Tuesday, April 10, 2012


it is so hot that my glasses are steaming as I write this from my mosquito net.  my mosquito net is outside.  it is night. 

i am completely infuriated. 

the nursing care here is horrendous and subpar at best. 

there is no incentive to do a good job, there is no incentive to take care of your patients and worse yet, there is no reference point for how things should be done.

there are 2 nurses working the 3-11 and 11-7 shift.  one has never really worked in peds before.  the other is still an unpaid nurse just out of school

they don't get trained in a service.  they just get put there.  because if there is no one to fill the schedule...we have to do something.  no orientation.  nothing.  full prescriptive power with a license to sleep

i spent all day yesterday, missing lunch, barely drinking water, until 4 pm and the same skipping lunch business today just trying to straighten it all out.  on crutches.

its so much easier when i'm not there, I am happier and less angry with everyone.  and I should be taking it easier, but I was out of work for 3 weeks in varying levels of pain and i decided i was just going to go back.  the pain is tolerable now but it is still 5 times as hard to do the same amount of work hopping and shuffling around.

yes, i guess i am getting dangerously close to complaining but complaining is NOT the name of the game here so perhaps if i post my worries on the internet that is so much more acceptable........

it is what it is and today was a wretched day

so Olen rounds first thing as I already may have mentioned.  he pretty much shows up when I do.  so we do the round with him and then straighten it all out afterward.

so today, for example, i started my own round after he left.  looking at the paper, what was given, what wasn't, looking at the carne, what he wrote, did they buy it, if its a one time dose,  I give it right away so it doesn't get missed, i listen to everyone's lungs and heart, the bare minimum of an assessment really, since no one seems to think respirations or pulse are vital signs here. 

vital signs in peds is temperature.  no one has a watch.  i say, buy one.  i don't care if your poor.  buy a watch.  do your job. 

so, I find that bed 13 has been given an adult dose of quinine at 2100 and again at 5 am.  they have written 600 mg every 8 hours.  now in the states, the foundation of nursing is giving medication correctly.  if you wrote it, you gave it.  here, if they wrote it, thats great, but who knows exactly if they gave it and in what dose.  so, we cross that out, calculate the dose (o.5 ml instead of 2) and change it to every 24 hours.  quinine is dangerous.  the fact that an adult dose was given twice in the space of 16 hours is ludicrous. 

then i find some metro sirop for bed 22 - metro is every 8 hours.  it was the wrong dosage, written for every 24 hours.  then for the same patient i find an unmixed bottle of amoxi sirop. not written down.  not given.  bought yesterday.  for that patient, Olen had just written for glucose X1 and not quinine.  they decided the kid had malaria ( to be fair, most do) added quinine and a siringe, and now they are having to pay even more money even though the kid is here for GI problems

i find worm medicine, albendazole, that has been signed for as given but has never been given

a find several children with high fevers - over 39 C that do not have any tylenol or antipyretic of any kind - they just took the temperatures and moved on. 

we put in 5 IVs almost one after another - because the drips had either stopped or infiltrated or the catheter stopped working in the night - no one bothered to fix it,
i find quinine perfusions that should be half or almost done, had been going for over 16 hours and only 2 hours worth was in the child. 

i find quinine doses, IV quinine, missed altogether.  they needed the nurse to write and have them buy another bottle - and no one bothered.  

I find quinine that has ran in way too fast - 12 hours instead of 24. 

if you do not have an intrinsic incentive, there is no incentive to do good work here. 

its not that hard.  it really isn't.  it just requires dedication and attention to detail.  and yeah, it took me 5 hours to get through 15 kids - but at night - there is no new meds to give, no carnes to go through - you give scheduled meds (if you want to ) and deal with whatever arises. 

its not hard.  will you have to work incredibly hard?? yes. 

for 2 patients - the entire morning antibiotics were not given - the ampi/genta mix for a baby was completely ignored.  the cotri for a kid that keeps having fevers was completely ignored.  there is no exscuse for that.  it was in their box.  on the paper.  can we get an lazier people?

and all of this is true stories, JUST FROM TODAY

and I feel aweful because i am able now and have been for quite some time to take shifts and take the place of a nurse.  but that would require me to work night shift and be unavailable for my commitments to Project 21.  when i said I would help with Project 21 i was excited - good experience - good resume building - but I never anticipated it to render me completely unhelpful in the hospital. 

if i could only take the place of one of the awful night nurses, then i could actually help.

and one could argue that I do help - yes i try to sort things out and monitor quinine drips and assess kids more thoroughly but everything happens just fine when i'm not there too......

the whole this is just sickening, exhasperating, and completely morally wrong. 

healthcare should be a universal human right

people pay alot of money to be here

they deserve the same standard of care as they would get in America or another country. 

I would like to get into these nurses brains and figure out what they are thinking while they are working, if they think they are doing a good job, if problems i find glaringly obvious are seen as problems in their mind..........

I just can't stand it.  i walk in there and I am livid within half an hour. 

and i'm mixing up ORS sachets with water bottles i have found, i make sure the parents understand they have to give X amount  - they simply don't give it. 

oh, has the kid burning up with fever had any water today?? no??? why not? oh, he doesn't want any??

I feel like I'm the water Nazi, a role i would have laughed before at the prospect of, but in the 115 degree heat, no one seems to think that a kid on quinine and sweating buckets should actually drink something. 

cockroaches on the floor

half eaten mangoes and flies swarming the patients, in their eyes, mouth, nose, swarming the medicine boxes, swarming the mothers,  buzzing and diving, in your hair, in your water bottle, in your mouth

and then try being on crutches when half your patients are outside.  sun stops quinine from being effective.  chasing down people and telling them to cover their quinine.  how are you supposed to monitor drips when everyone is scattered around the hospital compound?:? how are you supposed to watch for changes??

the whole thing is just so frustrating. 

and the families are there, have come from far away, are using ALL of their resources, have been brave enough to come to the hospital, are giving every medication with hope because they don't know what its for - and here we are - so completely nonchalant about the one thing we can ACTUALLY do for them - give them their medication properly

so - just a bad day......we all have those right??

maybe later i'll find soemthing constructive to say, but for now i'll just let all the negativity hang unbalanced -

cheers and sunshine

xoxo from the land of the searing sun and a thousand flies

Ps.  Mary Charles, chief of peds, is an excellent nurse - other select few are excellent- but in general.....really???


  1. Just to play the contrarian (from my very comfortable seat in the climate controlled med school library)... You are absolutely right that the nursing care there is abominable. But maybe try and think about it in the same terms that you started to think about the funerals. There is a cultural context to everything, from the reason an individual chooses their career to the reason they do or do not give an ordered med. Think about your nursing education, and the hours that you spent on clinicals, and the training that you got in both basic science and patient care. Think about what the Chadian-trained nurses get. Stay angry, but let the anger motivate you to teach more, do better and be better.

    Don't let the heat destroy your good intentions. And when you see mistakes, don't just correct them, but see if you can find out what was behind the mistake. I know it is too much responsibility to put on you. It all takes too much time, when time is precious, and the temperature is soaring and you just want to have a minute to yourself - to drink some water or eat something or remember who you are and what you are doing there. BUT, the rewards when you figure things out are worth it.

  2. Praying for you and your work and valuable experiences -at all of your work and homes! God give you wisdom in every circumstance. "Rejoice always. Pray without ceasing. In everything give thanks. For this is the will of God concerning you" and all that you do.
    I know it's easy to sit here and say that.