Trouble with Transportation

Transportation is such a PAIN IN THE BUTT!

The other day it was such a hassle getting someone referred/transported to another medical center...

The person came in with diabetic ketoacidosis coma, and so we put him on a drip, and i only had 2 blood sugar tests (b/c the dr. didn't give me his test strips before he left).  If it were type 2 diabetes, he'll be ok with some normal saline drip and oral medicine, but then he went into coma again.   He would need insulin if he's type 1 diabetes, and we don't have that.  To add more anxiety, he started getting rigors and high fever, but we don't have blood tests for that. Also the fever messed with his blood sugar, which I couldn't test. Sighs. So I decided he needed to be transferred on Sunday night...

And then it took ALL day on Monday to get him transported to Kenema - 1hr drive.

Since the morning I had said he needed transport, but his relatives took forever to come to help him get transport

and it was his luck that the hospital's only ambulance got totaled last week.  When his relatives finally came, it took FOREVER to get someone with a vehicle who'd be willing to take them.  Then I found out they were waiting for the driver to get some other passengers who want to go to Kenema to decrease the cost. Seriously, this guy is in a coma and rigors and fever of 41C and you want to wait for other passengers??? 

The driver's phone also failed to work, so that significantly slowed down the process b/c the brother had to keep on going down to town to negotiate and find out what's the delay.  Then there was no fuel in Segbwema. In ALL of this town, there was no fuel. Seriously?  So the brother had to go to the next town 7 miles away to get fuel. ...and then the driver said he had to fix the car's tire. Dude, you had the whole day, and you finally decide to do it now? This is what happens in Sierra Leone. There's always something else, some other problem.

They finally got to Kenema at around 9p? 10p?  At least it's a happy ending and the man got treated in time.

Hospitality and Visiting

I thought I was gonna be super lonely, but I've actually been pretty busy trying to visit people.  I don't really quite understand the culture...  It almost seems like it's an honor to the host for you to visit them.  Because I would go visit someone, and then someone else would say, "Hey!  How come you haven't visited me for 2 days? Do you have a new girlfriend???"  And when I visit, they always feed me, and would almost get upset if I don't eat with them.  It's strange.  So I've been pretty much having dinner with people everyday.  And I feel bad for just eating their food, so I've been cooking with them and bringing some supplies/fruit, etc.  But still...it's weird they seem so eager for me to eat with them.  I really hope they're not hoping I will give some huge donation when I leave.  That's the thing with Sierra Leone...it's hard to know if people are truly your friends or if they just want something from you.  But maybe I'm just cynical...maybe the smaller towns aren't like that.  Anyhow, now I have 3 places I visit pretty much now.  One is the under-5 nurse who used to cook for me, but now I just eat with her family when I go.  Another is this hostel of student nurses, and another is one of the smarter 1st year student nurses who speaks English pretty well and is super talkative.  One of the hostel student nurses is a lot older, and she's kind of a pseudo-mom to me now. Haha.  When I get upset, she listens to me complain. Haha.  

Match Day/B-day

When I was just about to find out where I match, my electricity ran out at 5p (1p eastern time), so I had to wait till 7:30p when the electricity went back on.  Those were two of the most anxious hours ever!

Result: Baylor Global Health in Houston!  

I was pretty surprised, and had an ambivalent reaction.  1) Couldn't believe I got into Baylor global health track 2) I was sad I wasn't going to be with KP's family in nice weather Cali and west coast w/my family 3) I wasn't sure how I'd like my new humongous Texan residency class.  4) I wasn't sure I'd like the 1 year abroad anymore because I had kind of a crappy day:

Present I got for my b-day (bad day): 

1) Newborn last night died this morning despite being on ampicillin.  Didn't cry when born, was blue for a long time. 

2) Heart failure patient died because I didn't go see him the day before (I was super sleepy and only looked at his chart, failed to do physical exam on him), so I didn't see that he had gotten more fluid overloaded and needed an increase in lasix or some other heart medicine.  And nobody felt like it was important to tell me that he was getting more swollen or had more difficulty breathing.  Darn it.

3) A lady w/high temperature started having convulsions, also heart went into some sort of arrhythmia/irregular pattern, and she ended up almost dying but got steroid and heart became normal again.  Her family, though, gave up on her, and decided to take her home.  But what was really sad was I hadn't made a strong stand to keep her in the hospital and give a strong enough hope that she would survive.  I didn't realize they were taking her home to prepare for her funeral.  One of the daughters was a nurse, and I thought she had her best interest in mind, but later, a student nurse told me she wanted the mother to die, and had told all the relatives on the phone that her mom had already died.  Sighs....why don't people tell me these things before it's too late????  Now it feels like I sent her off to her death bed.  Ugh.

4) A patient with severely high blood pressure ended up having a stroke 2 days later, I find she's still paralyzed.  Sighs...not a TIA (like a mini/temporary stroke).  And I think I had been distracted/trying to bag mask a kid when they told me she was having stroke-like symptoms...and so I said, ok, aspirin.  And forgot that a white doctor had brought in some thrombolytics a month ago.  Darn it...I need to pay more attention when people come to get me and tell me things.  Darn it.  

So yeah, those were my bad-day presents...

ODE to E

Haha, this totally made my day (Thanks friends for your amazing artistic/creative skills! Lol!):

Oh E, oh E

Every time I think of you
I crave candy

Because I want to eat you?
You're pretty sweet, I guess.
Never sour!
Like those awful Warheads that you strangely like.

Oh E, oh E

Every time I think of you
I want to dance.

Makes me feel like I have termites in my pants.

Thank heavens not!

But mice we had. A dozen mice! They all had names!
In our room, room 301

Oh Roommie, Oh Roommie
Every time I think of you
I laugh and smile.

Life throws its worst and all the while,
you've always been the best kind of friend
to share our lives with till the end [o_O]!

To think how different out lives would be,
if we had not met the one and only E.

For making this adventure brighter, whiter

Yummy-er, funnier

We thank you.

Happy birthday E!

Where There is No Doctor

Also other exciting (totally sarcastic) news:  The doctor left me all alone in this hospital as he went off for a 2 week ultrasound training course, which he told me about....yesterday.  Sighs.  Well, I'm not totally alone, I have pharmacist and charge nurses, and surgical tech.  Apparently, they run things when the doctor is away.  But still....doesn't seem like a good idea.  Especially since he failed to tell me ANYTHING about this.  I just happened to hear this from someone who was VISITING! Seriously??? You work with me and don't tell me jack??? What if I didn't happen to run into this visitor?  I had arranged to work at a peripheral health center so I can see more deliveries, and I would've been gone first thing this morning. Ugh.  I had to call him and ask him about it.  And even still, he said he would be gone 4-5 days.  But it's actually more like 2 weeks.  And he didn't give me any keys to to anything, any instructions, nothing.  Seriously.  Can communication get any worse?  Actually, don't answer that question, I know it can.  

Sighs, didn't mean to spill more frustrations out here.  I'm actually not too angry about it, knowing that sometimes there really is no doctor.  Since a lot of times, the nurses do just admit patients without the doctor anyways.  Ah well, maybe there's a reason I'm stuck here for another 2-3 weeks.  Haha.  

Sleepless night

Convo between friend and I: me: i'm sad

  a patient died :(

 KP: :( :( :(

  i <3 you

 me: i was with her all night (2mo baby)

12:50 AM KP: really? all night???

  oh my....

  <<BIGGGG HUG>>

  :( :( :(

 me: yeah, haven't slept

  and now i have to go round soon

  it was sad....we were bag masking the kid the whole night

 KP: oh yi

12:51 AM me: thanks a lot to the nursing students...even though half of them ran off and the other half were falling asleep

 KP: wow

  did you think the kid had a chance?

 me: i did

12:52 AM KP: sighhh

 me: but there was no petrol for fuel after 11pm

  and things went downhill soon after

 KP: because some of the equipment you were using no longer worked?

12:57 AM <3 <3 <3

 me: but he didn't understand me

  

  so there was no fuel = no oxygen

 KP: :(

12:58 AM oh dear

 me: yeah, it was bad

 KP: :(:(

  how many of the nursing students were with you throughtout the night?

1:00 AM KP: they varried...

  oh, i gotta go

  ttyl!

Termites - A Good Source of Protein

When Mama Ji (my adopted mom) told me she wanted to go catch termites, I had to ask her 3 times to make sure I was listening correctly.  "What? Did you say termites? What do you want to do with them??!"  And she said, "To eat them! They are a good source of protein." - Of course, why didn't I think of that.  

When she asked if I liked termites, my response was, "I don't eat insects."  But I ended up trying one anyways.  Thankfully it was dark, I stuck one in my mouth and chewed and swallowed.  It tasted like those small Chinese dried shrimps - crunchy and salty.  Later I had a better look at it and they were about 1.5cm with legs and everything.  Ewwwwww.  She was going to send me home with a bowl of them.  O_o 

It was fun helping them catch the termites.  Termites are attracted to light, so they were standing under the light, and swatting them with a piece of cloth and then throwing them into this bowl of water.  Once their wings touched water, they couldn't fly anymore.  I didn't even know termites had wings, but google confirmed it.  "Yes, termites do fly at certain stages of their life. They can be seen "swarming" usually in the spring. You can see their wings before they are shed in a later stage ..." (Wiki.answers.com). 

In the village, they don't have fluorescent lights, so they would go to the termite hill, create a hole close to it, and hold a fire over it.  Then they would sing songs to invite the termites out of the hill.  Well, the singing was more of a tradition, it was more the rain that would cause the termites to come out.   

Anyhow, Mama Ji would keep the termites in the water overnight, then dry them out on a pan, and later dry cook them over a fire with some salt.   

There you have it...a good source of protein in case you're ever in need!   

Pictures:

• Cooked termites (dry cooked with salt)
• Catching termites
• Termites can't fly when wings are wet

Popo

Darn it, there's a popo (papaya) tree next to my house, and I've been eyeing the popos there.  There were 2 large ones looking super succulent   I asked some nursing students if it's ready to be plucked, and they said no...then the next day, they were gone!  That happened with the other two medium sized ones on the tree.  Just gone!  So this time, I went and cut off the next largest one that I thought might be ripe b/c it's a little yellow...but now that it's down, i don't think it's gonna ripen for a month. Sighs.  I was too eager and worried that it would get stolen. 

Under 5 Clinic, Electrician

I'm taking a break by not being on the ward and just doing under 5 clinic where all the health kids are. Hahaha.  Although it's kind of discouraging because today there were only 2 kids that showed up!  2!  I think patients just don't have the money for transport to get to the hospital.  It's such a difficult problem.  I can't wait to see what the peripheral health unit is like and hopefully see some deliveries.  

I'm still trying to set up the ultrasound machine - get the electricity connected to the room it's in, but the electrician is being super flaky.  I've asked him 3 weeks ago, and he still hasn't set things up.  In fact, I think he lied to me about there being electricity in the room until I check again this past Sunday.  A big part of it is definitely communication, because his English isn't that great, but another is culture.  People here like to tell you they can do things even if they aren't able to or they don't have the time to or don't want to.  I wish he would just tell me if he's not able to do it, but instead he doesn't tell me.  It's a weird cultural thing that I see with the doctor too...and everyone in Sierra Leone.  I talked to my friends working on Plumpy Nut factory, and they have the same issue before.  Sighs.  Even when I was asking him everyday, he would still delay.  And when the midwife and I got on his back about how he kept on delaying even after taking my money for supplies, he got super defense and angry and wouldn't even talk.  It took me a lot of effort to stay calm, and I only got him to set up a later time to talk to me by asking him to be mature and professional.  Hopefully that will continue to work.  This trip has definitely been a major lesson on how to deal with difficult people.

Truly Needed Prayer

For some reason, lately I've been very irritable, bitter, sad, and angry.  I don't feel like I'm the same person.  I don't know if it's because I'm angry at myself for being inpatient or making poor decisions, or because I'm too frustrated by everything.  But anyhow, my dad sent a really great prayer and reminder that I really need right now:

Teach me, my Lord, to be sweet and gentle in all the events of my life, in disappointments, in the thoughtlessness of others, in the insincerity of those I trusted, in the unfaithfulness of those on whom I relied. Let me forget myself so that I may enjoy the happiness of others. Let me always hide my little pains and heartaches so that I may be the only one to suffer from them. Teach me to profit by the suffering that comes across my path. Let me so use it that it may mellow me, not harden or embitter me; that it may make me patient, not irritable; that it may make me broad in my forgiveness, not narrow or proud or overbearing. May no one be less good for having come within my influence; no one less pure, less true, less kind, less noble, for having been a fellow traveler with me on our journey towards eternal life. As I meet with one cross after another, let me whisper a word of love to You. May my life be lived in the supernatural, full of power for good, and strong in its purpose of sanctity. Amen.

Meanwhile, something else in a book I've been reading that's been making me think:

"You don't need the Holy Spirit.  You don't need the Holy Spirit if you are merely seeking to live a semi-moral life and attend church regularly.  You can find people of all sorts in many religions doing that quite nicely without Him.  You only need the Holy Spirit's guidance and help if you truly want to follow the Way of Jesus Christ.  You only need Him if you desire to "obey everything" He commanded and to teach others to do the same (Matt. 28:18). You only need the Holy Spirit if you have genuinely repented and believe.  And you only need the HOly Spirit if you understand that you are called to share in Christ's suffering and death, as well as His resurrection (Rob. 8:17). Paul demonstrated this when he wrote,

But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us.  We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed.  We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body.  For we who are alive are always begin given over to death for Jesus' sake, so that his life may also be revealed in our mortal body (2 Cor. 4:7).  

If you truly believe and have turned from the way you were headed and joined a different Way of living, then you desperately need the Holy Spirit.  You know you cannot live this Way without the Spirit in you." - "Forgotten God" by Francis Chan.  

Kid with Dyspnea and More Miscommunication

PIctures:

• Kid with dyspnea and malaria that improved
• Kids all better!
• Grouping and Crossmatching for testing donor for blood transfusion
• Nurse Francis

Shoot. I made the mistake of writing HIV test on one of the person's chart, and the doctor got really angry at me because apparently I'm supposed to write "Counseling by so and so." Apparently if anyone else finds out without the patient's status without his consent, then the hospital gets sued.

I didn't even know they do suing here. Anyhow, the doctor got really angry at me (oh great, in addition to me pissing him off before for asking why he's prescribing steroids for someone with pneumonia, now I make him even more pissed off).

But seriously, how am i supposed to know that you're not supposed to write on the chart? How am I supposed to know the chart isn't confidential? How am I supposed to know the nursing students aren't considered part of the healthcare team so they aren't supposed to know about the HIV test?

I suppose I should have asked beforehand how to do it properly before ordering it.  It's just so confusing b/c the doctor never gave clear guidelines how he wants things done. For example, he would tell me to write plan etc. on the chart, but then as with the HIV test, he wanted me to consult him first. I suppose the "bigger/more scary" tests I should still consult him first before writing on the chart. I suppose it's hard to remember to tell everyone that goes through the hospital about every policy...but still, I don't like the way he blames me for everything.

Well, this is a good lesson to better be safe and ask about things than assume things and be sorry.

What really bothers me is when I tried to explain, he just left the room without listening to my explanation. He is really annoying me. He does that a lot these days. He just leaves while I'm still talking.  It's really quite immature. I'm gonna blame it on miscommunication/language barrier to make me feel better.

I also think he's putting his pride before patient care a couple of times.  We discussed about this one kid having cough for a while (came in with malaria, difficulty breathing), and was really really dyspneic with stridor.  But now he's all happy and playful and plump. But he still has a cough, and so we talked a bit yesterday, and said that if he still had a fever, we would go get a TB test tomorrow. but today I saw kid, still very low grade fever, but his cough improved, and I talked to the lady in charge of TB for kids - apparently they just put them on imperic tb treatment, since kids can't do a sputum test. And talking to her, she thought he didn't need a test....

so then today when I was going over the status of the kids in c-ward, I mentioned he has low grade fever with improved cough, good breath sounds, and I thought maybe the fever was due to teething. I also mentioned talking to sputum lady. But his response was, "Didn't we talk about this yesterday? Why do you want to change things now?"  My thought: It's a new day! With new condition and information!  Is it that bad to confirm that there will be no change in the plan?? :( Well, the plan was to put him on TB treatment, but turns out there is no TB treatment available now at the hospital for kids, so he's actually going to come back later when the treatment is available.  I suppose it all worked out.

I need to get better at listening to my conscience/gut/God/Holy Spirit/divine/something. So many times I would get a feeling to do something, and then I'm afraid I'm wrong, or I'm lazy, or whatever....but then later I'm right or I find I should have done it.

Under-5 Clinic, Resources

Went to under-5 clinic where they just got a new supply of vaccines.  They had ran out a few weeks ago, and didn't have the fuel to pick it up from the overseeing district, Kailahun, so I helped supply some fuel.  So this Friday was focused on giving vaccines.  It was very efficient.  The nurse collected all the health cards, and read of 15 names.  The mothers would carry their baby and put them on their lap as they sat in a row on a bench in a tiny room.  Then the nurse would go across and give two drops of polio OPV in each babies mouth as they made disgusted faces.  Then she would give a penta vaccine (dpt, h flu, heb b) on one leg and pneumococcus vaccine on the other.  Each baby was so happy and unsuspecting, but then undoubtedly, they would start crying.  It was amusing to hear the different kinds of cries.  Then, they would have another row of mothers sit on the opposite side of the bench where there is more light for the nurse to administer the bcg subq.  Very efficient indeed!  

Also have been doing some online global health courses on globalhealthlearning.org.  Pretty helpful website with various topics/certificates. 

Resources I found to be very useful:

• Medscape, epocrates
• Catherine Wolf, M.D., Dennis Palmer, D.O.  Handbook of Medicine in Developing Countries.  

·        Also got a list of medications in the dispensary and emergency cabinet (for when the dispensary is closed – which seems like all the time) and list of laboratory tests available.  Wish I had gotten this the first week.

I ran into a bit of trouble regarding obtaining HIV tests on patients.  Apparently I'm not supposed to write for HIV test on the chart like every other test but that there's a specific procedure that involves writing "counseling by so and so," and then so and so is supposed to go counsel the patient on HIV first, and if the patient agrees to the HIV test, then she will get the test and tell you the result.  It makes sense considering how HIV is still so stigmatized, but I really wish I had known about this during orientation.  (Details later).

Humble pie

Wo, as I go through my email, I came upon a CMDA article that really struck me as I'm struggling to deal with my frustrations here in Sierra Leone:

As a physician, a woman and a Christian committed to serving Christ, I have to ask myself these questions:

• Am I depending on my own strength and knowledge as I go about my practice every day? ("Trust in the LORD with all your heart and do not lean on your own understanding" [Proverbs 3:5, NIV 1984].) [Oh man, I totally am these days]
  
  
• Do I get impatient or angry at interruptions? (a prideful heart) [Omg, I'm getting impatient and angry all the time these days]
  
  
• Do I criticize my colleagues, in front of staff or in my heart? (more pride) [Sadly, I have been critical and pretty argumentative, definitely prideful]
  
  
• Do I forget whose I am when the day gets stressful and hectic? [Yup. definitely forgetting.  I need to return to what's most important]
  
  
• What have I NOT surrendered to God? [My worries...for sure, my worries.]

The hymn written by Frances Havergal in 1874 about "Take My Life" really describes a surrendered life. It has been a great way for me to search out my heart and take inventory.

• Take my moments and my days, let them flow in ceaseless praise. Do I seek His direction as to how to use my free time? Do I readily respond to opportunities to serve others even if it requires sacrificing "my time?" 
  
  
• Take my lips and let them be filled with messages from Thee. Before I speak, do I ask the Lord what He wants me to say? Do I use my tongue to intentionally edify and encourage others, bringing healing?  [Nope, I've been pretty mean]
  
  
• Take my intellect and use every power as Thou shalt choose. Am I wasting my mind on worldly pursuits that have no eternal value? Or do I devote my mental capacity to serving Christ and furthering His kingdom?
  
  
• Take my will and make it Thine. Am I stubborn, demanding or controlling? Is there anything God has shown me to be His will that I have been neglecting or refusing to obey? [Probably!...hm...gotta think about this]

I am praying that this exercise has plowed up the soil in your heart as much as it has in mine, and that the Lord uses this to draw you closer to Himself. Your obedience to Him will bring Him glory and you many rich blessings. Really, in giving some things up, we have everything to gain. As Paul said in Philippians 3:8, "…I count everything as loss because of the surpassing worth of knowing Christ Jesus my Lord" (ESV). What a thrill!

Anyhow, I really needed a little pick-me-up these days!