Kind Of Sterile

Here’s the part I wrote on Monday that I didn’t post then:

Today (Monday) wasn’t that busy, except nothing the doctor had requested on Friday had been done. I spent the morning weighing patients and getting vital signs. None of the patients had been weighed and the most recent vital signs were from 6pm Sunday evening. The language barrier makes it difficult to explain to the nursing assistants WHY vital signs are important. One sweet girl all the way at the end of the ward was super, super sick. Heart rate 180s, elevated temp, respirations in the 60s. Severe malaria. We saw her on Friday and she was sick, but still responsive. Today she wasn’t hardly moving, but her little glazed eyes were tracking me as I worked around her. I told the doctor how bad she looked, he came and changed how often she got her paracetamol (Tylenol equivalent here) and ordered a bolus of fluids. I checked on her a little while later and she was much more responsive and her vitals were much better. Taught mom how to cool her down with water and fanning.

Another interesting case today was a 20 year old male that suddenly became comatose. MRDT (test for malaria) was negative. There’s no way to intubate or ventilate here, so he’s just chilling here, kind of breathing on his own. He would have been intubated the second he rolled in any ER’s doors in America. They can do a spinal tap here, but they’re out of needles, so they may do one tomorrow.

We went to the market on the way home to get metal rods to build little hand-washing trolleys for on the wards. Which is awesome because I like to wash my hands as often as you’re actually supposed to and there’s still no soap in the hospital. Except the bar I brought up there and put in the staff bathroom by the offices which you have to unlock 2 doors to get to. I spend a lot of time locking and unlocking doors these days. They told me not to leave it out or it will get stolen. Anyways, the rods are 6 meters long and the car is not. The dude who climbed up on top of the car wasn’t too dedicated to the tying-on job, so the ride home was pretty exciting. It was basically a jousting tournament.

When we got home, my lovely encouraging hosts decided to have story time about all the different animal sightings and encounters in the lake, which I had been assured many times before was “perfectly safe.” Now they come out with 2 hippo sightings, 3 crocodiles, 2 poisonous snakes, an eel biting, and a toothed-fish biting. I’m never going swimming again. I went kayaking and had to keep checking weird sounds to make sure there wasn’t a stray hippo alongside me. I’m not sure what kind of sounds hippos make, so I checked all of them. I’ll probably have a sore neck tomorrow.

Tuesday:

An eventful day, even without the 2 children dying I mentioned in my previous post. It started with a 1.5 hour staff meeting, which included the doctor meeting with all the head nurses to talk about expectations. He’s not positive it will make any difference. I remain hopeful.

We did an EKG on a gentleman with the only EKG machine in the hospital. Let me explain old school to you young thangs. Electrode gel. Metal cups with a suction bulb. Metal clamps for the limb leads. It looks like a torture device. And apparently this isn’t even “that old” of a machine.

After saying that I feel that I might get in trouble and hear a lot about computers the size of rooms or how they used to draw EKGs with charcoal back in the good ol’ days.

We saw 2 boys with osteomyelitis, which was cool. Not for them, but I had never seen it before. One of them had it in his left forearm, it was draining from the skin and his arm was huge. I almost cried over the other boy. His mom was sick and his dad was out of town and so he came up to the hospital by himself and was limping around with a plastic bag with his chart in it. It was so pitiful. He looked like he was 7. He didn’t understand where to go and kept walking around all lost. When he had finally gotten his x-ray and got back to us, he sat down and pulled up his pants leg and his left knee was massive and draining pus. His x-ray was nasty, his bone was destroyed. They were both admitted for antibiotics and referred for surgery.

We did the spinal tap on the comatose 20 year old. Who still has an O2 sat of 85%, despite not really breathing. You know how they make a sterile field here? They use the sterile gloves wrapping and tear a hole in it. The collection vials were “kind of sterile” according to the lab tech. "What do you mean, kind of sterile? Are these sterile?" "They're the most sterile ones we have." Allrighty, kind of sterile it is. When we finished, you want to know how the family transported the vials to the lab on the other side of town? In a glove. Each vial went in a finger of a glove, we tied the glove shut, and put a piece of tape with the patient’s name on it on the outside. Told the family member not to drop it, handed him the orders, and off it went. True story. In our hospital in the states we are required to walk LP specimens to the lab, so I guess it’s kind of the same… except he had to walk an hour and we walk 3 minutes, in air conditioning.

I’m learning a lot about being still and letting God be God. There is simply not that much that I am able to do. There are limited resources to work with and the staff is highly unmotivated and unreceptive to teaching/change. The doctor has been struggling with that for years now and we have had many discussions about how to create and maintain change. My BSN didn’t cover how to do that in a third world hospital. I don’t think the “You can be a change agent!” method will be effective here. However, as A. W. Tozer said: “How completely satisfying it is to turn from our limitations to a God who has none.”

Be still and know that I am God. I will be exalted among the nations, I will be exalted in the earth. Psalm 46:10

The Lord has established His throne in the heavens, and His sovereignty rules over all. Psalm 103:19

I am not good at sitting still. Or standing still. I want to DO something all the time. So I am learning. Slowly, and painfully, to stand still when the entire conversation around me is in Swahili. To sit on a kayak and look at the mountains and not rush. To leave the dishes to go read my Bible. To sit and pray when I have nothing to occupy my hands. To be still. To abide. To remain.

Remain in Me, and I will remain in you. No branch can bear fruit by itself; it must remain in the vine. Neither can you bear fruit unless you remain in Me. I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing. John 15:4-5