Let’s start with clinical. I’m not sure if I mentioned it in my last blog or not, but the nurses’ scope of practice in South Afr
ica is much greater than that of nurses in the U.S. They essentially act like nurse practitioners and are very autonomous in everything they do because there simply are not enough doctors working in clinics to oversee their practice. This is awesome for me because I’ve been able to do things that I would never get to do back home. So far I have learned how to draw blood, do pap smears, perform 6 week baby assessments, and extract teeth (ok I didn’t actually DO the last one, but I watched quite a few of them)! I’d never done blood draws on anyone (patient or nursing friend), so this was a completely new thing for me. Quite honestly, it was absolutely frightening to be that close to blood infected with HIV; however, I stuck those patients’ veins with confidence and drew vials and vials of their blood. If there’s one thing I’ve learned in nursing school, it is to be confident in every skill you perform; the patient will never know the difference between you and someone who has been a nurse for her entire life. I’d also never done pap smears before, so I was so excited when I did one correctly by myself. Those two procedures were amazing to learn, but my favorite experiences were definitely in the pediatrics and dental portions of East Boom clinic.On Tuesday, 10/14, I went over the pediatrics section of the clinic, which I was really excited for obvious reasons. I love kids! I got assigned to an Indian sister who was in charge of doi
ng 6 week assessments. When we saw the first baby, she absolutely grilled me on my assessment skills. I learned how to do a newborn assessment in OB (and a 6 week old is pretty similar); however, OB was 2 years ago and I was very rusty. After some practice, I became “pro” at the assessments and started doing all of them while she charted everything. All of the babies were so cute and I wanted to take all of them home with me. The sister turned out to be a great teacher. The only problem I had with her was her outright paternalistic attitude toward these moms. A lot of them were only feeding their babies for a few minutes at a time (when it should be at least 20 min) and were wondering why their baby was constipated, losing weight, or crying all of the time. All they needed was some simple education regarding feeding patterns; however, the sister took that as her opport
unity to belittle the moms and criticize their horrible mothering skills. It was really quite shocking to me. What made me even more frustrated was that half of the time, the moms didn’t even understand the criticism she was giving them. The sister didn’t know how to speak Zulu and didn’t care to learn. She was shocked when I used some of my Zulu to greet the moms. When the moms would respond with a blank stare because they didn’t understand English, she would just talk louder and louder. Even I felt uncomfortable. I can’t imagine how the poor mothers felt. Oh so an exciting story. At the end of the day, right before I was getting ready to leave, a mom brought in her 6 week old baby and said he had a cough for about a week and was doing “something funny” with his nose. I noted some nasal flaring (which is a sign of respiratory distress in babies) when I was assessing his head/face. When I lifted up his onesie, I noticed that he was having severe intercostal chest retractions upon inspiration. This is where you can see their ribs every time they breathe in; it’s another sign of respiratory distress. His respirations were 63 breaths/min, which is way too much for any baby (60 is the max you want them to have). All of the sudden, he started coughing and getting really red in the face, so I turned him on his side and started patting his back. This did little t
o alleviate his cough, so the sister told me to put him on my lap upside down to loosen secretions. That still wasn’t really working, and I started getting worried when the baby started getting quiet from being so tired of coughing. The sister instructed me to put him on oxygen, so I found the infant mask and hooked him up. All of the sudden, a million things started happening at once. The sister started making phone calls and another sister came in and did a heel prick to test for blood oxygen levels. My sister drew up ceftriaxome, a prophylactic antibiotic that would hold him over until he got to the hospital where they would start an IV of it, and administered it in his thigh. Oh man did he hate that. She said that he most likely had a serious bacterial infection like pneumonia. The sad part about the whirlwind of activities was that the sister failed to tell the mom that she was going to the hospital, much less that there was something seriously wrong with her baby. I let her know what was going on and that everything was going to be ok; she looked absolutely frightened. I’m guessing she was only 16 or 17. The paramedics finally arrived 30 minutes later (which I guess it a good response time here) and took the mom and baby away.Friday, 10/17, was our last day at East Boom. It was very sad for me because I had grown to love the clinic and felt like there was a lot more for me to experience. So for my last day, I deci
ded to go to the dental clinic because I knew this would probably be my only opportunity to experience something like that. The clinic was totally packed when I walked in at 8AM. There were 3 rooms with dentists and assisting sisters, so I just walked into the middle one and asked if I could observe/help for the day. The dentist in my room was a young Indian guy and didn’t really seem to care one way or the other, but the sister welcomed me in. When I asked about the massive amounts of patients waiting outside, the dentist informed me that this was nothing. This dental clinic sees over 200 pts per day and last month they saw almost 4,000 pts. The dental clinic in the PMB area that followed in 2nd place behind East Boom only saw 300 pts last month! Anyway, the plan for this morning (and I guess every morning) was extractions. Apparently it’s the main procedure they perform. Although they do perform cavity fillings and other basic dental procedures, patients would much rather get a tooth pulled than have it repaired because they have to make an appointment to come back and get the tooth fixed/filled, whereas they can just get the to
oth pulled that same day. The dentist was very efficient at what he did, and by the end of the morning, I could see why the patient turnover rate is so high at East Boom. First, all of the patients would come in, point to the tooth/teeth they wanted removed (some wanted 2 or 3), and the dentist would numb the area with a massive needle. That part took about 1-2 minutes. Then, they would all come in and get them pulled. There was one young man who wanted his 2 front teeth pulled and the dentist didn’t even blink twice before extracting both of them. After I composed myself from the cracking sound of the root being ripped out of its socket and blood gushing out, I asked the dentist how the man was going to eat for the rest of his life. The dentist replied, “He will manage just like everyone else.” He went on to explain to me how numb he has become to the pt’s pain and potential struggles in life because “it’s their own fault for not taking care of their teeth in the first place.” Basically he was saying that because they’ve already messed up, there’s no hope for them in the future. I was really shocked at his callousness toward his profession and life in general, especially since this was only his 1st year as a dentist. I later found out from my South African clinical instructor Wendy that dentists are required to do one year
of community work before going elsewhere, and that’s what this rotation was for this dentist. He wasn’t even doing it because he had a heart for these people. Anyway, the whole extraction process for each patient literally only took 1-2 minutes. They had the next patient standing in the doorway while the pt before them was getting his/her teeth pulled. The dentist would throw away the nasty rotting tooth, give them a cotton ball to stuff in the bleeding socket, give them 2 tablets for pain (something simple like Tylenol), and send them on their way home. I couldn’t believe how such a big procedure had been reduced to such a simple thing in this culture. I asked him if the patients literally just went home with that piece of cotton in their
mouths with hopes that they wouldn’t get an infection. He replied that a nurse gives all of the patients a group teaching session in the morning and they’re expected to follow them. I asked him how many people don’t listen and come back with an infection, and he said that a lot of them do and simply get the sockets cleaned out and are sent home again. I couldn’t believe how nonchalant he was about these people getting potentially life-threatening infections when they’re already immunocompromised with HIV/AIDS. It made me really frustrated at him, but then again, he was just doing his job and there wasn’t much else he could do for them if they didn’t take care of their own health.So now that I’ve overwhelmed you with stories from clinical, I’ll share with you one of my adventures outside of East Boom. On 10/11, I got to go to uShaka Marine World, which is a mari
ne and water park in Durban (a coastal city about 1 ½ hours away from PMB). There are two parts to uShaka: Marine World and Wet ‘n Wild. For a comparison to those in Southern California, the first is like Sea World and the second is like Wild Rivers or Raging Waters (but so much better). I went to the Marine World part first where I got to see all kinds of cool sea creatures like sharks, sea turtles, jelly fish, rock fish, sea horses, and sting rays. They even had a tank dedicated to Finding Nemo with all of the fish from the movie. Did I mention that this place is all underground in a big old steel ship? Pretty cool, huh? We also got to see a feeding, which was hilarious. A diver went in a huge tank with a bunch of food in a pouch and all of th
e fish, stingrays, and sharks swarmed him. They started sucking on any and every part of his body in the hopes of getting some kind of food. We also got to see a dolphin show, which was performed in a big stadium. All of the dolphins were incredibly smart (way smarter than American ones) and did a bunch of cool tricks. In the middle of the show, I was picked by one of the dolphin trainers to “get wet.” So I went down with 10 other people to the edge of the dolphin tank while a dolphin turned around and splashed us like crazy with his tail. I couldn’t stop laughing. After the show, we decided it was time to play at the water park. At first, I wa
s too scared to go on the super high slides and stuck to the lower, safer ones. When I saw some of my friends go down the big slide (and learned that it was the tallest water slide in Africa!), I decided that I had to do it. Climbing up the hundreds of stairs was probably the scariest part. If I didn’t have my friend Mandy with me (I dragged her into it haha), I probably would’ve chickened out. The slide was a straight drop down and managed to give me one of the worst wedgies in my life, but it was totally worth it. After my friends and I conquered all of the slides, we headed to the Lazy River, floated around the park a few times, and then were off to the beach (which was right next to the park). It was absolutely beautiful; unfortunately, the water was too cold (even for me), so we just laid out until it was time to go. I was exhausted and slept most of the way home, but it was an awesome day!On that note, I’m going to have to end my blog because I actually have to be studious and do work now. Please keep my health in your prayers. I got sick last week, got
better, and feel like I’m relapsing again today. I’ll be doing hospice visits this week, so also pray that I’ll have a positive impact on people as they’re ending their lives. Oh one more thing. I have a mailing address at AE and am welcoming any letters/packages of love, so here it is. Sala kahle!Nicole Hetschel
API Education Foundation
PO Box 13870
Cascades 3203
Pietermaritzburg
KZN, South Africa
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