On Holiday

…so the Health Tip will be temporarily unavailable.

Saying Goodbye

This will be my last post written from this little internet café here in Lusaka. On Sunday I leave for my holiday in South Africa, where I will probably spend most of my time doing transcriptions of my interviews. 

The interviews went well, although I did not manage to get 8 interviews, as there were not that many teachers that fit the criteria of the study, but I’m grateful for the 5 that I managed to get.

So now, I’m busy frantically doing last minute stuff, like getting my assessment forms filled and signed, saying goodbye to all the lovely people that helped me here, and last of my biggest worries…packing! argh…I really really hope that I don’t have overweight.

trying not to cry. Sorry in advance if I’m going to be in a bad mood for the next three days.

Anyway, Zambia has not seen the last of me. I’LL BE BACK!!!!! Mwuaahahahahahahaha.

This is me in the Operating Room, or as it is known in Zambia: Operating theatre. The procedure I’m scrubbed for is a tracheostomy.

I’m totally going to miss Zambian food! (which tastes best when using your fingers)

I went on a stroll into town with a friend. this road is just around the corner from the UTH.

Independence avenue where my friend and I happened to stroll by. Its actually a very pretty street

 

Health Tip: Avoid using unwashed hands to eat your food in Zambia.

Strike!

Right now the UTH is in a state of chaos. The doctors are striking, the nurses are striking and the patients seem to be striking as well because the wards are empty.

The government is keeping suspiciously quiet, the media is painting fantasy pictures of the situation and I’m stuck in the middle wondering why my friends are nowhere to be seen.

My best friend here in Zambia is also a student nurse, and she, amongst all the other students are being put to work.

This of course makes the nurse’s strike completely ineffective because they are using (or in my opinion abusing) med students and nursing students. The nursing teachers are also being put to work along side the students.

Uth has promised some kind of pay for the students, but its still not yet confirmed.

Today I spoke to one of the resident surgeons, and he informed me that the doctors will be going back to work tomorrow, following negotiations, but nothing has been finalized yet.

In my opinion, if you want a strike to be successful you should not give the government any options to bail out, or to cheat by using cheap labour. When the nurses were striking in Finland in late 2007, they went to extremes by actually threatening to quit their jobs (check out my post on the subject), and the student nurses signed an agreement that they will not work as substitutes when the registered nurses are striking. It came down to a bitter fight with people blaming anything and anyone and the media of course confusing people more than informing them, but in the end the nurses won because they stuck together. I think the nurses deserved to win and I was happy that things turned out the way they did because it affects my future too.

However when I look at the situation here in Zambia, it is clear to anyone that the nurses here are the most under appreciated, under paid and overworked workers, and yet they are the most vital together with doctors. It makes me very sad to see that a government seems to care so little about its health care workers by letting things spiral out of control like this.

I feel for the students, because they deserve, if anything, a better future than a monthly 1,3 million Kwacha (=€185) paycheck.

 

Health tip: try not to get sick in times like these….

Approved!

Finally today I went to see the secretary of the research ethics committee, and the chairwoman of the ethics committee happened to be there. I handed in my corrected papers… (yesterday I received the feedback, which stated that I was required to only draft a budget, and provide an information sheet with contact details for all participants, and then my proposal would be approved)…And I was asked to first wait in another office.

At the same time came another girl from England who was there for the exact same reason, and together we waited and exchanged our stories of frustration, anticipation and stress concerning the ethical approval of our projects. We had both at approximately the same time been calling the poor secretary almost everyday, only to be told to call the next day or the following afternoon.

Then the secretary, a very kind and friendly lady, entered the office where we were seated, and she handed each of us a signed letter announcing that our projects were approved ethically.

We were both so happy that we almost danced out of the university building and agreed to meet up again on friday to celebrate.

I sent a text message to all my friends, and to some important contacts in Finland and right now I’m sitting in this here internet cafe, perched victoriously on a high chair, having just conquered my nemesis, ‘bureaucracy’.

And now, the hard work is going to start.

Health tip: Oh I can’t think of a bloody health tip at this point…

P.s. the botswana trip went well. Spent one night in Gaborone, and spent altogether at least three days traveling on these wretched african busses. below are some pictures of the Kazungula border, and the crossing of the Zambezi river.

deported

Just this morning I realized that the stamp in my passport expired last week Thursday. So I immediately set out for the immigration office in town. Bad news hit me there, and they gave me initially 48 hours to leave the country, but I begged them for one more day, so I have until noon on Saturday to leave Zambia. Good news, I can come back the next day =)
So, I’m going on a mini holiday in Botswana this weekend.

I don’t know whether to cry or laugh. Things can be so ridiculous here.
One more thing to tell the grandchildren though

above: one last night together with the finnish girls (their blog link can be found on the right) and with our very close Zambian friend at the local bar and hang out place for the medical people, which is called Ridgeway and is situated on the university medical school campus, right opposite the UTH complex. The Finnish girls are leaving for Finland on saturday, so I will be missing their departure. I will surely miss the crazy times we had together. Hyvää matkaa, ja muista jättää raukkaus kunnes itte häviätte huimaavan tähtitaivaan alla! =)

from ICU to OR

Foreword: In order to commemorate the truly Zambian ability to speak in a language made up of abbreviations, this post will be littered to utter ridiculousness with abbreviations.

After spending two weeks at the UTH ICU, I decided to cancel the rest of my ICU CP (clinical practice) in order to concentrate on my final project DC (data collection), the ethical approval of which is still pending at the UNZA REC (university of Zambia Research Ethics Committee). 

To be honest, I was not really happy at the ICU, because first of all, it was crowded with nursing students, and there was a constant competition and elbowing around, which I detest. Secondly, the MICU, as it is called (Main ICU) is not even a proper ICU. At best it should be termed an acute med/surg unit, and it does not even pass as an obs (meaning obstetrics or observation, but in this case observation) unit because obs are only carried out  at an hourly basis. What really irritated me though was that the staff there expected me to understand  their Quack speak, and looked at me in amazement when I was unable to decipher that the patient in bed four needed to be reviewed because he was brought in with an HI (head injury), and was involved in an RTA (road traffic accident), and that X-pen (christa-pen..whatever that is) needed to be administered, because some other abbreviation led to his abbreviation, but because he was already in a state of abbreviation, we had to watch out that he would not lapse into another bluddy abbreviation….

So I decided to go back to the main operating theatre and work there just for fun, or part time, so that I won’t have to be running around like an HC (headless chicken) looking for people who in the end do nothing but WMT (waste my time) whilst I’m stressing about time.

Anyway, back in the OR (operating room), I’m as happy as an unabbreviated chappy =)

HT (health tip): If you want to let Zambians think you are smart, try using as many crazy lay terms (and don’t forget to abbreviate them!) as possible.

Kickin ass

Below: the Main ICU, ahead is the special unit for open heart surgery patients, and in front a ventilator and next to that the defibrillator.

Last Friday in the ICU I had to kick some Zambian ass. And not just any backside, but the very backside of a physician. Why?
Because he screwed up a diagnosis.

Okay there was no actual ass kicking, but it happened indirectly, and the ass was kicked in my imagination when I found out that I was right.

So enough with the pedantry and on with what happened.

So we had this female patient who had an incomplete abortion and her uterus was manually aspirated by vacuum. In the ICU her condition deteriorated, and she was confused, and had lesions around her mouth, and on her thighs, which suspiciously looked like herpes. What made me notice the patient was that she was pulling her face, which is a danger sign of a pathological process in the brain (see tardive dyskinesia or dystonia).

I told the nurses that they should check the patient’s neurological status, and contact the neurologist, which of course never happened. I then decided to check her neuro status myself. Both her babinski’s (plantar reflexes) were positive, her right side deep tendon reflexes were hyper reactive, whilst the tone of her right limbs was decreased (paraparesis) and there was stiffness in her neck. This pointed straight at meningitis, most probably caused by herpes.

When the physician came to review her, I tried explaining to him my findings, and I recommended that he check the patients reflexes and consider meningitis or any neurological condition, but he just shrugged and would not listen.

Anyway, to my gratification came the attending gynecologist to whom I revealed my woes about that patient. He immediately examined the patient, redid everything I did, and confirmed my findings, and made an immediate consult for the neurologist and passitus (request) for a lumbar puncture.

I found the patient this monday morning feeling much better after having received some acyclovir loading  (treatment for herpes infections).

Things like these make me proud of becoming a nurse.

Health Tip: When kickin that ass, kick it in Style!

Umkashana uwakosa

I was so frustrated today with one of my finnish colleagues and with the director of the nursing school that my poor door took a really bad beating. when I tried closing it (you kind have to pull it quite hard if you want to lock it), the door handle broke off (the metal handle broke in half!)

sometimes…I scare even myself.
so no wonder they say to me in bemba: Nineno Umkashana uwakosa! (this girl is strong!)

above: me showcasing my little bemba-english dictionary. I keep my colleagues greatly entertained with my bemba anecdotes.

Updates: the handle on my door was repaired, and my papers are now finally in. The previous two days have been hell though. On tuesday evening I was so frustrated that I cried, and the next day I ran a fever and had to skip the day at the icu and spend it in bed. I thank my very finnish friends who cause me much pain and headaches for being so supportive and for putting up with my crap. seriously, te ootte aivan täynnää p…mutta kuitenkin ihania

Mosi-Oa-Tunya

Got soaked sopping wet by the mighty ’smoke that thunders’ (otherwise known as the Victoria Falls). We tried looking for the boiling pot (a hot spring) in one of the gorges, but we got lost on the way and decided to turn back. When we got out we were covered in mud and my sandal straps were broken (they were not very good sandals).

There after we were picked up by some guy to take us to the abseiling and gorge swinging place. The abseil was short but sweet. My other friend who is considerably more blessed with money also did the gorge swing thereafter. In the walk back out of the gorge, one of the finns started screaming ’snake!’ and in a blind panic they ran almost half way out (where do they get the energy?!?). Upon closer inspection I found that we had almost stepped on a baby puff adder. Thank goodness she saw it! Puff Adders are terrible in that they are very poisonous, lazy, and bite easily. Even the small ones have enough poison to kill.

 

So we had quite an adventure today. Going to bed tired but happy =)

Health tip: Bang Jan, dooie Jan!

p.s. when we checked out our money this morning, we noticed that my two friends, who paid in kwacha were overcharged by double! the abseil was supposed to be $25, and they paid K235000, when the $-K exchange rate was supposed to be 5500, so the kwacha price was supposed to be 137500. See, this is exactly what I have against Africa, a lot of people are dishonest with money matters, and will always try to get as much money out of you as possible.

Yesterday one of the trainers commented as to why I was not doing the gorge swing as well, I said I don’t have the money. He answered in astonishment that I who an an umsungu should have lots of money. This is the attitude of most people here, that because I’m white its ok to extort me.

P.P.s. the money issue was brought up and sorted out. apparently the owners of the company had suspected the extortion for a while, and now we had provided them with concrete proof. the guys were caught and the police was brought in….how exciting!

below are some more pics:

 

 

 

Saturday in neurosurgery

So last week I got to scrub almost every day, which was very exciting. My supervisor said even that she is surprised as to how fast I have learnt. I guess its because I have been watching a lot, and that I have been really motivated to learn.

So last saturday I was asked to assist in two private neurosurgical cases. The first case was a depressed skull fracture  (’So why did you not try anti depressants, if it was depressed?’ said I, seems like I have become an anecdote firing missile launcher… which at least everyone here can appreciate).

One big problem here is that the operating theatre cannot provide me with protective glasses, and with almost every other patient being HIV+, and the operations being quite bloody, its not really safe for me to assist. So today I’m going to hunt for a hardware store to find some goggles so that I can assist with my mind at ease. Nothing has happened so far, thank goodness. 

On sunday morning I then went out to visit a pentecostal church service with my Zambian friend. I don’t usually go to pentecostal churches, but by now I have been so desperate for some christian fellowship. But I was pleasantly surprised that the preaching was good (don’t get me wrong, there are probably a lot of good pentecostal churches around, but after a few bad experiences, one cannot help but be a bit apprehensive), and I enjoyed the service overall.

The ethical permission application still dragging on, and one thing I am really worried about is the financial matter. Apparently I might have to pay about 80 €, which is a lot of money, and my school is probably not able to support me with that. I don’t know what will happen to my project then.

So, on thursday we finns will be joining our swedish colleagues at the nearby swedish school where there will be a may day celebration (in Finnish: Vappu). It will be nice to mingle with some non zambians, even if just for one evening. Change is good. 

I’m also going on a reformation crusade in the operating theatre here. The surgeons are slightly more respectful, and polite. I guess they take me seriously here because I am very straightforward, and by no means a suck up. ’Wila yangala naine!’ (’Don’t mess with me!’ in bemba)

Off to get more acquainted with langenberg retractors, kelly frasiers, and mosquitos.

 

Health tip for surgeons: when you want something, please specify. the scrub nurse is a skilled professional, but is not provided with training in telepathy. =) happy slicing!