the Mzuzu stadium the Malawi football team were playing against Namibia (I think)unfortunately this also meant the arrival of the police on mass so Czar and I decided a calming trip to the lake was in order. We had a really nice day but all too soon it was time to go back to work again!On Wednesday this week some UK students arrived at the hospital!! Sadly we were kind of busy although the local students arrived on mass this week so although there were only 3 'nurses' we actually had 15 students too all reasonably keen to do jobs so I actually had chance to chat once I'd found some syringes and explained to the students how to make 10% dextrose. So I was in HDU and the nurse in charge was showing some nurses around dressed in UK nursing uniforms, now this we don't see!! So eventually I escaped HDU and introduced myself to Pippa, Ciaran and Adrian who are just at the end of their 3rd year in fact I think they qualify in 3 weeks! They are in Malawi for a couple of weeks to see the difference between here and the UK, they are/were doing their training at the Norfolk and Norwich. I've always thought it a bit weird at home when people from another country want to spend all their time with 'people from home' but when you live away you realise how nice it is. I managed to talk without someone asking what I was saying or asking me to speak slower or nodding and not understanding!! It's amazing when you leave your native country you realise how many colloquialisms you use that are very hard to translate!! So I chatted for a while caught up on some UK gossip and they stayed for some of our ward round then they decided to have a little walk around the hospital and sadly I had to get on with some work. As I was leaving the ward for my lunch break they were stood outside maternity, waiting for the supervisor who had brought them to the hospital. They were hoping for a hospital canteen but all we have is the 'crap' shop also know as a tuck shop where they sell coke and bread! I did a very English thing and invited them over for a cup of tea and we had a bit more of a chat. Never has Norwich felt so close to Cambridge, it was so funny talking to people that knew places I was talking about! People always want to know what you miss about home which is a hard thing to explain because you miss different things. Obviously I miss my friends and family, but that kind of goes without saying. Generally I miss the ease of life in the UK, things like jumping in my car to do the weekly shop, not so easy when you are packed into a minibus or taxi, I miss being able to have a takeaway you can obviously eat in restaurants here but it's not very easy or convenient as you have to get transport sometimes after a really long day or at lunchtime you just want something you can just grab even just a pre-made sandwich. My life has changed a lot when I consider a pre-made sandwich a takeaway!! It is a pain to have to cook all the time, most of the time I enjoy it but there are times. I do miss stupid things too, just slobbing out watching telly, going to the cinema. But like I say it comes in phases, the other day I was really missing goats cheese! Anyway away from what I miss, we chatted a bit about what life is like in Malawi and what the health care system is like and the obvious and not so obvious differences.Generally speaking our ANTT (Aseptic Non Touch Technique– the way nurses give your drugs or put in lines or change dressings ect) here is non existent. Well that is perhaps too harsh, we have surgical spirit that we clean with before inserting lines and we have aseptic dressing packs. We do tend to re-use a lot, we obviously don't reuse cannula's but we use the same giving set for a long time an just change the bag on top, nasal prongs for oxygen are soaked in chlorine and re-used. To explain a little background quinine the treatment for malaria can cause your blood sugar to drop so you have to give it with 5% dextrose. We often have a litre bagof 5% dextrose and then the nurses tend to empty out a bag of ringers lactate or 0.9% Sodium chloride and re-fill the empty bag with 5% dextrose then add quinine. So there is often one IV line attached to the bag of 5% which is occasionally left in the sink (this policy is now against the Rachael law! Sadly how the nurses refer to my 'rules') then a bag of ringers is spiked and left in the sink to empty and then the 5% drained in.... They still do it and I know they do but if I see them do it I explain that the sink is not clean and that there are cleaner ways we can do it. Nurses will often put a cannula on a bed before inserting it, not only not hygienic but also a way to get a 'clean' needle stick injury. I have seen nurses re-attach IV lines if they have disconnected from the patient again a practice I try to discourage especially if you don't know when it was disconnected!! It's amazing really that these kids don't all die so perhaps we do worry too much about keeping things clean in the UK but I don't think I'll adopt these 'policies'!Generally life in the hospital is frustrating, once a child has received oxygen and blood you are at your limit. Blood here has a hep C prevalence of 1.3% and even screening blood misses 1 in 1000 HIV positive samples which when you have at least 15% of the population who are positive that means a 0.01% of giving HIV in a blood transfusion and that doesn't include people in the window period before HIV is detectable. To make that statement mean more WHO suggested there is a 0.01-0.09% risk of you contracting HIV after one episode of intercourse with a known positive person. Who wants a blood transfusion???? Yeah me neither. So you can understand nurses reluctance to carry out observations as they often feel they are just watching and are unable to do anything. I do enjoy work here it is definitely more frustrating at times than work in the UK but also more rewarding. We do have some amazing successes like tiny babies who survive or children with anaemia who get better but looking after malnourished children who are HIV reactive is always hard as they tend to very slowly deteriorate over about 3 weeks. It's really difficult as the guardians will often refuse an NG tube for feeding or oxygen therapy because they are worried that it will kill their child as they may have seen other children with these things die. It's so hard to try to make them understand that these interventions won't kill their child but they may not prevent their child from dying. My favourite little dude at the moment we'll call him 'M' (his mother would probably happily let me post a photo of him on here but I'll respect his confidentiality) anyway so he is 20 months old. Those of you in the UK you would expect a 20 month old to weigh around 12kgs and my little M weighs 6.1kgs. Unfortunately his mother is HIV positive and wasn't taking HAART (Highly Active AntiRetroviral Therapy) treatment to try to stop M getting HIV (PMTCT– prevention of mother to child transmission is a big issue out here) Sadly most recent studies suggest with no interventions 22% of babies born to HIV reactive mothers will contract the virus by the time they are 18months anyway I have no wish to conduct a lecture in HIV/AIDS needless to say my poor little M was tiny and sick. One morning his mum came and got me and asked me to come and see the baby. I asked her what the problem was and she said the baby wasn't breathing well. So I went over to my gorgeous boy and she was right there he was grunting away (Not good!!) so I tried to explain in Tumbuka that the only thing I could do to help was to put him on some oxygen. She thankfully agreed after I told her no-one dies from receiving oxygen (obviously this is not strictly true but she doesn't need to know that!!) they die because they are sick and sometimes oxygen isn't enough to help.So I put M on some oxygen and then she told me he'd been vomiting his F75 (build up milk) after reading his notes I realised they had asked for an NG tube to be passed for feeding so I spoke to one of our clinical officers who said the mother refused consent yesterday. I told him he should go and explain why it would help but that it wouldn't stop the baby vomiting and told him under no circumstances would anyone pass an NG tube on that child unless she was 100% happy. My main concern is simply that with no ART intervention (ART – Anti retroviral treatment) one in five HIV infected infantsdie before 6 months of age, more than a third die by one year and over half all children infected in infancy will die before they are 2, so M had done pretty well to survive this long but I didn't want someone shoving a feeding tube down when mum wasn't happy only for him to possibly die soon anyway. Anyway M's mum agreed to the tube and he started to tolerate his milk, when I left him this morning he was still grunting and looked really weak so I'll just keep my fingers crossed that he manages to be one of the 50% that survive infancy. I've never nursed a child who was HIV positive and I suppose living a relatively privileged life in England I wasn't really aware how it devastates sub-Saharan Africa, it's such a horrible virus and really does cause so much death.Anyway back to the Norwich students, Pippa was curious as to whether I found it lonely or not, that is a really hard question to answer. I quite like my own company and really always have done, so I have no issue being alone. Mzuzu is actually a really great place to live, there are other volunteers around from other organisations and also some people working independently out here. If you wanted to go out you could probably always find someone who wanted to go out and do something, it's really just a case of looking and texting around a few people and you can normally find something to do. Personally I quite enjoy being able to sit at home in the evenings listen to some music or watch some things on my I pod or laptop. I do go out sometimes but not a whole lot really maybe a few times a month, but like I say should I want to go out more often there is always somewhere to go. I'm more likely to go out for dinner or lunch at weekends or go to the lake, now the nurses are beginning to trust me more I occasionally go to their houses for dinner which is really nice. I think all of us miss having people around you that know you, it's always nice to make new friends but it's also nice to have people around you who know you really well, so in that respect I sometimes find it lonely but not often!Well that's all I have to say in this little update. I hope you all have gained some knowledge from my very brief HIV/AIDS lecture!!