Anamnesis

the adventures of a student nurse

Archive for April, 2009

Saturday in neurosurgery

Posted by anjasmith on April 29, 2009

theatre

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!

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What research projects are made of

Posted by anjasmith on April 22, 2009

cheap coffinsSugar, spice, and all things nice, thats what supposedly girls are made of. And many people think that research projects are made of brains, glasses, lost social lives, and all things boring. Actually I thought rather the opposite. However when I was just a child, both my parents having been researchers, did not seem to have very exciting lives sitting at their desks.

 but that changed when I was introduced to research methods and utilization during my studies, and I saw a whole new world open before my eyes. I saw that numbers actually meant something, and that countless hours fooling around with the SPSS programme proved to be insanely rewarding. The human experience, when you are really interested in what people think, can become like a tropical jungle just waiting to be explored.

I did mention before that social lives and most other fun in life can be lost in the gravity of formatting, correcting drafts, negotiations, database searchers, editing drafts, correcting drafts, and editing them yet again..and again.

But the worst has not been mentioned yet.

Bureaucracy- So aweful a concept has never been matched in its existence.

It can cut you down and let you crash back to earth with cruel malice. It will strip you bare of all dignity, confidence and esteem and even identity. Bureaucracy has been known to make grown men fall to their knees and many a bitter tear has been shed in name of this villain.

This is what is currently happening with me. My entire project has been compromised because of so many factors, its hard to actually determine where the blame lies. I am so frustrated with this, that I’m very close to losing my mind. 

Anyway, I am patiently waiting here, listening to the stories and the demands changing. I just hope that I will get the permission before I leave Zambia.

On another note, I have had a lot of fun back in the Operating room. I got to scrub (assisting the surgeon with the instruments) for four procedures on monday, the first two were neurosurgery, and the last two were circumcisions. For the last two I scrubbed independently. Zambian men are also constantly asking me for my number and to go out on dates…which is a radical difference from Finland!

Anyway, no fear, I don’t go out alone here. I spend most of my time hanging out with my finnish colleagues, who are very fun and supportive. We are all very different from each other, but yet we compliment each other, and stand by each other. I have also made one important friend here, a third year nursing student. She is absolutely crazy like me, and we have a lot of fun with her.

So, alongside with the lows, there are incredible highs. My transcultural experience so far has been a honeymoon-shock…so they kind of cancel each other out and I am able to remain surprisingly stable. Except when bureaucrats get in my way!!

Off to do more constructive things with my time. Cheers!

 

p.s. pic above taken near the UTH complex. I think this is an omen to futile attempt at getting my project underway.

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Kafue

Posted by anjasmith on April 19, 2009

Kafue District Hospital theatre

Last week I went to Kafue, which is about 45 mins from Lusaka. My finnish colleagues were doing rural health training, while I joined the gang at the Kafue District hospital operating theatre.

The Kafue district hospital was opened in 2004, so its a very young hospital, which on the outside looks very nice and clean. The operating theatre setting is also very well designed, and looks also very modern. However it is desperately understaffed, and I fear the hospital financial management is not the best.

Despite some hiccups, such as malfunctioning laryngoscopes, and a shortage in anaesthetic drugs, the procedures that I was able to watch in were very efficiently and professionally executed. Unfortunately I chose my timing at the hospital unwisely, because they were keeping elective cases to a bear minimum because their autoclave machines (which sterilizes instruments and gowns) were broken and their main surgeon, who is on a three year contract in Kafue from Italy, was on holiday. So what I did see was one cesarian section (pic below), one biopsy, one removal of a foreign objet in a child’s ear, and several cases of manual vacuum aspiration of the uterus .

cesarean section

The last was for me absolutely horrible to watch. In Zambia, Abortions have only recently been legalized, but its still not possible for the district hospitals to perform abortions. So if a woman needs an abortion, she has two options, go to a private clinic or DIY, which is also called criminal abortion. 99% of all abortion are criminal, where a desperate young girl will either try to break the placenta with a stick or with drugs. They suffer from terrible haemmorhage, other septic complications (infections), terrible pain and psychological distress. They are usually admitted to the hospital because of claimed ‘miscarriage’, and are treated in the theatre, where the uterus is evacuated of any placental material. I actually fainted (quite rare with me) when I saw my first case, because the smell was so bad, and the circumstances were so distressing. I was also rather appalled at the way the girls were being treated. No anaesthesia, and no psychological support whatsoever, and not even any analgesia (pain management).

So, honestly I feel like I spent an entire week doing nothing in Kafue (below, pic of my Kafuean colleagues waiting for cases to arrive), which is utterly annoying because I’m on a very tight schedule here. From my clinical experience point of view, it was a waste, however it was a nice change and I only slightly regret going there. What was really nice though was that we lived with four Zambian nursing students in one house. We cooked together, we ate together (with our hands) and we hung out together. The whole living together thing was sometimes slightly frustrating because of our great culture gap (they clean the house every morning starting at 5 am!), but on the other hand we became friends and in the end we were sorry to part.

Zambian nurses

So, in short, if you are completing a clinical practice in Zambia which is part of your basic studies, Kafue is great, but of you want to specialize in a field that has nothing to do with primary health care, I’d opt to stay in Lusaka.

Tomorrow I continue my training in the UTH main theatre, and in two weeks we leave for Livingstone!

I also learned some bemba:

‘Mwabukashani’-'Twabuka bwino’: Good morning? – answer to the good morning

‘Ninebo umsungu uwakosa!’ This msungu (white person) is tough!

‘Umkashana uju a lishipa!’ This girl is tough! ;)

‘Mwilalanda ichibemba pamenso yandi!’ Don’t speak in bemba infront of me!

 

Until the next time I invade this humble internet cafe in Mandahill, Lusaka…

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OR

Posted by anjasmith on April 7, 2009

UTH theatre

Finally started my clinical practice.
My first placement here is in the main Operating theatre.
Yesterday I witnessed a Craniectomy, which had never been done before in Zambia. The patient had a pituitary tumor, and there were two chinese surgeons doing the procedure. I found out today that the patient is doing well and able to speak!

Today I was in the speciality theatre, and today was the opthalmology day. There were three children being operated on, and two adults who had one eye removed due to eye cancer.

There are many doctors from russia working here. I would love to vent my feelings here about their behaviour, but for fear of being deported I think maybe I will leave it the readers to imagine what its like.

anyway, I love zambians. They are totally cool.
Next week we are off to a rural clinic for a week, which is in Kafue, not far from lusaka.

Cheers!

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Useful things to know before coming to Zambia

Posted by anjasmith on April 4, 2009

During the few weeks before my departure, my thoughts were mainly preoccupied with these thoughts. I was considering seemingly silly things like whether or not to cut my hair, whether or not to bring a sleeping bag, own sheets, how many shoes, what type of clothing to wear…

Well, this is the stuff that I brought along with me:

Medical supplies: Infusion sets, Ringer steril infusion bag, cannulae, needles, plasters, bandages, lots and lots of hand disinfection liquid, plenty of latex gloves, aprons, masks, medical tape, medicines (pain killers, anti-diarrhoeals, adrenaline, vitamins, probiotics, anti-malarial: doxycycline, hydrocortisone cream…) 

The most useful so far from the above was the gloves, the anti-malarials, vitamins, painkillers, and anti-diarrhoeals. Diarrhoea can be a big problem over here. We have not yet had to treat each other for any medical emergencies, but the infusion sets and cannulae always come with us when ever we travel. The adrenaline I always carry with me in my handbag, along with a small bottle of hand disinfectant, toilet paper, sun cream, mosquito repellant, a pair of nitrile gloves, a bottle of drinking water and at least 30 dollars cash….and plenty of SUNBLOCK!!

Dress code in some parts is rather strict, and we found  it was very important in malawi. For women it is recommended not to expose the legs above the knees, and not to wear too revealing tops, though tank tops are ok. Sandals are very useful, as well as closed walking shoes. Skirts and dresses are very comfortable especially in the heat. We bought a lot of nice clothes in malawi, especially pretty dresses and skirts and Chitenge (traditional materials printed with colourful designs), a skirt cost around 1000-2000 Malawian Kwacha, a dress around 3000, and 2 yards of chitenge about 450 kwacha. It is also a good idea to bring a raincoat or jacket.

Bring, if possible a mosquito net along. I bought one only later in malawi, which I regretted, because the quality is really bad.

Always have a good amount of US dollars with you. You never know when they might come in handy. On our way back to lusaka, at the malawian border we found out that we stayed two days longer than we planned, and that became a big issue with the authorities. They ended up taking our passports away, and threatened to have us deported. The issue actually was that when we entered malawi, we were asked how many days we were planning to be in malawi. We were not sure exactly how long so we just said 7 days. In the end we found out that we were not able to leave malawi when we planned to, because there were no buses going on wednesday or thursday. the next possible ride was only on friday, so we overstayed two days.

I made my first mistake at the border when I shouted at the passport control guys. Immediately they told us to wait aside and said that our journey ended here. After waiting for some 15 minutes we approached them again and I explained in a calm way as possible that we did not know of the rule and would very much like to continue our journey. They explained that we were supposed to apply for extra days at the immigration office in lilongwe, and that it costs about 5000 MK, which according to them was 100 dollars each.

I soon noticed that this was utter bollocks, and that they were asking us to bribe them. I asked them what the dollar-MK rate was, which was apparently 140 kwacha to the dollar. We worked it out that the fee was actually 35 dollars per person, and I said that I’ll pay no more than that. They guys first tried to get 40 dollars each out of us, but once I gave a disapproving look they accepted the 35 dollars.

I also found it quite useful to bring two towels along with me, because due to lack of washing machines , our handwashed washing dries very slowly. Sadly, one of my towels got stolen while we were staying at the malawi college of health sciences.

Concerning hygiene, at sometimes it is a bit tricky to stay clean, because of water cuts and travel. We found it very useful to bring wetwipes along, and to always have a bottle filed with tap water (which is not used for drinking) in the room. I luckily decided to have my hair cut just before leaving Finland. I had very long hair before, and with out regular washing and use of a lot of conditioner, it would e very knotty. Now it is shoulder length and I only need minimal water, shampoo, and conditioner to keep it clean and looking good. Also, its long enough to be tied back, which is very good.

Concerning behaviour, well, being a hardened Jo’burger, I’m as paranoid as can be. I’m always looking over my shoulder, and I always suspect everyone and I don’t accept any drinks from anyone (and I don’t take any alcohol at all). But that does not mean that I can’t enjoy myself, because I really do! I’m having a great time here, while having my feet firmly planted on the ground. One thing that I would warn any women when coming here is to avoid smoking in public places. First of all, its illegal in Zambia, and secondly white women (or any woman) seen smoking cigarettes is seen in the same light as a slut, ie, easy to get in bed with. This is just one of those culture things that needs to be respected in order to avoid trouble. One common phenomenon is that some african men are very blatant in that they will try anything to get in bed with a white woman. They will offer more and more alcohol, even if you refuse. In these cases I would recommend not accepting any drinks at all from men, and rather to buy your own, so that you can regulate how much you drink.

It is also very difficult to be a Mzungu woman (white person) and not to attract attention here. Sometimes the men can be extremely rude, and they make a big scene in some places in the streets when walking by. They are usually harmless if you ignore them, but once in malawi, this one guy was hassling us and following us, and when I turned around and told him in a very stern voice that he had better leave us alone, he walked away. 

Money issues, as pointed out before, can be rather annoying because honesty does not always seem to be part of the culture. When buying something in the market, the price is almost always at least 5 times more than the normal price. When bargaining, if they offer 6000 for a dress, I usually say 2000, and raise it to no more than 3000. If they still insist on more than that, walking away will usually help change their minds. Sometimes its easy, and sometimes they will put you in a guilt trip by bringing out stories of hungry mouths to feed. After a while it can be especially annoying because it seems like people here want to extract as much money from us as possible and will try anything to do so. Also its always good to have your visa or visa electron along with you because they work at most ATM’s, but usually only cash is accepted as payment method.

I would like to point out that I’m not trying to make africa look bad, but that this is just the truth as I see it here. In contrast, the nature here is so beautiful, and we have made many good friends, and the food is great. I was also surprised to find so many south african products in the shops, and so I actually feel rather much at home here.

One thing to keep in mind is that this is not europe or america, this is ‘wild territory’, and the rules that we have in the west do not apply here. Time is of no consequence, and honesty is not part of their principles. But this does not mean that you can’t make friends here, or that you can’t trust anyone. With an open mind and buckets full of respect and patience, you will be able to get along just fine.

Health tip: If you see a mosquito, kill the bluddy bugger!!!!

img_0001One minute the weather was nice and sunny, the next it started to pour!

img_0002

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