The Foot in Mouth Syndrome

The time has come to take a look at some interesting syndromes:

Foot in Mouth is what’s called ‘the act of saying something inappropriate’. If you have a habit of constantly saying or doing the wrong thing at the wrong place and time, then my friend, you have a classic case of Foot in Mouth (not to be confused with the bovine ‘foot and mouth’).

Symptoms are presented as impulsive and abrupt phrases, usually during sensitive situations such as funerals and weddings or interviews. It appears that people with high societal stature seem to be at a particular risk of developing this syndrome. Other symptoms that may appear after impulsive speech are increased blood flow to the facial capillaries, making the patient’s face appear red. Inability to keep eye contact and nervous twitching usually accompany the facial redness. It has been observed in some patients with severe foot in mouth, that they are completely unaware of their behaviour and appear to be unaffected otherwise. The people around the patient may appear to be affected. It has been debated that in such severe cases, Foot in Mouth by Proxy may develop in persons that are continuously subjected to the speech of a patient suffering from Foot in Mouth.

Foot in Mouth by Proxy is rather common, and the affected persons form a dependence on the impulsive and inappropriate speech of the Foot in Mouth victim. Such people appear to be well employed by tabloid magazines.

There is no known cause of Foot in Mouth, and no organic findings are present in live victims. There is no known cure either, although intensive psychotherapy and behavioural counselling have shown to decrease the symptoms by a third. Sedative drugs such as Benzodiazepam may be helpful in severe cases.

Because of the sporadic nature of the symptoms, it is very difficult to diagnose. Pathologists (that are way too bored and creative) have however observed when dissecting the tongue of deceased patients, that the tissue appears to have taken on the form of a foot (fig 1.1a).

Hence the name, ‘Foot in Mouth’.

______________________Drawing and words created entirely by my wild imagination_____

With the the second week of my surgical clinical practice behind me, I thought I should perhaps add an update to my previous post surgical nursing . First of all, I’d like to throw in a ‘by the way’ to my comment about free student labour. When I mentioned the words ‘Ilmainen työvoima’ (in Finnish) to my mentor, I was subjected to an angry stare. I can’t remember her exact words after that, but it was clear that she was offended…Sheesh I really managed to put my Foot in my Mouth.

I told her that I do not necessarily feel like I have been misused, but that I was merely enquiring the matter, which is true. My Question rather is, how much work are we expected to do, and when does practice go too far? It would be quite interesting if people could tell of their experiences and feelings.

Things are fine now between my mentor and I. I have started doing more interesting things, like removing drains and stitches. I have done blood transfers, drug calculations, fluid balancing, injections, IV’s, catheterizations, worked with physiotherapists, mobilization, and neurological evaluation. I have had some really tough days where there was really a lot to do, and then I have had some nicer days where I could sit and read about interesting medical stuff. I have been to a lecture in perioperative nursing and another lecture in post operative pain care.

I did talk more about the labour thing with my mentor, and we came to the conclusion that practice makes perfect. It is only by practice that a competent nurse can make a bed in under 60 seconds, while a patient is being mobilized on the first day after surgery. It is only by practice that a competent nurse can change a patient’s diaper in about one minute, just before the patient has to be transfered to another ward.

It is the art of being able to finish off every task required during one shift, efficiently and smoothly. A nurse has a hundred things to think of and do at the same time, and should be prepared for the unexpected. Yesterday I was busy helping a patient up from bed, and just then another patient fainted in a chair. As fast as possible I had to take my gloves off and run to raise the fainting patient’s legs, and help her back to her bed. She recovered after a while. Had my mentor not been there to tell me to raise her legs, I would not have known what to do. Every day, I learn that that the little things that I have been taking for granted end up being so important.

I found it very nice when through kind words and patience, did I manage to get an aggressive and demented patient to cooperate fully with me. It was also awesome that I managed to calculate the correct dosage for a bolus of 1.25mg Serenase (a strong sedative) on the first go, and that the nurse that I was working with said that she trusted me to do another intramuscular injection by myself.

Lastly: Attitude counts.

Health tip: Laughing increases Longevity and smiling makes you look younger. Take a generous dose of both daily.

Surgical Nursing

Finally, it has begun!

I am so excited about this, few would understand why. unfortunately due to some upper respiratory tract problems, I had to sit out my first two days at Töölö surgical hospital, squandering my precious time on sick leave. But sure enough, I recovered quickly and so I was allowed to join my new team at the orthopaedic ward.

My ward is specialised in spinal and neck surgery, broken limbs and we also treat trauma victims. So far I have been doing a lot of basic care, and just concentrating on getting to know the routines and properties of this ward. After about three days of not really doing anything special, I started getting a bit impatient, as I am supposed to be learning nursing interventions, and not just provide free practical nurse labour. But it has only been three days, so I suppose the bigger stuff is still to come.

Talking about free labour: Many students, not without reason, feel that they are just being misused by the hospitals during clinical practices. In Finland, nursing students are not paid for work during practical periods. Engineering students and other male dominated fields of study however, are not subjected to this. They are actually paid quite a handsome sum for their work during practicals. Please note that I mean not to raise any gender disputes. But it is true, how unfair it really is. During our placements in hospitals, we are required to spend a certain amount of time, 37 hours, a week on the wards. That is one shift a day (7,5 hours), five days a week. Our practical periods are usually 6-7 weeks long; And most of us don’t get state subsidy for studying, so are forced to work crazy hours during these periods, in order to make ends meet.

Luckily, I do receive money from the state (about 400€ a month), but that is only just enough to pay my rent, phone bill, and monthly groceries. If I want to have some pocket money on the side and some savings, then I have no choice but to work. I work as mentioned before, as a practical nurse in long term wards and old age homes. I actually have to admit that I hate it. I am definitely not the type for that sort of work. I honour the people that can do it, but I am certainly happier in acute care. Now can you imagine why I am a bit frustrated that I have only been doing basic care up until now, and not even getting paid for it? I understand that it is very busy there, and that things need to be kept going, but for crying out loud, I am a student. I am supposed to be learning new things, this is my third practical period and I’m in the second year of my studies. Basics of Clinical nursing was completed already one year ago. I know that there are many other students complaining about the exact same thing.

Well, what are we going to do about it then? Have a strike and refuse to go to lectures and sign pieces of paper that we are resigning our umm….studies? Is tehy going to help us out with this? I wonder…

All right. I am being silly. No need for anyone to take heed of the above. I guess I should just be patient and see what tomorrow brings. I need to start working on my goals and the project thingie stuff which entails the following: ”Choose together with your tutor nurse a patient who is coming to surgery. You’ll work as a primary nurse for this patient and you will concentrate on his/her nursing process. You will participate in the patient’s interview or the preoperative meeting (with the anaesthetist). After that you will take part in planning, implementing and evaluating the nursing care process.” -And excuse the Finnish accent, which I assure you is quite unintentional.

Anyway, sounds like fun, and I am looking forward to finding the perfect patient who would suit this task, and also to being a real nurse for a change. I honestly can’t wait to graduate.

Health tip: Do not argue with the nurse. The nurse knows better than you. Or at least should…

Out of Africa

It has been almost a month since I last wrote something on this Blog. How quickly time flies by.

November and December was that joyous season called end of term, any student will know about the dread of having to face the crushing wave of exams and project deadlines. When I left for Johannesburg on the 15^th, I had not realised that I forgot one essay, and thus had to finish it while on vacation. Luckily my classmate agreed to receive it via email and hand it in on my behalf. And under no other circumstances did I find time to write anything for this blog. So that is why I have been quiet.

Oh yes, I was in South Africa. Two glorious weeks of visiting my family and friends. In case I had not disclosed this yet, I am a Finnish-German who was born and raised in South Africa. ‘Interesting’ is the reaction I get from many. Well, it is nice, to have such an interesting background, but quite annoying that My two homes clash considerably:

Reaction from a typical South African: ‘Oh Finland? That is nice….where’s that, in Russia somewhere? An Island? Is that a country?’

Reaction from a typical Finn: ‘Oh, you are from South Africa? That is nice, so which country?’ umm that is the name of the country… ‘So do you speak Swahili?’ and ‘Are there dangerous animals like giraffes and lions?’

And the Germans in Germany are always amazed that there are Germans in South Africa (there are five huge German schools in the country, millions of German bakeries, and entire towns filled with Germans!). They also have trouble believing me that German is my mother tongue (We have our own dialect there in Africa).

Anyway, enough about me. What I originally wanted to write about was malaria, because I recently had a fright coming down with a high fever, chills and aches. Actually, I am still not so sure whether I have it or not, so I think I’ll go to pay my doctor a visit and ask for some blood tests. But I can’t be sick now! My clinical practice is starting on Monday and I can’t miss out on that. Actually, I am not at all inspired to write much. I’ll do an article on malaria next time, and also, I got my colleague to agree to write an article on the whole story about TEHY and the Government and the Nurse’s Salary dispute. She is sort of an expert on the matter and therefore I think she’ll do a great job on that.

I would also like to write a few words on the farming situation in SA.

As probably the whole world knows by now about Robert Mugabe and the White Farmers in Zimbabwe, probably very few know that the exact same thing is happening in South Africa. The only difference is that the practise of seizing farms is on a much smaller scale, and the media keeps relatively quiet about it, and so does the Government.

A couple of a hundred thousand White farmers have been murdered so far, and the land taken over is not cultivated (because the people who claim the land have no or little knowledge of farming). People predict that South Africa will end up just like Zimbabwe in a few years time. Currently in Zimbabwe, there is no food, no running water, the wildlife has been poached to pieces and it is literally one big chaos. It is very sad indeed.

My uncle is a farmer, and so is my cousin. They still farm in the same area where my grandfather farmed, in Luis Trichardt, Northern South Africa. The Area where they farm, is called ‘Levubu’, and is said to be the most fertile Land on Earth. Ten years ago there were about 90 farmers in the area. Now there are about only 30 left. The rest had either been murdered or chased away.

My uncle’s wife told me that about a year ago they received a letter from the state telling them to hand over their land to some man who claims that his ancestors owned centuries ago. She told me that the state is of course doing nothing about it, and she suspects that they can’t pay for the land as should be done, but that they are just waiting for the people to take the land themselves, by force. I was greatly grieved when I heard this, and I hope and pray for their safety.

There have been many accusations that the Government is responsible for the farm attacks. I will not point any fingers, but I do think that this is a serious problem, and the government is just shooting itself in the foot by encouraging the practise of ‘Land claiming’.

You will be able to find a few articles on the farm attacks on the BBC website:
1998

bloody battle

eviction

new racism

that shall be all for now.

Peace.

Update: Another post on this topic can be found at Fred Fry International

Health Tip: Don’t make the stupid mistake in going to work when you have a serious flu. It’s not good for you or your co-workers. 

I just could not resist trying out the beautiful rocks in the Pretoria botanical gardens.

The last of the beautiful jacaranda flowers. the nickname of Pretoria is not without reason ‘Jacaranda city’.

Approaching the ‘Hanglip’ in the Soutpansberg, from the south. This is past Luis Trichardt on the way to Musina

The same Hanglip seen from the north eastern side.

All photos were taken by me (except the first one).