.hard

I am completely exhausted on all fronts.  Sometimes, like right now, it is just so hard to be here.  hard to be in a culture you don't understand, you don't agree with.  hard to be always misunderstood and in return misunderstand.  hard to always make someone repeat their sentence because you didn't get it the first time.  hard to repeat yourself over and over, thinking you are using proper pronunciation the whole time.  hard to always be culturally incorrect - accidentally insulting someone, disrespecting them, not being a good host, a good guest.  hard always being insulted in how our culture would perceive insult - being laughed at, lied to, not taken seriously.  hard to be going about your business, maybe daydreaming, or walking from one place to another - and gradually the realization sinks into your consciousness that there are about 50 people staring at you.  hard to be so constantly the center of attention that you begin to just create your own world so you hardly notice it anymore.  hard to keep from saying mean things to people in French - things that i wouldn't just say in English - somehow if i say it in French I don't connect with it.  hard to start IVs in the dark with a headlamp.  hard not to make a mistake when you have 15 quinine drips.  hard not to be hard on others that make the same mistakes.  hard to be nice.  hard to be kind.  hard to cry.  hard to not complain.  hard to be grateful.  hard to face each new health disaster.  hard to get along with the combustible melange of different personalities that are the bane of any mission compounds existence.  hard to get  up at 5 30 am no matter what.  like i said, sometimes its just hard. 

i had a complete melt-down on Peds tonight - my third night working on my own.  while i am not ready to recant my scathing reviews of the efficacy of the nursing staff - I am willing to concede that doing a good job and trying to give American style care and assessment is very very very hard.  but to do it, you don't sit down.  you round continuously.  you painstakingly take temperatures with a mercury thermometer.  you yell and persuade and hassle and hustle and march here and march there and exchange this and write for that. 

and you can't just do the right thing.  you can't just write for what you think they need.  you can't pump that dehydrated kid full of fluids - you can't give him all the medicine he needs.  if he has only a dollar for his medicine, how are you going to spend that dollar??  the hospital HAS to support itself.  no matter which expat comes and goes it has to keep functioning.  to do that we have to pay the staff.  we can't give everything for free.  we just can't. 

you have to argue about money.  everyone will tell you they nothing.  everyone will say pas l'argent.  everyone will look at you with those pleading eyes and shake their head mournfully.  1/3 of the time - its true..... and for the others?  well, define, argent.......

and then the ones that spent their last cent fran - the ones that used everything they possessed, the ones the bought medications that were not entirely necessary that some pen happy nurse wrote - and then the kid dies anyway.  what about them. 

who is lying and who is telling the truth. you don't want that to matter when someone's life is at it stake, but unfortunately, here, it has to.

so you get creative.  exchange this for that.  bribe someone to give blood with three ripe mangoes, profusely thank the lab staff on call for the fact that he came in on his night on call, politely agree that writing A + can only be penned in red - be nice to the pharmacist so he will be nice to you - write for things one day at a time only - threaten and beg and point and somehow get it all translated

Nangere to Arab, Arab to French - French to Gumbi - sometimes, no one even speaks French. correction: most of the time

and tonight - i didn't sit for 6 hours - there was problem after problem - put in IV after IV - adjusted drip after drip.  gave medication after medication.  did assessment after assessment - and it doesn't help that i am so exhausted.  I got up at 5 AM because its impossible to sleep after 5 30.  just doesn't happen.  there isn't such a thing as sleeping in here.  they are sweeping right next to your face, screaming, cooking, singing horrific sounding hymns, and its all like nails on the chalkboard of your exhausted brain.  i cried this morning too.  at 5 30 AM.  because now I work evenings I don't get to bed until 10 at the earliest.....  i just wanted them to stop sweeping....just....for ONE minute.... and then i went to the village in the morning, and then went back to a previous one - training the community health workers - and then went directly to work - and then at work, problem after problem.   and its truly nerve wracking because you alone are responsible for people's lives, there are too many patients, you definitely don't want to intrude on the precious family time of the doctor unless its necessary - but then here, the emergencies are often what we DON'T see them about - because we already know there isn't anything to be done....but if you can catch the problem in that in between phase....then its worth a shot.  and then tentatively prescribing.....transfusing....turn around, how did that quinine go so fast??? trying over and over and over again to get an IV on an anemic and dehydrated baby - it jerks its hand and blood starts running all over your ungloved hand..... and then the three patients that were discharged....well guess what, they didn't go anywhere.  they have 3 or 4 more days of quinine and metro left..... guess what - they think the nurse will give them their meds, the nurse has "liberated" them, assured me everything was fully explained, and then tonight they had no idea what to take, when to take it, or who it was for - and that was the weird last straw that did me in, i was kneeling outside practically yelling in French at my poor translator I apprehended, trying to teach her about her medicine, doing a job that had been neglected by someone else, the sheer ridiculousness of the fact that we "discharge" people that are still staying in our service indefinitely.....that there is no such thing as adequate discharge instructions and when pressed the parents NEVER explain i back correctly - it takes patience - but if you don't do it?  what have we been doing?  if they don't take their quinine, their antibiotics...its all for nothing...... and of course at that moment the other nurses on night shift come by and start laughing hysterically - and then my hip hurts so bad from the horse that i can hardly walk..... i must have looked like such an idiot.  and maybe I am. 

but, i maintain - IT IS STILL POSSIBLE to give good care here - there is NO EXCUSE not to give your medications, not to asses your patients - but if you actually do it.......its very VERY hard.

BUT

despite this rant, I am TRULY delighted to have the opportunity to work on my own.  I do enjoy it.  I did ask for it.  I did take the steps needed to make it happen.  So in that aspect I am grateful and happy. 

I just don't do well with no sleep. 

I don't do well at all. 

and on that note, I've been up for.......17 hours

bon nuit