Eastwood Clinic & Change!

Hi everyone! I hope you’re ready to hear about my new clinical rotation in Eastwood Clinic, because I finally have time to write about it!

On Tuesday, 10/28, I had my first day at the new clinic. From the moment I walked in, I could tell that it was a lot different than East Boom. My first thought was, “Wow this clinic is tiny!” In reality, I had just been at one of the biggest clinics in town, so this was a normal sized clinic. Inside, there was one waiting room packed full of people, four exam rooms, an immunization room, and a front desk. I was assigned to work with the only nurse on duty, Sister Dlameni. She was totally stressed when I walked in because all of the other sisters were out “sick.” I found out later that they were constantly understaffed at the clinic and were lucky to have two sisters working at the same time. I offered to help in any way I could since the sister was obviously overloaded. She agreed and let me take over the 6 week assessments, which I didn’t mind at all because I love babies and had already learned how to do them at East Boom. The cool thing about this nurse is that she sees everyone from babies to children to PMTCT moms to TB patients (which there were a TON of) to men with minor ailments; thus, she is incredibly experienced and knowledgeable in all populations and corresponding health issues. I never got a chance to go to the TB clinic at East Boom (ok, honestly, I didn’t really want to because I didn’t want to come back to the US with TB), so it was really interesting for me to interact with the multiple TB patients and learn the treatment and documenting protocols. Sister Dlameni has a huge book called the “South African Department of Health National TB Control Program – TB Registrar” where she is required by law to write down the patients with TB and everything pertinent to their diagnosis, like the type of TB (primary, disseminated, abdominal, etc.), sputum smear results, HIV status (which is usually positive because TB is one of the most common opportunistic infections in an HIV infected person), treatment start date, and traceable address. On another form, the sister writes down all of the patient’s TB contacts and informs the patient that all of the contacts need to do a sputum or Manteaux test. Unfortunately, a majority of these contacts fail to return, which is one of the reasons TB continues to spread like a wildfire in South Africa. The only part I didn’t enjoy about the nurse was the fact that she continuously complained about being stressed and overworked. I completely understood why she felt the way she did; however, her complaining about something that could not be changed did not allow for a very positive working environment for her, the patients, or I.

Later in the week, on Friday 10/31, I was assigned to work with Shaun, the immunization nurse. He actually only has a 2 year degree, so he is called a staff nurse rather than a sister (who has a 4 year degree). Shaun was really fun to talk to and very willing to teach me about the various injections. He also had no problem letting me take over his job, which is something that I don’t always get to experience as a student nurse. I became very familiar with the child immunization schedule, which is very different from that in the U.S. The most common injections we gave were DTP-Hib, Hepatitis B, Petogen-Fresenius (a progesterone contraceptive that’s given every 3 months; Shaun and the patients just call it the “Family Planning” shot), penicillin, and ceftriaxome (for direct observed therapy, or DOT, of TB management). Unfortunately, we ran out of Hepatitis B pretty early on in the morning, so we could only immunize most of the babies with DTP-Hib. Apparently Shaun had ordered it a few days prior, but it hadn’t arrived yet. I couldn’t believe that they just ran out of immunizations like that. Honestly, it made me kind of frustrated. The children are the ones who suffer; just because the government doesn’t make it a priority to get the vaccines to the clinics in a timely manner, kids become at an increased risk for contracting diseases. Another issue I noticed had to do with the tube holders used in blood draws. At East Boom, the tube holders have a built in safety mechanism that allow the nurse to simply click off the needle into the sharps container. This prevents any accidental needle sticks. Oh, I forgot to mention that nurses in SA reuse the disposable tube holders because 1) they never actually come in contact with the patient’s blood and 2) they don’t have enough money in the budget to buy more than a few at a time. Anyway, the tube holders at Eastwood do not have this safety mechanism. Shaun literally has to screw the needles off after taking bloods. He informed me that he has had 3 needle sticks (and could potentially be infected with HIV because of them) in the past 4 years because of this lack of safety feature. Although I drew bloods at East Boom, I wasn’t about put myself at risk, so I let him do those for the day.

On Tuesday, 11/4, I got assigned to work with Shaun again; however, there were already 3 South African nursing students shadowing him. One of them was a third year student from Grey’s Hospital studying to become a sister, while the other 2 were second year students from a private nursing school training to become staff nurses (like Shaun). They had pretty much taken over the immunization process, so I was left to stand in the corner of this very small room. Shaun was in and out of the room the entire morning because, once again, there was only one sister for the entire clinic and she needed his help. When he left, he told me to “take care of [the student nurses]” and “make sure they don’t mess up”; hence, I became their instructor. It was kind of cool for me to teach these girls because for the past 3 years, I have been the student needing instruction. I’ve finally moved my way up the nursing ladder! These student reminded me exactly of how I used to be when I first learned how to do injections my sophomore year in Med-Surg. Their hands were shaking and they were fumbling around with just about every piece of equipment they came in contact with. One of them even managed to stick herself with a needle. Fortunately, it was before she had administered the immunization, so it was a clean needle. It was so strange for me to see their complete lack of universal precautions. They didn’t wear gloves, walked all around the room with uncapped needles, and touched all of the parts of the needle that shouldn’t be touched. I attempted to bestow some of my knowledge regarding injections and precautions without seeming condescending, and they seemed pretty receptive to my teaching. When the students went on tea break, I got to take over the immunizations while Shaun charted. That was the only time I got a break from the supervisor/instructor role; otherwise, I continued helping the students for the rest of the day.

So those were my most memorable days at Eastwood thus far. Now I have to tell you about something my fellow nursing students and I have been working on this past week in regards to this clinic. For our Community Health class, we have to assess, plan, and implement a nursing action for the clinic we’re working in. After seeing the major risk for needle sticks Shaun was being put at, we (Corey, Mandy, and I) decided that getting him safety tube holders would be our project. At first, we were just going to go out and buy him a few and be done with it; however, as we discussed it more, we realized that we couldn’t just do the “rich American thing” and simply buy our way out of a problem. We had to actually make an effort to change the policy of the clinic; additionally, we wanted to get that policy implemented in the 21 other clinics in the area that are all under the same management. With the help of one of our South African nursing professors, Glenda, we were able to get an appointment with the nurse in charge of infection control and the Expanded Program in Immunizations (EPI) over the entire municipality (22 clinics, including Eastwood).

On Wednesday, 11/12, Mandy, Corey, Glenda, and I drove to the municipality to meet with this woman (Sister Goga). She was really sweet (but straightforward at the same time) and turned out to be the perfect person to talk with about implementing these safety tube holders in the clinics. In her position, she gets notified of reportable diseases, investigates in the community and does reports, performs an outbreak response in which she immunizes the community where the outbreak occurred, visits clinics to ensure certain standards are maintained within immunizations (that’s where we come in!), and also trains staff about new immunizations. She was the first nurse to start infection control awareness in the community 5 years ago; there was no one in her position before. Obviously, she plays a huge role in community health and I can’t imagine what the system was like before she started her job. Anyway, we presented to her our idea regarding the safety tube holders, and she seemed very receptive to it. To implement any change within the clinics, all she has to do is send a letter of requisition/motivation to higher power. This letter basically does exactly what it sounds like: it requests of and motivates people in charge of supplying and budgeting to do something about the problem. So to implement our proposed change, she would have to write this letter. Instead of trying to figure out how to write the letter then, Sister Goga invited us to present our idea to her monthly Infection Control Committee meeting, which happened to be the next day at 2:30PM. We were so excited when we heard this and readily agreed.

So the next day (Thursday, 11/13), we did class presentations for Nursing Research all morning and then headed off to our very important meeting. There only ended up being two people there because all of the other nurses had last minute meetings to attend; however, the people that were there were the most important ones. One was Sister Goga, obviously, and the other was Sister Solomon. She is the senior district nurse (SDN) for Eastwood and Mason’s (which is the other clinic we have students at), so she was the perfect person to be in the meeting. Although they had to reschedule the meeting for the following week, they’d already planned for an hour and a half out of their day, so they invited us to present who we were and the change we wanted to implement. As professionally as possible, Corey, Mandy, and I presented our idea. They were very receptive to the idea and told us that they had actually tried to implement something like this before, but there were budget constraints and it didn’t go through. Both of the sisters expressed a desire to change a lot of unsafe practices within the clinics; unfortunately, a lack of monetary resources has not allowed them to do so. This was such a sad thing for me to hear. These nurses work so hard to create safer conditions for the nurses and patients, only to be shut down by budget constraints. Glenda, who was sitting in on the meeting with us, then mentioned that APU is giving $500 to each of the 3 clinics we’re working at (out of our tuition), and maybe we could use part of that money to supply all 22 clinics within the Municipality with one or two safety tube holders. One tube holder costs $5, so it would only be $220 to suppl all of the clinics with them. This would prevent accidental needle sticks and the spread of communicable diseases like HIV/AIDS, potentially saving the lives of multiple nurses. The sisters were SO excited about Glenda’s proposition and said they would be SO happy if we could buy their clinics some tube holders. Glenda told them that as soon as they decided what company they wanted to buy them from (since the end of apartheid, the government has required that clinics only buy medical supplies from companies that are Black Business Empowerment [BBE] compliant, meaning that they have a certain number of black people in management), we could buy them and hopefully bring them to our final clinical day next week. The sisters readily agreed, and I was pumped. After that victory, the sisters proceeded to ask us if there was anything else that we noticed needed improvement within the clinics. I couldn’t believe the opportunity they were giving us, so I started talking right away. The first thing that I mentioned was regarding the innovation paper and presentation I completed for Nursing Research that very morning. For this project, we had to find a research article from a topic of interest and apply the study’s intervention to a clinical setting we’re familiar with. I chose an article regarding the analgesic effects of breastfeeding and maternal holding during painful procedures like heel-sticks and applied it to East Boom clinic. Heel-sticks are common procedures performed in the U.S. during baby’s first few days of life to test for various metabolic and endocrine problems (PKU, hypothydroidism, & galactosemia). In SA, they are commonly performed during the 6 week check-ups to test the baby for HIV; however, at East Boom, I have noticed no attempts for pain relief. Basically, the baby lies on the exam table crying until it can cry no longer while the nurse squeezes blood from its heel for 3-4 minutes. It was absolutely heartbreaking for me watch and totally unethical. Based on the findings in the study, I suggested that the sisters educate the mothers to either hold their babies or breastfeed during this painful procedure to decrease pain. They had never heard of such a simple and cost-effective intervention and seemed to take great interest in implementing it. We also told them about the lack of soap at any of the sinks in Eastwood, how only one nurse has a TB mask, how the linens aren’t changed between patients (even with pap smears), and how none of the staff use gloves. Then we suggested changes to these unsafe practices. Sister Goga and Solomon wrote everything down and seemed very interested in all of the suggestions we gave. The meeting lasted a good hour, and by the end of it, I was so excited. I can’t even explain it. These women were key players in enacting changes within the clinics and we had to privilege to meet them and give them suggestions to improve their practice. We really are making a difference in people’s lives! Not only has this been this goal of mine in SA, but in life as well. It’s one of the reasons I chose to become a nurse. I want to make a difference. I want to be the person who people look back on and say, “Wow. I don’t know where I would be without Nicole’s influence on my life.”

So that’s a summary of my amazing time at Eastwood clinic. I have one more clinical there next week, and can’t wait to update you on what has happened. Believe it or not, I only have four more weeks in South Africa. Time has absolutely flown by. Nursing is getting more stressful by the minute, and I’m currently working on my huge senior seminar ethics paper. Please keep me in your prayers as I try to balance the craziness of school with my final weeks in this amazing country. I’ll try to write again within the next two weeks!

Sharks & Canopy Tours

Now that I’ve given a detailed account of my clinical experience, I want to share about my fun weekend with you.

On 10/25, our entire group went to Durban to see the Currie Cup Final, which is basically like the Superbowl of rugby. The Sharks of Kwazulu-Natal (KZN), the province we’re living in right now, were playing the Blue Bulls of Pretoria, which is one of the capitals of South Africa about 6 hours away from PMB. Based on our location, we were definitely supporting the Sharks. So we got all geared up the Sharks colors, black and white, and headed off to Durban for a few hours of street shopping before the game. As we drove into the city, we were overwhelmed with rugby spirit. The entire city was covered in either blue or black paraphernalia, depending on the team being supported. After surviving the shopping chaos, we drove over to the ABSA stadium into an even greater mess of people. It was totally packed and there were drunk people tail gaiting all over the place; no different than any other huge American sporting event! Every single person there was decked out in their team colors and extremely pumped to watch rugby. The stadium was huge and almost every seat was filled. I’m not a huge sports fan, but even this was exciting to me. Once we found our seats, which (of course) were situated right in the middle of a bunch of Blue Bulls fans, we started the face painting process. I painted Mandy’s face half black, half white while she painted stripes on my cheeks and wrote “Sharks” on my forehead. We wanted to make it very clear to the Blue Bulls around us that we weren’t a part of their crowd. The game started off pretty cool. A bunch of planes flew over the stadium, sky divers started flying down onto the field, and abseilers lowered themselves all around the stadium. The game itself was pretty intense and I was confused most of the time (I’m still working on understanding football), but it was a ton of fun. For those of you who have never seen a rugby game, let me explain to you my interpretation of what happens. The goal of the game is to get the ball to one end of the field by either running with or passing it. So that’s just like football, right? Well the similarities stop there. First of all, let me establish the fact that these are beastly guys who don’t wear any kind of protective gear like American football players. They just use their bodies as battering rams against other guys’ bodies with the hopes that their bones will stay intact. Second of all, just because you get tackled doesn’t mean the game stops. It just means that more and more guys pile on top of each other until the ball is wiggled out to another player who then proceeds to run with it. Thirdly, there are not a million time-outs like football; there are two 40-minute halves and they generally last 40-45 minutes each. Injured players are left to fend for themselves on the field. The only time the game stops to help them is if they’re in the way of the play; then they HAVE to be moved haha. Fourth, if the game stops due to an “infringement,” they do this thing called a “scrum” where they huddle in this massive group and push on each other for possession of the ball. It’s hilarious. Fifth, if they don’t want the players to steal the ball from them, they’ll kick it out into the crowd. This would result in a turnover to the other team anyway, so I didn’t quite get this tactic. Sixth, they don’t have offensive and defensive teams; they’re all one big group and are required to play any position needed. Oh they also do this really cool thing when the ball is kicked out where they lift up players to try to get possession of the ball. I know there are a lot more differences (like the shape/size of the ball, for instance), but I’m sure you all get the point. It’s really different than football…and a lot cooler. America needs to get with it and make it a national sport! Everyone at the game was way into it, which made me want to be more spirited too. The worst part of the game was when the Blue Bulls fans behind us spilled their beers all over our seats and feet, and then proceeded to blame it on the “stupid girl” next to them who happened to be in the restroom at the time. Anyway, the Sharks won! It was an awesome ending to my first rugby game. I definitely wouldn’t mind seeing another one.

On Sunday, 10/26, we had a completely different but equally fun adventure: Karkloof Canopy Tours! Like Durban, it took us about 1 ½ hours to drive there, but it was totally worth it. Karkloof Canopy Tours is situated in the middle of the second largest indigenous forest in South Africa, Karkloof Forest. So I’m sure you Americans are wondering what exactly canopy tours are (because if you’re like me, you’re probably thinking this is a tour of the plains of Africa to see all of the wild animals haha). Well, basically canopy tour in South Africa is just another name for a zipline. The entire slide is 1 kilometer long and is divided into 8 separate slides of varying lengths. The slides are as high as 35 meters (105 ft) and as long as 175 meters (725 ft). They take you from wooden platforms hidden in the tree tops (kind of like tree houses) past a sheer cliff face and a beautiful cascading waterfall. Oh and it’s the biggest canopy tour in Africa! So we got the usually safety talk, signed out lives away on some contract, got all harnessed in, and then were off to the top of the mountain. We rode in a 4x4 up an incredibly bumpy road, which we’re pretty used to after being in PMB for over a month where all of the roads are crazy. Ten minutes later, we arrived at a hidden, muddy trail and hiked our way up to the first wooden platform. Just like abseiling, I got picked to go first (of course). The guide hooked me in, placed one of my hands on the rope above me and one on the top of my harness, said “bye bye,” pushed me off the platform, and I went screaming over the top of the Karkloof forest. For once in my life, I wasn’t scared about being up so high; I was screaming out of pure joy. The only unfortunate part about the whole experience was that I couldn’t seem to get a hang out the braking system. To brake, you’re supposed to pull down on the rope; however, I wasn’t very good at judging the distance between myself and the platform, so I would almost run the guides down every time I landed (and nearly run into the platform in the process). I actually found it pretty funny, but the guides failed to see the humor in it. Oops!

Anyway, that was my weekend. I made some memories that I will never forget. When I have some more time, I will tell you about my new clinic that I went to this past week. Please continue to pray that I will be the hands and feet of Christ as I work in the community here!

Ethembeni - Place of Hope

On Thursday, 10/23, I went with Bobby to Mpophomeni for our rotation in hospice care. Mpophomeni is a rural community of 43,000 people about 30 minutes away from AE. More than 80% are unemployed and more than 1/3 have HIV. In 2000, Howick Community Church began a ministry to this community, specifically aimed at caring for those who are dying alone, hungry, and without hope. The ministry is called Ethembeni, which means “Place of Hope” in Zulu. Its mission statement is “to provide spiritual, emotional, and practical assistance to families affected by HIV/AIDS in the Mpophomeni area through provision of home based care, family support, and residential care for terminally ill people.” Ethembeni has 3 programs: 1) residential care unit, 2) family support program, and 3) family center. The residential care center can accommodate and care for 4 people at one time; it’s basically a very small hospice run by lay people in the community. The family support program provides a holistic intervention incorporating not only home based care for the sick but also food security, income generation, and psychosocial support. On average, they visit 45-50 families a month (200+ adults and kids). The family center cares for 40 orphans and vulnerable children a day by providing meals, psychosocial support, and structured play activities. The core values of these 3 programs are very simple: God’s love and hope. Since the beginning of these ministries, they’ve worked with over 500 HIV infected families, directly benefiting more than 2,000 people. After that lengthy intro, let me tell you about my day.

When we arrived at the residential care center (which I’ll just call hospice from now on), there were already workers taking care of the patients and our help wasn’t needed. Kathryn, the head nurse who pretty much runs the place, decided that we would go and do home visits with the church volunteers. They were supposed to arrive at 9AM, but this is Africa (TIA!) and they didn’t get there until 10:30AM. Once they arrived, things finally started to pick up. There were about 20 volunteers gathering in a circle outside, so Bobby and I joined. We sang a song in Zulu (with hand motions and dancing), prayed in Zulu and English, and then were off in our cars to do the home visits. I went with a really sweet older white woman named Susan* and an equally sweet older black woman named Nobeni* (she was the translator). The first patient we visited was a 40 year old woman named Katiwe*. She had 4 kids under the age of 18. Her eldest, an 18 year old girl, recently had a baby but wanted to stay in school, so Katiwe takes care of the baby during the day. Katiwe looked pretty healthy, just very tired. The only medical problem she was having was diarrhea, so we gave her a recipe for a simple and cheap oral rehydration solution (1 tsp salt, 8 tsp sugar, and 1 liter water) and told her to drink until she could go to clinic. Anne flipped through her Bible and decided to read Psalm 9:7-10. Katiwe followed along in her own Zulu Bible while Nobeni read out loud in Zulu. Can I just say how incredible it is to hear the Bible being read in a different language? It really just reminded me that God is a God of ALL nations. Anyway, my favorite verse out of that passage was verse 9, “The Lord is a shelter for the oppressed, a refuge in times of trouble.” Susan explained to Katiwe that no matter how poor or diseased she was, God loved her and would never abandon her. We talked for a little while longer about Jesus, Susan reprimanded Katiwe for not attending a knitting class at Ethembeni (part of their program to get people jobs), and then we prayed for her. After loading Katiwe up with a ton of food (sandwiches, yogurt, soup, eggs, avocados, baby food, etc.), we got back in the car and headed down the road to a new patient. Her name was Maureen* and she lived in an even smaller 2 room house without electricity. We found out that she was 39 years old and had 2 kids (ages 3 and 5) and a boyfriend (who wasn’t the father of either of her children) who had HIV. She was unaware of her CD4 count, which is an important indicator of where people are at in their illness. A count below 200 and an opportunistic infection of some kind (like TB or pneumonia) is diagnostic of AIDS. She gave me a bunch of medical records, but they were all dirty and worn away so I couldn’t really read them. She has been to church before, but doesn’t go on a regular basis and doesn’t own a Bible, so Susan said that was something we were going to change. We prayed for her and told her that someone would be back to visit her in 2 weeks. This woman looked a lot sicker than the first, which was hard to see. After that visit, Susan dropped me off at the Mpophomeni Family Center, which is right down the road from the hospice. It was created after the hospice a few years ago and is actually pretty nice (for the location it was in). They take care of kids during the day who are either AIDS orphans and live with random relatives who work and can’t take care of them during the day, or they live in child-headed households and have older brothers/sisters who are in school during the day and can’t take care of them. So basically what Bobby and I did all day was play with them, and I couldn’t have been happier. I love kids because no matter what language they speak, you can still have fun with them and love on them (they all were black, Zulu speaking). We did races with them and taught them how to play “duck duck goose” and musical chairs, both of which they loved once they got the hang of it. As more kids got out of school, the family center got more and more crowded and our games got bigger and bigger. It was awesome. They love cameras, so I took a bunch of pictures of them until my camera ran out of batteries. When we finally left at 4, I was covered in little kid snot and dirt, but was smiling ear to ear. There was one little girl who was probably 1 ½ who was attached to me the entire day, and any time I put her down she would reach her arms out for me to hold her. I just wanted to take her home with me. OK I wanted to take them all home with me. I’m having serious thoughts about adopting a kid from here someday. There are 1.5 million AIDS orphans in South Africa alone. I can’t save them all, but if I can make a difference in at least one, I would be so happy. It was a great day and I couldn’t wait to go back!

On Friday, 10/24, I returned to the Ethembeni for my final hospice day. Since I had already done home visits and been to the Family Center, the nurse in charge decided that I would stay at the hospice and help out there. There were two older black women working that day: Busisiwe* and Nelisiwe*. They were both really sweet and willing to let me help. Our job for the morning was to bathe and clothe the patients and change their bed linens. We walked all four of them to the shower (where a shower chair was waiting) because none of them were strong enough to walk by themselves. There was a man who appeared to be in his 30s, a 21 year-old girl, and two other women who looked like they were in their 20s or 30s. It was sad enough to see these people in their clothing, but to see them naked was a completely different story; they were literally just skin and bones. These patients could barely lift their arms for me to wash under them. I cleaned one of the woman’s pressure sores and multiple ulcers covering her genitals with salt water; they were unlike anything I’d ever seen before. I felt so bad for the woman because it was obviously causing her a great deal of pain. All she kept saying was, “Thank you sissy” over and over. It made me really sad, but really blessed to be able to serve her. After I was done cleaning her, the nurse brought in a bunch of leaves from a plant, squeezed the sap out of them, and rubbed them on the woman’s sores. Apparently Ethembeni grows a few medicinal plants in their garden and this was one of them. It’s called a bulbine frutescnes (Ibhucu in Zulu) and its sap can be used to heal ulcers and cure itching. Pretty cool huh? Bathing the 21 year-old girl was really hard for me, too. I’m 21 myself, and I can’t imagine being so near to death at this point in my life. I feel like it’s just beginning! It really made me realize that I’m so blessed with my health and take it for granted way too often. We finally finished getting the patients bathed and ready for the day around noon (it was a long process because they couldn’t really do anything for themselves). Washing these people who are incredibly sick and ostracized from society was definitely one of the most humbling experiences in my life.

So that was my experience at Ethembeni. It was something I will never forget, that’s for sure. If you want to find out more about Ethembeni, you can contact Grant Edkins at grantedkins@telkomsa.net or visit the church’s website at http://www.howickcommunity.co.za/. This ministry is doing amazing things for the community of Mpophomeni, so please keep them in your prayers!

*Please note that names have been changed to protect privacy

Last Week at East Boom & uShaka Marine World

Sawubona family and friends! Sorry I haven’t written in awhile! Between school, clinical, and random adventures I’ve been keeping pretty busy and would love to share some highlights with you all.

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 Africa 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 doing 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 opportunity 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 to 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 decided 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 tooth 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 marine 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 the 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 was 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